April 15, 2017


What makes a good massage good? Interoception, proprioception, and touch

The first time an expert massage therapist lays his or her hands on you, you know immediately whether they know what they are doing; or to put it another way, whether it is going to be a good massage. How does the body (or you) know this subtle thing so quickly? The answer lies in understanding the elusive qualities of pressure and rhythm, and what these qualities communicate throughout the body. In this note, I am going to explore this concept, and try to give you a different way of thinking about this most ancient of therapies.

The sense of touch

As we all know, of all the senses, the one we call touch is perhaps the most resistant to the rather blunt tools of language, both in terms of description and analysis, and when we consider touch from the perspective of the many sense organs involved (and at the many scales they operate), what I call the ‘bliss dimension’ of the experience of massage disappears altogether in discussions of afferent/efferent nervous systems, Golgi bodies and stretch receptors. So much has been written about the cellular and structural aspects of the sense of touch, rather than ‘re-invent the wheel,’ I will simply refer the reader who wants more detail to Deane Juhan’s excellent book Job’s Body. There is one aspect of core idea of his book that I wish to pursue here, though.

Going beyond the rules

You may recall the parable of Job, a man caught in a contest between Lucifer and God, Job was a righteous man, healthy and prosperous, and who followed the dictums of the scriptures. Unfortunately, in the contest between Lucifer and God, following the rules was insufficient: Job was sorely afflicted with numerous illnesses, and the received wisdom of the scriptures and the exhortation by his peers to increase his faith proved ineffectual. Job had to turn his attention inwards. In so doing, he discovered much about the processes of living that wasn’t covered in the scriptures, and in looking beyond the truths that he inherited, was able to perceive the workings of God internally, and which itself was a new wisdom. Juhan uses this parable as a stage for his own examination of the processes of touch and massage; it is a book that no one (massage therapist or not) should be without. Juhan is able to show how massage actually alters the way the body perceives itself, and how that image may be remade (if dysfunctional, as when the body is in pain) or enhanced for optimal health. The parable of Job, however, is a powerful injunction to seek wisdom within as well as without, and it distinguishes between external constructed and derived knowledge, appropriate for some inquiries, and other sorts of knowledge, necessary to understand other kinds of problems.

First impressions

The process of how massage can alter the way the body works (as it might be assessed objectively) and feels (both from the therapist’s point of view as well as the person receiving the massage) lies in the relationship between the place in the brain where the body’s image (I’ll explain this in more detail in a minute) is represented, and the myriad sensory organs found in the skin, muscles and connective tissue, which is what the brain uses to construct its picture. These nerves in a real sense are the brain’s ‘eyes and ears’ in the body: the brain is constantly assessing patterns of tension, temperature, pressure, the sense of effort of a movement or position of a limb, and much else besides. So, imagine the first time someone lays a hand on you, and the various sensations involved. First impression for most people is the temperature of the part of the body in contact with the skin – the hand must be warm. If it is cool or cold, the hand will not generate the desired sensations; instead the recipient will recoil slightly, retreating into themselves. The essence of a massage is that the patient lets the pressure of the various hand techniques ‘enter’ – the worst response is that the patient tightens up.

Going further

The next impression we receive is what I call confidence: if the pressure is the right pressure, the patient will yield. By ‘yield,’ I mean that the patients lets the pressure into his or her body rather than rejecting it. Here, ‘right pressure’ is neither too light or too heavy; it must be ‘just right!’ If it is even just a little too firm, the muscles tighten further; if too light, many patients feel that the massage therapist is floating about on the surface, refusing to engage more deeply, either physically or mentally, or to put it another way, the therapist may give the impression of not wishing to grapple with the problem the patient came to you with in the first place. The other disadvantage of too light pressure is that the recipient may feel that the practitioner simply lacks confidence, or doesn’t want to hurt you. Obviously the practitioner treads a fine line between too little and too much pressure. The ability to distinguish these limits marks the professional (or the gifted amateur), and in the instants you are assessing the therapist, he or she is equally engaged too in sensing your feedback, through a variety of indicators.

Speed of movement

The final sense dimension in this simple analysis is rhythm, or the frequency and cadence of the pressures being applied to the recipient. We may imagine at least two parts to this dimension, the speed of the hands across the body, and the increases and decreases of the pressures being applied during any traverse of the part being touched. Another way of thinking about this is to imagine two axes, at right angles to one another: the vertical axis is pressure, sometimes light, sometimes going deeper, and the horizontal axis is the speed of the movement. Together these twin dimensions give the massage its characteristic qualities: we resolve the pressure and speed dimensions as a third dimension, the quality of that particular touch – and every touch is unique. And just as the improvisations of a jazz saxophonist may delight you but leave another unmoved, so too will the rhythms and pressures of one massage therapist move you, and another leave you cold. Knowing these things can help you reach an understanding with the therapist; for example requesting faster or slower movements, firmer or lighter pressure, or even a different oil, which will influence the qualities of the friction and heat produced.

The brain is in the body

The image that the body has of itself has been the subject of intense study over the last ten years or so. A fascinating book charting these discoveries for the general reader is Antonio Damasio’s Descartes Error. There is an area in the brain called the somatosensory cortex, and represented there is an image of the body, in the form of specific ‘settings’ of muscular tension; what might be normal tension (or sometimes called ‘tonus’) for the biceps muscle in normal daily life, for example. Among Damasio’s more fascinating conclusions is that we experience emotions as changes to these base settings. For example, if something makes you angry (an idea or an experience) we know that we are reacting angrily – or feeling angry – by both the characteristic patterns of tension produced (shoulders pulled up to the ears and fists clenched, say) and the brain becoming aware of these changes is how we know or become aware of the emotion. Of course the story is much more complicated than this brief recapitulation can do justice to, but the fundamental idea is true to the original.

Protective mechanisms can be negative

In our workshops, we explain the efficacy of the particular approach to stretching we use to treat neck or back pain using some of Damasio’s ideas. We know that the tension in muscles is a property of the muscles, but we also know that the tension settings are not usually controlled from within the muscle in the chronic patient. We make this distinction because tension is controlled from within the muscles in the acute phase of trauma. In fact with the chronic patient we believe that it is a lingering, but now redundant, protective mechanism that is often the source of pain. That is, the natural process that the body uses to ‘splint’ or protect an injured part lingers on after its usefulness has past, and it will continue to linger until it is altered in some way. Using the Contract–Relax (C–R; this technique is detailed in my book Overcome Neck & Back Pain) approach, we gently signal to the body that the range of movement that moments ago elicited the pain response can now be safely moved into, and if used successfully can immediately alter the patient’s movement and pain patterns. I am certain that Damasio’s mechanisms are what allow us to do this, and which not coincidentally also facilitate the massage experience.

Beyond treatment

For both Damasio and Juhan from different starting points have been able to show that working on the body using massage can alter this image, in reality teaching the body firstly how to be a different way, and secondly that this new way is safe, or desirable, thought the pleasurable feelings that ensue. On the one-day workshops we run for private individuals (as distinct from the six-day ones we run for practitioners) we have been amazed at the instantaneous change that the use of the right stretching exercise can have on people who have in some cases had very long-standing problems. We feel that our techniques are extremely useful to the massage therapist, for they allow you to teach the most effective two or three stretches to your patients, and give them something tangible to take with them. Combining massage with stretching is the most efficient way to help the patient help themselves, and this empowers the patient as well. We all know that unless the patient takes responsibility for themselves, any intervention is likely to be temporary and palliative.

  • A very interesting article; I learned something and will be more conscious of how massage changes my body. I’m also interested in the very important benefits of touch to mental health some of which I extrapolated from your article.

    • Eyitayo, the right kind of touch can change the receiver’s body very positively, as the wrong kind can damage it so deeply. Touch is fundamental to humanness. Thanks for commenting.

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