This is my latest analogy for handling related to Simple
Contact. I’ve been working on it for a long time and I think someone
out there might find it useful.
Imagine yourself standing on one side of a swinging door.
There’s no handle on your side, and your only task is to cross the threshold.
Unfortunately, every time you press on the door, an equal and opposite pressure
is exerted. The harder you press, the stronger it becomes. The opposing force
perfectly matches your own timing, and it cannot be deceived.
Given this, how do you get across the threshold?
Typically, manual care presumes that an effect will follow
a linear relationship between the force, direction and speed of the
therapist’s hands. Much has been written about the possible consequences of
external pressure, though precisely what actually happens remains open to
question. I’m suggesting here that something needs be considered before we
presume that our manual pressure will have any predictable effect, and that
“something” is the potential connective tissue response. Fortunately, it has
been thoroughly studied.
Josef Threlkeld, PhD. P.T. studied the effect of manual
care in the aptly titled essay The Effects of Manual Therapy on Connective
Tissue (Physical Therapy Volume 72, Number 12/December 1992). Please
note that this reference is the Journal of the American Physical Therapy
Association. After a prolonged discussion of connective tissue (CT) properties
(including fascia, of course), Threlkeld concludes, “If 100% of an
externally applied force could be transmitted to a selected portion of a
connective tissue structure, then it could be presumed that forces commonly
produced during manual therapy could produce permanent elongation…the
external forces, however, are not direct and are not completely
transmitted to a preselected segment of a CT structure.” The
dispersal of manual force is an inherent reaction to pressure, and evidence that
manual force results in connective tissue elongation that is prolonged or
therapeutic is extremely hard to find. (emphasis mine)
Dispersing and reducing the force of any outside pressure
is a primary function of the skin, and, as you might have already guessed, the
skin is the “door” I’ve been alluding to. It reacts to force with
efficiency and speed, and it does its best to match the force applied. Should it
be powerfully overcome, injury is likely. This, for instance, is what the boxer
seeks to do to his or her opponent. The skin is especially good at dispersing a
slowly applied pressure or a pressure that does not include a relatively sharp
edge, and methods of manual management that do not include rapidly applied force
with the knuckle would predictably be ineffective, at least in the fashion they
imagine themselves to be. In fact, this combination of factors led to the demise
of bare-knuckle boxing; it was too damaging.
I’m not suggesting that coercive handling has no effect at all, only
that the natural defenses offered by the skin cannot be ignored.
You might reasonably wonder why the skin is so defensive
and why it so clearly represents a door that resists our entry.
In answer, I’d refer you to a passage from Ashley
Montague’s classic text, Touching: The Human Significance of the Skin (Harper
1971): “The skin in common with the nervous system arises from the outermost
of the three embryonic cell layers, the ectoderm.
The ectoderm constitutes the general surface covering of the embryonic
body. The ectoderm also gives rise
to the hair, teeth, and the sense organs of smell, taste, hearing, vision and
touch--everything involved with what goes on outside the organism.
The central nervous system, which has as a principal function keeping the
organism informed of what is going on outside it, develops as the inturned
portion of the general surface of the embryonic body.
The rest of the surface covering, after the differentiation of the
brain, spinal cord, and all the other parts of the central nervous system,
becomes the skin and its derivatives--hair, nails, and teeth. The nervous system is, then, a buried part of the skin,
or alternatively the skin may be regarded as an exposed portion of the nervous
system. It would,
therefore, improve our understanding of these matters if we were to think and
speak of the skin as the external nervous system, an organ system which from its
earliest differentiation remains in intimate association with the internal or
central nervous system. As Frederic
Wood Jones, the English anatomist, put it, “He is the wise physician and
philosopher who realizes that in regarding the external appearance of his
fellowmen he is studying the external nervous system and not merely the skin and
its appendages.” As the most
ancient and largest sense organ of the body, the skin enables the organism to
learn about its environment. It is
the medium, in all its differentiated parts, by which the external world is
perceived. The face and the hand as
“sense organs” not only convey to the brain knowledge of the environment,
but also convey to the environment certain information about the “internal
“…Clearly, sensory stimuli at the skin level have to be
interpreted at the cortical level and the appropriate motor reactions initiated.
The skin itself does not think, but its sensitivity is so great, combined
with its ability to pick up and transmit so extraordinarily wide a variety of
signals, and make so wide a range of responses, exceeding that of all other
sense organs, that for versatility it must be ranked second only to the brain
itself. This should not be
surprising, for as we have seen, the skin in fact represents the external
nervous system of the organism. The
sensitivity of the skin can, however, be considerably impaired by the failure to
receive the tactile stimuli necessary for its proper development. In this respect, such influences as family, class, and
culture play a fundamental role.” (emphasis mine)
So, when you touch, deform or otherwise influence the skin you are actually altering something whose connection to the nervous system is rarely appreciated for its intimacy and embryologic, anatomical origins. In other words, to “get to” the nervous tissue, all you have to do is influence the skin. Unlike your efforts to influence the connective, contractile or vascular tissues, there is no intervening tissue to deal with-the skin is the nervous system, and when you understand that, you have removed the door. You don’t do this with force, stealth, deception or speed, but with knowledge and understanding. A distinct alteration in manual technique will surely follow.