Originally published in Massage Bodywork magazine, March/April 2011. Copyright 2011. Associated Bodywork and Massage Professionals. All rights reserved.
Pain is the body's wake-up call. Although we often fail to notice minor stresses and strains, most people notice pain as the body calls out for attention. Our typical response to pain is to try and suppress it or get rid of it. However, there is another, more powerful way to work with pain: by feeling it instead of avoiding it. Body Sense and Pain
It may not seem like it at the time, but pain exists in our bodies as a way of getting our attention back to ourselves. Pain is one of the pathways our body uses to spontaneously and automatically remind us to notice a physical or emotional threat we may have been avoiding. This noticing and feeling directly into our bodies, even our pain, is what I call embodied self-awareness, or more simply, "body sense."1
Body sense is the ability to feel sensations and emotions in the present moment without the mediation of judgment or thought. In fact, whenever thoughts of any kind come into our awareness we immediately go offline from our body sense; we are not in the moment: "Am I sick or just lazy?" "I'm really good at what I do." "I'm definitely in the moment, right now, with this client."
Present-moment body sense is like a booster shot for the nervous system. When we become aware of feelings, including pain, it means that the self-regulatory network of the brain (including the prefrontal cortex, the anterior cingulate cortex, the thalamus and hypothalamus, linked parts of the brain stem and spinal cord, and the peripheral receptor neurons that help to locate and sense our body condition) can be activated as a single unit of neural integration. This integrated network is exceptionally powerful because it can find the most optimal form of functioning across neuromuscular, digestive, hormonal, cardiovascular, and immune systems leading to a reduction of pain and ultimately a return to healthy functioning.2
Body sense is one of the oldest, most powerful tools available for healing. It is as simple as noticing the aroma of good food, feeling your feet on the floor, or sensing the warmth and softness of touch. Body sense calls us to the present moment, brings us back to ourselves, and wakes us up to what our body really needs. Body sense is also elusive, mysterious, easy to forget, and difficult to rediscover. It takes practice, discipline, and concentration. Even those most skilled in the art of body sense can lose their way or get thrown off track.
This happens because of the pull of our thoughts and judgments--those nagging expectations from family, friends, and co-workers. If these pressures push you to ignore the subtle sensations of stress in your body, and later the pain itself, you may develop tissue damage like tendinitis, joint inflammation, loss of cartilage, bone compression in the vertebra, or a pinched nerve. Your body might be under stress for years, but you may not be aware of it until it progresses to the point of depleting your body's resources: literally destroying cells that maintain your ability to function.
Adjusting your posture, stretching, going to the gym, getting bodywork, doing yoga, meditating, taking a walk in nature, having fun--these are all simple practices that help bring us back to ourselves, enliven the body sense, and dampen the insistent thoughts that take us "out" of ourselves. Yet, even those most skilled in body sense may run into a roadblock when it comes to pain.
Let's look at the physiology of physical pain to understand why it can be difficult to handle. The sensations from the nociceptors (pain receptors) at the periphery of the body are not pain; nor are the nerve impulses that travel up the spinal cord and are represented in the somatotopic brain stem, limbic, and cortical regions that correspond to particular body locations. Pain is not any of these nerve signals. Pain is a state of consciousness in relation to the body.3
It is an emergent state of awareness across the entire neural network just described.
This means that even if the nociceptor sites are relaying a pain input signal to the brain, how that signal is felt and how we relate to it emotionally (fear or acceptance) can be changed, perhaps permanently, by becoming more aware of our experience of pain. To convince yourself that the pain experience may actually change with awareness, try the Body Sense Exercise on page 59.
Part of the work of getting in touch with pain is to convince your body that it is safe to go in there and feel it. Having accomplished that, you can begin to deepen your body sense of pain. You may be surprised that the pain morphs from physical to emotional (sadness, anger, fear, love) and back again. It may even be referred to other locations in your body. This is because pain is not, in fact, located anywhere in your body. It is distributed through your whole being, which is why training your body sense to encompass that whole being can be helpful.
Some pain, however, may not be soothed in this way. You may need to take pain medications and other medical treatments. Regardless of what treatments you use, your body sense can play an important role in your recovery. Body sense is itself a kind of medicine because the neural network that supports the body sense is directly linked to neural, hormonal, and immune system functions that relax, soothe, and restore.4
Body sense medicine relies on your own body's natural resources for self-repair and the dosage is automatically tailored to your needs.Bodywork For Pain
As a bodywork practitioner, if you can't explore your own pain (either solo or with help), you won't be able to help your clients explore theirs. You may need to focus part of your continuing education on body sense practices and treatments for yourself. Rosen Method bodywork5
and the Feldenkrais Method6
use both "listening" touch and talk to enhance body sense. In cases of trauma-induced pain, Rosen Method, somatic psychotherapy,7
and Somatic Experiencing8
are all useful practices. These methods help us find ourselves in the present moment so that our bodies can more effectively use their own resources for healing. Being willing to check in with your ability to access your body sense of pain is already a step in the right direction. Continued practice has demonstrated positive benefits for your own physical and mental health.
Assuming you are on the path to staying in the present moment with your own pain, you will already have an intuitive sense of what may help alleviate your client's pain. When contacting a client's painful areas during a bodywork session, you can use your experience to help you understand how to apply some of the following guidelines. Think Of Your Touch As A Resource, Rather Than A Remediator
Touch should be gentle, with full hand contact--just enough for the person to feel it but not so much as to aggravate the pain. Aggravating pain will bring up the body's defensive and protective responses, something the client is likely already to have been doing to avoid feeling the pain. Defensive reactions suppress the body sense.9
All pain should be initially treated as if it is "hot" trauma, as if you are working with a raw nervous system, with the goal of reducing reactive responses and increasing tolerance for feeling that part of the body.10
You can adjust your touch by asking your client: "Does this hurt?" or "Can you feel my hand?" We want the client's body sense to activate his or her body's own resources for healing. At this early stage of treatment, doing less is achieving more. Allow The Client To Feel The Pain Without Acting On Your Own Desire To Fix Or Make It Better
The self-regulatory neural network has to be able to locate the pain in the body before it can marshal the appropriate neurochemicals, hormones, and immune cells to address it. Many sessions may be required since this is a developmental process--literally regrowing parts of the self-regulatory neural network. If you can stay present with your own worries and questions and not act on them, you can get out of the way and let clients have their own feelings. It may seem as if you are causing the pain, but if you are fully present with your touch, what you are really doing is giving the client the opportunity to feel the pain, with you as a witness.Reduce Intensity, Pressure, Or Move Away From The Painful Area As Needed
You are primarily working with the client's neuroregulatory system and teaching about shifting between feeling pain until it becomes intolerable and then shifting to feeling something more comfortable. By touching adjacent and pain-free areas, you are reminding the client's nervous system that there are resources beyond the pain: comfort, relief, and hope.Begin Deeper, Or More Adjustive; Work Only As Pain Tolerance Increases Over Time
When addressing previously painful tissue, working more deeply has to wait until the nervous system can handle it. This could take weeks, months, or longer, depending on the person and the source of pain. It is essential to stay in touch with your own body sense, as well as your clients', to assess--asking questions and using your eyes and ears--when they may be ready for more. You don't know what the clients need until you observe their responses. This is not about you and what you feel is best for them. In order to avoid reactivating the threat and withdrawal response, allow yourself to engage with clients in a process of mutual communication and discovery. For instance, if feeling the pain brings up an originating trauma, you may want to refer the client to a body sense practitioner of Rosen Method, somatic psychotherapy, or Somatic Experiencing, all of whom are trained to work with the emotional and physical effects of trauma.Be Prepared To Wait
The practitioner may need to wait, to be in a state of non-doing, before getting a response from the client's body that indicates a renewed feeling and connection with the injured part. Some of the best massages I've experienced combine the usual strokes with periods of just this type of slow, patient, fully present contact. This gives my body a chance to feel, to settle, and to integrate the more active work that came before. Exploring Pain
Can you be content using your touch as a resource and support and not acting as a fixer or healer? Are you ready to address some of your own pain in this way, with patience and acceptance? Exploring pain can be highly gratifying and liberating, and a feeling of triumph comes from learning to stay with the pain and not run away from it, not try to make it better. Body sense approaches to pain allow the wisdom of the body to be the guide, while helping you move your own thoughts and intentions out of the way. This takes a lot of pressure off the practitioner because you don't have to figure out how to relieve the pain. The body can take care of a lot of things on its own if we give it a chance to just feel how it feels, right now, in this very moment. Alan Fogel, PhD, is a Rosen Method bodywork practitioner, a licensed massage therapist, and a professor of psychology at the University of Utah in Salt Lake City. He has been an active contributor to research on nonverbal communication, especially between infants and parents, for the past 35 years. He is the author of
The Psychophysiology of Self-Awareness: Rediscovering the Lost Art of Body Sense (W.W. Norton Company, 2009) and writes a blog on body sense for
Psychology Today magazine (www.psychologytoday.com/blog/body-sense). Fogel is also founding editor of the
Rosen Method International Journal (www.rosenjournal.org) and a Rosen Method bodywork teacher-in-training. Contact him at firstname.lastname@example.org.Notes1. A. Fogel,
The Psychophysiology of Self-Awareness: Rediscovering the Lost Art of Body Sense (New York: W. W. Norton, 2009).
3. C. R. Chapman and Y. Nakamura, "Pain and Consciousness: A Constructivist Approach,"
Pain Forum 8, no. 3 (1999): 113-23.
The Psychophysiology of Self-Awareness.
5. M. Rosen,
Rosen Method Bodywork: Accessing the Unconscious Through Touch (Berkeley, CA: North Atlantic Books, 2003).
6. M. Feldenkrais,
The Elusive Obvious or Basic Feldenkrais (Capitola, CA: Meta Publications, 1981).
7. D. H. Johnson I. J. Grand, Eds.,
The Body in Psychotherapy: Inquiries in Somatic Psychology (Berkeley, CA: North Atlantic Books, 1998).
8. P. A. Levine,
Waking the Tiger: Healing Trauma (Berkeley, CA: North Atlantic Books, 1997).
The Psychophysiology of Self-Awareness.
10. T. Luchau, "Working with Whiplash, Part 1: Hot whiplash,"
Massage `Bodywork, (March/April 2010): 108-15.