How Does Massage Work?

"How does massage work?"

My late Russian Massage teacher Zhenya Kurashova Wine asked this question at the beginning of my first class with her. We sat and looked at her blankly. No one raised their hand, no one offered an answer. What kind of a question was this, anyway? We never thought about this. You know, you put your hands on people and then . . . well, massage happens!

When it became apparent that no one was going to attempt to answer, Zhenya finally said, "I'll tell you how it works," and then went on to explain.

We have a brain, a spinal cord, and nerves going out to the periphery. When we put our hands on the client's skin, mechanoreceptors at the sensory nerve endings are stimulated. Impulses are generated that travel up the nerves, up the spinal cord, and to the brain. There, the impulse is "distributed," if you will, and the brain processes it. The brain generates efferent impulses of its own that travel down the spinal cord and out into the body, creating changes. It may cause blood vessels to dilate and the heart and breathing rates to change. If the brain likes our input, it may turn down the volume on pain and tension. If the brain perceives threat from our input, it may create a stress response, creating a sensation of pain and/or causing physiological responses that usually are the opposite effect of what we want. 

"First and last, we must consider the nervous system," Zhenya advised us. Yes, yes, I understand, I thought to myself, and then promptly went on to forget about the nervous system. Like most massage therapists, I'd been taught to focus my attention on muscles,  joints, ligaments, tendons, fascia.

My teacher's answer is not controversial. This is basic neuroscience and has been known about for at least 150 years. It's not that it has been studied in the context of massage. It's just what has been learned about how touch works, how the nervous system works, how the brain monitors the body's environment. Pick up any introduction to neuroscience textbook and you'll find this in the first chapter. Yet no one had ever bothered to tell us about this in massage school or in any of our continuing education. If they did, it was promptly ignored and forgotten about, a piece of trivia along the way.

Instead, we studied muscle charts that had the skin stripped off. We learned the names and placement and actions of muscles, learned what muscles laid deep to the skin when we put our hands on the client's body. It was as if the skin were not there; it became invisible to us.

"The skin is the surface of the brain."

In Job's Body, Deane Juhan says, "The skin is the surface of the brain." This may sound like a cute aphorism but, in fact, there is much truth to it. When we start out as a fertilized egg, the egg begins to divide and those early divisions produce a mass of undifferentiated cells that are identical to each other. At a point, something amazing happens - this undifferentiated mass begins to divide into three layers. The endoderm goes on to become the internal organs; the mesoderm later becomes the musculoskeletal system; and the ectoderm becomes the brain, the spinal cord, the peripheral nerves . . . and the skin.

The brain, the nervous system, and the skin are intimately linked from the very beginning.

This is not entirely surprising. Besides serving the function of keeping the outside world out of our body and keeping our insides in, providing a protective barrier between us and that which is not us, the skin is how our brain monitors our external environment. Approximately 1,000 nerve endings per square inch of skin, on average, are responding to temperature, pressure, stretch, vibration, light touch, chemical irritants, etc. The brain is constantly receiving information, processing it, responding, then continuing to monitor both internal and external changes. The brain and the nervous system never sleep, never take a break. It is constantly active and, in spite of comprising only 2% of our body mass, it uses 20% of our energy. It's a very busy, hard working system!

In massage school we're taught to think about muscles and other mesodermal tissues. We somehow get the idea that when we massage we're pushing on muscles and that somehow pushing on muscle fibers will get them to "release." But is that how it really works?

The only thing we can put our hands on directly is skin. This is such an obvious truth that many massage therapists scoff when this is pointed out but really, think about that. We are not stripping the skin off clients and pushing on their muscles. We are putting our hands on their skin, or the clothing or sheet covering their skin. When we put our hands on their skin, those 1,000 per square inch nerve endings are paying attention. They are responding to our pressure, our gliding, the warmth or cool of our hands. They respond if we vibrate the skin, respond if we poke at it, glide over it, or stretch it and sustain that stretch. At every moment those cutaneous sensory nerve endings are sending tens of thousands of impulses to the brain, informing the brain about what is going on where our hand meets the client's skin. At every moment, the brain is, in turn, responding and creating changes, creating the pleasant sensations we experience, slowing our breathing, allowing us to relax and shift out of the "fight or flight" sympathetic nervous system and into the "rest and digest" parasympathetic state. Yes, massage feels good (or should feel good!) and it is the brain that creates all those lovely sensations that we enjoy, allowing us to relax and feel refreshed. It's the nervous system that turns down the volume on pain and relieves us of the sensation of tension.

Once we come to realize that it's not our pressure on the tissues that makes them change but the nervous system doing the job, something magical happens: we realize we don't have to push so hard on the body to make it feel good. It may seem counterintuitive, but I've found that a less forceful approach can often be just as effective and does not carry the risk of causing pain or injuring the client. The body cannot be forced to relax; we cannot bully the nervous system into turning down the volume on pain. We cannot beat the nervous system into submission.

In fact, we cannot really make the body do anything. We can try to set up the right conditions, coax it, convince it, but we cannot make any changes happen with our hands. Change truly does come from within.

If you are a massage therapist who thinks in terms of pushing on muscles and making them "release," if you think you have to push hard so that you can do something to muscles that are deep inside the body, I would like to invite you to engage in a thought experiment. The next time you are doing massage, think about the client's brain and spinal cord and peripheral nerves going out to the skin. Think about your hand on their skin interacting with nerve endings, stimulating them, sending impulses to the brain. Think of the brain responding and sending out its own impulses. Think about your hands having a conversation with the client's brain. And if you do that for a day or even for just one massage, notice how it changes your experience.

If you are a client who has been led to believe that one must push hard on muscles in order for massage to be therapeutic, think about all those nerve endings in the skin responding to the therapist's touch. Think about how the brain responds. Does it find this touch inviting? Does it want to relax and let go? Or is it potentially threatening? Does it make the body want to tense up and protect itself? How does thinking about the experience differently affect how you receive massage?

If you're a client who just likes to stop thinking and enjoy the experience - great! You've already figured it out!


There's a lot we still don't know about exactly what goes on at a physiological level during massage. We once thought that massage reduced the stress hormone cortisol but that has been found not to be true. Exactly how does our touch get turned into a change in physiological processes and exactly what and how are those physiological processes changed? We don't have too many answers to that yet. But one thing we can say with a pretty high degree of confidence: massage stimulates nerve endings in the skin and ultimately it's the brain that creates the changes. I think we can work with that.


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