06/08/2025
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ποΈ As manual therapists, we spend our days working through our hands. But what are we really influencing? In the skin and below lies a dense network of mechanoreceptors that detect stretch, pressure, vibration, and temperature as tactile discrimination.
π§ Another type of mechanoreceptor called C-tactile afferents are slow-conducting sensory fibres that help the brain make meaning of touch, influencing the perception of safety, connection, and care.
π Tactile discrimination, that is touch that identifies texture, pressure, and location like finding the edges of a coin in your pocket, travels through different neural pathways to the brain than the C-tactile afferents associated with social or affective touch. C-tactile afferents are linked with interoception, our eighth sense, and emotional regulation. Both types matter, but affective touch has a unique ability to influence how someone feels from the inside out. The result is that tactile discrimination provides the what, where and how of touch, and social touch provides the meaning of those touch characteristics.
π€² Whatβs more, placing a hand on an area where a client experiences pain can offer new, non-threatening sensory input, helping the brain reprocess that area as safe, supported, and less guarded.
𧬠But touch is more than neurophysiology.
βοΈ Force-based manipulations (FBM), that is what we might be doing to the local tissues by touch, still have a place in clinical work. When used appropriately, they may support temporary changes in local circulation or reduced muscle tone.
π However, these effects vary significantly between individuals from things such as health and age.
𧩠Therapeutic outcomes also rely on more than just the technique, they rely on contextual variables like therapist tone, intention, confidence, environment, and the clientβs beliefs, expectations and perception of safety.
π« The narrative of βfixingβ structure or βreleasingβ fascia is outdated. Current research shows that touch does not change tissue in the way we once believed. Instead, it modulates the nervous system, often via meaning, expectation, and co-regulation, not mechanical correction. If your client has ever been told that their scans or X-rays look normal but they are still in pain, this is not because some kind of restriction or dysfunction isn't showing up, or because something mysterious is 'stuck' in their fascia. They don't need any false unprofessional claims to add to their anxiety or stress.
π§ Pain is shaped by the full context of someoneβs life, including past experiences, stress, safety, and belief systems.
π¬ What doesnβt show up on a scan may still feel very real in their body, but sometimes the nervous system gets overprotective. The result is a decreased threshold of a client's threat response, and they can experience pain despite no dysfunction, restriction, or tissue injury.
π This is called nociplastic pain and is a category of pain from the International Association of Pain. It is very real and has scientific support, but is not directly linked to physical damage. Thatβs why meaning-driven, safe, and respectful touch matters to help the brain change its mind about the body.
β Pain is not always a sign of dysfunction, and change is not always the result of manual therapy force. The therapeutic potential of touch lies not in pressure alone, but in presence, respect, and relationship.
π§ Itβs time to move away from rigid biomechanical models and towards a more integrated understanding, where hands-on therapy becomes brain-aware, context-sensitive, and client-centred.
π Read more about the science of touch and how our profession is evolving:
π https://www.in-toucheducation.co.uk/blog/rethinkingtouch
