Episode 129 – Is Your Touch Aging Out? (with Til Luchau & Whitney Lowe)
Summary
A new study shows that our fingertips lose sensitivity as we age. What are the implications for massage and bodywork practitioners? Tune in and listen as Til and Whitney think it through, and along the way, share fascinating tidbits about tactile sensitivity training, and its relevance to actual practice.
Key Topics:
• Discussion of Tactile Sensitivity Study
• Mechanoreceptors and Aging
• Proprioception and Sensory Discrimination
• Tactile Acuity and Practice
• Aging and Mechanoreceptor Deterioration
• Implications for Clients and Practitioners
• Qualitative vs Quantitative Touch in Therapy
• Social Grooming and Pleasant Touch
• Takeaways on Tactile Sensitivity and Aging
Resources mentioned in this episode:
- Samain-Aupic, Léonard, Mariama Dione, Edith Ribot-Ciscar, Rochelle Ackerley, and Jean-Marc Aimonetti. “Relations between Tactile Sensitivity of the Finger, Arm, and Cheek Skin over the Lifespan Showing Decline Only on the Finger.” Frontiers in Aging Neuroscience 16 (July 2, 2024): 1387136. https://doi.org/10.3389/fnagi.2024.1387136.
-
Bartsch, Katja Martina, Robert Schleip, Alberto Zullo, Kerstin Hoppe, and Werner Klingler. “The Stiffness Comparison Test: A Pilot Study to Determine Inter-Individual Differences in Palpatory Skill Related to Gender, Age, and Occupation-Related Experience.” Journal of Bodywork and Movement Therapies 24, no. 4 (October 2020): 1–6. https://doi.org/10.1016/j.jbmt.2020.06.009.
Episode Transcript
Whitney Lowe
Welcome to The Thinking Practitioner podcast, a podcast where we dig into the fascinating issues, conditions and quandaries in the massage and manual therapy world today.
Both
I’m Whitney Lowe and I’m Til Luchau.. Welcome to the Thinking Practitioner
Til Luchau
Books of Discovery has been part of the massage therapy and bodywork world for over 25 years, nearly 3000 schools around the globe teach with their textbooks, e textbooks and digital resources, books of discovery, likes to say Learning Adventures start here, and they find that same spirit here on the thinking practitioner podcast, and they’re proud to support our work, knowing we share the mission to bring the massage and bodywork community thought provoking and enlivening content that advances our profession and instructors of manual therapy education programs can request complimentary copies of books of discoveries, textbooks to review for use in their program. So please reach out to booksofdiscovery.com and listeners can explore their collection of learning resources for anatomy, pathology, kinesiology, physiology, ethics and business mastery at booksofdiscovery.com
Whitney Lowe
where Thinking Practitioner listeners can save 15% by entering thinking at checkout. So good afternoon Til How are you today?
Til Luchau
Right?
Whitney Lowe
It’s morning time.
Til Luchau
It’s morning. I’m still it’s getting toward afternoon.
Whitney Lowe
Yeah, it’s afternoon somewhere,
Til Luchau
somewhere. I’m well, thanks for asking. How about you, Libby,
Whitney Lowe
I am doing well. Also, what? What are we talking about today?
Til Luchau
We’re talking about an interesting study that came across my feed. It’s called relations between tactile sensitivity of the finger, arm and cheek skin over the lifespan showing decline only on the finger, a very descriptive title that kind of does give a spoiler to the study’s findings that there is a decline in our tactile sensitivity in our fingers. And that was authored by probably going to pronounce it wrong, because I may not pick at all. And the team published July 1 in frontiers on aging neuroscience. We’ll link it in the show notes, of course, to the original. But it had some interesting implications, I think, and started some interesting trains of thought in my mind, and I wanted to share those with you. Whitney,
Whitney Lowe
yeah. So tell us what’s the overall, overall view, what? What did this study show?
Til Luchau
Well, like the title of the study says, we get less sensitive as we age. The study found out, especially in our fingers, but they checked they also monitored sensitivity, or check they didn’t monitor they compared different age groups, but not in our cheeks, on our face or on our forearms, that that sensitivity was steady over all the different age groups, but as people were in the older group, they were less sensitive with their fingers. Yeah,
Whitney Lowe
I learned in reading the study there, I learned a new word I hadn’t been aware of before, a glabrous skin, blabber skin, right? So that’s the skin with no hair falls, particularly
Til Luchau
soles of the feet, palms of the hands, different. It’s got thicker epidermis. It’s got more mechanoreceptors. Skin behaves differently than other kinds of skin, and it’s relevant to our practice, to what we do as hands on practitioners, because that’s where we touch people from. Yeah,
Whitney Lowe
I think, you know, I’ve read that in the introduction to this study. I thought that was interesting. They they did make a mention of a much higher percentage of mechanoreceptors and other things in that skin, in the glabrous skin that was not skin with hair, remembering that correctly, which one was more? Yeah,
Til Luchau
yeah, meisners corpuscles in particular, yeah, yeah. That was interesting.
Whitney Lowe
I wasn’t aware of that, that difference in there?
Til Luchau
Well, yeah, right, it technically me, you know, it’s, it’s kind of a little known fact, But intuitively makes sense. I mean, our our palms are sensitive, our tips of our fingers are sensitive, the soles of our feet are sensitive. So I can get tickled there. Yeah, people don’t tickle your kneecap and have quite the same effect different mechanic receptors there. So, yeah, sensitive, at least in the beginning of life. The question is, what happens as we aged? How much less sensitive to get, and does that impact our work? What implications does that have?
Whitney Lowe
Yeah,
Til Luchau
they checked it with what’s called a Von Frey monofilament test, where they have these little pieces of filaments, like fishing line of different thicknesses, and they touch, would touch the skin in these three different places and see how fine a line they could use, and still have a report back of a sensation. Yeah. This
Whitney Lowe
seems particularly relevant for, you know what we’re doing, trying to find and discriminate, you know, different subtle aspects of soft tissue texture for us, because I know there’s a lot of exercises in massage school and manual therapy schools about how to develop some of that, that tactile sensitivity. So it’s emphasized
Til Luchau
a lot in different manual therapy trainings. For sure, I’ll still pay. Get a lot of training in that. And there’s the stories every now I did this in my craniosacral training of the phone book, using the thin pages of a phone book and putting a hair underneath it and tracing the shape, and then putting more and more layers and phone book pages on there until you could no longer feel the hair. So we had a score. We had a tactile score their number of pages, and we’d compete in class to see who could get the few, I’m sorry, the most pages. And still, yeah, the hair. Curious
Whitney Lowe
about that. Did you? Did you feel like you ever improved from like, an initial score? Did you get better at it? Yeah,
Til Luchau
and especially with there’s another one where we’d have a blindfold on, and there’d be like a treatment table or massage table there with a sheet on it. We’re blindfolded. We have a hold of the corners of the sheet, and then someone would put a book, a heavy book, On this table somewhere, and only holding the corners. We pull in the corners and then point to where the book is on the table. Oh, interesting. And that was harder, but with practice that got better too. That’s actually quite hard to do. Yeah, and the idea there that we have a hold of in the cranial work, we have a hold of the head typically, and we’re feeling for in the thought is the narrative goes that we’re feeling through the fascial network to feel where these restrictions might be.
Whitney Lowe
Yeah, that is a fascinating concept, because to me when, at least when I think about that, I think about that as being two very different sensory processes, because one is tactile sensitivity in the fingertips themselves, and the other is a super highly refined degree of proprioception, feeling different levels of tension and muscles from angles of that’s where something is pulling
Til Luchau
That’s right, and being able to triangulate it from your two hands and Yeah, guess there’s a lot, a lot of differences there, yeah. And so the question is, are those? What if those decline over time? Does that influence our effectiveness as body workers? That’s one question the study raises. Yeah. They also did us what they called a spatial discrimination test in the study where it was they checked their subjects ability to feel different widths grooves than a plastic plate, just by a very carefully regimented stroke over the surface of the plate. Could you tell the different size of the grooves? So, yeah, we can imagine, I don’t know about the filament thing, that’s a little bit of a leap, but for sure, the grooves and some of the other things we can imagine using those skills more directly in manual therapy.
Whitney Lowe
Tell me how you I have sort of an idea what I can think of I’m curious here your thoughts on how the groove thing you think would translate into what we do. Well,
Til Luchau
size. It’s you. You’re asking me to discriminate which which of these grooves is bigger, and give you two plates. And I think being able to perceive the relative size of things and compare them accurately, I’d say I’m I’m making the case that is important. I’m also, later in our discussion, going to make the case that maybe this isn’t so important. Just yeah, but let’s say it was important. Yeah, I can see that being able to discriminate small differences in size would make me more accurate, give me more accurate information, maybe be able to perceive things that couldn’t if I was trained there or since. Yeah, I should also mention here that Robert schleip and some collaborators did a study related. It was at the same time that the Berlin 2018 fascial Congress was going on, and they recruited people from that conference to participate in that different osteopaths and practitioners that were there. And barch is the lead author. Barch et al, 2020 we’ll link that in the show notes. And they didn’t check these things. They checked stiffness. They had these gel, silicon gel squares of different viscosities or thicknesses, resilience. And then they were checking your ability to determine which was the stiffest and least stiff. Yeah, so that was they were trying to make that even more directly related to what we feel in manual therapies and bodywork.
Whitney Lowe
Yeah, you know, in thinking about the groove experiment there, I can see a direct correlation with things like degrees of fibrosity in tissue where you’re trying to feel like do kind of stringy orientations of a particular myofascial tissue that might indicate scar tissue or some type of adhesion, or something like that that feels like it definitely has an orientation when you pluck or strum across it in one direction, but not in another. That could be something where those grooves would make a difference. But this also made me think too, it would be interesting to see what would be found in a study like this, because they were using direct contact with the contour surface to test it. But that’s not ever what we do, or not ever, but rarely what we do. We work through a medium, yeah, the skin to feel things that are underneath. It would be interesting to see, yes, what put you know, what might be felt? To in those tactile investigations, if they were having to also work through another medium to try to feel what’s down below that.
Til Luchau
That’s right. That’s right. I remember. I’m remembering now some games, we’d have these touch Olympics. We called them when I was training at the giving trainings at the Rolf Institute at the in the training that I headed up there, and we would layer, we put different numbers of blankets or sheets or pillowcases on the table, and then the game was to count them. How many layers are there? Oh, yeah, you’re feeling through these layers, and trying to determine how many layers you’re feeling through. All right, so let’s talk a little more about why the authors think this decreased sensitivity happened. There’s a lot to talk about here, but let’s go through it and make sure we understand their picture of it. They’re speculating that the decreased sensitivity in the fingers, over time over age happened because of deterioration. Basically, of the mechanoreceptors nerves do age, and that’s one reason, like neuropathies and things like that, are more common in older people, especially in the feet, because that’s the longest neurons in the body, and they maybe are most sensitive to age related degradation. Yeah,
Whitney Lowe
you gotta wonder too about mechanical compression of those over time, just because they they take a beating, you know, especially in the foot, when, when you think about the, you know, the weight loads and the compression loads that they are subjected to over time, in addition to the length of those nerves. So
Til Luchau
just wear it out. Just fatigue. Yeah, tissue fatigue, yeah. The structure of those is really these have a little different structure, and that’s related to some of the signal they generate, like the pean core puzzles around your joints, in your hands that help you sense grip strength. The grip force, rather, are like little onions. They’re layered, and as the pressure pushes the layers of onions together that transduces the signal it produces the signal that your nerve perceives. So maybe, yeah, who knows, if the mechanical qualities of those onions change, then they’d have a different signal generating capacity. And
Whitney Lowe
I’d be willing to bet that there’s some different degrees of adaptation, if you compare those in the hands versus those in the feet, because I would imagine, right over the millennia that we have probably adapted those proprioceptors to some degree to to be able to respond to the compression levels there absolutely.
Til Luchau
I mean, that’s why we have all these grip sensors around our finger joints, but not many other places in the body. They’re very adapted, very local. Yeah, the other thing was interesting to me about this study. I mean, one of the reasons that was interesting to me about the speculating about the change over time was loss of tissue hydration. And, yeah, our tissues are less hydrated as we age. And they cited a couple of other people’s studies that showed that using a moisturizer cream improved the spatial discrimination scores both immediately, yeah, immediately have to use the cream. But then they did a group where they had to use a cream for a month, and their overall scores changed too. So it’s like a long term thing. Oh, interesting. So just keeping your hand tissue hydrated seem to increase your sensitivity quite a
Whitney Lowe
bit. Yeah, huh. Okay, so. And hey, those of practitioners who spend all day long with their hands in lotion and lubricants working on people who might have some offsets to the age related degeneration, then
Til Luchau
maybe there is an argument for us getting a hand cream sponsor. Yeah, okay, yeah. Maybe there’s something there, yeah. And then they didn’t mention this in the study, but I had heard about it, and they referenced it in the study, that there’s also a lot of Central Processing changes that happen over time, meaning your central nervous system, your brain, the descending processes change. So this is a study good at all in 2018 found that top down processes, meaning ones that were determined by your brain’s ability to process or ability to facilitate or inhibit signals, was stronger. It changed more over time than bottom up signals. The signal from your hand didn’t change as much as your brain’s influence on those signals changed with age. Interesting. I hope I said that clearly enough, yeah, but it’s they say it’s tactile performance changes over age are mainly caused by a decline of central perceptive evaluative capacities, rather than by reduced sensitivity. So basically, it’s our brains that are getting older too? Yeah, they’re saying,
Whitney Lowe
and I guess that was gonna eventually take us back into that question of, like, we know, everything degenerates with age. So how important is that? And how much does it degenerate? I think those probably are end up being some of our big takeaways.
Til Luchau
That’s right. How much and how important. That’s good? Yeah, let’s get there, yeah. Should we talk about implications for clients first?
Whitney Lowe
Yeah, yeah, that’s that’s a good next step here. They
Til Luchau
weren’t thinking about bodily workers when they did the study. They’re thinking about tactile research into people with diminished sensation over time and how that might influence their activities, activities of daily living or treatments or therapies they engage in, and for sure, as just as a person you if you have reduced sensitivity in your fingertips that could make it harder to do, buttons, zippers, work, devices, phones, things that require a degree of dexterity. It’s also they mentioned this in the study to decreased postural feedback from the feet. If you’re generally less sensitive to tactile input that can lead to more falls you have poor balance, you know, adapting as quickly as accurately. Yeah.
Whitney Lowe
And that’s that seems like that could compound the other difficulties that people have as they age with with balanced challenges as
Til Luchau
well. You can imagine that. Yeah, and then they didn’t mention this, but I know about it. I know you know about it, but less tactile sensitivity correlates with more pain. People that have chronic pain have less tactile sensitivity,
Whitney Lowe
yeah. Or do we know why that is? Oh,
Til Luchau
there’s probably, yeah, I’ve, I remember, I remember reading some very technical explanations for some of those mechanisms involved. But in general, I’m just going to give you my probably way oversimplified way I think about it to myself, and that’s when there’s a lot of noise in the system. It’s harder to hear this anything, yeah. And that’s, you know, like, if you’re dealing with a lot of pain experience, you’re not going to notice a little monofilament touching your fingertip Exactly. Yeah, yeah, yeah.
Whitney Lowe
And I’m back to the the cortical smudging concepts of the difficulty of precisely identifying and narrowing down on where those sensations are coming from.
Til Luchau
That’s right, yeah, this is an interesting reference. In this study, they referenced Zamorano et al in 2015 who studied musicians of high level, classical musicians who were really good with their dexterity, had really good sensitivity to in their fingers. And they were asking, Is this more related to pain or less related to pain? Did musicians have it worse than other people who weren’t musicians just because they were more dexterous, and their takeaway was, basically, they do, the more dexterous you get, the more sensitive you get in your fingers, the more you more likely are to have chronic pain, too. Oh, really, yes. Sensitivity cuts two ways. You could say, interesting, yes, the more tactile sensitivity you had in that, in that study, the more likely you were to have chronic pain, and that that kind of makes sense. I can see that because sensitivity just means your you know, your threshold for sensing something, yep. And if it’s lowered, you’re gonna have more of all kinds of sensations, yeah. And
Whitney Lowe
you may be tuned into things a bit more significantly with that increased dexterity as well. Yep,
Til Luchau
yeah, you mentioned the cortical smudging thing. You know the two point discrimination test. I guess it’s a bit out of favor. Now, it’s pretty unreliable because there’s so many variables there. But the basic principle is, if you’re in pain, you need two points to be much farther apart to tell it’s two if you’re not in pain, you can tell it’s two point points. Even when there’s two points of contact, you’re close together, yeah? So basically, your refinement is reduced when you’re in pain. Yeah. Here’s an interesting thing, though, that, and this is the basis of a lot of what I teach. So it’s, it’s a, you know, I’m hanging my hat on a tenuous hook here. There hasn’t been a lot of research in in the ability to diminish pain by training tactile refinement. We know they’re correlated, but we don’t know that if we change one, that changes the other. So explain
Whitney Lowe
that a little bit. So when you talk about tactile refinement, tell me a little more about what you’re thinking. Let’s
Til Luchau
say you could practice with two point discrimination and get really good at telling if it’s two points or one, even at a at a closer distance, more refined. There hasn’t been a study that I know of, and the people I’ve asked that know of that say that makes your pain go down when you learn that. So a lot of these things we know about pain are correlations and assumptions about the causality. There hasn’t been a lot of study done into how we actually change it and if we can change it using this knowledge. Yeah, right now in my bias, informed may perhaps, or influencing, perhaps my clinical experience. Yeah, when people get. Really refined about their body awareness, their body sense pain, is a whole different animal. It’s much less bothersome, typically. So there certainly I have some empirical evidence of my own and experience that says, yeah, as I get people more refined in their tactile or proprioceptive sensitivity, all the body sense in general, pain is diminished and easier to manage.
Whitney Lowe
And why do you think that? Is because it seems like the more body sense that they would get, it would seem like the pain might ramp up. The key, the key
Til Luchau
word there is more. It’s not about more body sensation. It’s about refining it so that when I can get really accurate about what I feel exactly. Where does it hurt? Where does it stop hurting? What else in my body doesn’t hurt? When I can feel all those things, the painful experience has a different context. Otherwise it just takes over my awareness and smudges the whole screen. Yeah, I can really study those same principles as mindfulness based pain reduction, things like that. That can really pay attention to exactly how it hurts, where it hurts, and then also what doesn’t hurt. The pain itself changes, because some of the pain is a reaction, more than a signal. Yeah,
Whitney Lowe
you know that’s it’s interesting to think about it, because I remember reading this, I think in Jon Kabat Zinn’s work many years ago, discussions of of methods, of what you were talking about with mindfulness, pain reduction, of trying to focus on this. And I had learned this exercise. I don’t even remember whether this is actually before I became a body worker, just like I was early 20s, maybe late teens, or something like that. Somebody turned me on to this exercise of a way to alleviate headaches. And they were talking about just taking some time to, you know, quiet the mind think about, you know, just try to stop thinking about things, but give that pain a texture, a color, a smell, and just like zero in on it as much as you can, as a sensation to try to ascribe all of these different characteristics to it, and the more you focused on those characteristics of it, the less it got in intensity. That’s right, which was interesting, because it seems like you know, the more you’d focus on something, the worse it might get. But no, it seemed to have the reverse effect. It’s,
Til Luchau
well, it’s, it’s the type of focus. It’s that inquisitive focus about its qualities. It’s refining, like you said, texture, color, shape, perhaps, size. And a lot of times, if you ask someone, how big their headache is, they show they, like, spread their arms apart, it’s huge, yeah. And then when you point out that actually wouldn’t fit in your head something that big, yeah, that right, there is, like a mind blower. So then they actually go into study. Okay, actually, how big is it to be spatially right now? And as they get more present moment based and can feel the actual experience, it changes that whole reactive process, yeah, and the pain often diminishes. So should we talk about body worker implications to this study,
Whitney Lowe
absolutely. I mean, I think that’s, that’s the gist of why we’re here. So what does this mean for us?
Til Luchau
Couple of interesting trivia points that lead us up to that I talked about the phone book exercise and some of the others. But these are, these are things that we told each other in my training process there. And they’re, they’re they’re accurate. That’s true. Cars, automobile are manufactured for tolerances within a 1,000th of an inch, and these really fine micrometers, little devices and different kind of gages to measure the parts when they’re manufactured to make sure they’re within tolerances. Yeah, in aerospace, you know, airplanes, rocketry, things like that, the tolerances are a 10th as small. You know that 10 thousandths of an inch, yeah? And the hands turn out to be more reliable indicators of a match between two parts than micrometers. When they get that small, a machinist can feel a 10,000th of inch difference where a micrometer can’t really Yeah, huh. Run your hands across the seam and you can tell, do they match or not? Yeah, micrometer might not be, might be within their margin of error,
Whitney Lowe
Huh? Interesting, yeah. So I’m curious to know if they’re doing this in the aerospace or mechanics industry, they have people actually touching this stuff. Is their determination. This
Til Luchau
is what we were told each other. This, somebody brought this story to us, and we latched onto it and told each other this, that’s actually this aerospace machinists are using their hands to check their work all the time. Wow. I don’t know if that’s true or not, yeah, but there is good research that kind of tried to narrow down what’s the smallest thing a human finger can feel. And it turns out to be a reliable differences at 13 nanometers, which is pretty darn small. The comparison there is, if your fingertip were the size of the planet Earth, you. You could feel the difference between an automobile and a house on the planet Earth, huh? I don’t know if you get that sense at all, but you can just imagine there’s something that scale we can feel tiny, tiny little differences. That is a very, very small difference, yeah, much smaller than the actual mechanoreceptors involved.
Whitney Lowe
Huh? That’s fascinating.
Til Luchau
Okay, so again, these are the stories that we help us support idea that tactile accuracy is an important skill, and it probably is. But there’s also some skepticism about that is tactical, is tactile acuity really necessary to do good manual therapy,
Whitney Lowe
yeah. So I think the question would become, it’s one of those gray areas, like, how much of that will you use? Just like your brain, you know, we got an incredible capacity, but how much are we really going to use of it
Til Luchau
if you’re really sensitive to these small, little nanometer differences, is that going to make you a better body worker? Yeah. Because the argument goes, if those differences are really so small, do they make a difference to function or experience at all? If we’re feeling these small little differences in shape or texture or viscosity, and they’re that small, are they significant? The argument being that they aren’t, yeah. Case,
Whitney Lowe
this also kind of gets to the crux of a lot of the arguments about inter rater reliability in certain types of assessment strategies that involve palpatory investigation, you know, like SI joint movement or things like that. When some people say they can feel something and other people say they can’t, like, how, yeah, how relevant are those things?
Til Luchau
Well, that’s, that’s the argument that’s used to dismiss a lot of the hands on tests, is that there’s very poor we’re not really good on most tests of matching someone else’s results or even matching our own results on the next day, on the same situation, yeah. So we’re not very reliable, and that that’s brings this tactile acuity thing into doubt in terms of its usefulness from that point of view, right? And those are good points for goodness sake, it’s really good to question, do we really need to be that sensitive to do good work? And I’m of two minds of it. I don’t know. What do you think? What are your different minds of this? I’ll tell you mine, but you tell me yours. Yeah,
Whitney Lowe
I would have to say, for me, the way I would look at this, it’s one of those gray area things that getting better at sensitivity is, I think, helpful and beneficial, up to a point at which you know, like, there’s a point at which your improved sensitivity is probably not going to make as big a difference, like the jump, the early jump of just not doing anything to really training it and trying to get better at it is going to help you, but that that sensitivity increase later on down the road becomes less and less beneficial. So kind of like, there’s an analogy, sort of like, I remember a couple years ago, I was looking into getting a new stereo system, and I just, I could not believe what some of these, you know, high end stereo people were telling me about what people were paying for speaker cables. Yes, it’s like, you can buy speaker cables, you know, a really good quality speaker cable for, you know, like, 40 bucks. And there’s people that pay $300 for cables, like, really,
Til Luchau
for that last little increment of possible improvement, but
Whitney Lowe
the difference in sound between a a $10 cable and a $30 cable or $40 cable is significant, but it’s going to take somebody really highly specialized to tell the difference between a $60 cable and a $350 cable. So
Til Luchau
what else significant is subjective, isn’t it? Yeah, yeah. Well, I’m like that with my coffee. I’m experimenting lately with the difference between a 15 gram cup of coffee and a 16 gram cup of coffee. Well,
Whitney Lowe
that’s a small difference there. That’s
Til Luchau
a small difference that I can tell you. I could swear
Whitney Lowe
now, what are you what is the characteristic is that amount of coffee that you’re
Til Luchau
on a coffee Okay, that’s the amount of coffee beans I grind. Okay, and the 16 cup just has that little extra bit of bitter.
Whitney Lowe
Wow. Enjoy. I’d like to see the taste test done on that the blind taste, yes, and like exactly
Til Luchau
that’s on my list. I’m gonna check myself too. Yeah.
Whitney Lowe
So what do you So, what do you think I mean, pertinence, relevance for this?
Til Luchau
Yeah, the I like I said, I’m of two minds. One is that it’s fun, and it is a great skill to train. And I, I like I said, I trained a lot of people in this kind of sensitivity, and use that in my thinking for a long time. And there is value there, but it’s a quantitative value. We’re like seeing how many pages of the phone book, or we’re seeing like, what’s the smallest microfiber that can be detected, or the smallest groove? Those are all numbers, and that’s what you need to research it. But I don’t think you get good, a good experience in your client from. Purely quantitative point of view, it’s more the qualitative touch that makes a difference, yeah? And that’s not the same. You don’t have to be able to feel two more pages in the phone book to have a really amazing qualitative touch, yeah? And I think the qualitative thing is, is a is related to how much actually we listen? Yes, not so the sensitivity, but what we actually how we touch and how, if we take time to really hear and pay attention to and then respond to what we’re feeling. Yeah. So it’s that ability to actually hear it and then to actually let that change what we’re doing that makes a much bigger difference to me, then how small a thing we can feel? Yeah,
Whitney Lowe
yeah. I would definitely agree with that, yeah, that the quality of that, that experience, is going to because one of the other things that that’s very different here about what we do compared to this particular study is this study was really a one way evaluation of the individual’s capability to feel a discrepancy, yes, doesn’t have anything to do with necessarily, how our clients experience the nature of our touch, which is what you’re kind of getting at to when you talk about the quality of it. And that’s that’s another big factor. So this has an argument for saying, like, I mean, this would be a really good experiment, somebody who has maybe even like a prosthetic limb, but has learned how to touch in a very caring, compassionate way, comparing that client’s experience of a device touching or something touching, non human tactile sensation done with care and compassion versus something else. So it gets much more complex. I think when we start talking about the impacts on our clients,
Til Luchau
well, yes, and I can see that getting really trained in sensitivity could make your touch qualitatively better. You can tell when someone’s sensitive when they’re not, you know, but it’s not because you you know, they’re sensing your fingerprints or whatever. It’s because they’re really listening, they’re paying attention. Yeah, that’s, that’s the key one for me.
Whitney Lowe
I’d like to ask you this as a teacher. Since you do this, both of us are in this realm a great deal, because I see, see and feel this experience from students frequently, and I wonder, like, have you found a good way to teach the concept of that caring, compassionate touch? Because sometimes, when I’m trying to share or teach massage techniques, I can just watch somebody’s hands and see how almost awkward they look in terms of that experience of somebody feeling something. And I was just like, I try to think, like, what is it that I’m trying to get across here about the subtleties of the smooth, caring, compassionate touch process that you’re just not getting? You know,
Til Luchau
that was the question that got me into teaching. I was like an evaluator at the Esalen Institute. They go find anybody they could to get on the table and get a student massage, to evaluate these students they were turning out. So they grabbed me and I was on the table and got different massages from different students, and some were so good, and some were so not good, and they’d been through the same training program, yeah. And so that really started me to think, can this be taught? How do we teach it? How do we get those people to really feel and respond and listen? Yeah, and it’s an open inquiry here, 40 years later, I think how do we teach it was your question. I think there’s, it’s it’s hard, because it does involve slowing down. And people just have a clock speed that they’re moving at. Yeah, it was really about and still for me at this point, I mean, so much of what I learned through my wife’s process of of toward her end of life process recently was that it meant slowing down to be with her, and the touch was really important part of her care toward the end, but it was a whole different touch from my side. I talked about this psalm on an episode with her too, right? That continued where I had to really listen at a whole different level. Yeah, I had at any point in my career to that point.
Whitney Lowe
For me personally, I think one of the ways that I learned that as a practitioner and also tried to teach it as a teacher, was studying tai chi, and that whole process of some of the interactive exercises with another practitioner that have a lot to do with listening to, you know, the movement, or the intention of a movement, or something like that, and being able to just keep a very light touch in contact with them, but feel where they’re going, where their balance is, where their weight is, and all that kind of stuff and that that’s you can’t do that when you’re stiff, you know, when you’re doing something with with rigidity and sort of an. You’ve got to be that flowing water process of letting everything roll right over you, but also listening to it and responding to it at the same time,
Til Luchau
the whole body being part of that. The whole body listening that fluidity throughout the body. Yeah? Because hands aren’t the only way we listen to our clients. You know, there’s, indeed, yeah, there’s, there’s, sure, there’s the texture. There was resilience, the heat of the tissue. But we’re also using our eyes, our ears, our intuition, our empathy, our heart, all those things are listening to our clients. Yeah,
Whitney Lowe
so I’m curious too. Let me just tap on this for a second, because you know that we you did mention at the outset that there was a discrimination between lost sensitivity in the fingertips, but not lost sensitivity in forearms and cheeks. And I know, especially like with a lot of the manual therapy and myofascial work you do, there’s a lot of forearm, elbow and non fingertip type of interesting technique, things that’s true. Do you feel like there are also similar ways that of what we’ve talked about with the fingertips, of enhancing that sensitivity in other body parts that we use to work with forearms, elbows, you know, Knuckles
Til Luchau
and things like that. Well, yeah, can we enhance the sensitivity of other parts of the body? Yeah, I do use my forearms a lot. I use knuckles a lot. There’s, you know, this idea, the sensory homunculus. We did an episode on that the part of the brain that’s dedicated to sensation, processing sensation of particular body parts. The hands are huge. They took up a lot of real estate. There was some research. There’s been a couple different versions of this, but there was some research that showed that it changes really rapidly as people change their use patterns, that the the train sensitivity is basically more of the brain being recruited to process the sensitivity from that hand, and that there were observable changes in a period of two weeks in the study too. Yeah, I could tell someone who they did have musicians who stopped practicing, and within two weeks, their brain maps matched a more average map. And when they went back to practicing, they went back to this much bigger left hand. In this case, the violinist left hand was the one bigger because they were doing this delicate finger work on the fretboard. Yeah. So yeah, I think I imagine that I’m training different parts of my brain when I use different parts of my hand. Yeah. And I think there’s an interesting Your point is interesting. We don’t typically use our cheeks in the as tools in the body work, but that’s that’s a spot in the body that did not change over age in this study and form, it was steady throughout the age groups. Yeah. And if I’m just speculating here, that if those places are related to the idea of pleasant touch, the sea tactile afferents that go more have more impact on the insula of the brain, which is evaluating, is this pleasant? Is this unpleasant? This you familiar with that concept? I mean, we probably, yeah, somebody,
Whitney Lowe
let’s, let’s let’s elaborate that for the listeners a little bit. So okay,
Til Luchau
there’s a there was this afferent touch idea that came out maybe 1012, years ago that says that there’s a whole other class of of neurons that are perceiving stimulus that the brain is mostly making value judgments on rhythm, sensation judgments, it was saying, is this pleasant? Is this not pleasant? More than is this sharp or warm, right, or whatever? And that these C tactile air, France, these neurons are located in hairy parts of the body, so like the backs of the arms, the head, different places, the beard zones and, you know, on our face, those kinds of things, the argument being that they were probably social grooming reward circuits, that if we liked being touched there, we were more likely to seek out that kind of touch from each Other, and more likely to have our ticks picked off, and so more likely to survive and produce offsprings also like to be in touch there.
Whitney Lowe
Yeah, that is fascinating. Yep, yes, yeah. So
Til Luchau
maybe we don’t lose our equipment to enjoy touch, even as our fingertips diminished in sensitivity. Maybe the backs of the arms are chiefs, etc, are still really have the same degree of sensitivity when we’re young, because that’s such an important function, yeah, receiving that kind of pleasurable touch, yeah, as we age, maybe especially as we age, yeah.
Whitney Lowe
And I think hopefully that concept is not lost on listeners here, for recognizing then translating that into what gets done in the treatment room with people every day, that whole social grooming process, and that exactly what you’re referring to, there is a reinforcement of that entire process that can be a significant part of people’s positive experience. Experiences of of manual therapy work
Til Luchau
and shifting someone’s experience is just as therapeutic, maybe more therapeutic many times, than shifting the physical qualities of their tissue. Yeah. So that’s, that’s the other major idea here is that if we assume that what we’re doing is mostly tissue change, then this small significant might mean something. If we include the fact that we’re doing much more than that, then disproportionate in significance gets even smaller. Yeah,
Whitney Lowe
and I think you know we, we’ve talked before on this episode, in a couple different one of our, couple of our different episodes, about that degree of tissue change, the ideas around how much of that is really happening seem to be shifting and changing a little bit underneath our feet. Yeah, current research, as time goes on here,
Til Luchau
yeah, a lot of us are including more factors in our thinking than we were 1020, years ago. Yeah, well, and just, you know, should we do our takeaways here? Yeah, slide into mine. Yeah. You want to start? You want me to start? Yeah, go ahead and start. Then I’ll okay. So it’s this study showed only small changes over a lifetime. It’s linear, meaning it didn’t wait to the end and drop off. It’s gradual, from the early 20s, when they’re studying the subjects, to into the 60s. But the amount of change was like one newton meter. It was from like four Newton meters to three Newton Well, it was somewhere between three and five. The logarithmic scales are hard to tell. Anyway. There’s a small percentage change, so maybe we get less tactilely sensitive to monofilaments. But it’s not that big a change, and maybe over time, we get much better at listening and responding and more patient, and all those kind of things that, yeah, or that make up for the mechanical sensitivity changes. Yeah,
Whitney Lowe
I think, you know, I agree with a lot of those concepts and the takeaways here. I think that’s, it’s a fascinating idea to look at, but probably the degree of change that we see there is not something that is going to be tremendously noticeable to a lot of people over that longer period of time. And I think it’s something we can probably like we said, like, are there some ways that maybe we can make up for that loss sensitivity that we might have that’s something, you know, I was thinking of this too. Like this study looked at people that were aged, I remember correctly, 20 to 75 I believe, is what it was the age range in there. But it was really a short duration of that, that intervention and didn’t really get a chance to look at what was the degree of change in each one of those individuals over the course of their lifespan. So, you know that would be best anything to see how was that rate of change in each individual?
Til Luchau
And they didn’t, yeah, they didn’t follow individuals. They compared age groups. Yeah, so the assumption that all age groups started in the same place might be different too. Maybe people born a long time ago were born with less we really don’t know.
Whitney Lowe
Maybe those people who were 75 and did too many drugs sensitivity when they were 30,
Til Luchau
there’s a few confounding variables in there. That’s right. Yeah.
Whitney Lowe
So anyway, all right, well, that was a fascinating inquiry there, and thank you for bringing this study to our attention. It’s some great things for us to think about. And also, you know, keep our minds oriented to like this is something we don’t talk about a lot, but I think, you know, tactile sensitivity is something that we could work on, that and make ourselves better at, with what we’re doing with, with treating people, uh
Til Luchau
huh. Yeah, and, and the how we touch to it becomes the, the overriding growth edge for all of us, yeah, patients that listening what we do with the information we get those kind of things, right? Well, let me thank our sponsor, our closing sponsor. We are the thinking practitioner. Podcast is supported by ABMP the Associated Bodywork and Massage Professionals. ABMP membership gives professional practitioners like you a package including individual liability insurance, free continuing education and quick reference apps, online scheduling and payments with pocketsuite and much more and
Whitney Lowe
ABMP CE courses podcast and massage and bodywork magazine always feature expert voices and new perspectives in the profession, including those from till and myself thinking practitioner. Listeners can save on joining ABMP by going to a bmp.com forward slash thinking. So thank you again to all of our listeners for hanging out with us and lending us your ears for a little bit. You can stop by our sites for the video, show notes, transcriptions and any extras. You can find that over on my site at AcademyofClinicalMassage.com. Until where can they find that for you? That’s
Til Luchau
Advanced-Trainings.com. If you have comments, uh, quibbles, kudos. Um, anything, questions, things you’d like to hear us talk about, just email that to us. Or record a short voice memo on your phone and email that to us at info, at thethinking practitioner.com, or look for us on social media. I am at Til Luchau. Whitney, where can people find you?
Whitney Lowe
And I’m also on social under my name Whitney Lowe. You can find me over there as well, as well as our YouTube channel. And if you will, please take a moment out to rate us on Apple podcast. It does help other people find the show, and you can hear us wherever you happen to listen to your podcast. So please do share the word tell a friend, and we will look forward to seeing you in the next episode.
Til Luchau
Thanks everybody, thank you, Whitney.
Whitney Lowe
All right, thank you. Bye.
