“Monkeys, and other animals, groom each other often with a marked reduction in stress. Touch is good, and one doesn’t need to wrap it up in pseudoscientific nonsense for it to be beneficial.” - Mark Crislip discussing reflexology on ScienceBased Medicine blog
These are the opening words to a paper on the interactor/operator model by Canadian physiotherapist Diane Jacobs, who describes herself as a "human primate social groomer and neuroelastician." When I first read this paper, I wasn't always completely clear about what Diane had to say, but what I understood resonated with me and articulated a dilemma I'd struggled with for a long time.
Are you an interactor or an operator?
I have often said that massage is something I do with a client rather than to a client. At least that's what I'd like to believe. Many clients come in with the idea, "Fix me!" and I'm not always successful at educating them that this is a team effort. I also fall into the trap of being an "operator" myself. Still, it's an ideal to strive for, to keep in mind, and the interactor model can include acting from the operator model but doing so consciously, rather than by default.
When I read this paper, it marked a turning point in how I thought about my work. Not only did it make clear the distinction between working from the point of view of an interactor or an operator, but it brought into focus the role of the central nervous system, something that has barely been given lip service in the manual therapies.
The role of the brain.
During massage school and over the course of 20 years of continuing education, the primary focus of attention has been on muscles, bones, joints, fascia, lymph. Some modalities manipulate the internal organs. The central nervous system (CNS) is barely acknowledged. It is time that the role of the CNS got its proper attention.
During the past year, as I've learned more about pain science and the role that the brain plays in chronic pain, I've met people who have focussed on bringing attention to the central nervous system to manual therapists, in particular to physical therapists. I think this understanding is equally important to massage therapists. We tend to see ourselves as softening tight muscles, either through coaxing or through force, or stretching fascia, or perhaps affecting posture and joints. But tension and pain and posture intimately involve the CNS. Nothing changes unless the brain decides it should change.
As my attention has focussed on this new understanding, I am reminded that my Russian Massage teacher Zhenya Wine would tell us that the state of the CNS was always to be considered first and last and that the effects we create through massage occur through the brain responding to our input. I look back and realize that, at the time, I thought I understood. And I did at a level. But coming back to this with new knowledge, new information, I understand even more, at a deeper level, what she was trying to say.
The skin as surface of the brain.
I don't know who said it first, but already in 1987 Deane Juhan, in Job's Body, said that the skin is the surface of the brain. I always loved that. In the early stages of the embryo, when it begins to change from undifferentiated cells into differentiated cells, it divides into three layers: the endoderm, the ectoderm, and the mesoderm. The endoderm produces the internal organs, the mesoderm produces the bones, connective tissue, and muscles, and the ectoderm produces the nervous system and the skin. Skin and brain develop from exactly the same primitive cells.
Diane Jacobs points out that the skin is the only part of the body that we, as therapists, can touch directly. We cannot directly touch muscles, fascia, tendons or ligaments. We are always touching through the skin and, through the skin, our touch communicates with the brain. The brain decides how to respond.
These ideas have been examined by some physical therapists and related therapists for several years and one can find them discussed at length in the SomaSimple forums. However, I think the concepts have not yet penetrated the world of massage therapy and I'd like to encourage my fellow MTs to explore these ideas. Next time you have your hands on a client, think a bit about the skin as surface of the brain and the conversation that your nervous system is having with the client's nervous system.
To hear Diane Jacobs speak more about the interactor/operator model, the role of the nervous system, and her unique approach to manual therapy, listen to this interview with Will Stewart, "Interacting With the Skin to Change the Brain.
I also invite you to follow Neuroscience and Pain Science for Manual Physical Therapists on FaceBook.