04/09/2026
How to be Tissue Trauma-Informed.
With mental health being promoted in all aspects of life, manual therapy needs to be considerate of what this means for us as healthcare providers; in the least we should consider taking a course in Trauma-Informed Care. There are numerous free courses online providing an overview of topics to establish a baseline of knowledge. We should also be considerate of what this means for us on the cellular and tissue level; tension is tied to emotion.
What does being trauma-informed mean?
Firstly, there is an acknowledgement and recognition that trauma is multidimensional: trauma impacts biology, neurology, and psychology. By extension, trauma may also impact behaviour and sociological aspects of life. Supporting survivors of trauma minimizes re-traumatization while providing safety and empowerment. The symptomatic picture of trauma is variable and systemic with treatment often requiring a team approach.
Generally, a trauma-informed approach will recognize the four R's as established by the Substance Abuse and Mental Health Services Administration (SAMHSA):
Realizing - the widespread impact of trauma
Recognizing - the signs
Responding - by integrating knowledge into practices
Resisting - retraumatization
Further, there is also consideration given to safety and trustworthiness, empowerment and choice, cultural competence, and application of universal precautions that protect people who seek help but may not share (for various reasons) known experiences of trauma; physical, emotional, and psychological safety must be exemplified. We must consider our systemic biases.
As manual therapists, we can aid in supporting choice, building confidence, and giving back aspects of control that allow for small daily victories. For example, these victories could come in the form of performing daily stretches. Choosing to actively perform these exercises with consistency and efficacy is a form of success. This can build confidence.
What does being "tissue trauma-informed" mean?
We are manual therapists. We know that releasing tension can occasionally lead to an emotional reaction. The relationship between emotions and tension is bigger than the discussion of this article. However, many of us have experienced it on our tables more than once. From a massage therapy and osteopathic perspective, we must be observant of the vulnerability of tissue. This is different to tissue fragility.
"Part of the beauty of touching is that the body, especially at the level of the fine motility patterns, will tell you the truth" - Hugh Milne
We must approach the body with humility and patience. We must provide an ear to listen. We must be compassionate in our touch and transparent in our message. Trust is paramount. Vulnerability has a palpable presence. It often feels like either an absence of "energy" in the body or a hesitance of the tissue to touch. This level of palpation skill requires experience, practice, and awareness. However, gaining trust of the tissue will yield greater results.
Tension will not be forced into submission. We may feel tension beneath our hands, but the body may be either unwilling or unready to let it go. We have to be present to this. If the body is willing to accept treatment we may have to be in contact with the anatomy until it has become physiologically "ready" to participate in the work required to facilitate change. This waiting period will vary depending on the longevity of relationship to the patient, astuteness in discerning readiness, and quiet observation.
How does emotion present in tension?
In general, feeling somatic tension in tissue is enough in most cases. However, we also need to be open to the mood of tension. Some restrictions are overly eager when they realize help is at hand. Other tension may cower at touch and need to be gently coaxed out of its hiding place. Sometimes tension needs a moment to gather its resources to support the upcoming changes. Whatever the tissue presentation, we must be observant of the receptivity of the body to our techniques.
How do we quantify this sensory perception? It is a skill that is learned through time, presence, and openness. Like feeling temperature change in tissue with inflammation, vulnerability has a frequency that resonates. There is a tangible quality to it. Tension in anatomical form is not the only sensorial sign of dysfunction. We need to see the individual in their entirety. Body and mind.
Massage therapy is framed around the hard sciences. However, there is a philosophical and spiritual aspect to massage therapy that is more difficult to quantify. It goes beyond structure. It will not have meaning to everybody, but it can be taught. It is these skills that will help to discover when tissue may need extra compassion. This is being tissue trauma-informed.