Massage therapists have the tools clients need, and human touch is the outlet for our anxiety, loneliness, and depression. Erik takes us through valuable research, then guides us on how to down-regulate the stress response. From what to look for when clients enter your practice; to making them feel comfortable; to your communication, eye contact, and first strokes, Erik lets us in to his insights garnered over many years of bodywork practice. Learn about the Ida Rolf blanket tuck and the 50/70 rule.
This episode sponsored by Anatomy Trains.
00:00 Kristin Coverly: Anatomy Trains is excited to announce a new on-demand video course with Tom Myers coming soon. Deeper Ground: Restoration and Vitality for the Female Pelvis. Reach your deeper ground of embodied awareness and strategic confidence with this four-hour tour of the female pelvis, including its key points and unique challenges. Course highlights include: Hands-on palpation certainty and technique review for the major muscle groups, assessments and techniques for posterior and anterior pelvic floor, psoas complex and diaphragm, common perinatal biomechanical issues explained, and much more. Sign up for the Anatomy Trains newsletter at anatomytrains.com to be notified when the course is available.
01:00 Darren Buford: Welcome to The ABMP Podcast. My name is Darren Buford, I'm the Editor-in-Chief of Massage & Bodywork magazine and Senior Director of Communications for ABMP. I'm joined by my co-host, Kristin Coverly, Licensed Massage Therapist and Director of Professional Education for ABMP. Our goal is to connect with luminaries and experts in and around the massage, bodywork and wellness profession in order to talk about the topics, trends and techniques that affect our listeners' practices. Our guest today is Erik Dalton. Erik is the Executive Director of the Freedom From Pain Institute. Educated in massage, osteopathy and Rolfing, he has maintained a practice in Oklahoma City for more than three decades. Erik is also a columnist for Massage & Bodywork magazine. You can find his work, E-Tissue, in the Myoskeletal Alignment Techniques column. For more information, visit erikdalton.com. Hello, Erik and Kristin.
01:48 Erik Dalton: Hi, thanks! Hi, thanks, Darren and Kristin.
01:51 KC: Hi, welcome! We're so excited to have you here.
01:54 ED: How're you doing?
01:55 DB: Erik, we were so moved by your most recent column in Massage & Bodywork magazine in the September-October 2020 issue, that internally, we've been talking about it as a foundation of which practitioners can be aware what's going on with their clients right now, especially during these challenging times with the pandemic, but also, as a way to speak to consumers about the power of bodywork. In there, you talk a little bit about the addressing frustration, aggression, anxiety, loneliness and depression. Can you just give us a little bit of background about this column titled: Rethinking the Body's Stress Response, and some of the research that provoked you to write the piece?
02:36 ED: Yup, I'm glad you like my column, first of all, and I'd like to thank all of my friends with ABMP and also, all the virtual friends out there that are joining us. Howdy! So now, I'm back to my full-time bodywork practice, and I'm seeing a bunch of stressed out clients. Some are coming in with the typical pain complaints, but many are just trying to deal with their jacked-up nervous systems from all the financial and political and social turmoil brought on by this pandemic. So for my ABMP column, I decided to address the systemic nervous system problem to help us all get a better grip on how to deal with these stressed out clients that are coming in.
03:16 ED: So when I was back in college way long ago at the University of Oklahoma and majoring in psychology and graduate degree psychology, you couldn't mention the word stress without bowing down to the father of stress research, Hans Selye. And all of you have probably heard of him. He is brilliant, but a very odd fellow who was clumsy handling his lab rats. He had dropped them on the floor all the time, then he'd chase after them. And soon, he discovered some were developing stomach users. And so he thought, "Wow!" The ulcers from the experiment he was conducting 'cause he happened to be... Somebody had come up with this new hormone, adrenaline, and he was injecting this adrenaline in them. And so he thought that the adrenaline may have been causing their ulcers when in fact, it was his clumsiness running around chasing the rats that caused the stress.
04:14 ED: But anyway, this led him to develop the term stress to describe his observation. So to prove his case to the scientific community, Selye began delivering... Now, I don't like this part either, so I'm just gonna say it, but we gotta talk about. Mild electric shocks to the tails of rats, and then he had measured the amount of adrenaline, cortisol secreted in their systems. And he was thrilled when he found out that he could precisely measure the hormonal response to any stressful stimuli. It was a big deal, it was a huge deal in the endocrinology field at that time. He reasoned that the human body was simply based on an input-output system where the amount of stress created predictable elevations in the rats' cortisol levels, and he labeled it the stress response. So over the year, Selye was nominated for 17 Nobel Prizes in Physiology for these discoveries, and unfortunately, Selye's observations started out to be totally wrong. He screwed up the endocrinology field for nearly 40 years.
05:17 ED: So here's a flyby of what Selye thought. In a normally functioning body, first, we get stressed, we get knocked out of homeostatic balance, and then we turn on the stress response by secreting hormones that help us re-establish homeostasis, and everything's great. So that all was fine in a normal body. But if the stressor goes on for too long, we enter what Selye called the exhaustion phase, where our adrenal glands completely run out of adrenaline, and this is where he went wrong. And unfortunately, in the history of this planet, no one has ever run out of adrenaline. It's not possible! There's no such thing as an exhaustion phase, Selye was wrong. But for many years, scientists took Selye's stress response theories at face value, although all scientists didn't agree with his strict physiological view of the body as a tightly-regulated input-output machine where the degree of stress always resulted in a predictable hormonal response.
06:16 ED: And one of those critics was Rockefeller researcher Jay Weiss who, in a series of laboratory experiments, delivered the exact mild electric shocks equivalent to static electricity to a rat over a period of time... Causing it to develop a prolonged stress response, just like Selye, including elevated heart rate, increased cortisol secretion and eventually, an ulcer, same as Selye. But here's the catch that completely collapsed all Selye's stress response research. In the next room, a different rat was receiving an identical series of shocks at exactly the same time using the same intensity. But in the case of rat number two, after receiving the shock, he was allowed to run over to a stick of a wood in the corner of the cage and gnaw on it.
07:06 ED: So when Weiss retested rat number two and found that blood pressure and resting cortisol levels had suddenly dropped simply by offering a stick of wood to act as a psychological outlook for the rat's frustration, Selye's system bit the dust, allowing the psychologist to enter the stress field. Oh, they hated the psychologist in the beginning. They didn't have a seat at the table for a long time. The strict physiologist hated that icky-icky psychology stuff, they didn't want that entered into their strictly physiological field. Okay, but in my opinion, good hands-on bodywork is many ways like chewing on a stick experiment. We're very fortunate to be in this profession at this time in history because we have the tools to really get our clients through this. And this is a great time to be in this profession, so you guys don't give up out there. And that's all I got to say about that.
08:00 KC: Well, I'm gonna ask you to say a little more about that because I love what you say. In your article, you reference the rat has the stick as its outlet, and humans have, I guess in lieu of us sitting in the corner, gnawing on a stick, we have other types of outlets. One, you just mentioned human touch. Can you tell us a little bit more about that, and how that becomes a psychological outlet? I know you've had, you've talked about other research with touch and pain perception.
08:27 ED: Yeah, we're better dealing with both acute and chronic stressors when we have outlets for our frustrations and in my opinion, touch therapy is the ultimate way to downregulate the stress response. Exercise is also great, don't get me wrong, everybody's gonna go, "Oh, no! No, we get out there and exercise and lowers your stress." I don't know man, nothing like really good bodywork does it for me. An example of this is... In later experiments conducted by Jay Weiss, thank God, instead of allowing the rat to run over and chew on a stick of wood, the rat was able to enter another cage where he could cuddle and groom with a fellow cage mate. This was a rat that he'd been around before. They groomed there, they did all of that, that stuff. When Jay Weiss again measured the cortisol and adrenaline levels, the rat receiving the shock showed absolutely no hormonal stress response. In other words, that grooming knocked it down even more than chewing on a stick, which is... Makes sense. Weiss discovered [09:24] ____ was a long way toward explaining why touch therapy is so important in warding off our clients' tendency toward things like loneliness and anxiety and depression.
09:35 ED: So the brain has to know it has back-up, something it can trust in case the need arise. And so physical contact with hands-on therapy is absolutely, in my opinion, the simplest, most effective way of communicating those feelings of support. Therapists' hands are primary language of expression, and nothing is more psychologically concrete than human touch, I said that in my article. Our hands are the perfect, unambiguous tool for expressing emotion, which we all know, reassurance and compassion to our stressed out clients. So this is the time they really need it, so let's really start thinking about this, the stress response in our clients and observing for it.
10:17 DB: In the article where you mentioned that effective touch modulates pain perception, is that the Weiss, the second Weiss study, or is that another study?
10:26 ED: No, no. No, that was... I don't know if he ever got into the pain thing or not, and I think I've actually seen this particular scientific reports, 2017, when on an ABMP site somewhere, and it may have been a Ruth Werner. Let's see, it was 2017 titled: The Soothing Function of Touch. How Affective Touch Reduces Feelings of Social Exclusion. So there we go again, putting that social exclusion thing back into the touch and how it may affect pain. So these researchers found that slow, affective touch may help modulate the perception of physical pain by strengthening the feelings of social bonding while reducing the stress response. So the key here is the word perception of pain. Perception includes not only how well we use our hands, but also how we interact with the client.
11:19 KC: So Erik, you were saying earlier, too, that right now, a lot of the clients you're seeing have high, elevated, acute and chronic stress levels because of everything that's happening in the world today. What do you look for when you're observing them? When they're first entering your room, what are those stress response signs that you're looking for right now to recognize when they're at that elevated level?
11:43 ED: Yeah, that's a good question 'cause a lot of people don't pay attention to this, or a lot of people can't, depends on how your set up is in the office or you're working in the spa setting, you may not know the person until they walk into the room. But in my case, I've got a little hallway and when they come down, I'm able to watch them. I usually get behind them and walk them. So there, if they're in a slack posture, which may indicate depression or guarding, some sort of guarding where they're in the forward slack posture and all that, or rigid, a rigid posture. It could be anxiety that they're experiencing that they're just... And I've seen that a couple of times, just in the last two weeks. So I was down performing my history intake, which I always perform a history intake. You gotta be really getting good at history intakes, unless you're in a spa setting, you gotta be really good at history intakes because you learn... Experience after years, you learn at the history intake, you get 90% of your best assessments from history because you start to hear the same things, feedback. Feedback from other clients, you get good at that.
12:48 ED: So I observed for signs such as bogged eyes or daze, people are glazed over, or sometimes, their eyes aren't able to orient, they're flickering around. And sometimes, you can't even get them to look at you. So of course we see some that are irritable, kind of irritable and jittery, that always bothers me because I think it's me. And some have clenched jaws, that's another sign. But the one that I watch for more than anything else is shallow breathing and a pale complexion. That's a dead giveaway for me. When you can see them... Their diaphragm isn't moving at all. They're sitting there just upper chest breathing and they're pale. They're not getting oxygen to the brain, that's a sign they're either in distress or they're in shock.
13:35 DB: You know, you said something really interesting, I'll circle back to about the history intake and how important it is. I'm going to some physical therapy right now and there is the owner of the facility, and I'm not working with the owner but I'm working with some of the employees there and after a session with me, I could hear him correcting one of the employees and saying, "Everything, you need to write down everything. Every single step that we did so that we can revisit this next time." And I'm sure that the PT knew that but you could just see that correction in him. And I was just like, "Yeah, you need to know how to connect with me next time when I walk in," that you had got that story, you're building Darren's story every single time, that way we know progress. So absolutely, I couldn't agree more.
14:20 ED: I think physical therapists are the very best at that. And they have to do it for insurance purposes too, it's a different thing. But you know what, they all have it now really really formatted and they've got just great designs that most of the big clinics use. They go through these protocols. My wife... I don't mean my wife... My daughter's an MD, internal medicine and pediatrics and she's saying that the hospital's now, her major hospital that she works with, they have a protocol. Somebody comes in with assumingly a cold, they have a protocol. They can't just say "You know what, I don't think you need corticosteroids. I think... I really don't think you need an antibiotic right now. You can't say that. It's antibiotic, it's corticosteroids, the next stage, it's step by step how you do it. So it takes a lot of the physical observation and history taking and all that stuff out of it.
15:13 DB: So Erik you talked about now you have identified when clients have come into your practice and they appear stressed, how do you make them feel comfortable now, verbally or physically, that the massage is helpful and safe for them?
15:28 ED: Well, when dealing with clients exhibiting all those symptoms I just mentioned, I make sure that they know that they have my full, undivided attention and that they have come to the right place and that together we're gonna get them moving better, feeling stronger, and more comfortable in their bodies. They're the most important person in the room and that's the whole thing. And it's a hard thing to do because therapists have things on their minds too, you know. We've got stuff going on in our lives too. We go into that room and we may have a boss that's been yelling at us and all that stuff, but you gotta get in there and you've gotta make that contact.
16:00 ED: It's a learned technique. I always listen calmly and emphatically before proceeding with any hands-on work. However, if they appear too disoriented or distracted, I typically try and get them on the therapy table as quickly as possible. And sometimes I use an old Ida Roth technique which is absolutely fabulous, I've had great success with this. I cover them up with a lightweight blanket and gently tuck to the sides of their bodes. There's something womb-like about the blanket that makes them feel more secure and safe. I mean that is really amazing how it downregulates the nervous system. I usually... I almost always start my clients face up, where I can start communicating with them, and I do everything that we learned not to do in psychology transference. You don't have pictures of your kids, your family on the walls or you don't do any of that stuff.
16:50 ED: You don't talk about your family. We do just the opposite. My clients come in and they go, "How's the family, how's the... " Because that's where the bonding comes. That's where the bonding, that's what keeps people sending their whole family to you and all that stuff. Okay but we're talking still about a stressed client that comes in. Okay so if they're too disoriented or distracted, get them on the therapy table, do the whole thing and then, as I talked about a bit earlier about the importance of eye contact, I mentioned it in my next massage and bodywork article about the importance of eye contact. So it's said that the eyes are the windows to the soul and indeed all of the neuroscience that's coming out right now supports that. So eye contact increases the hormone oxytocin, the love hormone, which we all know about. It has... The science behind it, it has an inverse relationship with the stress hormone cortisol.
17:46 ED: So when cortisol goes up, the eye contact... When eye contact goes down, cortisol goes up. So it's an inverse relationship. When clients... When you practice good eye contact, oxytocin increases and your cortisol level decreases which leaves clients with a better sense of well-being and connectedness, which is kind of the antithesis of stress. So you're doing the right thing. But the thing is obviously, you don't wanna overdo it with eye contact. I found that a good guideline to follow is the 50-70 rule. So when you're talking to the client try to hold on eye contact for approximately fifty seconds 50% of the time. So when you're speaking to the client, you hold eye contact for 50% of the time.
18:28 ED: Now when you're listening, you try to keep on eye contact for 70% of the time. Really an interesting thing. I didn't come up with that myself. It's something that a lot of the psychologists have come up with, but it's really interesting because I have really had a good success with it, not only in my practice, but in my daily life particularly with my family members. So we've all evolved for face-to-face communication and eye contact definitely helps us knit together a better therapeutic and intimate relationship with our clients. So just treating them like they are the only person in the room and keeping eye contact and making sure that your room looks like something that they would want to relax in and you've got a lot going for you at that point.
19:18 KC: So Erik, we've got that client on the table, we've done the blanket tuck, which I'm totally gonna take and try with future clients, by the way, it sounds wonderful, we're using the appropriate level of eye contact, we're ready to start the session. Can you recommend some techniques that would be really effective to use to relax these clients as we're starting this session?
19:37 ED: Absolutely, yeah. The motor control center of the body's at the base of the skull. There's several occipital muscles, but it's really the OA joint, the atlas axis and the OA joint, which would be considered the upper cervical complex, that's where all the neurology is. That's where the midbrain is, which when those people are in that posture, that's what that is. That's the pontomedullary reticular formation, it's in the midbrain, that have memorized this posture.
20:07 ED: So to really make any change, you've gotta get up there at the base of the skull along the occipital ridge. I like to just work the occipitals first. Don't do too much movement as far as rolling the head and everything until I really get them to calm down. At the occipital ridge, the posterior occipital [20:26] ____ membrane, you've got skeletal and cranial nerves coming out, and that is a big deal. That's the epicenter for establishing a good brain-body communication. So to help down-regulate the client's fear center, which is the amygdala, and to stimulate parasympathetic tone, we can use the upper cervical complex, the vagus nerve, which runs through there.
20:50 ED: We all know about the vagus nerve, all of our internal organs, our second brain, which is the enteric nervous system, is all controlled by the vagus nerve and some of the subsidiary nerves. So I like to perform a variety of sub-occipital, all kinds of sub-occipital work. Everybody has sub-occipital work and it's all good. The only thing that I would suggest is try Sideline. Sideline's sub-occipital work is absolutely very best, because you've gotta realize in the front, you've got longus capitis and longus colli, which are the deep neck flex muscles, which are almost always weak. And sub-occipitals, because of forehead, posture, whatever, are always overpowering them.
21:29 ED: So when you are able to have the client go into head flexion while you're holding the sub-occipitals, you really can get a good stretch on it. It's harder to do when they're supine and you can also do things that can roll the client's head, which is a lot easier to do when you're having Sideline with thumbs. I have thumbs meeting at the rectus capitis posterior minor, move all the way along the occipital ridge all the way out to the mastoid process. That's the kind of stuff I do until they start calming down, watching their face, seeing if there's any kind of weird stuff going on. But once I see the protective muscle guarding is diminished, you start noticing the client making a little better eye contact and wanting to communicate a little bit more.
22:18 ED: Okay, so at this point, I verbally start engaging the client's prefrontal cortex, that's the part of the brain that tells you to do the right thing when you wanna do the wrong thing, with suggestions assuring them that, "You've come to the right place. We're gonna be working as a team and together, we're gonna recover your feelings of strength, safety, and confidence." You keep bringing that in all through the session, because when you have your hands on people, brain waves drop from 52 cycles per second, which is beta brain waves, starts giving into theta first, then delta. When you have your hands on them, those brain waves start to drop, and they become much more suggestible. Alright? If you took a lot of hypnosis, did a lot of hypnosis. The first guy I ever hypnotized turned out to be a priest. He didn't tell me but finally, we're communicating for a long time and he finally sent me a letter saying, "Where were you back when I was going through the school? But I just want to thank you, because you're the first person to ever hypnotize me."
23:27 ED: Hilarious, man. Alright, so back to this. Another thing I really like to do is sacral rolling. So you've got the head and you've got the tail. Those are the ends of the spinal cord. You've got all that neurology going through there. So any kind of sacral rolling with palms, prone palms going around the sacrum. Decompressing the sacrum feels great. People love that. Most operated on disc on the body, what? L5, S1. You're decompressing that L5, S1. Everything feels good back there. So myoskeletal therapy, we spend a lot of time on head and tail work. We have a little thing that we always say, that we never let a client get out of the session without at least leveling their head. In other words, leveling the OA joint and leveling the sacral base. So, the head and tail.
24:19 ED: I just wanna close this out by saying that I wanna talk one minute about establishing rhythm. It's really, really important. I talk about it in my workshops, but I don't talk about it enough, and it's something that I think is extremely important when working with stressed out clients. So the ability to move smoothly from one part of the body to the next is a key factor in getting people to relax. That only comes from experience, persistence, and good training. So you have to learn how to get your rhythm, and that is in the trenches work, I call it. Most people that are in the trenches, you remember Malcolm Gladwell's bestselling book, Outliers. He popularized the idea that it takes approximately 10,000 hours of appropriately guided practice to become proficient in a skill like massage.
25:11 ED: At this point, the whole brain changes. The whole thing changes. At this point, the hand's no better than the brain. In other words, at first, when you first start working on people, you know how when you're first in practice, you're thinking about everything. It's like driving a car and trying to think about what you're doing. Your conscious mind's having you do it all. It's going into what's called explicit memory. After a while, after a period of time, Malcolm Gladwell's actually not right about this 10,000 hours. If you add emotion to it, it's a lot less than that, but it was close. But for it to go into intrinsic memory where your hands know better than your brain, that's how you ride a bike or you... In my case, I'm a drummer, so I play drums every morning.
25:53 ED: So you finally get to a point where you don't have to think about those strokes, they're just going through your brain. But the only way to do that, you can philosophize... There's a lot of philosophy now out in massage therapy field and books and everything like that. And philosophy is good in body work, to theorize and philosophize and all that stuff, but that's not really what body work is all about. Body work is about getting in the trenches, working your ass off every day, and becoming the best therapist you can be.
26:23 DB: I wanna thank our guest today, Erik Dalton. Erik, our listeners can find you at erikdalton.com, correct?
26:29 ED: Right, erikdalton.com.
26:32 KC: Thanks, Erik. That was fantastic.
26:34 ED: Back to you guys. Bye.
26:40 DB: This has been a production of Associated Bodywork and Massage Professionals. ABMP is the leading association for massage therapists and body work professionals in the United States and Beyond. From liability insurance to professional advocacy, award-winning publications, to the world's largest continuing education library for massage, to this podcast, no organization provides more for its members and the profession than ABMP. ABMP works for you.