The Adaptable Body: Moving Beyond the Structural Model of Musculoskeletal Pain

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The Adaptable Body: Moving Beyond the Structural Model of Musculoskeletal Pain

Image note: A Practitioner Massages a Patient's Shoulder created by artist Pei Qun Zhou around 1890. Massage has been used for thousands of years to promote relaxation, healing, and overall well-being. While specific practices vary globally, the utilization of touch for therapeutic purposes is a consistent thread across most human cultures.

A Brief History: From Ancient Times to Modern Healthcare

For thousands of years, manual therapy has been a cornerstone of healing. One of our oldest records is found in the Egyptian tomb of Akmanthor (2330 BCE), where paintings depict practitioners working on hands and feet. Even Homer’s Iliad and Odyssey describe massage with aromatic oils to relax the "tired limbs of warriors."

Across the globe, ancient civilizations—from China and Tibet to the Americas and Polynesia—developed traditions rooted in an ecological understanding of health. They viewed the body as an ecosystem in delicate balance with its surroundings.

  • China & India: Tui Na and Ayurvedic massage focused on balancing energy and vitality.

  • Tibet: Ku Nye treated the mind and body as a multi-scale ecosystem, mirroring modern theories of embodied cognition.

  • Indigenous Cultures: Viewed touch as a way to bring individuals back into physical and spiritual harmony with the environment.

  • Greco-Roman: Greco-Roman culture recognized the therapeutic benefits of massage, incorporating it heavily into their medical and athletic practices.

The 19th-Century Shift: The Medicalization of Touch

Image Note: Royal Naval Hospital, Haslar: massage room. Oil painting by Godfrey Jervis Gordon ("Jan Gordon"). The combination of industrial-era health needs and the Physical Culture movement led to a resurgence of massage in Europe, laying the foundation for its modern practice.

The Industrial Revolution marked a turning point. As sedentary lifestyles and repetitive strain injuries emerged, the Physical Culture Movement championed fitness and manual therapy.

In 1813, Per Henrik Ling founded the Royal Central Institute of Gymnastics, developing massage techniques rooted in anatomy. His system was expanded by Johan Georg Mezger, who formalized "Swedish" massage, and Henrik Kellgren, who influenced the emerging fields of physiotherapy, chiropractic, and osteopathy (MacDonald et al., 2024; Ottosson, 2025).

However, as these professions grew, they were shaped by the prevailing biomedical model. This reductionist paradigm treated the body like a machine with isolated "broken" parts. We shifted our focus almost exclusively to isolated tissues—bones, joints, fascia, and nerves—often overlooking the interconnectedness of the human experience (Kerry et al., 2024; Low et al., 2025).

The 21st-Century Update: A Whole-Person Approach

While the biomedical model has driven massive advancements, it often fails in the face of chronic non-communicable conditions. We are now entering a new era that combines the ecological wisdom of ancient healing practices with the scientific rigor of Complexity Science.

A Modern Framework for Massage Therapy

To evolve, we must move from a tissue-focused approach to a Whole-Person Health framework (Kligler et al., 2026). This isn’t just a "feel-good" philosophy; it is grounded in the science of complex systems. Here are three practical examples how complexity science can help guide the treatment of musculoskeletal conditions.

1. Complexity Science and the "Zoom Out"

In complexity science, we recognize that symptoms are interconnected "nodes" in a network. For example:

  • Chronic Pain can lead to Poor Sleep.

  • Poor Sleep increases Systemic Inflammation.

  • Inflammation reduces the desire for Physical Activity.

  • Inactivity leads to Muscle Weakness, which loops back to exacerbate Symptoms.

As therapists, we aren't just "fixing" a node; we are looking for leverage points to disrupt these self-reinforcing cycles and shift the system toward health.

2. Allostatic Load and the 'Ball and Cup Analogy'

Health is an emergent property of systemic interactions, best defined by Resilience. We can visualize this using the "Ball and Cup" analogy:

  • The Cup represents our resilience. A deep basin means the system (the ball) is stable and hard to push into a dysfunctional state.

  • The Perturbations: Trauma, stress, and poor sleep are forces nudging the ball toward the edge (Lutke Schipholt et al., 2026).

  • Allostatic Load: This is the cumulative "wear and tear" on the body. When the neuro-endocrine-immune system becomes dysregulated, our basin becomes shallow, and our adaptability diminishes (Borsook, 2025; Kiverstein et al., 2022; Pitcher et al., 2023).

3. Fostering Adaptability: The New Clinical Goal

Our role as massage therapists is to help the client build a "deeper basin." We achieve this through multimodal and multidisciplinary strategies (Artz et al., 2024; Deenik et al., 2025; Klyne et al., 2026; Langevin et al., 2024; Lutke Schipholt et al., 2026; Nijs et al., 2024) that target the body’s ability to adapt:

Conclusion: The Scientific Bridge

"A shift toward Whole-Person Health recognizes that well-being isn’t just what’s happening in the body—it’s shaped by our environment, social context, and lived experiences."

To truly address musculoskeletal health, we must move beyond "fixing" tissue and start supporting the system’s ability to self-organize (Cohen et al., 2025; Fabiano et al., 2026; Low et al., 2025). This Whole-Person Health framework is informed by adaptability and complex systems theory to provide a scientific bridge to traditional healing practices. By emphasizing adaptability over structural alignment, we empower people to build resilience across several domains —physiological, psychological, and social (Lee et al., 2026; Minelli, 2026; Nesi et al., 2025; Vaz et al., 2023).

Glossary of Terms

  • Allostasis: The flexible regulation of physiology, underwriting the maintenance of variables within specified ranges by pre-emptive responses based on current and predicted future physiological states, external environments, and behavioral goals.

  • Allostatic load: The “wear and tear” on the body associated with chronically high levels of stress and arousal.

  • Complex system: A system in which the properties are highly dependent on the interactions of its many parts, possibly involving feedback, cycles, and nonlinearities. In this context, “complex” should not be equated with “complicated.”

  • Critical transition: The point at which a system suddenly jumps from one equilibrium to another.

  • Enactivism: A perspective that emphasizes the active role of an organism in constructing and experiencing the world through its interactions with its environment.

  • Equilibrium: A state of a complex system in which current functioning tends to be maintained despite perturbations occurring over time.

  • Exteroception: Perceptual inference based on sensory signals originating from outside the body (e.g., vision, hearing, touch, taste, smell).

  • Force-based manipulations: The application of mechanical forces to the outside of the body with therapeutic intent. This can include light touch, soft tissue massage, mobilization, cupping, acupuncture, or other needling interventions.

  • Health: A state of physical, mental, and social well-being and not merely the absence of disease and infirmity.

  • Interoception: The processing of sensing and perceiving sensory signals relating to internal bodily states.

  • Mechanisms: Mechanisms are the molecular, cellular, physiological processes or pathways contributing to a) disease development, b) treatment action, or c) pain signal sensation, transmission, perception, and modulation.

  • Musculoskeletal conditions: A broad term for problems that affect muscles, bones, joints, tendons, ligaments, and nerves.

  • Network dynamics: Changes of state in biological networks over time or the propagation of effects due to stimuli or disruptions; crucial for understanding disease progression and the impact of therapeutic interventions.

  • Neuroplasticity: Changes in neural pathways and synapses that result from bodily injury or changes in behavior, environment, or neural processes. This reflects the concept that the brain is a dynamic organ that constantly changes in response to internal and external events.

  • Non-linearity: A relationship where outputs are not always proportional to inputs. Small changes may lead to large changes in the system and vice versa.

  • Perturbation: An external factor that potentially interferes with the system’s behavior.

  • Resilience: A system's capacity to recover, grow, adapt, or resist perturbation from a challenge or stressor.

  • Salutogenesis: The process by which individuals move from a less healthy state to a healthier state. The concept emphasizes factors that promote and maintain good health rather than focusing solely on pathogenesis (disease).

  • Whole-person health: Involves examining interconnections among all organs and systems of the body, as well as the effects of multicomponent interventions across physiological, behavioral, social, and environmental domains.

References and Sources

Here are textbooks that focus on the history of massage for an more in-depth look at the history of massage:

Benjamin, P. (2015). The Emergence of the Massage Therapy Profession in North America: A History in Archetypes. Curties-Overzet Publications.

Calvert, R. (2002). The History of Massage: An Illustrated Survey from around the World. Healing Arts Press.

Graham, D. (1884). A Practical Treatise on Massage, Its History, Mode of Application, and Effects. W. Wood & Company.

Lo, V., Stanley-Baker, M., & Yang, D. (2022). Routledge Handbook of Chinese Medicine (1st ed.). Routledge.

Ottosson, A. (2025). The Lost Origins of Osteopathy and Chiropractic in European Mechanical Medicine. Taylor & Francis.

With over 15 years of clinical experience and extensive study of massage therapy research, I'm committed to creating resources that foster the professional development of massage therapists globally. Whether you're a seasoned massage therapist or a curious newcomer, this massage therapy glossary is here to be your one-stop shop for understanding terms as it relates to massage therapy. Additionally this post highlights a substantial body of evidence supporting the use of massage therapy in alleviating pain and enhancing quality of life across a range of health issues.

This is a selection of sources I used to help formulate my ideas based on over-lapping concepts from massage therapy, physiotherapy, chiropractic, osteopathy, lifestyle medicine and traditional healing approaches.

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