By Sage Hayes

Trauma is definitely a buzzword these days, and for an important reason.

Massage therapy training in the U.S. has been mostly geared toward providing physical support and relief from injury, pain or tension.

But recent studies are showing the usefulness of massage as a complementary treatment for those who have been exposed to trauma.

In fact, trauma expert Bessel Van der Kolk, MD, has written about how in the years following 9/11, a number of clients reported more relief from trauma massage therapy than talk therapy.

However, after 11 years of private practice as an LMT, one thing I know for sure is that my massage therapy training did not prepare me to work with clients who have trauma. Before writing this article I took a poll of LMT colleagues to ask what they learned about trauma during their massage school experience and this quote captures the essence of what so many shared:

“In my school, which was generally very holistic, we only focused on the physical tension and different ways to relieve it,” said Kiara Archambault, LMT. “I would have liked to have been introduced to the correlation between emotional [and] mental states and the physical body. An introduction would have been great.”

What follows is an overview of trauma and the role of massage therapy in addressing it, in an article that includes information about practitioner presence, consent and scope of practice.

Many People Are Traumatized

Experiencing trauma is not as rare as we once thought. A groundbreaking study on the prevalence and impact of trauma exposure, the Adverse Childhood Experiences (ACE) Study, revealed that the experience of acute and chronic trauma is quite commonplace for children in the U.S.

Other common events such as car accidents, falls, traumatic loss or medical trauma can also add to the residual tension and memories clients hold in their body.

Communities locally, nationally and globally are continuously navigating large and small-scale disasters. (Editor’s note: Read “Texas Massage Therapists Reach out After Hurricane Harvey” and “Support Your Clients Following Disastrous Events.”)

We are also dealing with prevalent social traumas such as racism, sexism and homophobia, which increases tensions between us.

Within current economic, political and environmental climates, massage therapy can offer a vital space and modality for clients to experience safe touch, relaxation, comfort, tension relief and conscious attention.

While not every massage therapist may have a desire to work specifically with trauma, having some baseline understanding and education about trauma can support all massage therapists to have skills, confidence and capacity to navigate the wide range of experiences with clients.

A massage therapist’s scope of practice specifies that we cannot actively engage in conversation about the trauma other than to listen, support and refer. It is in the listening and supporting that we can really hone our skills and make a palpable difference in a client’s experience of healing.

What is Trauma?

Most experts agree that trauma’s effects live in the body. Our bodies are brilliantly wired to maintain a dynamic equilibrium of health, which includes tolerating a fair amount of stress.

Sometimes overwhelming life events, near or far, disrupt this equilibrium and we become stuck in a survival response of tension and fear. On the most fundamental level, our bodies can maintain a level of homeostasis, a self-regulating process by which biological systems maintain stability amidst changing conditions.

Trauma occurs when our biological systems are pushed past a threshold of tolerance and remain stuck in the survival strategies such as flight, fight or freeze.

In the words of one of my teachers, trauma specialist Peter Levine, PhD “Trauma is a highly activated, incomplete biological response to threat, frozen in time.”

Another way of understanding trauma is as the condition of being overwhelmed by threatening and chaotic events a person cannot control.

With some basic trauma-informed education about knowing what to look for, massage therapists can play a complementary role in helping trauma survivors move toward healing and health.

Massage can calm the body’s sympathetic nervous system, which operates the fight-flight-freeze reflex, and engage the body’s parasympathetic nervous system (which calms) encouraging relaxation and rest and inducing calmer mental and emotional states.

Becoming a trauma-informed massage therapist takes some time and training. Even if trauma was covered in your massage training, there is so much new research emerging these days that it’s best to build an up to date library of resources, take continuing education classes or participate in a training in working with trauma.

Here are four important elements of practice that can begin to support creating a trauma-informed practice for your clients:

1. Practitioner Presence

My massage school taught me how to give a thorough massage, but did not emphasize what it means and takes to stay present during that massage. Presence is the embodied and dynamic capacity to be attentive to our clients and their treatment goals, and attuned to what they say and what their body is telling us.

Presence is a nuanced art; it’s the continuity of knowing when to shift pressure, when to slow down, when to ask how a client is doing and how to find a sweet spot of contact that creates containment while simultaneously supporting the release of constriction.

One difference between a good and great massage is how grounded the practitioner is within themselves. The art of being with a client is just as important as the actual physical massage

Practicing embodied presence is a gentle way in which client trauma can be holistically cared for. Grounded touch with the continuity of attuned attention can offer responsive, regulating, and restorative support for clients working through trauma.

Tools that support cultivating presence:

Do your own personal healing work to expand your overall ability to stay present with discomfort or tension.
Use physical practices such as yoga, tai chi, and mindful exercise to build your personal and professional embodied capacity to stay grounded.
Get enough rest and play in your life.
Have a simple grounding ritual before each client and a clearing ritual after each session.

2. The Art of Consent

Consent seems obvious, but I have learned from my 11 years of bodywork practice that it is more nuanced than it seems.

By definition, trauma is the result of something very overwhelming, an event that happened too fast for the person to fully protect themselves.

By its very nature, trauma often takes away a person’s sense of choice about what is happening. It is imperative that, as practitioners, we cultivate the ability to read client body language and underlying subtle cues which signal the message of yes, no and I’m not sure.

Massage therapy can support people affected by trauma to slowly regain control of their bodies. It’s essential that we help clients build capacity and voice to direct touch, adjust pressure or remove touch; this increases embodied agency and a sense of empowerment.

As a general practice, I am explicit at the beginning of each session that the massage is a collaborative process of choice.

Before clients get on the massage table, I offer a simple exercise of touching their arm where I encourage them to practice asking for increased and decreased pressure. I also have them practice asking me to stop and take my hand away, so they know that asking for this is 100 percent okay.

As I remove physical contact, I stay in supportive verbal and energetic contact to reinforce that.

Finding ways to pay attention to both the verbal and nonverbal ‘yes’ and ‘no’ creates a safer experience. It reinforces a client’s sense of control of their body as they practice setting limits and learn to receive what they ask for.

3. The Story Under Tension Patterns

Tension patterns are often what motivate a client to get a massage.

Massage schools teach the physical aspects and strategies of releasing tension, but often omit exploration and education regarding the non-physical nature of tension patterns, particularly when they may be related to recovering after trauma.

Clients may not be aware that muscular and whole body responses to an overwhelming threat can remain stuck in a stress response or pattern of tension.

A massage can offer an opportunity for clients to build awareness of these holding patterns, while slowly releasing them.

I approach tension patterns not only physically, but also mindful that they may hold stories, protection and fear. This can add a whole new dimension to softening, unwinding and release.

Being in mindful communication with the client and the tension while working on an area where a client braces or tenses up can make all the difference.

By touching with awareness, staying open to the stories and being curious about what support the tension needs, we can offer an opportunity to for a pattern to release in a safe, manageable and deeper way.

4. Scope of Practice and Collaboration with Trauma Trained Practitioners.

As noted above, it is not within a massage therapist’s scope of practice—even while practicing trauma massage—to actively engage in conversation about the trauma, other than to listen, support and refer.

When your client has self-identified a personal trauma history, being in communication with the client’s other providers will be extremely helpful for the client.

Peer supervision and consultation with other experienced massage therapists and/or mental health clinicians who have training in trauma can be very valuable.

To Learn More

This is a selection of books and an article I have found helpful in developing as a trauma-informed massage practitioner:

Rosen Method Bodywork: Accessing the Unconscious through Touch, by Marion Rosen
Waking the Tiger, by Peter Levine
Touch: The Neurobiology of Health, Healing, and Human Connection, by Michael Changaris
The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment, by Babette Rothschild
The Heart of Listening: A Visionary Approach to Craniosacral Work, Vol. 1: Origins, Destination Points, Unfoldment, by Hugh Milne
Massage and Bodywork with Survivors of Abuse, (article) by Ben Benjamin, PhD.

Heal a Life

Acquiring trauma-informed training, capacity, and skills can support massage therapists to appropriately engage with trauma, which inevitably emerges from our client’s histories and body experience.

While many massage schools have veered away from providing this training (as to be clear about the limits of our scope of practice), providing no or little education or training in trauma has left many therapists unequipped to notice, understand or support its symptoms.

It’s time for massage therapy schools to include adequate trauma informed education and skills development to be able to listen to, understand and support trauma as it surfaces.

Trauma-informed bodywork training means offering professional bodywork which has the capacity to navigate the wide range of histories, realities and experiences of all of our clients.

It’s exciting that massage therapists can play an essential role in trauma healing, that in our mindful touch we can help heal a life.