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  • Writer's pictureKirby Clark, MMT

Touch Modifiers

Updated: Dec 19, 2023

Do you know the twelve variations of touch? Touch is just touch isn't it? How can touch have variations or be modified?

There are twelve, count ‘em, TWELVE touch modifiers. Some of them are co-dependent, meaning that they impact each other or are connected in some way to influence each other. Other modifiers are completely independent and operate all on their own.

Pressure

The biggest and most talked about touch modifier is Pressure. It’s one of the first things taught in massage schools and one of the first things clients will bring up during an intake. We all want to talk about the pressure expectations we have for a massage. Pressure can easiest be thought of the amount of compressive force/load applied to a client’s soft tissue. It is common for pressure to be categorized as “light”, “medium”, and “deep” (some will also include “firm” as a mid-way between medium and deep, but that has never made sense to me. If a therapist is making direct contact with a client’s body- the pressure is “firm”.) I am also fond of using a pressure scale too, “0” for the lightest amount of pressure while maintaining contact with the client and “10” for the deepest amount of pressure imaginable and on the verge of being uncomfortable.

Point of Contact

Point of Contact can influence the amount of Pressure to some degree, but it really has a big impact on the next modifier, Magnitude. Point of Contact refers to the location or body region where contact is made between therapist and client as well as the broadness of the contact between the two. What do I mean by broadness? I mean, is the therapist using a very narrow contact like their fingertips or are they using a very wide contact like their forearms? Does the therapist use a soft fist amount of broadness, do they use a wide-open palm, or do they employ a lofty amount of elbow contact?

Magnitude

Pressure + Point of Contact = Magnitude. Another word for Magnitude can be “Intensity”. The depth of Pressure and the Point of Contact all impact the feeling of Magnitude for the client. If a therapist is using a deeper amount of pressure, they should be using a broader point of contact. If I’m working deeper for clients, I have to use my forearm and elbows. Not only does that afford me more leverage(and Pressure), but it prevents injury of both of us. If the Pressure is deep and the Point of Contact is narrow, the client’s soft tissue will tighten to guard against the perceive threat of compression injury. This is why I am so insistent on client’s relaxing as much as possible and staying in the feedback loop to communicate their experience.

Direction

There are several different ways to think of direction. Which way are the massage strokes being applied? A major key that therapists learn in school is Centripetal versus Centrifugal strokes. Centripetal meaning strokes that are made in the direction TOWARD the client’s heart, this is a general rule of thumb in massage- but it really becomes a strict rule when working with Prenatal clients or performing Manual Lymphatic Drainage work. Centrifugal on the other hand is the opposite, making the direction of the strokes AWAY from the client’s heart, down toward the limbs or up toward the neck & head. Not to be confused with Proximal & Distal directional terms. Centripetal & Centrifugal are terms that are fixed with the heart being the anchor of determining direction. Proximal & Distal change depending on what position/anatomical plane the client is in and which body regions you are working with. In the simplest way (and the client in neutral anatomical position), Proximal means how close to the Center of the body something is and Distal means how far away form the Center of the body something is. Proximal & Distal are used to describe one body part/region in relation to another body part/region. Finally, a really major directional set of terms (at least for therapists) is Linear versus Cross(or Transverse)-Fiber. Linear refers to working along the lines or “grain” of the muscle fibers and Cross/Transverse Fiber direction means working against the “grain” of the muscles.

Drag

These next two, Drag and Speed, are so closely related they are practically twins! Drag simply means the amount of Compressive force (Pressure) used while gliding (Effleurage strokes) to create Tensile force on the soft tissue. Tensile force on the soft tissue creates a stretching of the tissue. Drag is so important in the Myofascial Release (MFR) approach to bodywork! Creating that stretch on the tissue to release the bindings in the fascial tissues that surround the muscles.

Speed

Speed is similar to Pressure in that it can be easily thought of in three different gradients, “slow”, “variable”, and “fast”. Slow strokes, generally speaking, tend to encourage mechanical changes and promote general relaxation. Fast strokes will increase motor tone and will stimulate the sympathetic nervous response or arousal of the central nervous system.

Pacing

Speaking of the Central Nervous System, did you know it takes the CNS 30 to 60 seconds for the nervous system to take the Pressure input of compressive force and focus on it? That’s not a lot of time at all when you contrast it to the 2 to 5 minutes it take the connective tissue (Fascia) to focus on Pressure? The touch modifier of Pacing plays a big part in this! How much time is the therapists spending on each muscle or body region? Is there enough time left allowed for everything to be addressed during the massage? I don’t bring these questions up to get clients riled up in a panic about the time constraints of their session. I’ve had my share of clients lift their heads in a panic, “are you going to work here?”, “is there enough time for you to work…?” There’s nothing wrong with communicating that you’d rather move on to a different body region but exercise a little trust that your therapist knows what they are doing in terms of Pacing. Often time, clients make the mistake of thinking that a longer session (90 minutes, for example) will mean better results. That isn’t necessarily the case- not everyone needs 90 minutes of massage. Especially if you have self-imposed boundaries like regions that cannot be worked on or Points of Contact that you don’t prefer.

Rhythm

This is another major one that therapists will often call “flow” when talking amongst colleagues. Essentially Rhythm (or “flow”) comes down to the regularity of stroke application and the intervals of those application. Is every stroke feeling even and rhythmic or uneven and nonrhythmic? Rhythm can have a lot of overlap with the next modifier, Transition. Do the strokes easily transition into the next stroke or body region? Or does the massage feel choppy and disconnected?

Sequence/Transition

Sequence refers to the order in which a treatment or protocol is performed. Some therapists prefer to begin working Supine (face up) while others (like me) begin Prone (face up). Some therapists begin work at the legs & feet; others start with the shoulders & arms. How does the therapist order the Sequence of each body region? Transition again means seamlessness in moving on from working one muscle group to another or moving into one technique following another. Transition also can mean how easily can the therapist/client transition from each position to the other? Recall from a previous post the four main massage positioning options: Prone, Supine, Side Lying, & Seated.

Frequency

When we talk about Frequency, we’re talking about how many repetitions of each stroke are made? The general rule of thumb for massage is the Rule Of Three that we’ll discuss more in a later post. During your next massage, see if you notice your therapist employing the Rule Of Three, making the same identical stoke three times to a specific region or muscle. Even more interesting, when does your therapist break the Rule Of Three? Not following the standard three repetition isn’t always a bad thing; some muscles are more responsive to treatment than others. Three passes of strokes may not be necessary. Therapists should keep in mind that Frequency is recommended to increase if post assessment of treated tissue reveals remaining dysfunction.

Duration

We touched on Duration briefly above. Duration can mean how long does each stroke last. Speed & Drag being big factors in Duration of individual strokes. Duration can also be used to describe how long a therapist spends on one particular muscle or body region, Frequency being a big player in that case. Duration most commonly is used to talk about how long does the entire session last? Again, having a longer session doesn’t guarantee better results or more relaxation. Some people don’t need a longer session if there is less to work on. Other people need a lot of time to work on just a specific region or two. Keep that in mind and when in doubt, discuss it with your therapist beforehand.

Intension

Finally, good old Intention! Possibly the most important Modifier of them all! Intention is EVERYTHING! Why is the therapist doing this in the first place? Why are they approaching each individual client with specific modalities or strokes as opposed to others? Is the therapists centered and grounded, working with selflessness? Is the Intention to benefit the client’s quality of life? And on the other side of the same coin, what is the client’s Intention? Is the client open to receiving treatment? Remember from my post about Massage Goals, you have to have a goal in mind when you book the appointment. If you don’t know what you want, how will you know if you don’t get it? Intention doesn’t have to make sense or be important to the therapist, it will become important once you share it. Again, the therapist should align their Intention to match the client’s goals. Often times when a therapist and client aren’t a good fit, it can have more to do with Intention being out of tune than it does with incompetence on either side. Every other touch modifier can be executed with technical perfection, but it all rests on having the right Intention in the first place. Everything rests on Intention. Intention is the driver for everything else that happens in a massage. Have an Intention in mind (whether you share it or not… although you SHOULD share it) when you enter the sacred practice of massage therapy. All else will fail (including the other other modifiers) if there isn’t a solid foundation of Intention.



Peace and Healing,

Kirby Clark, MMT, BCTMB

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