Massage is a form of manual therapy in which mechanical and kinetic stimuli are applied to soft tissues in order to elicit a physiological response. These effects are achieved through the use of specific manual techniques (grips), selected according to the structure and function of the tissues being treated. The range and sequence of techniques may differ depending on the therapeutic approach; however, they share the common principle of targeted tissue stimulation designed to modulate local and systemic adaptive responses.
Interactions between the nervous system and peripheral tissues constitute a fundamental mechanism through which manual stimuli may influence the function of organs and body systems. The literature describes relationships between pathological processes within internal organs and secondary changes within cutaneous and myofascial tissues, attributed to segmental and reflex mechanisms (including viscerosomatic and somatovisceral reflexes). Within this framework, visceral disorders may be associated with functional and structural alterations in superficial and deep tissues, including the skin, connective tissue, skeletal muscles, periosteum, vascular structures, and the spine. The co-occurrence of such phenomena suggests functional links within the segmental “functional unit,” encompassing the nervous system, visceral organs, and musculoskeletal structures.
In clinical practice, observations have been reported that may indicate the involvement of reflex-related mechanisms, such as altered paraspinal tissue tone in inflammatory conditions, compensatory postural changes associated with urinary system disorders, or referred symptoms in patients with cervical spine dysfunction. However, it should be emphasized that the clinical presentation of these phenomena is complex and may result from multiple coexisting mechanisms, including nociception, peripheral and central sensitization, biomechanical factors, and autonomic contributions.
In this context, massage may be considered a supportive intervention in selected conditions, particularly those in which pain and increased soft-tissue tone constitute relevant components. Potential mechanisms of action include modulation of nervous system activity (including the autonomic nervous system), effects on sensory transmission and pain processing, and changes in local blood flow and microcirculatory parameters. Massage may also influence venous and lymphatic drainage as well as the mechanical properties of tissues, which in specific clinical contexts may translate into functional improvement and increased load tolerance.
From a procedural standpoint, the effectiveness and safety of massage largely depend on technique-related parameters, including the direction, intensity, and duration of manual pressure. Excessive mechanical force may provoke undesirable pain responses, increase protective muscle guarding, and reduce overall treatment tolerance. Particular caution is recommended when applying techniques involving concentrated fingertip pressure, as localized excessive loading may generate discomfort and lead to excessive nociceptor stimulation. Therefore, continuous monitoring of patient responses and ongoing adjustment of treatment parameters are essential. Clinical practice also emphasizes avoiding routine reliance on a narrow set of techniques and maintaining a flexible, individualized therapeutic approach adapted to the patient’s changing functional status.
Point-based techniques (e.g., stimulation of acupuncture points) are sometimes used as an adjunct to classical massage methods. These approaches include sustained pressure, friction, and pinch-based techniques applied to selected anatomical locations. Within such frameworks, tissue responses to point stimulation may contribute to clinical assessment and allow for individualized modification of treatment intensity and strategy. In spinal pain syndromes, attention is often directed to points and areas located along paraspinal structures, which may remain functionally related to segmental innervation and symptom presentation.