Updated: Jul 28, 2021
Massage therapists tend to focus on specific tissues. Muscle, and tendon come to mind. If they're really going for extra credit, maybe one or two other connective tissues. One of them lately has been of particular interest: fascia.
We massage therapists as a profession don't think about nerves as often as we should. I've had massage sessions where the therapist drilled an elbow into a muscle 'knot,' but it felt like a nerve. Sustained, uncomfortable, and aggravating pressure.
Skin is even less important to a massage therapist. It's this giant organ that gets in the way of us feeling what is underneath.
One of my goals in life is to catch the massage therapy profession up with the latest research. To make it more congruent with what we understand now of pain, and neuroscience.
If I'm being honest, in the context of manual therapy, I find skin much more fascinating than fascia. Skin is highly innervated, protective, physiologically important, force dissipating, and 'slide-y.' It's also the only thing we as therapists can truly claim to be touching.
I've begun to ask; why do we ignore this skin organ, and all the nerves embedded within?
Nerves are long, walled cylinders that protect neurons. All of the neurons in the entire body and brain comprise only 2% of whole body, but they use 25% of all available oxygen and glucose 24/7. They only get what they need through adequate blood supply. We have 45 miles of peripheral nerve in our bodies!
Getting blood through these thin vessels can be a difficult task. Especially when mechanical tension may be pulling vascular structures in opposite directions of the nerves they supply. If a nerve does not receive adequate blood supply, it becomes backed up, and hypoxic (lack of oxygen). This is very apparent, and well documented in tunnel syndromes: A tensional threat to the neurons in a nerve tunnel. The nerves contain nociceptive neurons that signal danger. When these signals are sent to the spinal cord, and then the brain, pain and discomfort can arise.
We've for many years provided massage therapy services with various treatment narratives to explain what we're doing. I'm asking the massage therapy profession as a whole to re-imagine, and think differently about what we see and feel on the table. Research into massage and manual therapy is lacking. We can however, take what we do know, and create a new narrative.
Treatment narratives can often become harmful. It can be detrimental to a client when they believe they are out of alignment, or their fascia and muscle is full of 'knots.' Our brains take all sorts of information into account when deciding whether or not to warn us of danger via pain. Don't implant bad information into your client's brain!
We've all heard motion is lotion. Let's think about motion in the context of skin, the nerves embedded within, and underneath. Moving nerves therapeutically, and strategically helps maintain their physiological and biological health. Healthy nerves are well fed through varied movement. These healthy nerves do not contribute to pain experiences!
Often through not enough movement, too much of one kind of movement, or previous injury, nerves can develop tunnel syndromes via tensional threat.
I believe we as massage therapists are well positioned to help modulate a pain experience via skin, and nerve. When we touch skin, a cascade of novel sensory information is sent to the brain, and all its maps. When we move the skin, through slow and strategic force with our hands, we begin to move the nerves embedded in the skin, and the deeper nerve trunks underneath. Vascular tissue supplying these nerves can also move, feeding the brain useful information, and feeding the nerves useful blood supply.
I don't mean we should immediately throw out other treatment narratives, or massage techniques. The body is complex, and there could be multiple answers or solutions to a client's pain or discomfort. Only proper assessment will begin to make that more clear. I only ask that we don't ignore what is right in front of us.
Copyright 2016 by Diane Jacobs