Recently, I returned to my old bachelor's thesis, written many years ago. Reading it again, I realised that even back then, I was interested in something more than simply performing massage according to a particular routine. I wanted to understand why one method helps one patient but produces much less improvement in another. Could combining different techniques make treatment more effective? Does the patient's position during treatment matter? And finally, do we always need to work exactly where the patient feels pain?
Today, after 35 years of clinical practice, I still ask myself similar questions. What has changed is my experience, knowledge and the range of therapeutic tools available to me.
From Classical Massage to Combining Different Techniques
My bachelor's thesis examined the effectiveness of different massage techniques in patients with spinal pain syndromes. I compared classical massage with an approach that also incorporated elements of Tui Na, Shiatsu and acupressure. I was interested not only in how individual techniques affected pain intensity, but also in how frequently pain occurred and how much it interfered with patients' everyday activities.
The results were interesting. Classical massage produced a clear improvement in pain intensity. However, the combined approach showed more favourable changes in the frequency of symptoms and limitations in daily activities. Of course, this did not mean that one method was always better than another. The study was small and did not allow such far-reaching conclusions.
Nevertheless, it showed me something I would observe repeatedly throughout my clinical career: what matters most is not always which technique we use, but why we choose it and what we are trying to achieve.
Pain Relief Is Not Everything
Even back then, I recognised the difference between reducing pain intensity and achieving a meaningful improvement in a patient's ability to function. We can perform a treatment after which the patient says the pain has decreased. But will they be able to move more freely the following day? Will it be easier for them to work, walk, sit or sleep? These are the questions that matter most to me.
Throughout my practice, I have met many patients who had previously tried different forms of treatment. They often experienced relief immediately after a session, only for their symptoms to return shortly afterwards. This does not necessarily mean that the treatment was inappropriate. Sometimes, not all the factors contributing to the patient's problem have been taken into account. That is why reducing pain, although extremely important, should not be the only measure of treatment effectiveness.
More Than 25 Years of Working with Deep Tissues and Trigger Points
When I wrote my bachelor's thesis, I was not yet using trigger point therapy to the extent that I do today. Over more than 25 years of working with deep tissues and trigger points, I have gradually developed my clinical approach, combining different manual therapy techniques.
Over time, my interests extended far beyond spinal pain syndromes. I began using these methods to address problems involving the upper and lower limbs, shoulder girdle, pelvis and other areas of the musculoskeletal system. On many occasions, I have observed significant improvements and, in some cases, complete resolution of pain. This does not mean that massage is the answer to every problem. It does mean, however, that appropriately selected soft tissue therapy can play an important role in managing many musculoskeletal pain conditions.
Over the years, I have also become increasingly convinced that the location where pain is felt is not always the place where treatment should begin. A patient comes in with knee pain, but the examination suggests that the hip also deserves attention. Another patient reports shoulder pain, yet the problem requires a broader assessment of shoulder girdle function and the cervical spine.
These are not ready-made diagnostic rules. They are examples of why an assessment should not be limited to the area where the patient feels pain. Pain is a symptom. The therapist's task is to investigate what may be causing it and determine the most appropriate course of action.
Technique Must Never Replace Clinical Reasoning
Over the years, I have learned and used many different manual therapy methods. Each has expanded the range of options available to me. However, knowing a large number of techniques does not automatically make a therapist more effective. You can master a particular massage technique and still fail to achieve the expected improvement.
Why? Because patients are different. Even when they report similar symptoms, the underlying causes of their pain, tissue condition, tolerance to loading and response to treatment may be completely different. That is why I do not begin by choosing a technique. I begin by talking to the patient, examining them and trying to understand the problem. Only then do I decide how to proceed.
Sometimes, gentle soft tissue treatment is enough. At other times, a more intensive manual approach may be appropriate. There are also situations where the original treatment plan needs to be completely reconsidered. The key is to observe the patient's response, both during treatment and afterwards. If a particular method does not produce the expected result, it does not mean we should simply apply it for longer or with greater force. Sometimes, we need to reassess the problem.
Treatment Should Be Adapted to the Patient, Not the Patient to the Treatment
This sentence probably sums up my approach better than anything else. I do not believe there is one universal method that works for every patient. Classical massage, deep tissue therapy, trigger point therapy and other manual techniques are tools. Each has its strengths, but also its limitations.
The effectiveness of treatment is not determined by the name of the method. What matters is an appropriate assessment, the selection of techniques, how they are applied and the evaluation of the results. Manual therapy alone is not always enough. Sometimes, appropriate exercises, adjustments to physical loading or changes in everyday habits are necessary. In other cases, further investigation or a medical consultation may be required. Recognising these situations is just as important as being skilled in performing therapeutic techniques.
These principles form the foundation of my work at FYSIOMAS and the approach I continue to develop through PRT — Pain Relief Techniques.
What Have 35 Years of Practice Confirmed?
When I read my old bachelor's thesis today, I can see that many of the questions I was asking back then are still relevant. Over the following years, my treatment methods evolved. I learned new techniques, gained experience and developed a deeper understanding of just how complex pain can be.
Not everything I believed at the beginning of my professional career has stood the test of time. Some views had to be reconsidered, while others I eventually abandoned. But one conviction has remained unchanged: massage can be a highly effective method of reducing pain and improving musculoskeletal function, provided it is applied appropriately.
Throughout my clinical career, I have repeatedly observed outcomes consistent with the conclusions I was already beginning to draw while writing that thesis. However, I do not regard these clinical experiences as scientific proof that one method is superior to another. They are, above all, the foundation of how I think and work with patients.
After 35 years, I still believe that a therapist should constantly observe, analyse and learn from the results. Because even the best technique, when applied without sound clinical reasoning, remains just a technique.
The patient should not have to fit the treatment. The treatment should be adapted to the patient.