THE USE OF MASSAGE IN CLIENTS WITH UNRESOLVED TRAUMA

Having been a massage therapist since 1997 in addition to working as both a nurse and a midwife, combined with my own personal experience of domestic abuse, PTSD and unresolved trauma, it will probably come as no surprise that one of my specialist areas is PTSD and trauma. I see many clients with these issues who have unexplained pain, high levels of depression and anxiety and fatigue among other things, yet there still seems to be such a lack of understanding in the industry about trauma and PTSD.

In a national survey of over 8000 subjects, Kessler et al, found that:-

• 6.5 % of the subjects had a lifetime prevalence of PTSD

• 2.8 % had a 30-day prevalence of PTSD

• Women were 50% more likely to develop PTSD

• those with PTSD were at increased risk of developing other psychiatric disorders, eg. anxiety and mood disorders

 The common belief is that it is simply a psychological issue and so should be treated with psychological therapy such as counselling, EMDR etc These therapies certainly have a place in treatment programmes, but the problem is that they only address the symptoms and not the root cause of the trauma. As someone who treats numerous clients with PTSD and unresolved trauma, and who overcame my biggest PTSD trigger through massage, I feel it is important to address the reasons why massage can help and the precautions that therapists should be aware of.

TYPES OF TRAUMA

• SHOCK

- eg. car accident, natural disasters, physical and sexual abuse over 5 years old

• ACCUMULATED STRESS

 – overtime due to work environment, life issues, not enough sleep

• MEDICAL

- eg. near death experience, under anaesthetic or in a coma, date rape while unconscious, bad treatment experiences

• EARLY AND DEVELOPMENTAL – under the age of 5 or in utero, for example:-

- In utero stresses – foetus is affected by stress response in the mother

- Birth trauma eg.forceps delivery, shoulder dystocia

- Premature birth resulting in incubation

- Health scare eg. choking episodes

- Medical procedures or surgery

- Neglect

- Physical and sexual abuse

This is the most common type of trauma, originating from a lack of secure attachment to a parent or caregiver, possibly affected by the parents health and their ability to bond,eg. a parent may have been abused and unable to express love in a healthy way. A safe environment in which to have needs met is vital to an infant because their autonomic nervous system isn’t matured and is unable to calm down or self regulate by itself. This means that infants can’t deactivate survival responses or activate the more evolved part of the nervous system, so have difficulty feeling safe and connecting with others. To summarise, lack of attachment causes dysfunction of the evolved autonomic nervous system maintains high levels of survival stress. Neural networks in the brain can remap themselves, through somatic and massage therapy, enabling systematic adjustments such as activating the more evolved part of the nervous system.

The ACE (Adverse Childhood Experiences) Study showed a correlation between early childhood trauma and adult health, with an increased risk of:-

• Cancer                                                  - Victim of violence
• Heart disease                                    - Violent tendencies
• Chronic illness                                   - High social and economic issues
• Mental illness                                    - Increased health service and criminal justice costs

The type of adversity is irrelevant, because the survival mechanisms simply recognise toxic stress and danger rather than the specific type of trauma, and once activated in an infant who can’t self regulate, the survival response can’t return to baseline.

THE EFFECT OF TRAUMA ON THE NERVOUS SYSTEM

When most people experience high levels of stress, they do what they need to do to survive and then heal, but clients with untreated trauma, have spent too much time in survival mode and not enough time in healing mode, meaning that they have had to disconnect from their own bodies, because the nervous system was unable to cope physically, emotionally or mentally. This trauma is held in the cells of the body, sometimes for many years, until it emerges as mental, emotional or physical symptoms. The most common symptoms are:-

Physical symptoms

• chronic conditions eg.chronic fatigue syndrome, chronic pain, autoimmune conditions, fibromyalgia, migraines, severe PMS, IBS, anxiety and depression
• insomnia
• persistent weakened immune response
• inability to work
• seeing specialists but no diagnosis
• inability to lose weight despite regular exercise and healthy diet
• loss of our neurological capacity to act
• structural rigidity/hypotonicity
• resistance to healing
• accident prone

Psychological symptoms

• feeling numb/dissociated/disembodied
• trouble focusing
• irrational fears
• fatigue and feeling overwhelmed
• problems setting boundaries, sometimes resulting in destructive/criminal behaviour
• staying in toxic and failed relationships
• lack of confidence and self worth
• inability to move forward in life
• obsessive patterns and addictive tendencies that reduce energy levels
• dysfunctional sexual patterns

THE STRESS RESPONSE

The autonomic nervous system protects us from external threats by triggering 4 responses  – fight, flight, freeze and fawn.

The autonomic nervous system automatically turns on, bringing about this stress response when we  feel unsafe,  but if we are unable to fight or flee from the threat, then we freeze and shut down. This means that we enter a more primitive area of the autonomic nervous system, numbing ourselves to the feelings, potentially for years, during which the fight or flight hormones are still circulating in our system. Even if we are aware of this, we may be unable to release them in a healing way. Since the autonomic nervous system controls all automatic body responses, such as digestive functioning, immune function, blood pressure responses and internal fluid regulation, if it remains on high alert, then these automatic functions may not work, meaning that further traumatic experiences will overload the system, and the health deteriorates.

In the long term, this sustained survival stress can affect:-

• how we digest food
• how we recover from illness or heal from injuries
• how process information
• how we tap into our creative potential
• how we relate to others
• how we decide what we want
• setting boundaries
• our tolerance levels or empathy for others

The fight or flight response is intended as a short term response and the body isn’t equipped to deal with constant high levels of stress. so activation of the more primitive part of the autonomic nervous system  means that our systems will become dysfunctional because our energy is drained on literally surviving,

The body will respond in one of 2 ways:-

• HYPER-AROUSAL due to sympathetic nervous system dominance

 ie. when the body is on high alert due to thinking about the trauma, even though there may be no actual threat, the body acts as if there is, causing ongoing stress

• FIXATION due to parasympathetic nervous system dominance

ie. a persistent focus of pleasure-seeking energies when an issue, usually involving sexual abuse remains unresolved, leaving the individual focused on this stage and unable to move forward

Storing survival stress and high levels of adrenaline long term reduces short term memory and the capacity to feel internal body sensations, resulting in reduced healing capacity due to the biological processes shutting down. Hence PTSD starts to become an issue.

POST TRAUMATIC STRESS DISORDER

WHY DOES PTSD OCCUR?

The fight or flight response occurs as a self preservation mechanism during traumatic events, releasing adrenaline to enable someone to physically fight or run from the danger, but if the after-effects aren’t dealt with, the initial trauma can remain in the mind and body. PTSD occurs when we attempt to override the fight or flight response, either because we were trained to, as in military cases, or because we have no other option, causing a surge of adrenaline which has no exit route, because you didn’t physically run or use the energy in any other way. This state of shock can last years, releasing bursts of adrenaline when similar aspects of the initial trauma take place. The rational mind wants to ignore it, but the body is still struggling to resolve the effects of the experience. This often results in hypervigilant traits or avoidance.

Hypervigilance 

• Intense physical reactions to triggers e.g. heart palpitations, nausea, muscle tension, sweating, chronic fatigue, chronic pain
• Flash-backs
• Irritability, aggression or angry outbursts
• Irrational and intense fear
• Prone to panic attacks/anxiety/depression/mood swings
• In a state of near-constant stress
• Increased emotional arousal
• Reduced tolerance to noise
• Easily startled
• Feeling constantly on edge
• Concentration problems
• Prone to suddenly crying
• Difficulty falling or staying asleep

Avoidance and numbing

• Work-related or relationship problems
• Inability to remember important aspect of the trauma
• Loss of interest in activities and life in general
• Sense of a limited future
• Feeling numb and empty
• Avoidance of people and places
• Feeling isolated
• Frequent periods of withdrawal into oneself
• Re-experiencing the traumatic event
• Flashbacks (Acting or feeling like the event is happening again)
• Nightmares (either of the event or of other frightening things)
• Feelings of intense distress when reminded of the trauma

Additional symptoms:-

• self-harming- by feeling pain on the outside of our bodies we can temporarily trick the brain into re-directing us away from the traumatic memory
• Suicide
• self-destructive behaviours such as

- Misuse of alcohol/drugs/gambling/sex and/or food

- Seeking out high-risk/dangerous pursuits

• Feeling distrustful and suspicious/blaming others
• Guilt, Shame, embarrassment or self blame
• Exhaustion
• Physical aches and pains, often chronic
• Skin disorders resulting from high levels of inflammation linked to sustained psychological stress and sleep deprivation
• Over-reactions to minor situations
• Fear of being alone and fear of being in crowds

Depersonalization and dissociation, two coping mechanisms provided by the brain during abuse, cause the individual to have a lack of self awareness , feelings of detachment and observing one’s own feelings, actions and thoughts as someone elses.

Memories are stored in our tissues, so abuse can cause us to retreat from physical touch, even when coming from someone who cares for us, until we heal both the physical tissues as well as the mind. The brain only understands what we tell it and is unable to distinguish between a memory and an actual traumatic event, so if we hear or feel something that recalls the trauma, the brain senses danger, placing us back into the event that caused the damage in the first place.

Clients with PTSD almost always have altered cortisol levels, and a prolonged exposure to these increased hormones can cause some unexpected, and very inconvenient physical problems, but this is why massage can be so beneficial, dealing with the root of the problem as opposed to psychological therapies which deal more with the thought processes and behavioural symptoms that occur as a result of the sustained coping mechanisms.

HOW DOES MASSAGE THERAPY HELP WITH PTSD?

Massage therapy can specifically help clients with PTSD through its capacity to:-

• heal the areas where the memories are held
• bring about positive biochemical changes such as reduced cortisol and increased serotonin and dopamine, reducing anxiety and increasing relaxation. Dopamine release also assists with helping to reduce self-destructive and addictive behaviours. Reducing cortisol levels can improve adrenal gland function, which then reduces high prolactin levels that can be responsible for pain sensitivity.
• loosen up tension in the soft tissues, improving flexibility, which may have been affected by long term stress
• offer positive human touch which stimulates hormones in the body, such as oxytocin, which initiate the relaxation response, and long-held stress patterns can begin to dissolve
• reduce nerve hyperstimulation and release of corticotrophin, a stimulating hormone, which promotes release of stress hormones from the adrenal glands. This causes skin cells containing histamine, an inflammatory chemical, to break open, spreading the histamine to other cells, causing redness and itching, so massage can also assist with reducing skin complaints
• reduce tachycardia by suppressing release of stress hormones
• improve circulation, helping to oxygenate the tissues and therefore promote healing
• reduce electrical conduction of the skin which intensifies sensations
• Reduce pain levels which may occur due to hypervigilance and constant anxiety which increase muscle tension, even during sleep. Reduced pain levels will then promote participation in exercise which can be restricted in those with PTSD

Trauma focused therapies such as Eye Movement Desensitisation Reprocessing (EMDR) and cognitive behavioural therapy (CBT) can be successful, but some clients will find repeated exposure to the trauma too much, hence why massage, which deals with PTSD on a physiological level, as opposed to simply a psychological one, can be beneficial, by helping clients to process the stress correctly, bringing changes about within the brain.

The autonomic nervous system helps to protect us from threats, but the brain prevents the release of the stress hormones, keeping us stuck in our survival response with limited access to the more evolved part of our autonomic nervous system. If we can’t regulate the nervous system we will remain at the peak arousal stage of the stress response, rather than deactivating into an open state of awareness so that we can respond to whatever happens next. Through massage we can reprogramme and regulate the nervous system, returning the client to a relaxed state that enables healing at a cellular level, healthy social connections and higher brain function, because the, shutdown was enabled by the body and not the thoughts. This is why psychological therapy alone often fails with early trauma, because it doesn’t deal with the root of the problem, only the symptoms.

DYSREGULATION OF THE NERVOUS SYSTEM

Trauma arises from the reduced ability of the nervous system to regulate bodily functions properly in order to heal rather than from the traumatic event itself. This is known as nervous system dysregulation and it restricts healing because the bodily systems are unable to connect. The sooner the nervous system is regulated, the earlier the stress is released, and the sooner the client will  generally function better, have a more efficient immune system, improved digestion, more restorative sleep and they will generally feel more in control.

HOW DO WE RECOGNISE UNDIAGNOSED TRAUMA IN A CLIENT?

 In cases of severe trauma such as abuse or military service, flashbacks and uncontrollable anger of PTSD are often evident, but in those suffering from early and developmental trauma, the nervous system shut down early leaving them to adapt to life with minimal access to the deactivated state and to the potential for healing and regeneration, so any signs can be misread for personality traits. However,  trauma may also be exhibited in various medical conditions, which we may pick up on in our clients when a few issues start to build a bigger picture.

PHYSICAL AND EMOTIONAL PROBLEMS

Heart disease                                                                    - ulcerative colitis

Obesity                                                                                - Crohn’s disease

Chronic fatigue syndrome                                            - osteoarthritis

Addiction                                                                             - depression

Sleeping problems (insomnia, sleep apnoea)              - anxiety

Anorexia nervosa                                                             - panic attacks

Osteoporosis                                                                     - low self esteem/self worth

Adrenal fatigue                                                                 - helplessness/hopelessness

Fibromyalgia                                                                      - susceptibility to certain cancers

Irritable bowel syndrome                                             (specifically breast and melanoma)

Chronic pain

RELATIONSHIPS

Perpetuating toxic relationships                - trouble communicating/expressing oneself

Inability to set clear boundaries                 - difficulty with intimacy and deep love

Struggle to demonstrate/feel empathy  - no desire to connect/bond with others

Going blank in the middle of a                    - parenting struggles

conversation

PRODUCTIVITY

Procrastination                                                 - resistance

Mental blocks                                                    - trouble focusing (brain fog)

Dissociation                                                        - the need for perfection

Never being good enough                            - playing small

Fear of failure                                                    - fear of success

Trouble asking for help                                  - lack of inspiration

No sense of real purpose                              - lack of drive

Inability to move forward                             - scattered thoughts

The problem in terms of recognising trauma is that it comes from different sources and untreated trauma has many forms, so while a life event may not seem traumatic on the surface, survival stress may not be immediately obvious, and repeated subtle stresses can be more difficult to overcome than bigger stresses because they really become integrated in our lives.

Common indicators of repressed trauma that we may identify through conversation with our clients are:-

• RESISTANCE - becoming stuck in survival mode means we often feel unable to move forward  due to overthinking. Suggesting behavioural strategies to overcome this eg.  routines and being answerable to motivational external forces, may not work because the freeze response in the autonomic nervous system, resulting in an internal lack of drive to move forward, inhabits more storage in our overall physiology. Therefore, it will always surpass higher brain based strategies such as goal setting. External motivators may not be successful because new tactics are constantly required to get things done.
• GOOD NUTRITION BUT STILL UNWELL - clients with unresolved trauma often suffer with chronic health issues and inability to lose weight despite regular exercise and a healthy diet, because the physiological system is still stuck in the freeze response, leading to slower metabolism, energy stores being locked down due to the constant perceived threat and insufficient oxygen supply at a cellular level. The primitive part of the autonomic nervous system will always override these healthy behaviours.
• ANXIETY AND FEAR FOR NO REASON - constant anxiety, fear and panic attacks are common when stuck in the freeze response, and no amount of positive thinking, behavioural strategies or healthy routines seem to help because the autonomic nervous system is still fighting a perceived threat, so the survival patterns continue. Certain sensations in the body will then arise when we try to release this stored up stress:-

• Tightness in the throat                   - Feeling nothing in our immediate awareness
• Butterflies                                           - Inability to connect to internal body space
• Feeling spaced out                           - Feeling like you don’t have enough air
• Feeling constantly on edge          - A racing heart rate

These can be overwhelming enough to feel like a heart attack. Lack of understanding about how traumatic stress is released means that we fear these intense sensations, so the stress gets buried deeper. Massage can help clients who are living in a disembodied reality to heal and release stored survival stress by improving mind-body connection and sensation.

• TOXIC RELATIONSHIPS AND SELF SABOTAGE – clients with unresolved trauma often demonstrate toxic relationship cycles and self sabotage, because they don’t judge situations correctly or have a good gut instinct when stuck in survival mode,  hence they don’t set boundaries. They may also participate in risky behaviours because if all they know are perceived threats due to the freeze response, they can’t accurately perceive dangerous situations or judge safe environments correctly. Inability to trust one’s own instincts leads to toxic relationships socially, romantically and with oneself and inability to express oneself or to move forward leads to self sabotaging behaviours.

• CHRONIC HEALTH CONDITIONS – reduced energy and inability to regenerate lead to various  health conditions, despite a lack of diagnosis. This may be because the doctors aren’t aware of or are uninformed about the effects of trauma, or don’t recognise the dysregulation of the nervous system which impacts on the body systems, hence people get labelled as a hypochondriac.

If the nervous system can be regulated, healing responses and immune function will be increased, reducing the occurrence of these chronic conditions.

HOW CAN WE REPROGRAMME THE NERVOUS SYSTEM?

While the survival response has its uses when we need protection from a real threat,  it must be deactivated shortly after, allowing the system to reset itself to a baseline level so that we can naturally self regulate. In early trauma where there is an unsafe environment, the ability to self regulate is substandard, so a high level of the stress response remains but this can only remain at such a level for so long, hence the freeze response in the parasympathetic nervous system takes over to keep us protected from perceived threats.

Various physiological responses happen with shock, which preserve the tissues and numb the mind during trauma, but when constant they can be destructive, for example, bradycardia, hypotension, release of analgesic chemicals and a circulatory shift towards the core to protect vital organs, hence pale skin during shock.

There are things that we as massage therapists can do to help a client reprogramme during the course of a treatment.

• IMPROVING SELF AWARENESS

“Awareness also means learning what the signs of stress are in our own bodies, how our bodies telegraph us when our minds have missed the cues….the physiological stress response is a more accurate guage of the organisms real experience than either conscious awareness or observed behaviour”

(Gabor Mate)

We have 2 types of memories:-

• EXPLICIT (DECLARATIVE) MEMORIES – memory of an event with explicit details
• IMPLICIT (PROCEDURAL) MEMORIES – where we don’t have the tools to be able to process an event from a somatic and survival point of view, so the protective instructions are still trying to complete inside the body, causing tension

Therefore, trauma is in the body as well as the conscious memory, and the higher brain needs the correct information to be able to heal at nervous system level, so that when we enter survival mode again it will take over. By developing awareness of ourselves individually and with the surrounding environment we become more aware of feeling tension and bodily impulses, and slowly learn how to feel and follow our impulses ie. we can help clients tap into their internal physiology and recognise when it is trying to tell them something and to orientate to their external environment.

• SUPPORT AND COMMUNITY

A supportive and protective social structure is essential to cushion people from stress, heal trauma and self regulate, as positive social experiences impact on the social engagement portion of the parasympathetic nervous system, enabling connection to others, and on a physiological level by self regulating the heart rate and blood pressure at times of stress. Without a social support we are susceptible to falling into a survival mode, negatively impacting our health.

• UNDERSTANDING OUR OWN PHYSIOLOGY

Understanding our body needs brings about an internal shift  in how we connect with and follow our impulses, eg. autonomic nervous system impulses for muscles to contract. If we are to heal stress responses, we must be able to feel them and to address the source of the body’s stress response in the primitive system.

THE KIDNEY/ADRENAL INTERFACE - The adrenal gland secretes adrenaline and cortisol as part of the stress response, and if in constant activation, this will cause burnout.

THE GUT/BRAIN INTERFACE - The vagus nerve assists with complex processes in the digestive system. Often clients with PTSD may also have digestive issues such as IBS.

THE BRAIN STEM AND UPPER SPINE - The autonomic nervous system automatically orientates towards the core structures to protect us in survival mode, so working in a non-intrusive way in these areas is important in overcoming the stress response.

THE EYES

• FEELING DISCOMFORT AND FEARS

Reliving past events is common as we start to understand the survival stress response, and this may include fight/flight/freeze reactions, because fight and flight may not have been safe options at the time of initial trauma, hence why we froze and disconnected from our environment and our bodies. Massage is a good way to rebalance the nervous system, release tension and consequently gradually release emotions that surface, in a manageable fashion to deactivate the stress response. It is important to be aware of how ready a client is to confront certain experiences and for these emotions to surface. In the early stages a deep tissue massage may be too much or they may not be ready to release a lot of emotions so the treatment process may need to be a slow one. There may be a need to alternate between a painful and triggered state of arousal and a more pleasurable calm to make the massage treatments more manageable for the client. The treatment room also has to be a safe space for the client who is still early in the healing process and they should be encouraged to gently let the tension go but this can bring with it feelings of anger or aggression and the therapist must be understand that this is all part of the healing process and not to be taken personally.

• BUILDING CAPACITY TO HEAL

By increasing capacity, social connections and understanding of our physiology, clients can process triggers quicker allowing stress to be released more quickly before it causes avoidance, freeze response or dissociation. This means that we become more self aware or ourselves and the way we move and improve our diaphragmatic flow, not only our thoracic diaphragm which helps us to breathe, but also the other diaphragms in the body (tentorium cerebelli, tongue, thoracic outlet and the pelvic floor) which store unprocessed emotions. Survival stress causes the diaphragms to contract, increasing anxiety and physical pain, but if as massage therapists we work on the diaphragmatic areas individually and the systems that work between them, we can improve healing capacity by releasing stored stress.

It is also important that massage therapists remember that building a baseline level with the right practices will take longer in a client with early and developmental trauma, because these clients will not have experienced internal safety due to their dysregulated nervous system, so healing methods may be overwhelming and extra care must be taken to avoid opening them up to their stored survival stress before they have the capacity to handle emotions that may be released.

HOW DOES MASSAGE HELP SURVIVORS OF DOMESTIC VIOLENCE AND TRAUMA?

In addition to benefits of massage already mentioned in terms of the stress response there are further benefits:-

• The massage therapist can be a confidant – a relaxed client will often start talking about personal things that may not be discussed with anyone else. Bruising which may otherwise be covered by clothing, can be seen, potentially bringing about a conversation. It can be a passive form of asking for help, of showing someone they trust the bruises on their soul and body
• For victims of domestic violence, massage can offer a time of refuge and healing with someone they trust
• Massage therapy can be used in a recovery program, reducing stress and anxiety and encouraging relaxation, which allows an abused client to reconnect with their body in a positive and healthy way, and to rebuild trust in a safe place with a compassionate and skilled therapist. This can allowing them to function rather than dissociating, which is used as a defence mechanism to protect themselves from fully experiencing the abuse.
• Human touch can bring out hidden trauma, demonstrated as changes in skin tone, muscle tension, voice intonation, gestures and quality of contact.
• Even after victims of domestic violence have escaped, they bear physical and emotional scars, having been repeatedly made to feel not good enough, which impact on their health. Massage can be rejuvenating, allowing the client to heal on the inside and out, putting their struggles aside for an hour and recognising their value.
• The body remembers trauma, and massage can relieve stored trauma and tension.
• Many victims of trauma are often not present in their bodies, and massage can ground people and create a feeling of safety again
• Being believed and respected is transformational and can be more of a potent intervention than a specific treatment, so this can be incorporated into the intention of the therapist.
• Massage can honour the client for herself, without being objectified or judged.
• Massage re-educates the nervous system in order to heal and allow the client to feel safe in their own skin. Talking therapies do not address the physical scars.

 However, there are some precautions that the therapists should take:-

• Be observant – ask client about unexplainable bruising or cuts

• During a massage a client may have flashbacks of past trauma or abuse

• Listen to your client- both verbal and non verbal communication and don’t be afraid to ask questions, particularly about client admissions of chronic fatigue, joint or muscle pain, nightmares or a weakened immune system.

• Be supportive, empathetic and compassionate – victims of abuse or trauma are often unable to adequately communicate their needs, and may have problems defining boundaries, so it is up to you as the professional to help with this. Take care to follow proper procedures eg.draping and where you place your hands and body during a massage session.

• if you suspect or know that a client has been abused, avoid deep tissue techniques as they may be perceived as unsafe or encourage flashbacks to the abuse.

• Shock and trauma are locked in the body and touch will activate it. If there is resistance at any point, either physically or emotionally, don’t push

NEUROGENIC TREMORS

Clients with PTSD or unresolved trauma may experience neurogenic tremors during a massage so this another thing for therapists to be aware of.  Wouldn’t it be great if we could simply shake off stress to maintain homeostasis in the way that an animal does when it has been attacked, but instead we suppress stress due to social conditioning and fear of being seen as weak, causing dysfunctional and chronic pain patterns to develop. Sometimes when there has been a continued stress response and the adrenal glands are in overdrive, the central nervous system will instinctively get rid of excess tension through rapid muscle contraction to relax the body, sometimes accompanied by heat or feelings of release spreading throughout the body ie. neurogenic tremors. This shaking releases stress hormones such as adrenaline and cortisol, enabling us to deal with the threat so that we don’t remain in survival mode. Neurogenic tremors are the result of a complex neuroendocrine system overcoming an over-active hypothalamus-pituitary-adrenal axis in order to  release emotion and restore homeostasis. Clients who have suppressed emotions from an early age may have lost the ability to re-calibrate our nervous system in this way, hence why emotional trauma is stored in the muscles. Individual neurogenic tremor patterns will vary according to past history and experiences, upbringing and patterns of tension, and range from large amplitude tremors with significant shaking, often due to a large amount of superficial tension being broken down, to more of a vibration that moves through the body as it relaxes.

Clients with PTSD will be more prone to neurogenic tremors because the body is constantly anticipating a threat due to being stuck in the freeze response, so they have excess energy trapped in their bodies, contributing to chronic emotional and physical pain. They will often suffer from high blood pressure,  deposits in the arteries and changes in the brain leading to anxiety, depression and addiction as a result of constant stress.

Massage allows these therapeutic tremors to occur in a safe and controlled environment, allowing the body to rebalance itself as it releases years worth of deep rooted tension and trauma and rejects the fight or flight response, calming the nervous system in the process. The brainstem will then initiate a release of the deep physical tension that pushes the client into defensive postures. If the client experiences  intense emotional release alongside neurogenic tremors, potentially with recollections of past trauma, they can straighten the legs or roll onto their side to stop it.

CONCLUSION

After psychological therapy for the initial trauma, shock may still be experienced, revealing itself through somatic issues which are often unresolved, but through massage with an experienced therapist who understands the physiology behind trauma, these dominant responses in the autonomic nervous system can be stopped enabling the client to have a healthy response to any future threats. This allows the client to enjoy not only physical movement, but also productive relationships and freedom to express themselves. Even minimal touch, when combined with respect and a safe environment, can calm the nervous system and allow transformation at a cellular level, bringing about resources such as positive human contact, which were previously unavailable.