For today’s guest article, I thank Ana Varona, MA, LMT, a bodywork therapist and movement specialist.
The power of touch to soothe and heal: What’s depth got to do with it?
Skin and brain
During a kinesiology class in college one of my professors made a statement that tingled my spine: “One could say that the skin is the nervous system turned inside out.” Since our skin contains countless nerve endings, it’s as if the nervous system peeks out of every single square inch of the exterior surface of our bodies. These receptors form the first link of the somatosensory system, responsible for mediating the processes that allow us to survive, adapt, and respond to stimuli: a cold wind, a warm bed, an abrasion, a soft sweater. And of course, human touch.
Different types of skin receptors communicate information about pressure, vibration, tension, and temperature. In the brain it gets even more interesting: the brain receives all this somatosensory information and responds by adjusting levels of hormones and neurotransmitters according to the nature of the input.
The tangible experience and benefits of human touch, of skin-to-skin contact, are difficult, if not impossible, to replicate by other means, be it devices, tools, or interactions with the natural elements. Physical contact with pets (dogs in particular) can confer some of these benefits, but it cannot replace the intimacy, empathic recognition, and other implications of contact with what the human being, highly attuned to the social sphere, recognizes as one like me.
The need for touch
Much has been written about the need of the newborn for human touch and the tragic long-term consequences when it is denied. It is now routine in neonatal units for preemies to receive regular sessions of caring touch either by a parent or a health care attendant. The improvements to health, when touch is added to the care of these most vulnerable of people, are measurable and significant. What is surprising is that we ever lost touch with something so basic, so obvious. Likewise, we now know that touch therapy at the end of life can also yield positive outcomes, leading to reduction in pain perception, depression, and anxiety. It is worth noting that the sense of touch is the first of the sensory systems to mature in humans before birth and it is believed that along with hearing, it is the last to go as we die.
What about those of us neither recently born, nor about to die? How do we benefit? At a minimum, the reciprocal experience of sensory contact –a handshake, a hug, a pat on the back– reminds us that we are not alone, not separate. We are instinctively drawn to touch those who are hurting physically or emotionally, thus providing a familiar measure of comfort. There are historical records dating to at least 5000 years ago of various forms of massage being used in ancient Egypt, as well as China and India, and it is reasonable to assume that people were using the power of touch long before that — from time immemorial. It is as natural as dancing or singing, and in much the same way as these performing arts have developed, healing touch has been elevated over the ages to an art and a science. And what an explosion of knowledge, modalities, and techniques we have seen in the last four or five decades!
There are many factors that distinguish one bodywork technique or approach from another, but one of the most salient is the amount of pressure that is applied. For this article, I wanted to dig deeper (no pun intended) into the subject of pressure and depth and come up with a rationale that would help us understand why deeper is not always better.
During a recent phone conversation with a colleague, we shared the frustration we feel when clients ask that we go deeper or press harder when our experienced hands tell us that the amount and type of pressure we are applying is appropriate at that moment.
It is worth clarifying, before continuing, that pressing harder during a massage does not necessarily mean that you are performing a deep tissue massage. Rather, a deep tissue approach implies that you are working on tissues that lie below those that are superficial (deep muscles and their associated fascia, tendons, ligaments, and even joint capsules) and that you have the knowledge, expertise, and technique to access and treat those structures appropriately. These may include myofascial techniques, trigger point therapy, friction and stripping techniques, and movement-based modalities, among others. They require a thorough command of human anatomy and kinesiology and advanced training beyond what most entry-level massage training provides.
In the context of deep tissue massage, we often speak of adhesions “breaking up”, soft tissues softening, lengthening, relaxing, “releasing”, trigger points “dissolving”, or improved movement between tissues. Although the mechanical effects of deep tissue massage are difficult to quantify, it is thought that these techniques facilitate change either by reorganizing soft tissue fibers, by influencing the fluid environment, or by stimulating mechanoreceptors that affect our proprioception (our sense of position and balance in space), thus promoting more wholesome and balanced neuromuscular patterns.
I love these deeper techniques and use them regularly. Clients will often report a lessening of pain and a sense of being better aligned, more connected, more whole. And it often shows. So, of course, there is a place for deep tissue techniques in our toolkit and using them is often advisable and productive. But it need not be our default approach. What then of modalities that focus on lighter pressure? What benefits can be derived from this way of working? And more to my point, what is it about touch itself, especially lighter touch, that has a power to soothe and heal?
Person to person
Bearing in mind that the nervous system is exposed to the outside world at the skin juncture, when I place my hands on someone with the intention to assess, treat, and heal, my nervous system is interacting in a very direct way with theirs. And it so happens that hands (along with the lips and tongue) have the highest concentration of cutaneous mechanoreceptors of any body part, as illustrated by the now-familiar brain homunculus. This means that I am using this tool, my most sensitive body part, to receive information and communicate with my client. At the most basic non-cognitive yet very human level, a comforting touch conveys the message “I am here, I care.” For the practitioner trained in the sensitive and receptive art of palpation, administering therapeutic touch is a form of deep listening.
As therapists, we communicate with the nervous system of the client in ways that can be absorbed at a subconscious as well as a conscious level. When necessary, we can encourage the latter by involving the client in the process, suggesting they participate through mindful attention to their breath, to sensations, degrees of tension and relaxation, by offering visualizations, etc. We are then involved in a conversation nervous system to nervous system, mind to mind, heart to heart. We generate a feedback loop between our hands and our client’s body that informs our every move.
The value of light
Since the tissues right under the skin have connective tissue connections to deeper levels, we often can, even with moderate or light pressure, affect deeper tissues and promote the types of neuromuscular changes we tend to associate with deeper work. But the value of the light touch in massage is much broader.
Massage, particularly light massage, has been shown to influence the release of certain health and wellness-enhancing substances and the suppression of others that are stress-inducing. Oxytocin, often called the bonding or love hormone because it is implicated in relationship-building, trust, and empathy, is released in response to low-intensity stimulation of the skin, and it is believed that this kind of touch has many of the benefits of other positive interactions between individuals.
Additionally, it has also been observed that massage causes a reduction in ACTH, a hormone that stimulates the release of cortisol, which in turn is the hormone responsible for the oft-cited fight-or-flight response to stress. Along with the reduction in cortisol from massage, an increase in the stress-reducing neurotransmitters serotonin and dopamine have been observed, thus reducing stress levels and anxiety. It is also thought that this type of massage enhances vagal activity, stimulating the parasympathetic (calming) division of the nervous system with a concomitant lowering of blood pressure and heart rate. Massage may even enhance our immune system. Finally, the type of massage we have been examining here, the low-intensity or moderate-pressure variety, has been shown to reduce the perception of pain. It is widely acknowledged by researchers that more studies are needed to substantiate these findings, but what they point to is encouraging and offers guidance for practitioners.
As an extra bonus, there is evidence that the therapist administering massage also reaps some of the same stress-reducing, health-enhancing benefits as the person receiving the treatment. No wonder we love our work!
Knowledge of anatomy and a variety of modalities allows the practitioner to respond in an appropriate manner and with the appropriate amount of pressure. But it is not a precise science. Choosing what kind of pressure to apply as we proceed with any given treatment will depend on the needs of the client and their expressed wishes, on our careful assessment, and on what we might call clinical intuition: our perception of how to deliver the best treatment for the best outcome as we attend moment to moment to what our hands discover.