What is interoception (and why does it matter)?

by Aran Bright

According to Wikipedia, interoception is contemporarily defined as the sense of the internal state of the body. The Wikipedia entry on interoception is surprisingly comprehensive and interesting, including a brief history and etymology for the word nerds amongst our ranks.

So WTF is interoception really?

Interoception could be seen as the scientific term for how someone feels. More technically, though, interoception is the internal bodily sensations, such as:

• breathing
• pulse
• nociception
• muscle tightness.

Interoception also includes sensations of bodily systems, such as:

• cardiovascular
• respiratory
• gastrointestinal
• genitourinary;

and autoregulatory systems and sensations like:

• thermoregulation
• endocrine
• immune
• soft touch.

Current definitions of interoception generally don’t include pain or proprioception as part of interoception but they are closely related.

This short animated video gives a useful overview of the terrain. Even though it’s aimed at exploring the connections between interoception and autism, it provides some clues about why the concept of interoception might be something that massage therapists could use in practice and in self care.

 Why are bodily sensations important?

Recent research, for example, here (pretty darn heavy!), here (very readable) and here (rewarding for the brave) has shed light on how interoception relates to pain and all sensation within the body. This has a huge impact on what we do as massage therapists because most of what we treat is sensations created by the nervous system that actualise the brain’s best representation of what is going on within the body. Most of the time, the brain does this really well but sometimes it needs a little help.

Pain, like interoception, is very real, but you can’t put it in a cup or take a photo of it, and you can’t objectively measure it. You can only measure someone’s experience of pain.

Have you ever tried to measure how much cold air hurts your face?

Why is interoception important to massage therapists?

For a long time, we have been trained to think about muscle knots, tight fascia, joints that are out or locked, and all sorts of physiological maladies that may occur. However, research is increasingly showing that many of these previously used concepts are fallacies and that manual therapy has, at best, a minor impact on the physical structure of the body.

BUT … we do know that massage and manual therapies are an effective means of treating pain, including chronic pain. While the effects are only mild to moderate, they do meet the criteria required for a clinically effective method for treating pain.

The simple conclusion drawn from this is that manual therapies can be effective for managing pain and soreness via changing the ‘output’ of the nervous system. One of the ways this might be mediated is through interoception. This means that massage is more likely to change our perception of what is going on in the body rather than actually changing the physical structure of the body. Tasha Stanton’s recently published findings on perceptions of stiffness are relevant here.

It is likely that it’s these central changes or changes in brain function that lead to decreased pain and improvements in function, demonstrated by range of motion and motor recruitment tests.

Does this spell the end of manual therapists being human bulldozers?

For a long time, manual therapists were the ‘go to’ for getting fascia lengthened, knots rubbed out and spines realigned or put back into place. Manual therapists have kind of been human bulldozers, required to pummel, crush, crack or stretch the body into better shape. Anyone wonder why massage is such hard work?

Is this really the most effective way to think of massage? Should we be thinking of ourselves differently? Should we be metaphorically massaging the brain instead of the brawn?

Interoception, and the practical application of what we’re discovering about it, may change how massage therapists approach treatments.

Why your client’s interpretation of what you are doing matters more than what you are doing

Our increasing understanding of placebo shows that the brain has powerful pain modulating mechanisms that can make our body more (or less) sensitive depending on how it functions. Manual therapy may be able to tap into these mechanisms. There is one important factor with placebo – the client has to be believe it will work.

A client who likes strong pressure typically doesn’t feel better unless they have that style of treatment, much like someone who is sensitive can feel worse with too much pressure. Or they want to hear a crack or be stretched or needled. The client’s interpretation of what sort of treatment they received will matter more than the actual type of treatment. Clyde Andrew’s alluded to this phenomenon in last week’s AMT blog post.

Integration, intersubjectivity and interacting

Instead of working on people, why not focus on working with people?

We are not that human steamroller needing to put bodies back into place. Understanding the sensations that someone is feeling (interoception) will begin the process of allowing a client to reintegrate into their body.

If the sensation therapists provide through manual techniques is sufficient for a client’s nervous system to decide pain is no longer an appropriate sensation, then we see changes in how clients feel. This is because we’ve changed the client’s perception of their body.

This process of interacting with a client on a neurological level has been called an interactor model of therapy, as compared to a traditional operator model. The interactor model has a requirement to always check how a client perceives a treatment. Is treatment being received in the way the therapist intends? Or is the client experiencing a treatment that may actually make things worse for them?

The concept of intersubjectivity describes how, between the client and manual therapist, a view is formed about what is happening. Intersubjectivity is neither objective nor subjective – perhaps a shared subjectivity is the best way to describe it. Manual therapists need to constantly check with the client’s impression of what is occurring during a treatment to ensure that client and therapist are sharing in the therapeutic process together and communicating optimally.

AMT’s post-conference Workshop on interoception

Interoception is a more complex than can be conveyed in a short blog post. On Sunday 22 October 2017, I’ll be co-presenting a post-conference workshop with Colin Rossie on “Interoception – why you are the best person you could ever hope to meet”. We’ll be digging deeper into how massage therapists can integrate interoception into their treatments. If you haven’t signed up to attend the conference, you can still register here.

About the author:

Aran Bright started his career as a massage therapist in 2002 after graduating from the Australian College of Natural Medicine in Queensland. In 2006, he completed his Diploma of Remedial Massage and, in 2007, his Bachelor of Health Science in Musculoskeletal Therapy. Aran has also graduated from University of Queensland with a Graduate Certificate of Sports Coaching, completed a Certificate IV in Fitness and an Advanced Diploma of Myotherapy. He currently runs his own businesses, Bright Health Training and Brisbane Workplace Massage, with his wife, Sheree.