Moving Happily

This is an interesting article, about some research into mortality rates and the ability to stand up easily:

http://vitals.nbcnews.com/_news/2012/12/13/15870881-can-you-do-this-simple-sitting-test-predicts-longevity

I haven't had a chance to look at the research itself, but the simplicity of this test appeals to me, as compared to the tests that are more favored by medical people. Controlling your blood lipids or your blood pressure or your heart rate is tricky, a bit difficult for the layman to measure properly, and generally discouraging. But trying to keep, or regain, your ability to get up off the floor without using your hands, elbows, or knees? That's pretty straightforward and cuts a lot of crap.

I don't link to this because I'm perfect myself at it! I'd score eight out ten on their test: I can rise confidently from sitting on the floor without using my hands or elbows, but I can't even imagine doing it without one knee. Not without losing fifty pounds, anyway. I don't know what I weigh (I haven't weighed myself in years), but I imagine it's 220 pounds. or so. I can't figure out how to get my center of gravity up that first foot or so without rocking up onto a knee. But I can do that, fluidly and easily, and from there, it's a piece of cake.

Now it is. In my forties, I couldn't have done it without at least one hand, and probably two knees. I'm much stronger now than I was then, more flexible, and my balance is better. I intend to keep all these capacities as long as I can, and never to relinquish the firm friendship I now have with the floor. I take to the floor almost any time I have a chance, without looking too odd. I really do not want to become one of those people who totters along in perpetual vertical, perching on high chairs, unable to get up and down. I love the ground, to go easily into a deep squat, to roll readily and smoothly onto my stomach or my back. And I don't do weights or training or formal yoga or anything; the closest thing I do to what modern people call “exercise” is ride my bicycle into my breakfast place, or into work, a few times a week.

But I do what kids do: I try stuff. I challenge myself all the time, silly challenges. Can I crawl over the couch without using my arms? Can I hop up the short steps to the basement on one foot? When I'm riding the train, and hanging onto those rails I hang my bike from – and which are so enchantingly like monkey bars – can I haul myself up, surreptitiously, so that my feet are dangling, without anyone noticing? When you weigh as much as I do, this is no mean feat.

The thing about all my silly challenges is, that they actually have to do with moving myself around, in ways that I might actually need to do, sometime. If you like lifting weights and doing stuff with machines, that's great, but the real point of exercise is being able to move yourself, even if you're injured or stuck or thrown into some terribly awkward position. And if you're willing to be silly, your own body has all the weight and resistance you could ever want, even if you're not as hefty as I am.

The other day a client told me, “I'm so grateful for your advice last time.” I couldn't remember what I'd said, so she filled me in: “you said, 'find some way to move during the day that makes you happy.' That's just been so important to me.”

This body. It's such a marvelous thing, and the more battered and time-worn the more wonderful, really. You can always try things. You don't need to be an athlete, or a yogi, or a gym rat. You can just crawl happily around the house, dance on any limbs that still work, see if you can step on every third flower on the carpet. Scuttle like a crab. Roll over in bed without using your arms. Whatever. What I don't like about the American Way of Exercise is its damned grimness, repetitiveness, and solemnity, and its emphasis on trying to make your body and yourself be like some ideal. Forget that. Get on the floor with the kids and just horse around. Put on some music and dance. Move happily. Treat your body like the wonderful, unexpected, and delightful gift that it is.

Earning My Keep

“There's a time during your massages,” said a client with MS, “when I'm completely without pain. It's amazing, because that never happens. Not even on the pain meds. I get to remember what it's like.”

Then she added ruefully, “It ends exactly when you start working on my calf.” A perennial problem area, lots of spasms. Her point, I think, was that this area was so bad that the pain was insuperable there. But I remembered that moment too: it was the moment when I became anxious that I was just giving a fluffy superficial massage, and reckoned I should do some real work and fix something. Earn my keep. I had shifted then from extremely light work – just stroking, really – to work that, though most clients would still find it irritatingly light, was identifiably massage.

A blunder, I think. My guess, in the light of what we're learning these days about persistent pain, is that any minimal improvement I may have induced in the calf will have been trivial compared to the benefit of walking her nervous system through the experience of being without pain. That's the important thing I have to offer. Valuable in itself, in the moment, and probably the most effective intervention I can make in her hyperalgesia. The next time I get anxious about earning my keep, I hope I remember that. I'm not a body repairman: I'm someone who talks to nervous systems. That's my job, and I'd do better to stick to it.

Pause

The backs of my hands in her flanks, rolling over, slowly, until my palms settle on the back of the hips, on the rises of the iliac crest: one of those places that call out for the palms; they fit there, like a sleepy child's head fits between shoulder and breast. I come to a complete stop.

Disengage cleanly, says David Lauterstein, often. Nothing worse than a handshake that just sort of indistinctly peters out. Shake and be done. And usually I agree with him. But sometimes I stop like this, for two or three full breaths. Sometimes the absence is a presence; sometimes the drumstick that doesn't fall is more audible and important than the one that does.

A Brief Salute

I drew a chair up to the head of the table. My client's eyes were closed, and her face was beatific. (Do people have any idea how beautiful they become, after twenty minutes or so? I don't think so.) I slid my hands under her shoulders and lifted, and gently rocked them from side to side: her head lolled slightly, back and forth, loosely and easily. That's what I like to see.

Her eyes opened, and she asked, “what's the benefit of that?” Not in a snarky way, but like someone who can see something's important but can't quite see why.

“I haven't the faintest idea,” I said, and she laughed.

“I could make something up,” I said. “I could say, 'this is what you do all day, hunch your shoulders forward, and if I do it for you, then you can finally see it and let go of it.' How's that?”

She laughed again. We come from the same Buddhist tradition, one that values skepticism about the stories and explanations we're constantly manufacturing. Other clients are not so happy with my reluctance to tell a story. They want me to have a whole connected, consistent narrative about the healing journey we're on, complete with heroes and villains, risks and triumphs, critical turning points and grand accomplishments. I won't do it. Even though it has some real therapeutic value, at least in the short term. In the long term, though, it's just more of the same, more that binds us to the wheel. It's how we got in this mess in the first place: by believing our own stories.

No. Of course I lift the shoulders for a reason, for dozens of reasons. One being that I would like someone to be doing it to me, right now. I take a deep breath, and exhale slowly as I lower them again, and something unlocks in me, something deeper than scapulae or trapezius: something in the heart that imagines them, and imagines hers – both our hearts, not that they're two separate things at this point.

That's another story, of course, and I treat it like all the others: something to acknowledge, with a brief salute, as it flickers by. No need to believe any of them or hold on to any of them. We have the real shoulders and the real hands: something deeper and better than all the stories in the world.

Geography of the Body

I flex my hands experimentally, as I do, these days, in the way that any careful workman checks his tools. They're good: flexible, only a faint muscle soreness along the thumb metacarpal – the adductor pollicis brevis and the opponens pollicis; under what palmists apparently call the mons veneris (yes, I know! You'll have to ask them.) No hesitations, no glitches, no twinges in the joints. Good to go.

I have to be careful what I do with my hands – especially, how long I leave them wet. I can't let the skin get too soft: It's risky, for instance, do a lot of dishes and then take a long shower, because it leaves my skin dangerously soft, too soft for the strength of my hands. Before I was a massage therapist, I scorned work gloves: now I always wear them to sling lumber or cinder blocks around. I'll tear the flesh right off my fingers if I don't watch it.

“I'm so grateful for your hands,” said a client, yesterday. “Paws,” she added, which surprised me. I always think of my hands as being distinctive for their sensitivity: I like to imagine that my brain, like that of a raccoon, devotes an inordinate amount of room to the sensory map of my hands. But it was an intriguing glimpse into how they were being received. What did “paws” mean? Large, blunt, friendly, undemanding? It was clearly meant as praise. I'll have to mull that over.

There's a gulf between bodyworkers and most other people. For us, the whole landscape of the body is closely mapped, full of named landmarks: we can easily describe any location within a quarter inch or so. Each particular spinal vertebra has a name, and distinct parts: a body, tranverse and spinal processes, facet joints. To the layman, it's all a vast unknown, unmarked country. A client says “my back's been hurting,” and asking for details plunges him into confusion. It's sort of the middle of the back? Or maybe the lower back? It's not just the lack of vocabulary, but a lack of sensory training: I don't think their brains really bother to map these sensations to different places. It's not just that they can't say: it's that they don't know. It's just the back. It hurts. It might have a left side and a right side, it might have a lower, a middle, and an upper, but that's about it.

It strikes me as a deep, pathological alienation, not knowing the landscape of your own body, not having names for all these parts that creak and hurt and impinge, that give comfort and pleasure or pain and distress. I feel about our general anatomical ignorance the same way I feel about Americans' geographical ignorance: no wonder the world is such a threatening, mysterious place, if you can't really locate anything in it, if you can't tell Saudi Arabia from Pakistan. All news is equally bad news: none of them can be up to any good.

Remedial Work

I guess I feel about being a professional massage therapist the same way I feel about being part of an organized religion. It's not something to be proud of. It's remedial work. We need to do it because we're such a sorry troop of lost primates, not because we're so sophisticated and advanced. We don't even know how to groom each other or pray: we're having to start over from scratch.

Dryden & Moyer

Fully caffeinated and ready to roll. Another three massage day. Life is good.

Reading Trish Dryden and Christopher Moyer's Massage Therapy: Integrating Research and Practice. I'll come up with a formal review at some point, but to cut to the chase, I can't imagine any massage therapist who reads at all wanting to pass this up. The four chapters on special populations (pediatrics, pregnancy & labor, athletes, elderly) and the nine chapters on particular conditions (headache, neck pain, low back pain, anxiety & depression, sexual trauma, scar tissue, fibromyalgia, cancer) should interest anybody who ever lays hands on a body. 

I've made no secret of being dubious about whether viewing massage as medical treatment is very useful. But I'm a huge fan of medical research on massage. We need to know what can reliably be said about how touch affects people, so that we don't spread misinformation, or adopt wrong-headed or even dangerous methods of bodywork. I view research information as largely negative: it tells us what not to do, how not to screw up. But that's important, no matter what it is you think you are doing.

Underbearing

Three massages today – my limit – and I look forward to all of them. I still always look forward to my massages, in fact. At worst, when I'm tired, I have a mixed response of “how lovely this will be!” and “oh, I'm going to have to watch my body mechanics tonight!” I'm not a big alignment buff: not one of those people who thinks it matters all that much that your head be balanced on your spine and your shoulders over your hips, not so long as everything's moving and fluid and easy. But when you find yourself straining you know you're doing something wrong. There's always an easier way: a way to let gravity and bones do the work, to make a solid supported structure with your wrists, thumbs, and fingers, and load it with the weight of your body, or the weight of your client's.

There's a move I particularly love – with my client face up, I take hold of their nearest wrist and pull their arm straight up toward the ceiling with one hand, while with the other I reach under to the spineward edge of their shoulder blade. It opens up the whole shoulder assembly, so that I can work everything in that rich lode in between the spine and the shoulder blade. Once I've got the shoulder up, I can let their arm fall over across their chest (as if they had half-rolled away from me while saying the pledge of allegiance). The whole weight of their upper body is now resting on the hand I've got under the shoulder blade – plenty of force for anything I might want to do.

But if I tried to do this move while standing beside the table, carrying their weight with my back, I'd kill myself. The mechanics are all wrong. Instead I put a knee up on the table, rest my forearm on my thigh, and hold most of the weight with my wrist, which settles nicely into the hollow of their shoulder blade. After I've let their arm fall across the chest, I can then take their shoulder with my free hand and move it around wherever I want it. The weight-bearing forearm is exerting practically no force now: it's just rocking across my thigh. It's a lever, and my own considerable upper body is its counterweight. I can dig in with my fingers when I like, and relax them when I like. Once I got the knack of it, I found I could do this indefinitely and effortlessly. And clients love it. Pressure that comes up, I've found, feels much different from pressure coming down. It's unexpected, and it feels less, well, overbearing. I do a fair amount of wedging my hands under the body, one way or another.

A Word on Deep Tissue

“Deep tissue,” like most terms in the woolly world of massage therapy, has several meanings, none of them very precise.

 1) It's mostly commonly used in contrast to “relaxation” massage, or “fluffy spa massage.” Deep tissue is serious massage, massage that really does things, that digs in and finds problems and fixes them. It's not just petting. In this sense, it's really just a vague word of praise: it carries the same positive force – and carries about the same information load – as “real.” That was a deep tissue massage; a real massage.

 2) Its only reasonably precise meaning is also its most useless: it can mean “massage that reaches under the superficial muscles to reach tissues underneath.” All massage does this, of course; there's virtually no way to avoid it. And all competent massage therapists, however they advertise themselves, know how to move the body around so as to get better access to deeper muscles. A massage therapist who won't do this, who just pets an immobile body with a uniform light pressure, won't last a week. Even the supposedly fluffy relaxation therapists do this. Some are more aggressive than others, but they all do it.

 3) There are a variety of methods that advertise themselves as “deep tissue,” some patented and some not. These are particularly common among people who specialize in, and talk a lot about, fascia (connective tissue) and adhesions. They can get very excited about the thixotropic properties of fascia – how it softens as it is warmed and worked – and about how it can get stuck to things. Some of them talk a very persuasive line. Unfortunately when it comes to results, no one has been able to show that they are better at fixing anything than the supposedly fluffy relaxation therapists. (See my review of Cherkin's low back pain study, which directly pitted therapists trained in “deep tissue” against therapists who described themselves as doing relaxation massage. The relaxation therapists got slightly better results.) As for adhesions – as Paul Ingraham writes, “In active people . . . it is basically impossible to develop any significant adhesions, anywhere in the body.” People would love to believe that their bodily problems are simple mechanical ones, which can be fixed in the same way you'd fix a car – bang on this part, lube that one up, take this conglomeration apart and reassemble it, and voila, now your neck works fine! But attractive as this idea is, it's almost never that simple. The fact is that the verifiable effects of massage are rather mysterious and maddeningly unspecific. Massage makes you feel better, sometimes dramatically better, but it's very hard to say why.

Now having said this much, I have to make an embarrassing confession. I have, on occasion, advertised myself as a deep tissue massage therapist. I did this for a very simple reason. I myself like firm massage. I like a therapist who is not squeamish, and who will use enough pressure to really make a difference, when it's called for. I don't like to get manhandled or beat up, but I don't mind if there's occasional pain along the way, so long as I'm confident that my therapist knows what she's doing and won't really hurt me. Long before I trained as a massage therapist, as a client, I searched for therapists who would do that sort of massage, and I vaguely associated the term “deep tissue” with it. It was to tell my prospective clients that I could do that, if they wanted it, that I called myself skilled in “deep tissue” massage. (I have in fact studied fascial methods, pin and stretch techniques, various contract-and-relax protocols, so I wasn't just whistling Dixie. But I don't have a whole lot of faith in any of that stuff, as practiced by massage therapists.)

And the point here is that massage therapists can basically say whatever they want. It's very much a caveat emptor world: let the buyer beware. Someone who bills herself as a “deep tissue therapist” is probably one who isn't afraid to use a lot of pressure, which can be a good thing or a bad thing, depending on how sensitive her hands are and good she is at reading the body. But it doesn't tell you much more than that.

Five More Clients

I want about five more clients. I imagine writing fan letters to fifty Portlanders I admire, enclosing gift certificates. Super-targeted marketing. Would that net me my five? Or even one? I've been putting off advertising again, it's such a tiresome business, and I haven't needed to for a couple years. You get spoiled when that happens.

Massage in Portland

He wakes up enough to latch on again: a brief struggle and then quiet. His head is backstopped by a roll of the linens, his two-week-old body draped over his mother's ribs. All sleepy little mammals are much alike: he could be a puppy or a kitten.

I kneel behind the table and slide my hands, palms up, under his mother's shoulders, working my fingers into the endlessly rich territory between the spine and the scapula, lifting a little. My thumbs come to rest easily on the anterior side of the upper traps: with a little fish-like wriggle, easier to do than to describe, they can get down to the strands of the levator scapula. Caught at last: I've got them between my thumbs and third fingers, and I can give them the long elaborate squeeze they've been looking for. A barely audible “oh,” from the mother, a little whuffle from the baby. I move on to the more accessible upper traps. Hold for a breath, maybe two, move a fingers-breadth down, and hold again.

Behind me, the baby's sister, a serious trouper, who kept him entertained for a full fifty minutes, sits on the couch, doing her math homework. She's using a calculator, both for the work and for a flashlight: the Spring daylight has run out, and the room is almost dark.

I stand up and move around to the side, to finish up with a little gentle abdominal work. No point in trying to get under the linens: I work through them, taking care not to put any lateral drag on the rectus abdominis, in case there's been any separation. I really don't think there has been, though. No particular tenderness. I use the contact improv skills I learned thirty-plus years ago, to roll my hands tenderly over the belly without pulling on it. When I come to his feet, I just incorporate them, working the ribs with them a little. Perfect massage tools.

When I'm packed up and heading out the door, half an hour later, she hands me a brown paper bag: a dozen eggs. They can't keep up with their chickens. I don't ordinarily accept tips, but fresh eggs, yes, I'll take those.

Portland is not, maybe, the earthly paradise, but it's close. It's close.

Hands

Hands. The way they fit to the human body. It's completely magical, and becomes more so, not less so, the longer I practice massage. The hand is not really that flexible an apparatus; most of its joints are not that mobile; but there's nothing in the whole landscape of the body that it can't mold itself to and speak to.

Home Massage

Other massage therapists, when they find out I do in-home massage, often ask, “how do you like that?” They ask gingerly. A delicate question. Some of them maybe are thinking: “can't the poor guy get work in a regular office?” They're inviting me to share my sorrows with them.

“I love it!” I say, and they're a little startled by my exuberance. It's true, I have to schlepp my table, which is a nice solid custom Robert Hunter, not a lightweight aluminum job. No hydrocollator for wet heat, and no spa goodies: just the table warmer, the linens, and a bolster. A few pillows if its going to be sidelying. It's a minimal kit, and occasionally I have to improvise, to borrow another blanket or pillow from my client. My array of lubricants is four narrow bottles: two scented oils, one unscented oil, and an unscented lotion. Rapid improvisation is the name of the game. Some people are too ill or fragile to climb on and off the table. I've worked on people in beds, in recliner chairs, in wheelchairs. I've worked in spaces so tiny that my table had to be against a wall, and I had to do the whole massage from one side.

I love it. Just the materials at hand and the will to make it work. Figuring out how to deploy in a new space is often the first thing a client and I figure out together, and it's a model for how I work. This isn't about a lofty health care provider dispensing treatments on his own terms. This is about how things work for you, in your own tiny apartment or your mansion on the hill. This is about something that makes sense in your life, in your world, not in a standardized florescent-lighted hospital room, and not in a vaguely Asian shrine which looks serene because nobody ever actually lives in it. This is about relaxing in the home you really live in, and in the body you really live in.

I'm honored by people admitting me to their homes. I learn so much about them. I meet their kids and their pets. I see the stuff on their walls. Some people are tidy and some are not: some seem in control of their space and some seem overwhelmed by it. Some are frou-frou and some austere. Some share their space easily and some don't. Most people apologize to me about something, the way something looks or smells or sounds, which to them seems not quite right. Every new house I go to is a new world, with its own laws and culture. Every one is fascinating. By the time I've set up, and washed my hands in a new kitchen or bathroom, I understand more about my client than I could have learned in hours of intake interviews.

Every home is wonderful to me. Human beings make homes like spiders make spiderwebs: there's common structures and purposes to all of them, but all contain surprising and enchanting adaptations. There's no such thing as an ordinary one. In that way, they're like bodies: accumulations of love and distress, made sacred by being inhabited.

This is, after all, why I wanted to do massage in the first place: because I wanted to meet people as they really are and where they really live. Not as they think they should be. Not as they have to present themselves to the working world, buttoned up and held together. I've always prefered the backstage world, raw and messy and slapdash though it is, to sitting out with the general audience seeing how it's supposed to look.

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.