Some therapists get caught up in working out the knots, by any means necessary. Gouging elbows into sensitive, over stretched, over worked, already achy muscles is not comfortable for the client and sometimes produces muscular rebellion- burning, spasm, bruising, tightening, or soreness. I prefer the passive aggressive approach of MFR, because if the body doesn't want to do it my way, I can adjust my technique and approach from a different angle or change some other variable, like adding more heat or creating movement in a tissue by stretching.
Clients seem to respond well to a balanced approach combining direct, assertive neuromuscular techniques and passive aggressive, more forgiving techniques like myofascial release and thermal therapy. It is both physical and mental- nobody likes to be forced into something they don't want to do. Mentally they have to know that the more aggressive techniques are meant to benefit them before they can accept them physically. That is where clear communication from the therapist is vital. Education of the client grows more and more important as the bodywork is more and more intense.