Caring Touch: A Fundamental of Therapeutic Massage

 In Educational Philosophy

Very often, when new students start practicing massage for the first time, they assume that massage involves rubbing, squeezing, and pressing on tight spots on client’s bodies to make them relax.  Also, both givers and receivers tend to assume that if you find a tight spot that is also tender – so that when you press on it, it hurts a little bit (or even more than a little bit) – then that’s a good place to press harder.  Since most of the time that “technique” is fairly ineffective and people don’t seem to relax from it, then it is assumed that to make it more effective, you have to press even harder.  A lot of friendly shoulder rubs turn out this way, with the receiver breathing through the mild to moderate pain as the giver’s thumbs dig into the tightest, most tender places on their shoulders.

Many people really do enjoy this approach to massage, and there are reasons for that.  One reason is that the pain produces endorphins, which are the body’s natural opiate pain modulators.  An endorphin-high does feel nice, but the body only releases endorphins when it is in a stress state.  In that case, the mild to moderately painful sensations produced by the massage trigger a stress state, and the body releases endorphins to modulate the pain.  In other words, the body says, “Uh oh, that hurts, and hurting isn’t good, so I’m going to release some pain modulators.”  It is not a state of relaxation – it is a stress response.

Another reason why many people enjoy painful massage is because the strong sensation helps you to pay attention to your body.  Because muscles are under our voluntary control, the principle way to get them to relax is to pay attention to them.  Muscles don’t really relax – they just contract or don’t contract, and the signal to contract comes from the nervous system. A tight muscle is a muscle that is getting a sustained unconscious signal from the nervous system to contract, and the sustained contraction makes it sore.  In order for the muscle to relax, it needs the signal from the nervous system to become conscious, and then it can consciously deactivated. When someone presses on the sore, tight muscle and produces pain in the tired, inflamed tissue, a side effect is that the receiver’s attention goes to that place.  Since the muscles we massage are voluntary muscles, once a person pays attention to them, they can begin the voluntary process of relaxing them.

Perhaps you’ve had this experience: While you are receiving a vigorous shoulder rub from a friend or massage therapist, it hurts (not too bad, kind of good, or just on the edge of tolerable), and you find yourself concentrating all of your attention on that area, maybe enjoying yourself (maybe not so much), and also kind of looking forward to when it’s over.  One way to get it over-with more quickly is to relax the muscles that are hurting, and since you are concentrating your attention on those muscles, you may be able to relax them a little bit.  Then, when the shoulder rub is over, you feel pleasantly refreshed from the endorphins, and more relaxed because you voluntarily relaxed your muscles.  In that situation, the person giving you a shoulder rub has stimulated your fight-or-flight response, caused and endorphin rush, and focused your awareness on a particular area.  That is the style of many massages given in the world today.

On the other hand, you may have also received a massage or shoulder rub that was too light, too weak, and not as effective as the deeper, painful kind.  In that case, there wasn’t enough pain to cause your body to release endorphins, and there wasn’t enough sensation to help you focus your awareness.  Thus, many people who have had both of those experiences (deep, painful massage, and light, boring massage) naturally tend to prefer the deep, painful approach, because at least it gets something done.

But something about this doesn’t seem right. It’s the part about the fight-or-flight response.  Stress-related diseases are the leading causes of preventable death in the United States – and by stress we mean the fight-or-flight response.  Massage that stimulates the fight-or-flight response is counterproductive.  We’re supposed to reduce stress, not add to it. So, the question is, do you want to be part of that problem or part of the solution?  Of course, that’s a rhetorical question.  To be part of the solution, you’ve got to carefully and attentively study touch and its relationship to the fight-or-flight response, and learn ways of touching that stimulate the rest-and-recover response instead.

We call the kind of touch that stimulates the body’s natural rest-and-recover response “caring touch,” because when we come from a place of caring, we are naturally sensitive enough to notice the effects that our touch is having.  If we touch a person in such a way that they breathe a sigh of relief, relax and smile, then we must be using caring touch.

Caring touch can have the same effect as painful touch in that it can help a person focus their attention on a particular area, so that they can voluntarily relax that area.  But instead of pain, the sensation that we use to help a person focus their attention is pleasure.  The benefit of pleasurable sensations is that they don’t necessarily stimulate the fight-or-flight response.  To be accurate, it should be said that all touch initially stimulates a small fight-or-flight response, simply because the fight-or-flight response is the body’s natural reaction to all new stimulation from an outside source.  But just after that initial response, a person can relax into pleasurable sensations in a way that is completely different than what happens with pain sensations.  So, to help a person focus their awareness and relax, caring touch relies on pleasurable sensations, rather than painful sensations.  This is especially true in the beginning of a massage when the client is settling down into the rest-and-recover state.  During some treatments, an experienced therapist may use stronger, pain-like sensations for various purposes, but only after they are familiar with the whole relaxation process and the anatomy of the area.

There are important qualities of listening and responding that go into creating caring touch.  These qualities are most easily described by using the example of a conversation between friends.  If you notice that your friend is very stressed out and upset, and you walk up to her and abruptly say, “You should relax.  You should let go of your worries,” she’s not very likely to say, “Yeah, you’re right,” breathe a sigh of relief, instantly relax, and stop worrying. If you’re good enough friends that she’s willing to tolerate your rude behavior (let’s pretend she is), then she might say, “It’s not that easy.  I have real problems, and big decisions to make!  I can’t just let go of my problems.  I have to deal with them.”  At that point, if you step forward, raise your voice a little bit, and say, “No!  You should just relax!  Don’t hold on to your problems!” then, even though she was willing to tolerate your rude advice once, this time, she just shakes her head, says, “Whatever, man,” and walks away.  Raising your voice certainly won’t help your friend relax and feel better.

Now let’s consider that situation in terms of the conversation that a massage therapist has with their clients on a physical level.  If the woman in the story is not your friend, but instead your client, and otherwise everything else is the same, then let’s look at what that conversation looks like when you put it into the context of the therapist’s quality of touch.  The therapist notices that the client is very stressed out and upset.  The therapist finds evidence of this from the way she talks, the way she moves, and the way her muscles feel.  The therapist quickly finds the tightest place on the woman’s shoulders, and begins to press hard on that place.  It is moderately painful, and the client is immediately aware that she is very tight in that area.

With their abrupt and direct quality of touch, therapist is effectively saying, “You should relax.  Let go of this tension.”  But for the client, it’s too soon in the massage, and the pressure just hurts and reminds her that she’s really tight.  She says, “Wow, that’s really tight and sore right there,” which is a form of body awareness, and can in that way lead to relaxation.  But have you ever just had a place that no matter how hard you try, you can’t get it to relax?  Well, given her stress level at the time, let’s say this is one of those places.  By not relaxing into the pressure, and stating that it feels tight and sore, the client is saying something similar to, “It’s not that easy.  I have real problems.  I can’t just let go.” Since she is unable to relax, the therapist pushes harder into the tight, sore area, ignoring the fact that the technique really isn’t working, and instead just “raising their voice,” so to speak, by making a strong physical demand.  At that point the client is experiencing real pain, noticing how tight she is, and getting frustrated with herself for not being able to relax.  Since the therapist is in the power position in the relationship (unlike in a friendship), often clients in this situation give up their power, and resign themselves to whatever the therapist wants to do.  In the best case, the pain produces some endorphins and the body awareness helps with some voluntary relaxation, but that’s not an ideal outcome by any means.

Reading this story, it may seem like I am pointing out the obvious, and describing a bad scenario that anyone with a shred of common sense would avoid, but the fact of the matter is that I have just described the communication between therapist and client in a surprising majority of professional massage interactions.  The reason that this kind of interaction is so widespread is that standardized, institutionalized Swedish and Deep Tissue Massage training programs place too much of an emphasis on technique, and not enough emphasis on sensitivity training and the fundamentals of relaxation.  Add to that the basic cultural preconception that harder is better, which is an expression of the even broader cultural attitude that you have to push (and stress out) in order to get things done as quickly as possible, and you have the perfect recipe for fairly ineffective massage technique that is bad for therapists’ hands.  Just because McDonald’s is the most popular restaurant in the world doesn’t mean that the food is good, or good for you.  Just because painful massage is popular doesn’t mean that it is the best way to help people relax.

Let’s look at this scenario again, but this time, change the attitude.  You notice that your friend is stressed out, and very upset.  You walk up to her with true caring in your heart, place your hand gently and supportively on her shoulder, and ask, “How are you feeling?”  She sees your caring, and slumps into you with an exhausted sigh, and says, “I am so stressed, and so tired.  I have so much going on right now, and I just feel like I don’t get a moment’s rest.”  You let her lean into you, and you use the hand that is on her shoulder to gently massage her in a way that feels simple, caring and pleasant.  She sighs again, not from exhaustion this time, but from relief and a feeling of being supported by a good friend.

In the context of a massage, the interaction between therapist and client is surprisingly similar.  You greet your client with care, ask her how she’s feeling, and listen to what she says.  She touches her shoulder when she talks about how stressed and tired she is, so you decide to start the massage there, but instead of pushing straight into it, you place your hands there in a supportive, soft, caring way and give enough pressure for her to feel some genuine pleasure. After a moment of settling and focusing, she breathes a sigh of relief.  As her muscles relax, you massage them in a way that feels great – not so hard it hurts, and not so gentle that it isn’t interesting.  Her muscles relax even more, and soon she begins to drift in that wonderful not-quite-asleep state (the rest-and-recover state) that will leave her feeling serene and refreshed when the session is over.

We use caring touch to give our clients the sensations of support, pleasure, and peace.  We use caring touch to communicate that we are listening to our client’s feelings and needs.  Rather than pushing hard into sore, tight areas in ways that produces pain, rather than reminding clients of their tension and forcefully requiring them to relax (if they can), we push respectfully into responsive, good-feeling places in ways that produce pleasure, and our clients are reminded that relaxation is possible and enjoyable.

Sometimes, since such a strong emphasis is placed on caring, respect, and sensitivity, and abrupt painful techniques are shown to be less effective, students swing to the other extreme, and become too gentle, afraid to really get in and get the job done.  But the technique is called caring touch, not wimpy touch.  If you care, then you’re going to want to get the job done.  People make an appointment for a massage because they want something to change, and oftentimes, change requires some kind of force.  But the force we use is appropriate, pleasurable, and responsive to the immediate and unpredictable needs of our clients’ bodies in each and every moment.

Sometimes, we will discover that our clients’ bodies are saying, “I am so sick of holding on to this tension.  Will you just break it all up and wash it away?  I’m ready!” But a person will only trust a therapist to break up their tension and wash it away if first they have established that they care, and that they are paying attention, and not just rubbing around doing some pre-conceived routine.  When we start with caring touch, it makes the deeper changes possible in a way that is easier on the therapist and more pleasant for the client.

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