Soft-tissue techniques such as massage therapy, myofascial release, trigger pointing and dry needling have been getting a bit of a beating recently. More and more well-respected figures in the physical therapy field are denouncing their use as a waste of clinical time.

This was backed up recently by the "Choose Wisely" campaign, run by the American Board of International Medicine and endorsed by the American Physical Therapy Association. The campaign aimed to encourage more exercise rehabilitation and patient-led treatment, and discourage the use of what they called "passive physical agents" during clinical time (into which category soft tissue therapies would fall).

I wrote a review of these new guidelines when they were first published and, on the whole, I agree with the principle. However, I have noticed lately (especially on social media) many people making statements along the lines of "if your therapist uses massage, you're wasting your time and money."

I understand where the negativity toward such hands-on therapy comes from. After all, there is little good quality evidence that demonstrates the efficacy of massage and other techniques. On the other hand, there is a lot more research that shows the effectiveness of exercise rehabilitation in the vast majority of musculoskeletal injuries and pain syndromes.

Let's look a bit closer at some of this research. Whichever side of the debate you come down on, you have to admit that the quality of massage research is poor. If you're not aware of this, have a read of "Why Massage Research is Flawed," issued in the January 2015 edition of SportEx Dynamics. In the vast majority of papers, at least one if not more of the following issues apply:

• low study numbers
• a combination of treatments used with the study — not just massage
• the use of experimental exercise conditions prior to treatment as opposed to real-world participation
• a lack of explanation regarding the exact dosage and techniques used
• the therapists' experience

To make matters worse, all will be affected by difficulty in obtaining any physiological data of worth and the inevitable reliance on observational parameters and patient perceptions of change, as well as a complete impossibility when it comes to blinding the subjects and the therapist to the treatment administered.

Research into exercise-based programs have far fewer barriers to producing a high-quality study. Exercises, reps and weights can all be documented, as can progress in the form of strength and flexibility measures, for example. The subjects can also more easily be blinded to whether they are performing the exercise on which the study is based, or another form of exercise.

So, while massage and other soft-tissue therapies have been "proven" ineffective, you can see why many people debate the evidence. Add in to this their (and my) own clinical experiences, and the debate heats up.

Every experienced soft-tissue therapist the world over will be able to provide copious case studies of happy patients who have felt the benefits of massage and similar treatments. I've treated everything from torn calf muscles, to back pain, tennis elbow and headaches with massage therapy.

I can understand the arguments against its use. The effects are only temporary, it's an inefficient use of treatment time, and it's not a patient-led form of therapy that they can continue at home in their own time. That's why massage and soft-tissue therapy in general should be used as an adjunct to further treatment where possible. It can be a fantastic tool to assist with injury rehabilitation.

And that's really the point, for me — they work together. Not one over the other, but both forms of therapy together with the same aim — improving tissue quality, muscle strength and joint mobility.

I rarely see a patient, "give them a rub" and send them on their way with no homework to do. Exercises and home treatments, as well as things to avoid, should all be thoroughly explained and recorded for the patient to follow between visits. For some people, soft tissue work isn't suitable or worthwhile, and in that case a rehabilitation program is usually the way forward.

All qualified therapists have the right to treat their own patients in the best way they see fit, drawing on their experience and knowledge. As long as their treatments are safe and can be justified by either research or past success stories, then who are we to cast aspersions?

So, until further, higher-quality research proves me wrong (or right), can we stop with the negative comments and unfair criticism of any therapist who chooses to use soft tissue therapy as part of their repertoire of treatments, please?