‘Massage breaks the pain cycle’: the return of touch – after almost two years without it

In a pandemic that has meant keeping 2 metres away from one another whenever possible, it appears that physical contact is beginning to return. Even handshakes are making a comeback: one poll found younger people were shaking hands again, although older generations are more uneasy about it. “We are wired to respond to emotional touch,” says Francis McGlone, a professor of neuroscience at Liverpool John Moores University. “My analogy is that [touch is] like a vitamin – if we are depleted, there are consequences in terms of our physical health. I make the same argument about the C-tactile afferents – the nerve fibre that evolved in all social mammals to provide the reward associated with close physical contact. When the fibre is stimulated, it does a number of measurable things – it lowers heart rate and it lowers cortisol, the stress hormone.” It’s one reason, he says with a laugh, he believes so many people got pets during lockdown: “That’s the brain recognising ‘I need to touch something’.”

For the pet-less, touch-starved, skin-hungry among us, physical contact is a welcome thing. Even before the pandemic, we were living through a “crisis of touch”; perhaps the enforced distance of the past 18 months has made us realise how vital touch is after all. For the people whose jobs rely heavily on touch, it’s been a particularly difficult time. Here’s how they are navigating its return.

I haven’t run any group workshops since the first lockdown: it’s still too early, and it doesn’t feel responsible yet. Some of those who come to me are nervous around touch, they want to get more comfortable with it, and some are desperate for it; they don’t have enough of it in their lives.

I still run one-to-one sessions, but for a long time I didn’t. With touch, very often there’s a backstory. For some, it’s purely about being in an unconditional space where somebody caring is holding their hand while they talk. For others, it might be that they had a childhood full of neglect, and now they just want to be held. I have, for two hours, sat with my arms around somebody in full foetal position and just held them. Slowly they just unfolded.

Touch is the primary form of bonding, so without contact, even in a subtle way – we’re still talking on the phone, we can still go for walks, but we haven’t touched – there’s something lost. Touch is all about happiness, relaxation and stress reduction. It is about that feeling of connection to others. Even if it’s a simple handshake, there’s a bond. When I think about what is lost on a friendship level, and on a society level, I do feel sad about it.

Some people who have come to see me said they hadn’t been touched for nearly two years. The touch in the sessions, and the connection that comes with it, have been very important to them. I also get a joy out of it, I get the benefits of the oxytocin. I did really miss it.

Having gloves on makes quite a difference. From the nurse’s point of view, you don’t feel as if you’re actually making that contact with the patient. We do quite a lot of things that reassure – hold their hand if they’re upset, or put your arm around them – but we were encouraged to keep our distance as much as we could. My daughter-in-law really struggled with it: she works in a hospital and said that, with a dying patient, she felt really awful because she was holding his hand through a plastic glove. We’ve had to learn to stand back from patients, which is difficult.

At the beginning, we were wearing a full gown, a pair of gloves, a mask and a visor, so there was a complete barrier. When we started to understand more about how the virus is transmitted, and we started the vaccines, the guidelines were eased. You get close to patients if you need to – for a smear test, for example, or a vaccination – but we still keep distance where we can. And actually, some patients are scared and don’t want you in their space. Sometimes, you have a really upset patient that you have to try to console in a different way; you have to verbalise your reassurance or your empathy.

Touch is fundamental to the connection between a nurse and patient, to make them feel that you hear them, and that you understand what they’re going through. We definitely missed it. I think touch was something we took for granted, and now it has become something we don’t take for granted any more.

I believe the feeling of touch really helps when you’re feeling low. Touch is a big part of my job. The skin prep – cleansing, moisturising and massaging someone’s face – is such a lovely, relaxing feeling. People love touch. Even someone just putting their hand on your shoulder gives you that good vibe, and I think a lot of people missed that.

We weren’t allowed to work until the middle of August last year, although I did a lot of teaching online. To begin with, I was nervous going back. I’d wear a mask and a visor; I was washing not just my hands, but my arms as well. People would arrive with their mask on and they didn’t remove it until I was about to do their makeup. I tried to stand to the side of people more, instead of directly in front of their face. I do a lot of weddings and, instead of the big wedding parties that used to be in the room getting ready, it was just me and the bride.

It never made me question what I do because I love it. The first time I had my makeup done, it made me feel so good, and I’ve always wanted to give that feeling back to others. A lot of people want to feel someone touching their face. Getting their makeup done by someone else made them feel special.

This time last year, people were saying: “You’re the first person to have touched me, outside my family [since the pandemic began].” That’s a privileged position to be in; it’s such a big deal to people that haven’t been touched for so long.

It was frustrating not to be able to be hands-on. Over Zoom, I was showing patients stretches which try to mimic the care I would usually give, but sometimes what they really needed was for me to get into those muscles and use my hands to do the manipulations and the soft-tissue work.

We advised that practitioners return to urgent care at the end of May last year, and by the middle of June most chiropractors were able to go back to seeing all patients. We had an enhanced infection-control procedure, we had PPE that we’re still wearing – gloves, masks, aprons. I wanted to make sure that I was creating a safe space, because when people come in to see the chiropractor, they’re usually in a bit of pain, so that makes them nervous and anxious anyway.

With touch, it’s always important to remember individual differences. Some people really don’t like being touched, but for the majority, I think that power of being hands-on is a really important part of our role as chiropractors. We spend years developing that fine-touch technique. If you’re gentle, but firm and in control, that can be really powerful for a patient.

I think many of us were lacking in touch anyway, but more so through lockdown. I’ve really noticed how much emotion and stress people are going through and how much they have been holding that in their bodies. I’ve found that I’ve been doing more of a nurturing touch than a deep-tissue-style massage; people are wanting gentleness more. The facials that I do all involve massage, for people who hold a lot of tension in their face and jaw. A lot of people have been clamping down and holding their breath, so their jaw is really tight, which affects the neck and shoulders. A lot of young people, going back to school, have been coming in with these issues.

When clients returned after lockdown, some hadn’t been touched for months. It was a real shock to the senses, so there was a lot of emotion. In a lot of the treatments I do, I have been holding people’s hand just so that they feel held. We’re going to see more conditions and problems come up over the next year or so, because people have really had a lack of support. We’ve started asking ourselves questions of what we need, and what we have been lacking.

During lockdown, it was really strange for me not to have that physical contact through work. It made me aware of how much I need to have that contact with people. As soon as I got back into it, I thought, “this feels so good”.

From March to July last year, we could operate over Zoom but we postponed hands-on treatment. It was frustrating. There were clients in need of manual therapy, but we just couldn’t do it.

I think patients were initially cautious about coming back, but the feeling of touch and being hands-on straight away puts the client more at ease. It breaks down that barrier, particularly the barriers that everyone’s become used to over the last couple of years. I don’t think it’s any coincidence that we always end up building a really good connection with our patients.

There are multiple uses of touch. It gets the client feeding back to you on how it feels to be taken through a movement. When we’re educating people in the gym with rehabilitation, sometimes you’ve got to be hands-on, making sure the client’s aligned properly, from a biomechanical point of view.

We find that massage helps break down the pain cycle. If someone’s coming in and they are very tense or they’ve got pain, manipulating the tissue doesn’t necessarily make it heal straight away, but it breaks that pain cycle, and the client feels better at the end of the session, whether it’s just by warming the area or increasing the circulation, or the release of endorphins and just making them feel relaxed. There’s a reason why, if you bang your knee for example, your natural reaction is to rub it. It’s built into us. If the patient feels better at the end of a session, they’re going to be more adherent to doing their exercises and following what we advise.

I still do haircuts for the people whose hair I cut when I first qualified, and you create a unique relationship with a client. They come to you, they confide in you, and it’s difficult when suddenly it feels as if there is distance between you. Before the pandemic, most clients would have a hug or a kiss. It’s as if you’re seeing a family member, and not hugging them makes you feel slightly uncomfortable.

Hairdressers were one of the first [professions] to reopen after the first lockdown. We had clients who really didn’t care about the situation – I was struggling to make them wear masks – but we also had people who were almost shaking with nerves and anxiety because they were so worried. In certain situations, you can’t avoid being face-to-face – if you’re cutting a fringe, for example. I got used to working around a mask quite quickly; getting to know new clients took longer, and it was harder, but masks weren’t a massive inconvenience.

Cutting hair is very personal; you’ve got your hands all over somebody’s head. Half of a haircut, I think, is about connection, and I would say that a large percentage of the reason people come back is because of that relationship.

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