Putting aside for the moment the question of mechanical obstruction, there are two kinds of tissue, the result of pathological processes, which impede the restoration of function. These are white fibrous and yellow elastic connective tissue. Sometimes we are also called upon to stretch certain normal tissues which have become shortened owing to some pathological condition. The most common condition of this type is tendon-insufficiency.

With the bands of white fibrous connective tissue which require to be broken we have, or rather should have, little or nothing to do. They concern the surgeon only and should be broken down by him, preferably under an anaesthetic. But all adhesions do not partake of this nature: the yellow elastic adhesion can rarely be dealt with thus, and in massage treatment lies one chance of relief for the sufferer.

If we desire to make use of a spiral spring and it is a little too short for our purpose, the manner in which we should lengthen it is to pull the ends of our spring apart with a slow, steady traction and then relax almost equally slowly to see how far our effort has met with success. Exactly in this manner should we deal with our yellow elastic tissue or with any normal structure which we desire to lengthen, for all tissues within the body, except bone, are elastic. Spasmodic slight tugs at the end of our spring would not serve to lengthen it; sudden violent stress might tend to break it or so to modify its shape that it would be useless for our purpose. So with our elastic tissue, be it muscular, tendinous, or yellow fibrous. If we subject it to a series of spasmodic tugs, each tug will no doubt tend to lengthen it; but, being elastic, the recoil will undo at once any good that may have been achieved. If, on the other hand, our movement is so violent that we succeed in breaking the offending structure wholly or in part, we shall thereby set up a reaction of such severity that all attempt at movement in the immediate future will be seriously impeded. The only safe treatment after this accident is to rest the part till recovery has taken place, when we shall find that the impediment of function is as bad as, and possibly worse than, it was before. This is, of course, only part of the truth, and refers to such stretching as can be performed in the massage-room. The surgeon in the operating theatre and under an anaesthetic may be able to break down even elastic fibrous tissue, but then he enforces a period of rest in the corrected position, preferably by the use of plaster of Paris applied firmly over exceedingly thick padding, until the reaction has passed off. Failing this, he will probably retard his patient's recovery no less than would the masseur had he attempted similar treatment. In fact, he often does so; the whole question of "breaking down" is a matter of judgment, and error is unavoidable (see Chapter XVII (Forced Movement - "Bone-Setting").).

When a case is recommended for massage treatment and we find that our work is to stretch some impeding band or structure, we may then be sure that what is required is slow, steady tension or some other form of gradual stretching, and take it for granted that, had forcible tearing or breaking down been desired, it would have been performed by the surgeon. We have only to decide upon the best method at our disposal to attain the end in view, and this we shall see, when we consider the treatment of scars and contractures, is to loosen the structures throughout the neighbourhood of the lesion, subsequently placing a gradually increasing tension on the offending structures, while an attempt is made to add slowly to that tension by means of manipulation.

Seeing, then, that the slow, steady pull is our chief remedial agent, it is evident that the longer this pull is exerted the greater will be the effect. The possibilities of splintage now become evident. This much is certain: in suitable cases splintage will effect more stretching in a week than massage and manipulation can do in a month. It is also safer, being easily amenable to adjustment and comparatively free from the danger of excess.

In many cases of failure to effect a cure by massage, the true explanation lies in the fact that it has been asked to perform an impossible task. Where this is so there is a very grave danger that, legitimate treatment having failed - as fail it must - less legitimate methods may be attempted. Irremediable injury may be caused, and, in addition, massage has been abused.