Making It New

Someone recently – I don't think it's worth linking to, because he hadn't done his homework – wrote a challenge to massage. Having googled massage a bit he'd come up with half-page list of claims for its medical benefits, from curing asthma to boosting immune function. Easy to do that: most massage sites have those bullet lists. I've written disparagingly about them before. What I'm interested in here, though, is the way he framed his challenge. “Sure, massage feels good,” he said, “but what if it doesn't really do any good?”

Discussions of the worth of massage tend to accept these as the two alternatives. Either massage is medically effective, or it “just feels good.”

Now, my heart revolts – and I'd guess yours does too, if you're bothering to read this – at the idea that massage “just feels good.” You could say the same thing, after all, about love or art. They are, in some senses, not very useful. You can, without too much of a stretch, come up with “uses” for them – love ties together the social fabric, say, or art extends the boundaries of thought – but really, nobody falls in love in order to knit together society, and no one stands transfixed in front of a wonderful painting in order to conscientiously do their self-development exercises. Some things are worth doing for their own sake. If we make up justifications for them afterward, it's only because we fully intend to keep doing them anyway, and we need some excuse to present to our utilitarian critics. That's how the bullet lists of the medical benefits of massage have always struck me. “If your spouses object to the expense, show them this list, and a link to the Mayo Clinic page, and maybe that will shut them up.”

To say that massage feels good is like saying that Cezanne's paintings are pretty. It's not that the statement is wrong, exactly: it's just inadequate, and it makes you wonder if you and your interlocutor live in the same world. Someone in the comment thread said, a little petulantly, “have you ever gotten a massage?”

I've been trying to work out an explanation of what exactly I think massage, as I practice it, is, and why I think it's important. In a therapeutic massage group yesterday, I wrote this explanation of why I was rejecting massage as therapy. It's the best summary I've been able to come up with yet:

It's not that I think my practice is particularly ineffective, from the therapeutic point of view: I don't think my outcomes differ markedly from the mean. But back when I was a client, I didn't get massage for therapeutic reasons, as understood in this group. Nor did I get it because it felt good. (Though it may well have been therapeutic, and it certainly often felt good.) I got massage for the same reason I meditate, or read poetry, or listen to music: it's a form of -- how can I put it? -- of travel. It's the closest thing I can imagine to borrowing a different nervous system and trying it on. Ezra Pound said the job of poetry was to "make it new": that's what massage does for me, both as giver and receiver. I want to own up to that being my basic project, without taking on any of this healer or shaman or "energy worker" stuff.

How Often You Should Get Massage

Every ten days.

Okay. I made that up. The real answer is “it depends.” It depends on what you can afford and what you want massage to do for you.

If you have pain that massage therapy can help directly, the answer is really, “several times a day,” which, unless you're fabulously wealthy, translates into “get a therapist who will teach you how to do it yourself and see them till you get the hang of it.”

If you want massage to increase your circulation, lower your production of stress hormones, improve your immune system, or decrease systemic inflammation, the answer is, well – nobody knows. But at least daily. Most of those benefits, touted on many a massage therapist's website, last only a few hours. Again, if you're fabulously wealthy, go for it! That's what I'd do. But if you're really interested in just those benefits, take a walk, eat some vegetables, and learn to meditate. Cheaper and more effective.

But I don't think that's exactly what most of my clients come to see me for. It's certainly not why I get massage. I get massage because I feel like something accumulates in me that I need to get rid of, some physical equivalent of mental confusion. I feel I'm losing my place, somehow. My perceptions are getting dulled and clouded. I'm sort of perched in my body, instead of fully inhabiting it. It gets gradually worse, until one day I wake up knowing, “damn it, I need a massage!”*

For me, this cycle runs, sometimes faster, sometimes slower, at something like ten days. When I was a computer programmer with money to burn, I got a weekly massage. That was about right. Nowadays, when I get most of my massage by trading with other therapists, the timing often depends more on when our slow times are than on anything else. But if I was building the ideal massage schedule from scratch, with no constraints, I'd do it this way: I'd see a favorite therapist every two weeks, and have a second therapist I saw every month. And – after all, this is the ideal world – maybe a third that I saw once a month, too. That would add up to about weekly.

I'd get other people because no one therapist, no matter how good, seems to clear every register and clean every window. I encourage people, including my regulars, to go out and get massage from more than just one person. Fabulous I may be; I don't deny it; but massage therapists, like singers, work in a certain range. There are notes I just can't hit.

In general, you should get several sessions from a therapist before you make up your mind whether they're right for you. It takes two or three sessions for therapist and client to tune to each other. The relationship deepens: the therapist gradually discovers what works and what doesn't, what to work on and what to let be. The client gradually releases more and more resistance, as the work is more and more apt. It's a lovely process and it never really stops. I'm much more creative and experimental with my long-time clients. In general I think they're getting much better massages than my first-timers.

So that's in the perfect world. In the real world, “how often?” usually comes down to: as often as you can afford. Monthly feels to me like maintenance. I really try not to let a whole month go by without getting massage. But weekly is a maybe a bit luxurious, unless you're working on specific physical problems or under unusual stress. (Several of my monthly regulars ramp it up to weekly at particular times: bookkeepers in tax season, say, or teachers at the beginning of the school year.) The people I see at wider intervals than monthly, I have a vague feeling that we're slipping behind, not keeping up with the accumulation of – of whatever it is that accumulates.

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* This feeling – and the fact that massage is so effective at getting rid of it – accounts, I think, for the prevalence of the “massage gets rid of toxins” myth. See Laura Allen's video about this, or Paul Ingraham's systematic take-down. Massage does not flush toxins, or metabolic waste, or anything else out of the body. But yes, I hear you. It sure feels like it does.

"Trigger Point" Revisited

Here's the first installment of Paul Ingraham's re-evaluation. I've been waiting for this! My experience has been much like Paul's -- the "trigger point" has been the clinical concept that's served me best, in dealing with pain, but -- it doesn't really hold water. There are also many times when, mysteriously and frustratingly, it doesn't work at all. And the theory behind it doesn't entirely make sense.

One big plus to leaving it behind would be leaving behind that ridiculous name. I've always hated the term "trigger point." I much prefer the older, native English, and more frankly ridiculous "knot."

Attention

Some of the time it was just a laying on of hands, while the storm of pain quieted. A few very gentle moves, inviting the jaw to relax, opening the frontalis, checking in with the skin and muscles of the face, neck, and chest, but very little that most people would think of as “massage.” One of the things experience teaches you is that the amount of pressure – the “depth” of the work needed – varies wildly, not only from person to person but from session to session. It's encouraging when you find you can do much deeper work than you could in earlier sessions. It makes you feel you're making progress. But you also have to be ready to dial it way back, especially when you're dealing with those disquieting immunological syndromes that are so common nowadays: fibromyalgia, IBS, ME/CFS. You have to meet the nervous system where it is. If it's struggling with the sensations of ordinary life, so that the scrape of a cotton sleeve on the arm is an irritation and the fatigue of blinking the eyes is a burden, you're not going to help matters by flooding it with new and unfamiliar input.

But massage does seem to help. I really don't know why: theories come and go, none of them terribly convincing. I have no method, no protocol. I just work to give my full attention to the person I'm touching, to tune in to them physically and emotionally. Once I can feel their breathing in my fingers, I can just follow it. That's one way of conceiving it, anyway. I can enlist various senses. Some people “see energy,” hijacking the brain's visual processing to think about the emotions and sensations they're sharing. I sometimes have faint auditory hallucinations: I'll think I'm hearing sighs or groans or even muttered words. It's my way of registering what's probably mostly tactile information about tissue relaxing or softening. When I first started I sometimes mistook these for real, and said, “what?” – to the puzzlement of my client, who hadn't made a sound. Fortunately I've read enough about perception and neurology to know that this sort of synesthesia is quite common and does not need to be believed in – or dismissed. It's neither second sight nor delusion: it's just another way of processing information.

At the end of the session, my client said her headache was gone, the clenching of her eye muscles had released, and that she thought she might really sleep, tonight, for the first time in days. Did I really do anything? I have no idea. Placebo, non-specific effects, meaning-effects, psycho-social effects (a lot of different names, for more or less the same thing, used according to how legitimate you think it is) – that might account for it. Lying quietly in a dimly-lit room for an hour might account for it. Sitting beside her and holding her hand might have had the same effect. It's hard to know whether my own sense of what I'm doing – bringing a disciplined attention to bear – is really responsible for the therapeutic effects I see. But it remains my best guess about it.

Why We Don't Tell You How Much to Undress

You sound your client out, of course. “Have you had much massage?” And you hope the answer is yes, because you really don't want to have the Talk. If they're an experienced receiver of massage, you can just rattle off the old formula. “Undress to your level of comfort, and get under the covers here,” – at this point you demonstrate, sliding a hand between the sheets: you wouldn't think people could get this part wrong, but they do – “and I'll be back in after I've washed up. I'll knock.”

But if they're new to this, or new to massage in America, or if they seem particularly hesitant or uncertain – well, you're going to have to have the Talk. You're going to have to tell them how much to undress. And the trouble is, you can't do that.

The instructors in massage school make this clear, and they're quite right. You tell your clients they should undress as much as they want. You don't specify. You don't helpfully say, “most people undress all the way, but some people keep on their shorts or undies: it's all the same to me.” That would be tendentious. It would make them feel they should undress that much. So I say, as neutrally as I possibly can, “undress as much as you like, and get under the sheets here. I'll keep you covered up: I'll just uncover the areas I'm working on.” I could go on to say, “I'll keep your breasts and genitals and gluteal cleft covered, no matter what.” But it is a bit awkward, discussing genitals and gluteal clefts with someone you've just met. I could say “I'll keep your private bits covered,” but nobody really knows in this day and age, just what bits those are. Sometimes I skip that. I go on to say, “Bra straps and some waistbands – jeans waistbands, for instance – take some working around, but I can work around anything. The important thing is that you feel comfortable.” But I don't really like saying that either: it sort of implies that people should keep some clothes on.

And I know that I'm not actually telling clients what they want to know. What they want to know is: how much am I supposed to undress? And that's just what I can't tell them.

But here on my blog, I can tell you. The answer is: nobody cares. Really. All other things being equal, I suppose I'd rather have a client buck naked: it's a bit simpler. After years of doing massage, the chances that I'll uncover anything by accident are zero. I know what I'm doing. I like to be able to glide on the skin, to “tie in” all the parts of the body, as we say. But if you have your underwear on, I just leave the sheet on and glide over it, to get – for instance – from the thighs to the lower back. The only things that really present difficulty are thick waistbands – they get in your way, right where you want to get into the lumbar paraspinals and the QL – or bra straps that run horizontally across the back: they run right over that all-important lower trapezius.

But you know what? I work with that. I enjoy the challenge. I am much happier working with that than I would be working with a naked back, and knowing that you had undressed more than you wanted to. You're not dressing for me. You're dressing for yourself, and you should dress however you damn well please.

I can tell you what my clients commonly do. About half of them undress completely, and about half leave on shorts or panties. But there's lots of exceptions. I have a regular client who always wears sweat pants, and one who never undresses at all. What does that tell me about them?

Nothing. Nothing at all. I don't think about it. I don't speculate about it. It doesn't mean a thing. We all live in a larger society that's so hyper-aware of undressing, and so intensely attuned to its meaning, that it may be difficult to believe this. But we massage therapists belong to a subculture in which undressing means nothing at all. We spent years in school, working on each other, throwing our clothes off and on at the drop of a hat. Underwear isn't an intimate frontier, to us: its a bit of cloth that alters the sort of massage strokes we're going to do.

But we know that undressing can be terribly fraught for our clients. We care about that. We want people to feel as safe as they possibly can. I've been in this business for years, and I've never heard a therapist say a negative word about how much a client undressed. People are afraid, I think, that there's some secret code: that leaving their undies on or taking them off sends some sort of signal, and they're anxious not to send the wrong one. And I just want to say, as emphatically as possible: there is no secret code. There is no signal. Your therapists don't gather in the breakroom to discuss your underwear. They don't remember whether their last clients wore their skivvies or not. The answer, realio-trulio is: nobody cares.

Postpartum Massage

Pregnancy massage gets talked up a lot. I talk it up myself: it's great stuff, and it's fun to work with pregnant bodies. Pregnant bodies are stoked, hormonally: you can practically feel them growing under your fingers. They're vibrant and responsive. They feel extraordinarily alive.

Lots of people give gift certificates for massage to pregnant women. My impression from surfing the web a bit is that pregnancy massage is a booming business. And that's grand: but I tell you, if my budget allowed for only a few massages, I'd save them up for the postpartum year. That's when women need it most, and when they get it least.

Pregnancy stresses the body, but it does it relatively gradually, and the hormones surging around, while they are not always easy to deal with, at least always remind you that you're doing something out of the ordinary. During pregnancy, and especially during a first pregnancy, things feel rather epic. Your body changes drastically, and everybody's into it, often annoyingly: strangers, without permission, will be placing their hands on your belly and exclaiming. Interest in the last couple months is intense. Everybody wants to know: when are you due?

Then, bang, the birth. Huge to-do. Lots of excitement. People cooing over the baby, pictures flying around the web.

And then two weeks later – it's all done. Nobody's interested any more. The party's over. Just when you really need the support, when the new life is really starting, you're on your own. People may still be interested in the baby, but they're no longer interested in you. Your body, which was the center of the world and a matter of absorbing interest, the temple of new life, is now a seedy all-night snack bar. It has, in the space of a few days, gone through huge changes, and it has challenges every bit as big as the challenges of pregnancy to deal with. If you've had a C-section, you've got major surgery to recover from. If you had a hard labor, you have exertions and injuries to deal with that make running a marathon look paltry. In either case, especially if you've been primed by overly chirpy birth-preparation books, you're liable to feel that you somehow failed by not have an easy, radiant birth.

Even if you had an easy, radiant birth – some people do – what your body now has to accomplish is extraordinary. The uterus has to return to its former shape. All your displaced abdominal organs have to find their way back home and re-seat themselves. Your abdominal muscles have to shrink to a third of their high-tide size and recover their tone. All the ligaments and connective tissue has to tighten back up. Your nervous system has to rewire its sense of where your body is in space. And this while, in all likelihood, you're working harder, and sleeping less, than you ever have in your life. But now – at least by comparison to the glories of pregnancy and birth – nobody really gives a damn. No strangers are rushing up to coo over your shriveling stomach; nobody wants to congratulate you on the fact that in some lights your stretch marks will hardly show at all.

What surprises me, really, is that anyone doesn't suffer from postpartum depression.

This is when you need massage. When you need someone focused on helping your body, which is working harder and changing more rapidly than ever. When you need the soothing and the comfort and the being-made-much-of. This is the time when you're most in danger of losing touch with your physical self, when you're ignoring warning twinges and discomforts and spasms because you're too damn tired and there's no time to do address them: when you're tempted to stop caring for your body because nobody is interested in it anyway. This is when you realize that your body is going to be different now forever (it is) and that it's lost all its resilience (it hasn't: it's just that the big hormone party is over.)

Why don't more women get massage postpartum? Lots of reasons. Here are some bad ones:

Sometimes bowel or bladder are untrustworthy for a couple weeks postpartum. Any experienced massage therapist should be prepared to deal with that. Bodies leak: so what? You clean up and go on. No problem.

You can't get childcare. You still have options. There are places, in large cities anyway, that offer childcare as part of the package. There are a number of massage therapists who, like me, offer in-home massage and are not fussed by having an infant on the table with Mom, nor by wide-eyed older siblings wandering into the room from time to time to ask for things. I have clients who get their massage sidelying, with the baby snuggled in and nursing from time to time.

You're too tender to get massage. You do need someone who understands what the body goes through, in childbirth and after. Do find someone who thinks that massage should not, ordinarily, hurt. There are times when trigger point or deep tissue “hurts good,” but that's a special case, and the therapist should know exactly what they're doing. You neither need nor want to be manhandled, postpartum.

Your belly is still too big, or your breasts too sore, for lying face-down to be comfortable. But there's never any need to be face down, any more than there is during pregnancy. Your therapist can arrange you on your side perfectly comfortably. It's a little mysterious to me how little massage is done sidelying. In many ways it's much better position than face down: I can move the top shoulder freely, any way I want, and the hip rotators are much easier to get at. I can't get as much leverage on the thick lumbar paraspinals, but on the other hand, the pressure I do use isn't bearing down on the still-tender abdomen. I have longtime clients who took to sidelying while pregnant, loved it, and now, years later, have no intention of ever getting back on their face.

You're too ugly. This is a surprisingly common reason. I guess it comes of all those spa ads with gorgeous perfect women luxuriating in a massage: you feel you don't look the part, so you'd better wait till you do. But this is exactly backwards. The problem is not that you're ugly: the problem is that you feel ugly. And nothing dispels the delusion of ugliness like a good massage. You always deserve a massage. You don't earn the right to it by being lovely. You earn the right to it by being a human being.

Those are some bad reasons for not getting massage. There is often, unfortunately, one good reason: it's too damn expensive. So plan ahead. Make clear that one of the baby shower gifts you'd love to receive, in lieue of yet another darling onesie that will be too small in five weeks, is a certificate for an in-home massage. Or for a package of in-home massages: the perfect thing to hit up a rich aunt and uncle for. And remind your friends who were so free with offers of babysitting before the baby's arrival, but have since become too terribly busy, that a massage certificate is an acceptable substitute.

Morning

I wake briefly at five: the full moon has broken through the clouds and its light is pouring over moving boxes, the shining covers of library books, a glittering glass on the bedstand. Then, as I watch, the moon sinks below the stand of trees to the west, and everything dims again to the ordinary city glow. I fall asleep again.

At seven I wake again, wander out to the bathroom. Tori intercepts me on my way back: can I help wake Mom? They need to be going at 7:30.

I make affirmative noises. I can't remember what they have to do, or why Tori is here. But I can wake Martha. I begin with the shoulders, sliding a hand under each scapula in turn, to loosen it up as I work the traps and the back of the neck. Then the arms and the hands, and back again, the pecs and anterior neck, some brief face work, then down the breastbone, over the abs to work the quads and adductors – pushing one of my pajama-ed thighs under hers to serve as a bolster – and the calves, on to the feet. The metatarsal of the big toe gives a satisfying click as it shifts, and Martha gives one of those involuntary groans that tells you you've hit the sweet spot. I'm not really very awake, but I don't need to be. I pay special attention to the feet and work my way back up. Catch the lower back by reaching under – always my favorite route to the QL and the lumbar paraspinals. She's waking, slowly but surely, and finally she turns over on her side. I find myself up on my knees, with a wide stance, working the rich field between the sacrum and the greater trochanter with paired thumbs. There's that trigger point. I'm rounding up the usual suspects. I roll her over and do the other side, and I finish by coming back to the hands, twining my fingers in hers to spread the metacarpals apart and get to the little interosseous muscles that sit between them.

I check the clock. It's been fifteen minutes, and I've done a creditable full body massage. When I worked at the East-West clinic I used to hate trying to cram a full body massage into an hour. I know a bit more now than I did then, but mostly it has to do with knowing the body I'm working with so well: that and not having to fiddle with drapes or lubricants, and not having to worry about steering around breast and vulva. Makes me realize how much time and attention I have to put in, “tying in” different areas of the body by circuitous routes, when I work with clients. We pay for having taboo areas of the body: we pay in time and attention, we pay in a loss of somatic unity. I know, Esalen and the Revolution are history, and we meekly accept the boundaries of a fallen world. But like Galileo, I permit myself to mutter, “still, it does move,” as I leave the court.

Martha's awake and grateful. People scurry to and fro, collecting what they need for work and school. The moon has gone wandering far to the west, hanging now huge over pre-dawn Hawaii, I suppose, and scattering trails of glory over the ocean. Morning and the workaday world, here. And coffee calling me, like a thrush singing in the yard.