Episode 135 – The Neuroscience of Bodywork (with Mark Olson)

Summary

Episode Transcript

Til Luchau: The Thinking Practitioner Podcast is supported by ABMP Associated Bodywork and Massage Professionals. ABMP membership gives professional practitioners like you a package including individual liability insurance, free continuing education, quick reference apps, Online scheduling and payments with PocketSuite, and much more.

ABMP CE Courses, Podcasts, and Massage and Bodywork Magazine always feature expert voices and new perspectives in the profession, including Whitney Lowe, my co host, and articles by me, myself, Till. A thinking practitioner listeners can save on joining [00:03:00] ABMP at abmp. com slash thinking and mention to them that you heard about them on our show.

That always helps support the show as well. How you doing, Whitney?

Whitney Lowe: I’m doing fine today. How are you doing, sir? All right. Thank you. All right. We have a wonderful guest joining us today on our discussion, and we would like to welcome Mark Olson to the Thinking Practitioner. Mark holds a master’s degree in education and a PhD in neuroscience from the University of Illinois, specializing in cognitive and behavioral neuropsychology and neuroanatomy.

His research focused on memory, attention, and movements. And aesthetic preferences. Dr. Olson is a published author with recent articles on chronic pain and trauma informed care. I would also briefly mention that we did a whole episode on one of Mark’s articles quite a while back. So we’re looking to dive into some of that stuff again.

So Mark, welcome to the Thinking Practitioner. Great to have you here.

Mark Olson: Great to be here. Thanks.

Whitney Lowe: Yeah. Anything you want to add in talking [00:04:00] a little bit about your background in relation to neuroscience and massage before we jump into our discussions, things we didn’t cover there.

Mark Olson: You covered the, the critical details basics, I guess I would say that for my PhD research, I studied memory of complex ordinary scenes like we see every day.

And I did it with implicit. variables. So as instead of asking a person, have you seen this before? That’s an explicit variable. I used implicit, or you might say somatic variables. We looked at your eye movement patterns. Looking at implicit variables to see under the hood is one of the things that seems really relevant to massage therapy, because there’s a lot of things going on, aren’t of conscious awareness.

So I just want to, I think that’s good to mention that. Implicit variables go back a while.

Til Luchau: Tell us a little bit about how you got involved in this field.

Mark Olson: Yeah, I’m curious to hear that as well. In massage therapy. Yeah. I was not thinking about [00:05:00] massage therapy at all when I was in studying neuroscience.

I, I studied neuroscience because I just wanted to understand what makes us tick, understand behavior, thought, feelings. And I. Thought massage would be a fun thing to learn just for kicks and giggles. And little did I know that it was much more than fun kicks and giggles. I took the class in it after I got my PhD and I realized, Oh, I really liked this.

And there’s lots of really interesting things going on here that are A lot more interesting than I would have expected.

Whitney Lowe: Great. You’ve certainly contributed some wonderful things to us. And we want to dive in today to some of the discussions about the relationship between neuroscience and massage.

And I was wondering maybe if we could just start with giving us just a an overall review concept of the basic outline of nerve processing, such as the input and output pathways and Motor versus sensory activity, and we’ll take that as a starting point for some of our other discussions there.[00:06:00]

Mark Olson: Yeah, great. I think that would be really good to establish a baseline of terms here, because there’s so many terms.

Yeah.

Mark Olson: The, the input, the output, the sensory, the motor, the afferent, the efferent, the top down, the bottom up, and just to get them all to make sense is a task in and of itself.

I think we’re used to thinking in terms of a stimulus and a response and an input and an output. And I think most of us have learned this idea that we have sensation from our eyes or from our skin and then there’s a signal that goes up to the brain and then we see things or then we feel things.

But that is a far oversimplified version of how things actually work. And with all the sensory systems including pain, including normal touch, that there’s a lot of what we call top down influence. So you have the signal going up like you would imagine, but there’s also signals going down. Probably all of us in [00:07:00] massage schools learned that you have afferent signals, which are sensory signals going up, and we have efferent or motor signals going down, but we could also say we have efferent, but we usually use the word descending signals going down that influence the whole process of the sensation or the perception.

And what I mean by that is, I don’t mean that we get the incoming signal, and then we think about it or compare it to a memory, and then we act. After that’s a different thing. That would be a stimulus response model. What I mean is that the ascending signals are influencing the ascending signals so that our experience, the actual experience of what we taste or what we see or what we feel is influenced by what we already know ahead of time.

So we have all this prior knowledge from decades of living that Shape our perceptions and shape the incoming [00:08:00] the raw data coming up. So we call those top down influences as opposed to the bottom up raw data influences. So the descending modulation that I’ve written about. That’s an example of a top down.

influence on sensory processing.

Whitney Lowe: And this, of course, is, from what I understand, influenced by all kinds of things of previous experiences illnesses, neural problems and things like that can make that descending activity either increased or decreased. Is that correct?

Mark Olson: Absolutely. Sure. If you’ve had terrible experiences with doctors or great experiences with doctors or massage therapist or whoever there’s conditioning responses there that are going to influence you.

Whether, I say conditioning, meaning that you may not even be aware of your preferences or opinions about. Those individuals and those kinds of treatments and also you could have a conscious expectation. So those would be two different kinds of influences, [00:09:00] positive or negative that could come to play.

Til Luchau: Yeah. Are there influences top down besides expectations?

Mark Olson: Yeah, absolutely. So the expectations would be if somebody said, Hey, I heard that Till was a great body worker. So I’m gonna, this is going to be great. That’s my expectation, right? But I could have these conditioned responses to the people with beards or, colors of the wall or probably not colors of the wall, but other Aspects of the environment that, That could be influencing.

There’s also with that particular person or with this, the setting in general. So any number of things are influencing all the time that we couldn’t possibly know about or control.

Til Luchau: It’s fascinating to me that those conditioned responses, especially are below the level of our cognition or thinking, it’s not even, I’m thinking, Oh, somebody is a great practitioner.

It’s deeper than that, or it’s thought to be just the way that we’re responding to things that’s been [00:10:00] conditioned into our nervous system.

Mark Olson: Yeah. So much of life is that way. We, we think that we have these conscious thoughts and we make these conscious choices, but neuroscience keeps on showing us that’s just not the case.

That the show is really being run by a lot of subconscious influences that we don’t really know. It’s Freudian, but it’s also like the neurosciences backing up those ideas.

Whitney Lowe: And this stuff is obviously happening very fast in terms of the time it takes for those influences to make changes in descending activity would seem like incredibly fast.

Mark Olson: Absolutely. Yeah. I can’t quote you the different studies, but if you do EEG studies, we have things called P three hundreds and and two hundreds and other markers that show up in relation to different kinds of stimuli 200 milliseconds or 300 milliseconds before you have the conscious awareness of the stimulus.

Whitney Lowe: Yeah. So this is explanations of that descending [00:11:00] activity, but there is also you’ve talked about before ascending inhibition of pain as well. Correct. Yeah. So how does that work?

Mark Olson: Yeah. So the, ascending inhibition, which is often often referred to as gate control theory.

That’s the idea that you have myelinated signals that make it to the spinal cord first, and then they turn around and look at the slow unmyelinated signals coming up and say, Hey, we’re not going to let you through. You shall not pass or something like that. So that’s an ascending. We do this all the time.

If you stub your toe, your hands immediately go to your toe and they surround your toe. And that. dampens that ascending signal because of the other touch information around it is influencing it. There’s other aspects of that besides ascending inhibition, but that would be, it’s two ascending signals that are going at different speeds and one is inhibiting the other.

And then descending inhibition is requires the brain to get involved. [00:12:00] So you have signals coming down from the brain and inhibiting signals at the spinal cord. And in both cases, you have the inhibition happening at the dorsal horn of the spinal cord. So whether the signal is coming up from your toe or coming down from the brain, there’s an inhibition that happens right there at the dorsal horn, which influences whether that signal is going to keep going or to what it’s going to get dampened, or if it’s going to be accentuated on the way.

up to the brain.

Til Luchau: Let’s go really practical if we could about that because we’ve, these are really, you’ve explained them really clearly. They’re concepts that have been bantied about in our conversations for a while. What’s an example in an actual table top situation of descending modulation, say?

Mark Olson: Yeah somebody, so the therapist makes a comment, That could be either say comforting or disturbing just because of their own relational skills.

[00:13:00] And obviously if it’s comforting, they say something that feels like, Oh, this person cares, they’re with me right here. They’re going to have more implicit safety and that’s going to influence a descending modulation signal. Which basically

Til Luchau: makes it hurt less. It’s

Mark Olson: hurt less, right? Great.

Somebody holds your hand when you’re sick, that feels better but somebody says something that says, ask you

Til Luchau: about politics.

Mark Olson: Yeah. Ask you about

Til Luchau: politics

Mark Olson: Or gosh, your shoulders, it seems like it’s really messed up here. Yeah. It changes your idea about yourself and or says something that doesn’t make you feel safe with that person that changes the.

implicit safety levels, which is going to change the descending modulation.

Til Luchau: Changes the descending modulation. In other words, it hurts more perhaps, or there’s more protective responses in

Mark Olson: general. Certainly more protective responses because it’s the spinal cord, which is going to be influencing those muscular outputs.

So you could tense up [00:14:00] from that as opposed to allow more relaxation. But yeah, you could have more pain, at least in theory.

Til Luchau: Okay. I’m trying to go really practical, but I can’t help this little divergence. Is there such a thing as descending facilitation or stall inhibition? Okay. So it can go, you can amplify or it can dampen.

Yeah. Okay. So now a really practical example of the bottom up the gate control say, how is that, how’s that. show up on our table?

Mark Olson: I think that’s probably just happening all the time. If whatever, so we have low lever levels of nociception happening all over the place. And some of it we’re aware of, we become aware of as pain and some of it we don’t.

So as we’re being touched, that’s providing tactile input, which is going to be potentially kicking in the ascending inhibition. So during a session, you have ascending inhibition potentially happening all the time, all [00:15:00] over the place.

Til Luchau: Let me see if I can say that in ordinary English. So when we’re touching, you said there’s tactile stimulation, there’s a touch sensation.

The sensation of the touch itself might be modulate or turn down the pain sensation. Yeah. Pain signal, say. Yeah. Okay. And

Whitney Lowe: since my understanding, too, that a lot of the benefits of the ascending modulation have to do with proprioceptive sensations that are traveling faster than the nociceptive sensations.

Is that correct?

Mark Olson: Propreceptive is fast, yes.

Whitney Lowe: Yeah would you then say also that, for example, movement incorporated with massage might even provide more potential ascending inhibition than just massage alone because there’s increased proprioception from the movement activities?

Mark Olson: Might however I can’t speak to that like with absolute certainty.

Yeah. If that’s been determined or not.

Til Luchau: You’re thinking, Whitney, you’re thinking just [00:16:00] more signal has more effect, or are there other means of generating that proprioceptive signal? Yeah,

Whitney Lowe: just curious, like if more of that signal might overwhelm more of the nociceptive signals, based on the gay concepts during the ascending activities there.

Mark Olson: Just in general, the way the nervous system tends to work, I would expect something like that to be the case. Yeah. But I don’t have a paper or study in mind that, or anything that tells me that is the case. Sure.

Til Luchau: I don’t have a study or paper in mind either, but I’m thinking about the well known phenomenon of night pain when there’s not movement that people’s, especially neuropathic pain will cause.

More acute, get it more intense without the movement that happens during the day, and they start moving again and just perhaps the nervous system activity proportionally dampens down the experience of that.

Mark Olson: Yeah, absolutely. Absolutely. I think that makes a lot of sense. But then there’s also the fact that you have more inflammation at night, too, is that it’s compounding there, right?

Yeah, there you go. Yep. But I think both are probably [00:17:00] happening.

Whitney Lowe: Yeah, that brings up another interesting thing I was thinking about because I know a lot of the studies about motor learning that I’ve looked into have advocated and said that basically thinking about a particular movement can be very substantial in training that movement in addition to doing the actual physical movement.

And I wonder man, maybe you know something about this in terms of our dreams when we are active in our dreams and doing something like that. play a role in night pain because we’re activating those motor pathways that are associated with pain in the waking hours.

Mark Olson: Yeah. Okay. The, the practice of a motor skill in your mind is activating those same pathways as would be if you’re actually doing it.

The only thing that’s different is you don’t have that last efferent signal to the muscles. But that’s all happening in the brain. So if it, if there is an inhibitory effect there on pain, it’s not going to be at the spinal cord level. Cause. Cause it’s not happening at the [00:18:00] spinal cord.

Yeah.

Mark Olson: But dreams are actually practicing things that we’ve learned.

We’ve studied, seen that in rat studies quite a bit.

Til Luchau: Yeah. Interesting. We’ve seen rats practicing things they’ve learned.

Mark Olson: If you give them a task and you look at what, which neurons are activated during that task, you can see that the, while they’re sleeping, That the same neurons are activated, it’s as if they’re, because there’s an integration that goes on during sleep and dreams.

And if you disrupt that process, then they don’t learn it as well. They won’t the next day.

Whitney Lowe: Yeah. Fascinating. I know there’s been a lot of discussion of pain being more about perceived danger than sometimes tissue injury in a lot of instances. How can massage and manual therapists. Integrate that concept into their practice more effectively.

Mark Olson: Yeah I think it’s very natural to think that, to think about pain in terms of injury, because that’s how [00:19:00] we grew up learning about pain is by injuring ourselves and, but then we ended up with adults, as adults with a chronic pain and kind of transfer that idea over when actually the chronic pain doesn’t work in that same way.

It doesn’t have to require no susceptive input. know, at the skin or at the tissue level. So it’s important to let go of that idea that we have that, Oh, that means that there’s something out here in the tissues. So you can actually. Ask me that question again, because I’m forgetting what you just asked.

Yeah,

Whitney Lowe: just curious, like this whole idea of pain, pain perception, or pain being not about, or being about perceived danger in relation to tissue injury, and like, how can we use that clinically, or use that information and this sort of leads into, let me ask another question on top of that, because I’m curious to hear your take on this.

I know with the popularity in the recent decade or so of the, Pain science movement, a lot of emphasis on [00:20:00] learning more about pain. There’s been a greater effort for us to encourage teaching our clients or patients about what’s the nature of that pain problem. But I think that’s also opened up another group of problems of recognizing that it’s really difficult to do that for people who have no background in this, for them to understand the complexities of neuroscience in just a few, short sentences or short conversation.

Does that whole thing about, the, this whole idea of your tissues aren’t really injured. This is just a perception problem of your brain. Does that create more problems sometimes than it solves?

Mark Olson: Yeah. It definitely creates new challenges, right? Because People have the ideas that they have and it’s, they’re very ingrained.

And it does take quite a bit to reeducate fully. I teach classes on this and we take many hours to do that. And so at the end of the class, it’s okay, now what? Because now we have to figure out how to convey this in two minutes. So that is a [00:21:00] problem. I don’t think that we need to educate our clients to the, the same extent.

It’s not like we have to have a whole neuroscience lesson. But I think if they have limiting ideas, if, and which a lot of clients do, that they think that their back pain is associated with what they see in that x ray, I think it’s really helpful for them to realize that a lot of the things people see in x rays are things that happen for people who don’t have pain.

So you can’t, it’s very easy to just, see A and B and put them together and assume that they’re causally related. But I think it’s good to drop the idea into one’s mind that, it’s possible that pain that you’re having, isn’t because of this. And so it doesn’t feel like a prison sentence, because if you think that it’s a tissue related problem, phenomenon and that it’s something that you really can’t change, then there’s a little bit of descending facilitation right there.

Oh, guess [00:22:00] it’s hopeless. We don’t want to instill false hope, but I think we should remove false despair and give people hope where it, it is where it’s possible.

Til Luchau: Yeah, that’s nice. And there’s at least two avenues there. One is what we, the possibilities we might open up for our clients in our conversations or information we might share, the education part.

But the other one that’s even lower hanging fruit is this the way we’re thinking about it as we’re touching it. It’s a big shift sometimes to think that I’m actually affecting the brain. with my touch and that’s going to have an impact on someone’s experience no matter what their scans say or what they think of their scans or their ideas about it but just to actually give someone an experience on the table with my touch is itself a potent lever that I can use.

Mark Olson: Yeah, absolutely. I think that there’s this focus generally to think that we’re working with tissues. It’s usually defined as soft tissue manipulation, right? And we’re thinking, oh, it’s muscles, it’s fascia, and that kind of thing. And [00:23:00] I think it would be better if we thought of ourselves not as soft tissue manipulators, but as interoceptive modulators.

We’re changing

Til Luchau: interceptive modulator’s. Great. . I actually think of myself as a soft tissue manipulator. The brain is pretty soft tissue . Yeah. But that’s that’s my target anymore. And I

Whitney Lowe: put a plug in this till you said something in one of our very early podcasts when we first got started, and I have quoted you in almost every workshop that I’ve taught since then of saying that the, perhaps most important tissue that we work on is the one between the ears, yeah.

Mark Olson: I like that. It is very soft.

Whitney Lowe: Yeah. And obviously quite malleable in various different ways. Yeah. Yeah. Mark taking this a step farther talk a little bit about environmental and social cues that play a role in pain perception and how some, maybe therapists can optimize these things.

I know we’ve talked a little bit about this, but people often ask what are really some of the other benefits of things that we can do, and there [00:24:00] are I like to encourage people to recognize that there’s some real value in the things like the soft lighting, the quiet music, the smells, the, all the things that come along with what you do with your hands as part of the total package.

Is that is that something that’s grounded in neuroscience as well?

Mark Olson: Yeah, absolutely. I think a lot of times people want to make this distinction between spa work and quote therapeutic work. And because the spa work would probably be more about the soft lighting and et cetera, that kind of thing.

But I think if you want to work with pain, you need to dial that in. Really so that you create an environment that the senses are naturally going to generate more implicit safety around. And that’s especially true for individuals with trauma or shock trauma, anything you can do to bring the system into a more regulated state is going to make your work easier.

It’s going to, you’re going to get to the places you want to go to quicker if, by using those other modalities.

Til Luchau: Or grief, my favorite topic [00:25:00] lately. This day, I mean I had an amazing session with a practitioner who orchestrated this whole sensory experience with the, essential oils she was bringing in, the music, the lighting, and her touch was fantastic too.

But that whole sensory package, I could just feel it changing in my state and providing me a place to let go into that no amount of skilled touch by itself would have done without those other factors there.

Mark Olson: Yeah, absolutely. Yeah. And with the social cues, that’s, we’re social creatures.

So we respond to social cues so strongly. And I think it’s fair to assume that everybody who goes into body work as a caring, loving person who You know somewhere in there, somewhere we don’t all do it to the same level of skill. And to whatever extent we can improve our relational skills, because people say things [00:26:00] on the table that require a response.

Of some kind, whether they sit there sharing something that’s potent for them or emotions just arise. And there’s 1000 different ways we can respond at any moment. And some of them are more skillful than others. Those are going to go a long way for creating a sense of implicit safety.

Whitney Lowe: I’m curious to know your thoughts on this too, with this exploration into recognizing the incredible power and influence that the brain and the nervous system have on our experiences of pain.

How relevant or important do you think it is in terms of, somebody comes in and says, for example, my neck hurts, my shoulder hurts, or whatever. How relevant or important is it to try to identify. If there is a nociceptive cause to that, or if this is something that is more general of a pain complaint in there is that therapeutically beneficial, do you think?

Mark Olson: That’s a great [00:27:00] question. I think if you can determine what the source is. That would be great, but many times you’re not going to be able to.

Til Luchau: Wait a minute if you can determine what the source is, meaning like a nociceptive tissue located pain driver, is that

Mark Olson: what you mean? Is it nociceptive?

Til Luchau: I see.

Mark Olson: Yeah. But this is

Til Luchau: complicated, but yeah, I guess this is complicated. Yeah,

Mark Olson: So if we could see, with a God’s eye vision and know. Is this is this inflammation? Is this an impingement situation is, are we talking about sensitization? That’d be useful to have that, but can we acquire it?

We can make some educated guesses based on various variables, but ultimately we’re still going to provide quality touch and care, and that’s going to go a long way for in all those situations. So I don’t think we have to know in order to [00:28:00] be helpful because I think we are helpful, almost all the time without actually knowing.

But at the same time, I think sometimes we apply false ideas about what’s happening. If I think, Oh, this is a problem because your posture and that’s actually not the case. But I still gave a good session with that false belief, and you came out of it feeling better.

Yeah.

Mark Olson: But if I had a better idea about what things were, what, how things were actually working, I’d probably be able to fine tune that help more.

Whitney Lowe: So when you have, for example, because I’ve seen this situation a fair amount too let’s say a client who is, absolutely convinced that they have fill in the blank, whatever it is, that they have plantar fasciitis or they have, something that’s causing their pain, but you might not necessarily think that’s entirely true because you can see that there’s a lot of other factors that might be playing a part in there.

Would you [00:29:00] say that it is counterproductive to try to convince them of something different or is it beneficial to try to do that?

Mark Olson: Great question. I don’t. I think it’s a hard and fast rule across people because it’s going to depend on who they are and what your relationship is to some extent. And there’s some things that are better to leave sleeping dogs lie.

I think that’s reasonable. And also, I think sometimes it could be useful to just drop ideas that some people have this and it’s from, other things and, just Maybe help them, if the idea that they have is limiting them unnecessarily. I certainly would try to provide a little, some education in some way, but if it’s going to reduce, the quality of the therapeutic relationship, then, I’m going to have to judge cost and benefit of that in a moment.

Whitney Lowe: Yeah. [00:30:00] And you have a new course that you’ve been recently doing on trauma care. So how does that tie in with your study with neuroscience and the other things that you’re focusing on here?

Mark Olson: Yeah. Yeah. Thanks for asking about that. So I I offer this course. Trauma informed care and it’s really for any helping professional, but it was developed with massage therapists in mind because it’s really a compression of everything that I used to do as director of the Pacific Center for Awareness and Bodywork.

Whitney Lowe: And

Mark Olson: Mark,

Whitney Lowe: maybe can we backtrack for just a moment and talk a little bit about what is trauma informed care? Cause I know that’s a term that gets bandied about a lot and I’d like to hear your take on that as well.

Mark Olson: Yeah, it’s really important to get clear on that because whenever I say it, I get a lot of different, it’s clear that there are a lot of different ideas about what that means.

So you have trauma treatment on one hand and you have trauma informed care on another. So trauma treatment is what psychotherapists and counselors [00:31:00] do with a license to do that. And trauma informed care is something that any helping professional could be educated in. You’re not actually treating trauma.

So we’re, not going into the trauma, you’re not trying to change. People’s patterns or, get into their psychological strategies or anything like that. Can we go one step further

Til Luchau: back even and say what we mean by trauma?

Mark Olson: Yeah, absolutely. Great. Very important to do that too. So a lot of times people think trauma is the event.

an event that occurred. But actually it’s really what you take with you from that event because lots of people can experience the same event and some people walk away rather unscathed and other people are, impacted so that functioning is impacted, long term. And so trauma is that thing that is within us that Prevents that normal functioning and that could be shock trauma from like a singular event, like a violent event, [00:32:00] or it could be developmental trauma.

That’s something that’s occurred relationally in one’s childhood, probably over a long period of time. So it really is. It affects people’s like social strategies. So that would be from developmental trauma. So either one of those, it’s unfortunate that we have the word trauma for these two very different things because the first one, shock trauma is more an autonomic fight or flight whose kind of things, whereas the developmental trauma is more about structural psychological changes.

It’s not an autonomic. Kind of thing, although autonomic responses can be involved. So trauma informed care is about, how can we respond? How can we work with people who have trauma in the most effective way possible? And it’s like we all take first aid and CPR classes, but we’re not doctors.

Okay. So you want to be able to be prepared with something like a strong trauma [00:33:00] response comes into play. That’s the, that’s a minimum requirement in my mind of a trauma informed care of how do you respond to somebody who said they have a panic attack on the table? What are you going to do? Or you could think of it as being ADA compliant.

We don’t do hip surgeries, but we put wheelchair ramps in. You’re working with people with trauma, but you’re not treating it. You’re just making sure that you know how to best accommodate individuals with it. And it’s so important.

Til Luchau: Are there important examples short of a panic attack of how this might show up on people’s tables?

Why they’d be interested in this?

Mark Olson: Yeah, absolutely. And especially with the developmental trauma. You’re experiencing it all the time. People can’t really say what they want in a session because they have a lot of trouble expressing, their needs. That’s a really big deal because expressing needs and their past has not gone so well for them during their childhood.

So they’ve learned to not really have needs. And so if you ask them what do you need in this session? It’s almost like I don’t even know [00:34:00] that’s one, one of many examples just expressing boundaries. There’s all sorts of personality dynamics that are occurring between client therapists that it would be really easy oftentimes to get annoyed at or not know how to respond to or just to think, Oh, this person is annoying or weird, or I don’t feel good around them or to just judge them as something that’s like wrong or bad about them.

So a trauma informed approach is a non pathologizing approach. It realizes that anything that people are doing that you might put under, under that like pathological or annoying quality, there’s a reason for it. There’s a function there. And Once one recognizes that, it becomes a lot easier to work with people and to actually provide better quality care for them.

Whitney Lowe: These are, I think, crucially important skills that you’re talking about here. And things that I think are [00:35:00] pretty substantially missing from our training in a lot of respect. And I’m assuming that’s probably one of the reasons why you’re doing these things in your courses. Are there any other ways that you can encourage or suggest that practitioners learn even some basic fundamental skills around the best kinds of things that they can do for that without getting too far in the weeds.

Mark Olson: Yeah, there’s definitely levels that one could get into. And maybe before I answer that, I should just mention that I think for a massage therapist, it’s really much more important than it is for other professions. Other professions. As long as there’s people around, there’s trauma,

as

Mark Olson: long as you’re taking care of people or you’re like in a room, like just alone with people, there could be, trauma, but we have touch added to the picture and there’s just so much to that.

And we think maybe touches like the obvious thing is, Oh, what if they’ve had sexual traumas before? So touch, that’s the easiest [00:36:00] one to think about, but there’s so many more things that are relevant and counterintuitive, like even feeling good. Can be a issue for people. People come in, they get a massage, they feel great.

You think what could be wrong with feeling good, but, you look at the ACEs study for trauma where people were on this diet and all of a sudden they quit and then they quit right before they, they succeeded in their diet. And that’s, it had a lot to do with not feeling worthy to actually complete and to be successful.

So there’s a lot of things where. You think of course I want to feel good, but actually feeling good is a challenge for individuals who have issues of self worth. You have to know that, as a massage therapist and as a massage director of a school, too, that people are coming in, they’re feeling good, and that actually is going to create some interesting psychological issues of where they could push back.

against you [00:37:00] in various ways. And you gotta be prepared for that because otherwise people are going to think and it could actually show up as pain the next day. And then we think, Oh, they show up, have pain the next day. Was it my elbow? I put too much pressure on, but actually it could have the, it could be this, psychologically driven trauma response.

And now I’m forgetting what your original question was. I’m sorry.

Whitney Lowe: That’s all right. We were getting into that. the kinds of skills or basic things that people could be aware of that would help them just act a little bit more aware or prepared for some of these types of things that might encounter them.

The reason I ask that is that, spent a lot of years teaching entry level education and had a lot of therapists talk about the first time something happened in the treatment room where they were I’m unprepared for the emotional response that came from the client of something that happened and they just felt like they didn’t really get prepared for what to do in those situations.

Mark Olson: Yeah. Yeah. There’s so much to this. I could talk all day. One, one [00:38:00] aspect, is we know what do you do when emotions arise and that’s a There’s many answers to that. I’ve heard of people who’ve gone to massage schools where they say we were taught if someone starts crying, you should just leave the room and come back in two minutes.

So that would be an example of what I wouldn’t promote. I think we can do a lot better than that. On one level, there’s this idea of acceptance. And so let’s say somebody is crying because of grief. I think, yeah, we should be like, certainly just be there in acceptance to whatever extent one can be there.

But on the other hand, if you have other responses that are not I wouldn’t, I would call grief a primary emotion, and I would call other things you don’t actually want to if you’re having a panic attack, you don’t want to take an acceptance Principle there. You actually want to change that.

So learning. When do I want to just sit and be with and allow and facilitate and when do I want to shift it? That’s a skill [00:39:00] to, develop with trauma. And I think one of the major ways we probably make mistakes as helpers is we have agendas. A lot of times we think this is what’s going to help you.

So I’m going to do this to you. And it’s, as opposed to just listening with the body and really feeling what’s the next right thing. I think we’ve Many people have stumbled upon this idea that without being trauma informed, just if we just learn to listen, we can go, we can do the next right thing as opposed to just coming in there with an idea of this is what you need.

And that, that can be problematic for people who have been traumatized. Haven’t really had a voice or a say. Yeah, I think there’s just this kind of Till, go ahead, yeah.

Til Luchau: You’re saying that listening can be the problem for people who haven’t had a say, or not listening?

Mark Olson: Oh no, if we’re not really listening to them.

If we’re not

Til Luchau: listening, okay. [00:40:00] You’re implying in some of your answers too that there’s a step possible beyond listening. Listening is pretty inarguably Great. And the better we can be as listeners, the better we’re going to work with. But you’re talking about some discrimination to abound.

How do I interact at that point? How do I let people know I’m listening and what are the possibilities that opens up in that moment?

Mark Olson: Yeah.

Til Luchau: Different discussion, but that’s great. That sounds like you’re working into that in your course, perhaps.

Mark Olson: Yeah, there’s it’s in my course, we work with skills about how to respond to individuals in those moments.

And then we also do some learning that’s like self experiential learning. So we’re not just, Doing the concepts on the chalkboard, we’re actually experiencing them. So especially around the ideas of whatever our strategies are, there’s something useful to those strategies. And that relates to ideas around posture too, to the idea of [00:41:00] not thinking of posture as this bad thing, like whatever somebody is coming in as, that’s actually a great adaptation.

And we should. Stop telling people that there’s something wrong with their posture because actually neuroscientifically, if that’s the posture they’re in, that’s actually the least no susceptive posture probably that they have found. Which has a whole other topic I could talk about forever, but but it’s a similar principle though, of we have just to stop pathologizing around all across the board, both physically and psychologically.

Til Luchau: Yeah. I want to dig into the posture one at some point. That’s great. I got some thoughts about it too. But Whitney, where would you like to take it?

Whitney Lowe: I would, I want to go down the posture road for just a moment as well, because I do think this is so pervasive and relevant in our fields just for at least a little bit of rabbit hole on this one.

Mark, what do you think is the There were degree or relationship in which, like, when is that necessarily relevant? Because there are people who might come in that are doing something that we see, that [00:42:00] we think that the repeated posture or the repeated movement pattern they’re doing is a part of what’s causing their behavior.

nociceptive driven discomfort. Do we intervene or are you saying that this is most of the time just something that’s it’s secondary and adaptive to what else that they’re currently living with?

Mark Olson: Yeah, clearly if they have a job, like they’re painting ceilings all day. That’s a different I don’t really consider that really part of the posture discussion.

That’s more of a task based Kind of thing, that person wouldn’t choose to be in that position all day

Yeah,

Mark Olson: so I’m not sure if that’s what you the kind of thing you’re referring to or if you just cause there’s a general thing of Oh, your head’s too forward or your shoulders are forward, which isn’t really about a task.

It’s just about people’s natural position.

Yeah.

Mark Olson: That’s more where I would. Yeah. Yeah. So I wouldn’t try to change anything. I don’t care about people’s posture at [00:43:00] all. I think it can be useful to, as a starting point for exploring things, but I have no agenda whatsoever to, to suggest that they should be in one particular place or another unless they want to be.

It’s not, it’s their choice. They’re, it’s their choice. Interesting that let’s say they want to

Til Luchau: say the client comes in and they want to be in a different boy. My head’s too far forward. I really don’t want that.

Mark Olson: Yeah. I can’t change that. I can’t change their tissues. So they’re going to have to, figure out a way to change their their habits.

People, when they try to change those habits, they often find that they get more pain because that they were already in the least no susceptible position. We do that in our sleep. We find our least no susceptible position. We do it all day long subconsciously. It’s reasonable to assume that whatever position we’re in is.

the least nociceptive. So if we try to find another one, it’s probably, there’s probably a reason why we’re not there. But, there’s so much more to it than the nociception. There’s also these, a whole bunch [00:44:00] of psychological pieces too, that if we really wanted to dive in, we could dive into as well.

But, some people have postures that are more psychologically based than other people. And, if they wanted to change it, I’m not going to, first of all, I’m not going to change it, but even if I could, I’d be fighting a nervous system that’s saying, Hey, I, I’m doing this position because this is what the position that made me feel safe as a child.

So

Til Luchau: I like, and agree a lot with a lot of what you’re describing it passed through that I’m in is the least nociceptive arrangement. There’s something very Taoist about that going with what is manifesting as the best possible outcome from all the different forces at work. And the part of me that is oriented toward possibility says, is there a role I can have in opening up options for people?

Yeah.

Til Luchau: Not to place them in the correct posture with the belief that’s going to make them pain free. We were not, we have mostly, [00:45:00] most of us are in agreement. That’s not a fruitful path, but is there a way that resting position, habitual posture is. A an avenue toward more well being or toward less pain.

Mark Olson: Yeah. I think that’s definitely worth exploring and looking into possibility for sure.

Whitney Lowe: And how do you recommend I’m thinking of in terms of what the client themselves might express or what certain practitioners might express. How do you unwrap or unravel the perception of these two things being causal and not just correlated when somebody comes in and says Oh, my neck hurts and that person has.

Yeah. Forward head posture and slumped shoulders or whatever it is the immediate jumped in. That’s why your neck hurts What are the kind of strategies or other ways that people could look at that?

Mark Olson: Yeah. The immediate Putting things together like that. I, I just think we should not do that.

[00:46:00] Cause it’s, you shouldn’t assume that things hurt because the heads

Til Luchau: for it.

Mark Olson: Yeah. Yeah. We shouldn’t try to think that we can know these things in the first place.

Til Luchau: Just for fairness, I should bookmark. There are entire disciplines and schools of thought that basically that’s still the central.

Mark Olson: Absolutely. Yeah so I’m not sure about your audience here in terms of where they’re at with that, but I encounter it all the time. It seems very important to, on Facebook groups all the time, people are saying things like that. I think it’s a very important thing to get away from, but if we’re going to look at, if we’re going to move the discussion forward with individuals, we’re already on that, who get that, that’s not the case.

How do you explore, other possibilities is, is to explore with them. Different positionings and movements and letting them introspect on how that feels and what that’s like for them which is interoceptive, but is also psychological, a person could say, what’s it like if, when I bring your shoulder into this position, they say I guess it feels okay, but I also feel nervous for some [00:47:00] reason that would be, why is that right?

That’s a whole thing to explore. And like one of the, I just have to mention this, that if one of the, we were all familiar with the fact that we get into a certain posture is to express certain feelings. But I think one of the things that we don’t really realize is that. Certain postures that we get into actually block certain feelings and try to stand at attention and also feel grief at the same time.

You can’t do it. And there’s a whole bunch of postures like that, that you can’t feel certain emotions. I could

Til Luchau: do it.

Mark Olson: Yeah. Sorry. Okay. It’s harder.

Til Luchau: Extinguishing circumstances, but yeah, your point’s taken. It’s tough to feel different. Everything in every position. Yeah.

Mark Olson: So someone comes in, and they’re in this upright position, maybe it’s, so they don’t feel, nevermind pain, how about emotional pain?

So there’s this whole other realm there that I think is much more nuanced and sophisticated realm that than just thinking about blocks being stacked on top of [00:48:00] each other.

Til Luchau: Yeah, I’m a little personal anecdote there. I’m really enjoying some Pilates instruction I’m getting. It is very much form based.

It’s very much about alignment as an externally applied template which is not my therapeutic model at all, and I’ve spent a lot of time railing against that. And yet to have someone skillfully inviting me to move into places I didn’t think I could No, I wasn’t moving into is opening up lots of possibility for me.

Yeah,

Til Luchau: and there’s oh, wow, I didn’t realize that I wasn’t even doing that. If I do that, and this is pretty cool.

Whitney Lowe: And there may be something to just novel movements associated with that too. They give positive sensory experience from those novel movements.

Mark Olson: So many of the things we do, work because we’re just riding on the coattails of all this, interoceptive goodness, right?

Whether we have good ideas about what, how they work or not, it’s still good. [00:49:00] Yeah.

Til Luchau: Options are helpful. And I don’t even realize what options I’m not exercising sometimes.

Whitney Lowe: . Yeah. Mark, I know we’ve talked about some of these things, especially here recently. Any other big myths or misconceptions you see out there about pain associated with the work that we do as manual therapists, massage therapists, that you might wanna help us dispel?

Mark Olson: Yeah. I imagine that you’ve probably dispelled, before. Same ones I would mention, these posture ones and a lot of the structural ideas which again is, it’s a nuanced conversation of course there are structural and tissue based phenomenon. It’s just, we need to get away from this idea that everything Is that way, and it makes sense that we think that way because we grew up working with objects and manipulating objects and understanding how objects work.

So it’s easy thing to it’s a metaphor that we first go to, but [00:50:00] a lot simpler than understanding how objects work. Neural networks

Til Luchau: and the big paradigm shift that happened around somatic arts emerging was that there’s a physical aspect to a lot of these things we hadn’t thought of as physical, right?

And so the pendulum swings like, okay, so everything’s physical and maybe we can affect everything through the physical means. Plus I can feel a dent, a harder place in your body, and when I get it to soften up, you feel better. So that’s that’s evidence then that we just need to make you soft and you’ll be great.

Mark Olson: Yeah. I got less than that rabbit hole a little bit. Yeah. It’s complicated. It’s I think, it’s just a lot of, a big dose of humility is really important for all of us to recognize that it’s really hard to figure out what’s actually going on. Yeah.

Til Luchau: And that there’s a place beyond.

Being agnostic about everything or just it depends as the answer to everything or even nihilistic saying it doesn’t really matter What we do or how we stand or how we are. For example, there are ways to [00:51:00] into Experience that bring more of what the person or the car clients want what they’re more aligned with what they’re Motivating to seek their times with us Yeah.

And your empirical experiential based examples of giving, helping someone find an experience and then checking with them and following their lead around their side of that and where that might be useful, what’s in the way of that. It’s a very interesting way forward.

Mark Olson: Yeah. We can do good work if we think we’re changing tissues, even though we’re not changing tissues.

Just because touch goes a long way,

and

Mark Olson: being a caring person goes a long way with the descending modulation and all that, but if we know that we’re not changing tissues, then maybe we don’t have to worry about that. work with that mindset and we can think interoceptively like how can I change interoception without working so hard.[00:52:00]

Whitney Lowe: But essentially there is in some instances would you say that there is I mean what Till just said a moment ago in terms of a an experience that we have of something was feeling dense and we worked it and it now feels less dense. We have somehow or other facilitated that change of tissue quality, right?

Yeah, and the tissue, I should

Til Luchau: just say, the tissue debate is not settled about whether or not we’re changing tissues and the clinical significance of that. It’s a great, it’s a really great juxtaposition to think what if everything was based on that idea and what if nothing was. But we’re still not in agreement in our field about the role of the tissue change or our ability to affect it.

And there’s good evidence on both sides.

Mark Olson: Yeah, that’s why it’s important to be open and not too fixed.

Whitney Lowe: Yeah, indeed.

Mark Olson: Yeah

Til Luchau: Just massage out those dead spots in our thinking.

Whitney Lowe: Yeah So mark is a wrap up if you could give us like or our listeners one piece of advice to [00:53:00] practitioners Looking to deepen their understanding of pain science if what would be the one thing that you’d tell them Go do this at least to deepen on

Mark Olson: pain

Whitney Lowe: science.

Yeah. Or just their understanding of the role of like you’ve talked about the complexities of the whole neuroscience of pain process. What kind of would be really the most beneficial things for somebody to get started if they haven’t really dived into this very much?

Mark Olson: Yeah. I think it’s really important to understand descending modulation and I don’t know if I mentioned this at the beginning that, descending modulation is just one type of top down process, but all the other endocrine and immune changes that can occur, if you feel safe or cared for all those things, they’re not, we’re not just doing descending modulation to the spinal cord.

We’re also influencing a whole chemical soup in the body that can be, could be relevant, which is probably why a lot of the, things change after massage for a few hours or days. To really understand, like to dive into [00:54:00] those explanations, these endocrine immune neuro understandings, and to see if you can replace those structural mindsets, with these, I think that’s, that would be where I would encourage one to go.

Whitney Lowe: Great. That sounds good. Thank you so much, Mark. And is there any Thank you. Places that you want to encourage people to connect with you if they want to learn more about what you’re doing with your courses and things like that, where can people find out more from you?

Mark Olson: Yeah, absolutely. They could go to my website, which is dr olson.com and that’s D-R-O-L-S-O-N.

. And yeah, that just, you can see all the courses there. I’ve got courses on pain and trauma-informed care and other topics.

Whitney Lowe: Okay. Excellent. We want to thank you so much for taking some time out to chat with us today. This is absolutely fascinating discussion and I think I did make note of at least quite a few other rabbit holes we probably want to try to dig down into sometime in the future [00:55:00] as well.

So I would love that. Yeah. Great.

Til Luchau: I appreciate the voice you’re putting forth in our discussions too, and the place you hold in the perspective you have, thanks for doing that all these years.

Yeah. Thank you too. Yeah. Please keep

Whitney Lowe: it up for us. Yeah. Please keep it up. Yeah. And thank you all for being with us here today where books of discovery has been a part of the massage therapy and bodywork world for over 25 years and nearly 3000 schools around the globe teach with their textbooks, e textbooks and digital resources.

Books of discovery likes to say that learning adventures start here and they find that same spirit here on the thinking practitioner podcast and are proud to support our work knowing that we share the mission to bring the massage and bodywork. community thought provoking and enlivening content that advances our profession.

Til Luchau: Instructors of manual therapy education programs can request complimentary copies of Books of Discovery’s textbooks to review for use in their programs. Please reach out at booksofdiscovery. com. Listeners can explore their [00:56:00] collection of learning resources for anatomy, pathology, kinesiology, physiology, ethics, and business mastery at booksofdiscovery.

com. where listeners like you save 15 percent by entering thinking at checkout. And as mentioned, please let them know you heard about them here. That really does support this show.

Whitney Lowe: And thanks to all of you, our listeners and to our sponsors, you can stop by our sites for the video show notes, transcripts, and any extras.

You can find that over on my site at academyofclinicalmassage. com until where can they find that for you?

Til Luchau: My site advanced trainings. com and Whitney and I want to hear your ideas about what you’d like to be hearing here, or your input, your feedback, your questions for us or our guests. Send us a message or an email, our email is info at thethinkingpractitioner.

com or look for us on social media. Just under our names, my name, Till, Luca, Whitney, what’s your name?

Whitney Lowe: Today, my name is Whitney Lowe. People can find me on social under my name over [00:57:00] there as well. And also be sure to check out the wealth of resources for Rehabilitative Massage on our YouTube channel also under my name there.

We’d really appreciate it if you would take some time out to leave us a review on Apple Podcasts and know that it does help other people find the show. So you can hear us wherever you happen to listen. For your podcast, please do share the word. As always, tell a friend and we will see you in the next episode.

Til Luchau: Thanks for joining us today, Mark. Yep.

Whitney Lowe: Thank you again, Mark. I’m grateful.

Okay. That is a wrap. That was fun, Mark. Thank you so much. Hang on one second here.