Massage Therapy and the Safe and Sound Protocol
Written by Autum Romano, LMT, and originally posted on autumromano.com.
I have been using the Safe and Sound Protocol (SSP) in my massage therapy practice for several months now and am seeing a significant decrease in my client’s pain. Some individuals carry extra tension in their bodies. They have hypertonicity, meaning they have tight muscles. Yes, we can practice mindfulness and awareness and drop our shoulders and focus on decreasing tension in our face, our jaw, our hands. But ultimately, the amount of tension we have in our skeletal muscles is determined by our nervous system. If an individual is in a mobilized state, her nervous system is in a fight-or-flight mode, and she will have extra activation or tension in her muscles. Dr. Stephen Porges explains this relationship between the nervous system and muscle tension in his Polyvagal Theory (PVT).
When I discovered his work and read the full PVT, I instantly understood why some clients continued to be trapped in pain patterns even when they had a dedicated self-care practice. Dr. Porges created the SSP to encourage a state shift in our nervous system to a setting of safety. It’s not creating neuroplasticity; it moves the train to a different set of tracks that have been there all along. I initially discovered SSP when searching for interventions to help my son who has a diagnosis of autism, dyslexia, dysgraphia, dyscalculia, and ADHD. Dr Porges’ initial research focuses on how the SSP impacts the population on the autism spectrum. SSP creates a setting of safety in the individual’s nervous system increasing their capacity for social engagement. For my son, this means increased eye contact, more prosody in his voice, greater communication, and less sensitivities to being touched. It’s profound really.
As I studied, many stored away questions started to be answered. Why did some of my patients struggle to make the necessary gains in physical therapy after joint replacements? There was often a disconnect between what they wanted me to work on to help them and what their body would tolerate. I began thinking of this phenomenon as body PTSD. Their nervous systems had not recovered from the trauma of surgery and was responding to my hands as if I, and massage therapy, was not safe. The body, and more specifically the nervous system, responded to me as if I was a threat. Yes, I could get the nervous system to calm down and upregulate the parasympathetic nervous system by avoiding the injured area and using massage therapy elsewhere; yet if I returned to the area in recovery, the nervous system would return to a mobilized state. Before you know it, the hour is over and not a lot of progress is made. Then I discovered SSP!
I started using it with a few individuals with frozen shoulder symptoms. I would put the headphones on them and play the music. I would work on the adjacent areas until I could see an upregulation in their parasympathetic system—scratching around the nose and mouth, stomach gurgling, and deeper, more relaxed breathing—taking anywhere from 7–20 minutes. Then, I would return to the injured area and right away things were different. Muscle tonicity was lower overall, and the superficial muscles were guarding less. The specific points that were struggling became obvious. These trigger points are where the true tension was all along, yet the other “guards” kept the doors closed to my hands. Suddenly, I could gently and specifically treat the individual troubled areas creating more movement in the shoulder. Hour long sessions were yielding wonderful results. Also, these clients weren’t experiencing tenderness post-session, which can often be the case with this type of work. Why? Because I wasn’t working against the nervous system. Their ventral vagal branch was activated, the train was on the track for rest, digestion, safety, social engagement and healing. Also, people’s bodies tell the truth to me about what is hurting in a new way. Old injuries uncover themselves to me and let me treat them and coax them into greater healing. These sessions project them into healing in a dramatic way. Often massage therapy can be a “wash, rinse, repeat cycle”; people have their perpetuating factors, and I do my work, and then I see them again at their next session, and we repeat. This type of work is still a part of my practice, but now there is new work happening with SSP. Sometimes I will discover a new holding pattern, release it, and the body fundamentally changes. When a pattern is interrupted, greater healing emerges.
These deep centers of pain and holding often store emotion. Our bodies are interwoven; we don’t store experiences that are pleasant—we store pain, fear, grief, and other difficult emotions. Uncovering them requires deep guidance on my part. Trauma informed care is necessary when working with these complex cases. More and more, I have been using Reiki to increase my ability to lend my regulated nervous system to their nervous system for co-regulation. Massage therapy is co-regulation. SSP with massage therapy is supercharged co-regulation. Sometimes there are tears, but not always. Sometimes my clients will share what is happening for them using language, sometimes not. Language isn’t the only way to process. Yes, naming emotions and events helps some, but not all. Having a therapeutic environment to process is the single greatest factor. This work is humbling and awe-inspiring. I am constantly amazed at people’s capacity to heal. Our bodies are intelligently designed to heal and regenerate. Yet, this only happens when the nervous system is in the safe setting. SSP creates the setting for healing and restoration to be possible. My research continues daily as I explore, learn, and expand my understanding of pain and the Polyvagal Theory.