Whitney Lowe:
Welcome to the Thinking Practitioner Podcast.

Til Luchau:
A podcast where we dig into the fascinating issues conditions, and quandaries in the massage and manual therapy world today.

Whitney Lowe:
I'm Whitney Lowe.

Til Luchau:
And I'm Til Luchau. Welcome to the Thinking Practitioner.

Whitney Lowe:
Welcome to the Thinking Practitioner.

Whitney Lowe:
Hi, this is Whitney Lowe and Books of Discovery has been a part of massage therapy education for over 20 years. Thousands of schools around the world teach with their textbooks, eTextbooks and digital resources. In these trying times, this beloved publisher is dedicated to helping educators with online friendly, digital resources that make instruction easier and more effective in the classroom or virtually. Books of Discovery likes to say, learning adventures start here. And they see that same spirit here on the Thinking Practitioner Podcast and they're proud to support our work, knowing we share the mission to bring the massage and body work community in livening content that advances our profession.

Til Luchau:
This is Til. Check out their collection of eTextbooks and digital learning resources for pathology, kinesiology, anatomy, physiology. They have all kinds of teacher resources too, as well as student resources at booksofdiscovery.com, where Thinking Practitioner listeners save 15% by entering thinking at checkout. Hey Whitney.

Whitney Lowe:
Good afternoon, sir. How are you doing?

Til Luchau:
I am very, very well. Thank you. Yourself?

Whitney Lowe:
Doing well also. Been on a little bit of a short hiatus here, so good to be back with you once again.

Til Luchau:
Are you going to tell us anything about that or is that a secret?

Whitney Lowe:
I think, no, it won't be a secret. At least for me, I took a little bit of time off and went and soaked up some sun and tried to do some mental health time. So I think we all need that every once in a while, so that's what I've been up to over the last couple of weeks. You've been busy, however, teaching a bunch of classes and getting stuff rolling.

Til Luchau:
Yeah. We launched a big class. I went to Alaska and had a great time in the classroom.

Whitney Lowe:
All right.

Til Luchau:
And then back.

Whitney Lowe:
In Anchorage or where were you?

Til Luchau:
Yeah. Anchorage.

Whitney Lowe:
Yeah. That is a beautiful part of the world and I do miss it sometimes. Used to live there for a while.

Til Luchau:
Oh, I'd forgotten that. Beautiful part of the world and hit it just right. We got there three days of fall or whatever it was, on my weekend. It was spectacular.

Whitney Lowe:
Yeah. Indeed a spectacular place. Well, we've got an interesting thing happening today. We're going to do something a little bit different than usual, which is I am going to interview you.

Til Luchau:
Oh, I'm so glad.

Whitney Lowe:
All right. So you wrote an interesting article for Massage and Bodywork Magazine recently on in interoception. And this is a fascinating topic and one that I think a lot of people don't understand real well, and I think it's highly pertinent to what we're doing in our field and a lot of what our work is about. So I want to talk a little bit more in depth about this and explore some of the concepts that you brought up in this article. So that's where our adventure is going to take us today.

Til Luchau:
I'm looking forward to it. How should we start?

Whitney Lowe:
Well, let's start at the very beginning with definitions. Interoception. Interesting word. Tell us what does that mean? What is in interoception?

Til Luchau:
Intero means interior, ception of course is perception. So it's perception of our interior. And that word has meant different things over the years. It used to be used almost exclusively for visceral sensation like, am I hungry? Is my stomach full? Is my bladder empty? Is my bladder full? But in the last couple decades, it's been expanded to mean any sensation from inside the body. So it's basically internal sensation in its most current usage.

Whitney Lowe:
Yeah. So I know I've come across some discussions of different terms that are similar. Exteroception, I guess, would be then sensations from the exterior of the body.

Til Luchau:
Yeah. Like touching something.

Whitney Lowe:
Okay. So that's exteroception. So external stimuli like texture, heat and temperature and those kind of things.

Til Luchau:
That's right.

Whitney Lowe:
Okay. That makes sense.

Til Luchau:
Yeah.

Whitney Lowe:
And then of course the term we hear a lot in our field to begin with the term proprioception. That also is internal sensation in the body. So what's the difference between proprioception and interoception?

Til Luchau:
Yeah. I am so glad we can have these conversations because this is such a minute little geeky detail that my wife just changes the subject when I try to talk about it. So it's great to have somebody to talk to about this stuff, because it's important to some of us. The difference between proprioception and interoception is that... well, I guess I should say that for years the word proprioception was used the way interoception is now. In fact, and during my education in the eighties and nineties, we used proprioception in the way we're using interoception now. That might have been just colloquial to our field. But the strictest definition of proprioception is awareness of position and space. And that's in the case proprioception is basically your brain figuring out where your limbs are based on joint angle. The basic data comes from joint angle. And that's the narrowest definition of proprioception. While interoception, like I said, is expanded to mean just about any internal sensation.

Whitney Lowe:
Wouldn't some of that information about position and space again... Well, maybe let me just backtrack a little bit. Because we know we're getting a lot of information, for example, from muscle spindle cells about level of load but at a particular joint angle. That is still proprioception? And it's not necessarily about position space as much as it is load that it's carrying and things like that spindle activity, that kind of thing.

Til Luchau:
I couldn't claim to speak authoritatively. But one of the simplest divisions really is about location. That's the classic distinction. Proprioception is about location. What location are your limbs in? And interoception is the rest of it. The thing you brought up is like the load on the muscle, is that... and part of it is how you about the load on the muscle, how you're reacting to that load on the muscle. All that gets bundled into the interoception puzzle as well.

Whitney Lowe:
And my assumption and we'll, I believe be digging into this in a little bit more detail. I assume that some of this gets a little bit fuzzy because some of the same receptors might be used for both kinds of information; is that correct? Or would you...

Til Luchau:
Can we wait till you ask about receptors and talk about that?

Whitney Lowe:
Yes.

Til Luchau:
That's a lot to say that.

Whitney Lowe:
We are going to get there.

Til Luchau:
Okay, cool.

Whitney Lowe:
Yeah. So just want to highlight that it's like, that seems like it might be one of those things that leads to some of the difficulties in making distinctions is that there is some crossover with some of those kinds of receptors there.

Til Luchau:
It's receptors or perhaps it's functions in the brain. Maybe the different functions are accomplished by the same areas of the brain or different team functions or network functions. So there may not be clear divisions.

Whitney Lowe:
Right. So tell me a little bit about this whole idea. I mean, this is for you and I especially, fascinating kinds of things for us to delve into. And like you said, we could geek out on these discussions for a long time.

Til Luchau:
Yes.

Whitney Lowe:
But let's talk about the average massage and body work practitioner in their treatment room. Why would they want to know about this? How does this impact what they're doing on a day to day basis with their clientele?

Til Luchau:
Great question. The short answer is because that's the only reason people are coming to you as a practitioner, is they want to shift in their interoception. They want to feel differently in their body. No matter what the other motivator is, whether it's stress or pain or just basic self care, they want a different interoceptive experience in their body, and that's what they get from their work with us.

Whitney Lowe:
Yeah. I remember hearing a story from one of my colleagues years ago about... this is in a sports massage environment where this sports massage therapist was trying to make some inroads in with one of the high level athletic teams and he was getting some real pushback from the athletic trainers and the staff there. And they were saying like, "Well, all massage does is make the person feel better."

Til Luchau:
Yeah.

Whitney Lowe:
That's about right.

Til Luchau:
It is.

Whitney Lowe:
So that might have an impact on their perform if they feel better.

Til Luchau:
Well, right. And people who feel better perform better and live better and are happier and probably throw a fast ball better. I don't know. But yeah, that's right. They're often teased apart, or the feel better part of it you could say is even marginalized or even discounted quite a bit as a valuable thing in and of itself.

Whitney Lowe:
Yeah. So this seems like the kind of thing that needs some, maybe I would say delicate language or some knowledgeable language about the ways in which you might communicate some of this kind of stuff with your clients. So when you're working with your clients, do you say things to establish what that'll mean for them? Something like, what would feeling better be like for you or what is your goal at the end of our session? What do you want to feel like? Do you frame those questions that way for clients?

Til Luchau:
Well, that's great. You mean in a pre session conversation or in the expectation setting phase?

Whitney Lowe:
Yeah.

Til Luchau:
Yeah. I want to know a couple things. I want to know what feeling they're having now that's disturbing them or motivating them to come see me. And I want know on a feeling in the moment level, essentially the interoceptive or proprioceptive level. And I want to know like you said, what change they want in that, how they want to be feeling. And so the exact language might vary by the client or the amount of time we're spending with that conversation. But those questions you asked are a good one. But it could be as simple as, can you describe to me exactly the thing that bothers you. And then I'll find out, is it bothering you now? Is it a present moment experience or are they describing a memory, which is a really different thing to listen to, and gives me really different information.

Whitney Lowe:
Yeah.

Til Luchau:
And by the way, I want to write a follow up to that article. The article we're talking about now is three questions for interoception. I'm thinking about doing three questions for proprioception, where we'll break out even more of that pre-session interview, location, quality kind of questions, because those are so valuable too. But you're right, there's a crossover there and I want to know, like you said, how do my clients feel now? What do they want to be different? Because that becomes my target.

Whitney Lowe:
Yeah. So does that direct you in a particular direction with the type of work that you would do or the approach that you'll take in that session with somebody if they say one thing versus another?

Til Luchau:
Absolutely. I'll bet it does. I mean, from what I know about your orthopedic tests, you do pain provoking tests, you do different sensation provoking tests. That's an interoceptive test that lets you know under what conditions, under what angles, what movements, et cetera, provoke that disturbing interoceptive experience, the pain. And that helps you strategize what you do. Or even somebody that works more intuitively, you get a sense of what it is that's bothering the client. And you go draw on your innate wisdom or you draw on your knowledge and you try something and you see if it helps. So I think we're doing that feedback loop all the time with interoception. But the promise by making it more deliberate, understanding it better is that we can get better at it. For sure. We can ask the questions or we can realize what I'm checking in about is how does the client feel or how does this thing shift to what we're working with.

Whitney Lowe:
Yeah. In the article you had something that you made reference to, I thought it was... semantically I just wanted to acknowledge just good writing first off.

Til Luchau:
Oh, thank you.

Whitney Lowe:
It was semantically well done in terms of the concept that you were getting across here, talking about improving how you feel or learning to feel better, which is like, we're not asking people to actually necessarily... If I understood it correctly, the way we traditionally think of feeling better, but you're talking about improving your skill or ability at feeling if I understood what you were saying frankly.

Til Luchau:
That's right.

Whitney Lowe:
Yeah.

Til Luchau:
Yeah.

Whitney Lowe:
Can you explain a little bit more about that and how does one go about doing that?

Til Luchau:
Well, I think you're talking about the... this is the piece that got pulled out as a call out in the article, says ironically, the hidden key to feeling better is often just feeling better. That is simply refining the interoceptive intersensation functions of the body sense. I mean, first of all, I owe Zenki Christian Dillo an attribution for that. He said that, or at least he's the one that told it to me. But that's the idea that when we get more accurate in our ability to perceive our bodies and we can attend to the details, we do feel better, we do feel more pleasant, pain diminishes strangely enough.

Til Luchau:
It's different than to say hyper focusing or getting obsessed with a painful sensation. But when we actually are able to open to the sensation in a way, and in a way study it from a place of some sort of perspective, or even just simply feel it, it often gets better. Because so much of what we are experiencing as pain is both the sensation and the reaction, you could say, both the pressure and the intensity and the unpleasantness, for example. And so interoception, that concept helps us tease those things apart.

Whitney Lowe:
Yeah. When I was reading that at section, it really rang a bell for me in sounding a lot like what is described in many of the different types of mindfulness practices, be that meditation or yoga or whatever is your own type of mindfulness practice. Would you say that that's similar in terms of tuning into those sensations more completely in your body, listening to the breath and doing all those kinds of things?

Til Luchau:
Yes.

Whitney Lowe:
Yeah.

Til Luchau:
Yeah. Really similar. It might be without the trappings of a meditation practice, but it maybe is the essential part of say a somatic based meditation tradition where you're simply feeling the sensations in the present moment.

Whitney Lowe:
Yeah.

Til Luchau:
Yeah. That's right.

Whitney Lowe:
Yeah. Well, there's so many different ways too to engage in that. And I think this is an important lesson for all of us in terms of what a mindfulness practice might look like or a way to help enhance that sense of inner awareness. It could be all kinds of different things. I remember hearing this story years ago on one of these audio tapes from a lecture by Ram Dass. And he was talking about giving this lecture to a group of people. This was in the sixties or something and they were doing a lot of the explorations of alternative mindfulness practices and eastern spiritual traditions and things like that and experimentations with psychedelics.

Whitney Lowe:
And he said he was giving this lecture and all these young kids in audience just nodding their heads and really getting into it. And there's this elderly woman sitting on the front row, grandmotherly type. She was sitting there and smiling the whole time and nodding and just in total agreement with everything he was saying. And he said at the end of the lecture, he just got up and he had to go talk to her. And he said, "I notice that you seem to be really connecting and resonating with a lot of these things. So I was saying like, I got to know how did you get here? And what is it that you're doing that lets you connect with what you're doing?" And he said that she looked at him with this glint in her eye and she said, "I crochet."

Til Luchau:
That's right. Nice. And so yeah, it could be anything. And our mindfulness practice is this work. We're actually using our sense 8 experience to be in the present moment, and we're helping our clients do the same. We're helping them feel their bodies and shift that feeling towards something that's even easier and more comforting to feel or nourishing to feel.

Whitney Lowe:
Yeah. I think that is an undervalued and under-taught aspect of what happens in our work. When I hear a lot of people talking, some of the massage discussions on social media and things like that are talking to practitioners who speak about getting bored in the treatment room with the things that they're doing with people, because they're doing the same kinds of stuff over and over again. And yeah, I get in some ways that that can sometimes feel a little bit repetitive. But if you can turn on the awareness during your work about the fact that what you're doing is really a mindfulness practice and it allows you the ability to take a great deal of your work day to get paid for a introspective personal development process, that's pretty lucky that you can do something like that and have that kind of personal growth and development process be a part of your work even.

Til Luchau:
Well, and people talk. It's a pretty open secret that people say, "Boy, I was having a really crummy day until I went and did that session, and then I felt so much better." And some of it's just, again, that grounding in our own bodies coming into sensation, coming into contact with our human being, but also just following our own bodies and feeling them.

Whitney Lowe:
Yeah. Because clearly there's going to be a lot of proprioceptive and interoceptive information coming in while we do our work in addition to the receiver end of it as well.

Til Luchau:
That's right. Information, but also just time spent. I mean, some of it's bandwidth, but some of it's just duration that we just hang out there in feeling and we feel better for goodness sake.

Whitney Lowe:
Yeah. Right. So I want to drill down for just a moment a little bit more technical anatomical with this. You talked in the article a little bit about some of the interoceptive signals converging in the insular cortex. So what kinds of signals are converging there? What kinds of information is getting pulled into that area?

Til Luchau:
By the time they get to the insular, some of them have done a couple of hops already. So for sure, it's the signals coming from say somatic nerves in the body that get relayed up the spinal cord and they have been processed or pre-processed or linked together in different parts of the brain. And then they converge or get synthesized or networked in the insular, which is where... you can say interoception is a process of all those things, but the insular gets a lot of the attention because that's the coming together place and the place that, again, the brain studies, when it's damaged, people don't have this sense at all. But it's probably a network phenomena that involves all of those somatic nerves, nerves from the periphery, spinal cord and then different brain regions coming in. But the insular, it's classically thought to be associated with pleasant, unpleasant. The question of valence, whether we like something or don't like it, whether we find it painful or pleasant, whether we move towards it away from it.

Whitney Lowe:
Yeah. You use that term in the article valence, an emotional or effective valence. Can you expand on that a little bit. Tell me a little bit more about what is that and how do we develop it.

Til Luchau:
Well, that's a geeky word. It's one of those neuroscience answer words that talks about something that we all know about, but talks about in a very specific way that might be helpful. Valance is again that. It's not quite emotion, it's more like, do we like it? Is it pleasant, unpleasant? Do we move towards it or away from it? You mentioned mindfulness, maybe on those terms it's basic attraction or aversion. Do we actually open to something or do we feel like we need to protect from it? It's not the same as say the amygdala, which is assessing threat. And one model of the amygdala is that it basically decides if something's threatening or safe. Insular is more about do I like it or do I not like it.

Til Luchau:
This is onto your question about receptors, a lot of the signals from many different kinds of tissue or body-based receptors converge there and get sorted and processed. And basically it's the insular that has the key job in saying, is this good for me or not? Do I like this or do I need to withdraw from it? And that includes temperature, that includes pressure, that includes itch, that includes many kinds of pain. It includes pleasant touch too. All of those are getting sorted out in the insular.

Whitney Lowe:
And I would assume there is a corresponding very comprehensive and thorough integration with the individual's emotional experience about the personal interaction with their therapist and the person that they're working for. We've learned many times over the years that that is probably the most important element in any therapeutic encounter is that client therapist interaction and relationship.

Til Luchau:
Totally. Keep going. No, sorry.

Whitney Lowe:
I was just going to say, there's so much emphasis in all of our continuing education courses and things like that on techniques and modalities. But in reality, the same exact technique performed by two different people can have two very different experiences by that particular individual just based on the interaction or the energy exchange between those two practitioners.

Til Luchau:
Yeah, absolutely. The emotional tone there determines the therapeutic outcomes in so many ways. And it's probably a little bit, but not too much of an oversimplification to say that valence or that do I like it or do I not, is the basic building block of emotions. That is what the emotional reaction to the work comes from is that basic assessment. It's not quite emotions yet, at least in the way that they're being talked about in neuroscience. Emotion has a lot of context and meaning and associations and all those things woven into it as well and bodily reactions, but it's just that basic fundamental assessment, can I open to this or do I need to protect from it? That's happening here in the insular.

Whitney Lowe:
Yeah. So for the practitioner, in terms of trying to get a practitioner to be better skilled at some of these kinds of things, these are things that are really difficult to teach in a lot of what we do with our entry level education training. So do you have any suggestions for how a person goes about developing better skills and abilities to connect or resonate with a client to enhance that effect in their treatment session with somebody?

Til Luchau:
That's a good question. I want to take a step back. I was getting all wound up to talk about predictive processes, so I want to bookmark that to come back to. But in terms of how we actually teach it or how we learn it, we say a lot. I've caught myself saying it, that this is difficult to teach. I'm not so sure, honestly. I'm not so sure it is. And I think we probably do a much better job of teaching it and learning it than we realize because we're doing good work and people going through the profession are doing amazing work. They got it somehow. I think it's difficult to break down incognitive linear terms perhaps. And then as soon as we start to apply the lens of measurability and reproducibility and things like that, it's not the friendliest topic in that realm, but it's a very friendly topic in terms of embodiment, practice and experience.

Til Luchau:
We probably get a lot of this through instinct, but also through emulating people that we see doing it that resonate with us on our own affective level. They go, "Oh, that looks good. I want to do a like that." And so we do it like that, and that works really well. That's probably the way we're learning these kind of skills as much as anything. But then I think at some point in my own probably graduate level studies, I started to break it down in conceptual ways and understand, oh, here's where I'm strong, here's where I'm less strong, and here's where I see my students really able to do things and less able to do stuff, and then we can start to fill in the blanks. That is more of a cognitive analytical process of that assessment and filling in. But even then it comes down to just being a mensch, just being there, just feeling it, just being it in yourself so often.

Whitney Lowe:
Yeah. That was my sense of that. And this is sometimes I think a little bit more challenging for some people to get. When people have asked me about this or we've had discussions about this, I've said, quite honestly, I believe that a lot of this has to do with the work you do on yourself in terms of being that thing, and exactly what you said too about emulating those that you feel like do a really good job at looking them at the way in which they interact with people or the way in which they interact with clientele, that sort of things. But doing work on developing both compassionate listening, compassionate interest, compassionate touch, those kinds of things go a very long way towards helping enhance the effectiveness of those very, very powerful factors in our treatment processes here.

Til Luchau:
So it's great to have models, people that we have experienced that do that, but it's also making me realize it's great to have experiences of the need for that. Because so many of us come to the work from our own pain, either physically, having been in the place of a patient and worked with people that inspired us or worked with processes that helped, and we get inspired to help people in other ways. Or you can say relationship pain too, finding mentors who were healing in a sense of our capacity to learn, our capacity to do good work was relationships that come through this learning process or what ended up inspiring us. And there's probably an interoceptive aspect to all those things. Our good teachers helped us feel better in our bodies. They gave us a somatic experience of wellbeing and feeling good, and that inspired us, motivated us, healed us in some ways.

Whitney Lowe:
Yeah. Right. You mentioned a moment ago, you wanted to come back to saying something about predictive processes.

Til Luchau:
Yeah.

Whitney Lowe:
So I'll give you that cue there so we don't lose that. Tell me about that.

Til Luchau:
Again, it's one of those simple ideas that we could get... Wish me luck. I'm going to try to keep it simple.

Whitney Lowe:
Okay.

Til Luchau:
We've been talking about signals from the body converge on the insular and produce interoception. It's probably not that way. The insular is a predictive part of the brain, and the networked processes there are predictive, meaning they predict what I'm going to feel based on little-

Whitney Lowe:
So previous experiences and things like that.

Til Luchau:
Previous experience, context expectations. And then I get a little bit of data from my sensory nerves to validate that prediction. But much of the sensory data can be ignored or irrelevant. And so there's very little of the sensory information that I might even be reacting to, to have a whole insular experience or to have a valance experience, to have a pleasant, unpleasant experience. So that includes, well, all the contextual factors. How the smell is, for example. How they looked at me, what I was doing before I came in, all those things predispose my entire being to respond to a particular touch as pleasant or as unpleasant.

Whitney Lowe:
Yeah. So we made some references early on to wanting to talk a little bit about some of the specific cells that are associated with this. Like with proprioception, there's a lot of focus on muscle spindle cells, golgi tendon organs. Are there particular interoceptive cells that are uniquely classified for producing those kinds of sensations in a similar fashion?

Til Luchau:
Not that I know of.

Whitney Lowe:
Yeah.

Til Luchau:
Because of what I just said, because it's a convergence of cells from all sorts of locations. Or you could say there's any list of sensory receptors, including muscle spindles perhaps, but for sure, including Ruffini, Pacini, Meissner, golgi, all those tissue receptors are sending information to our brain, some of which gets processed by the motor and sensory cortex, which we talked about in our homunculus episode. And now we're talking about a different part of the brain, the insular deeper, farther forward in the brain that basically decides do I like it or do I not? So, no, there's not a, do I like it, do I not receptor, there's a do I like it, do I not function in the brain, and the insular is the star of that function.

Whitney Lowe:
Yeah. So let me ask this question about that process of comparing the information again, between the client's lived experience and the therapist's work experience in working on that particular individual. Do you find that there's instances or situations in which the client's lived experience may be almost in opposition to what the therapist is indicating? So for example, you're working on somebody in a certain place and they say, "Oh, man, that feels like really hard or really tight or something like that." But what you feel under your fingers is not that.

Til Luchau:
That's such a good question. I got to go with it. Even though I want to asterisk going back to my last answer and talk about C tactile afferents. But anyway, lived experience. We feel something in the client. They go, "Oh man, is that tight." And we go "Really?" Is that what you're talking about?

Whitney Lowe:
Yes, exactly.

Til Luchau:
Okay. Yeah. I mean, in my article I asked the question, who's interoception, is it anyway?

Whitney Lowe:
Yeah.

Til Luchau:
As practitioners, we use our own interoception to have an empathetic experience with the client all the time. We use our tactile or our exteroception faculties to feel their tissue, and then we use our interoception to essentially come up with a prediction about what that means, what they must be feeling. We get really, really good at it. All the time we get people saying, "Wow, how did you know I hurt there. Or wow, you found it before I even knew I had it or whatever it is." That's that process at work where we're combining our tactile skills with our interoceptive skills and helping reveal to people's awareness, their own body, their own interoceptive richness. But that's us. That's our process, the feeling of the tightness and deciding it hurts.

Til Luchau:
On the client side, it's just their experience, it's just their interoceptive process of deciding whether something feels good or not. And so that could be really different than tissue tightness. This is the whole tissue debate, isn't it? Is tissue quality synonymous with how it feels? Sometimes, but often not. So that even if I feel something hard from the outside, it doesn't mean it necessarily feels a certain way on the inside. It's pretty good to guess, but I would say, when I feel something tight, I'm actually predicting based on lots of contextual things, including the actual grams of pressure I'm having to use to get it to dent, but maybe dent is one small part of it, I'm predicting, oh, this is probably one of those places that feels sensitive based on all these other things.

Whitney Lowe:
Yeah. And so we often have to make the decisions about, do we feel the necessity to do something with a particular area if it feels a certain way to us and it may or may not feel a certain way to them.

Til Luchau:
Right. So I ask the basic question, is your job description meet grinder? In which case, yes, grind it all up, make it all soft. Or is your job description something else, something about helping people feel better, in which case retarget the proprioception, the interoception, the sensation, the inner experience and work with that.

Whitney Lowe:
Yeah. So along those lines, and I got another question around this in terms of how the client's experience might govern the way in which we work. There are those people who have certain types of areas in their body that they like to have worked to the point of what we would consider pain or discomfort, and that feels therapeutically beneficial for them.

Til Luchau:
Yeah.

Whitney Lowe:
How do we judge, when are we going into the point of something that might be therapeutically not so beneficial versus a person that feels like they need something like that to really get the resolution that they're looking for?

Til Luchau:
There's probably a tissue answer. There's probably an ethical answer. There's probably a sociopolitical answer. There's probably lots of answers to that question. On the tissue level, and this is probably the least important one that it's maybe the easiest one to answer. On the tissue level, my own guideline is, is it sore later in a way that disturbs the client or in a way that persists? If it was, I used too much pressure. I injured them. I damaged them in a way that they don't recover from quickly enough. Now, there's lots of nuance to that, as we do in our work, we go into that and we find ways to either nuance that or work up to it or maybe contextualize it. But that's the basic answer; are we injuring them? The sign of that is feeling worse later that doesn't resolve quickly enough.

Whitney Lowe:
Yeah. So what if we compared that, for example, to a heavy duty workout where a person is sore the next day? It's not necessarily damaging. It might be good that they've exercised those muscles which haven't been worked in six or eight months. And sometimes that post treatment soreness might be, well, because these muscles have not been addressed or mechanically loaded, stressed in a way that pushes them closer to their limit. And maybe there is some therapeutic benefit in that to some degree.

Til Luchau:
Right. So there's two things. I've heard that analogy a lot. Well, it's like working out. And sometimes yeah, sometimes maybe not. The difference there is, does it disturb the client? Is that what they're okay with? Do they contract with you for that? Do they expect it, and does it resolve? Is it like a workout where you feel even better each day that goes on beyond that?

Whitney Lowe:
Yeah. That certainly makes sense. So that brings up some of these other things. I wanted to ask too, is there in your experience or perspective in looking at this, anything that a practitioner might be doing that would be, I don't know how to phrase this, interoceptively damaging? Is there a way to do bad analysis or interaction with an individual from that perspective?

Til Luchau:
Sure.

Whitney Lowe:
Tell me about that.

Til Luchau:
Anything that hurts more than the client wants it to is interoceptively bad. You could make the argument too, that maybe... I guess, this is more of a value judgment, maybe working so aggressively that the client gets desensitized to the nuance is not helpful, you could say. But you could also say that working so subtly that the client doesn't perceive any benefit is a waste of their money and time and resources. So who knows? But it's basically, the damage we can do, certainly is all the damage we can do with our work, which injuring people physically, or if we get into the ethical part, there's all the body image concerns and all that kind of thing too. But that's less interoception probably and maybe different parts of the body or different parts of the body awareness, the body sense.

Til Luchau:
Interestingly though, while I'm on that topic, interoception some people are better at it than others, just in terms of the measures we have for it. One quick measure is, pulse detection and that's used a bunch in research. It's an interesting one. That's the question, can you feel your own pulse without touching your wrist or your neck or something like that? Can you feel your own pulse from the inside out, just sitting there quietly and breathing.

Whitney Lowe:
Interesting. Yeah.

Til Luchau:
And there's some really-

Whitney Lowe:
Sit here and think, well, can I do that?

Til Luchau:
Yeah. Let's just do that while I talk about that. Just see if you can feel your own pulse. There's some really simple measures of taking your own pulse and then comparing that to a pulse meter or something that took a measured pulse and you get a measure of accuracy. So people have really different scores and they tend to have really high scores, or they tend to have lower scores in their life. And people that tend to have lower scores have a higher incidence of things like body dysmorphia, meaning feeling like you look really different than other people think you do, like I feel like I'm really fat. Also it's correlated with really low interoceptive scores, certain eating disorders. A few things like that are correlated with low interoceptive scores, which gives us a clue that there's lots of dimensions to this question of the body; how I am in my body and how I feel like I appear to the world. Part of it is from inside out.

Whitney Lowe:
Yeah.

Til Luchau:
Well, I'll just say, it might be related to the role the insular plays in self-awareness, in a sense of self. That just psychologically the sense that I have of being an individual, being a person or being a being is thought to be largely the insular's function. Because people that had the insular damaged, there's not that sense of being a separate, discrete individual in a way with the idea that we construct our sense of self from amongst other things, our somatic sensations, our bodily sensations, knowing that we're not just sensations, our somatic valence, our sense of like, am I at ease or am I not at ease in my body?

Whitney Lowe:
Yeah. So again, it comes back to a whole big picture process of... It seems like a very highly complex jigsaw puzzle of pieces of information that are all having to come together to make the picture work correctly.

Til Luchau:
Yeah. I think that's what my wife's saying when she politely changes the topic. So I like it that you keep asking about how are we going to use this, because that's what really counts.

Whitney Lowe:
Yeah. In terms of your clients in terms of working with them, obviously you probably see different levels of interoceptive awareness amongst your clients. Some people who seem to be super, super tuned in to what's going on in their body and some people, it's that client that's on the table that they just feel all tight and wound up and you might say something about encouraging them to relax. And they say, "Well, I am relaxed." That's what relaxed feels like in their body. So is this something that you might try to aim to improve or change with somebody in a session as you're working with them?

Til Luchau:
Absolutely. Every technique. And people ask, okay, so what do I do when I lift up their hand and their elbow stays straight in there? It's lots of ways to work with that, but my basic answer is that is your work right there, is bringing someone's awareness to their body enough that they can relax the elbow or they can feel how it's hard to relax or whatever it is. But that feeling process that you bring someone into is the therapeutic intervention. And it might be shaking, it might be stroking, it might be talking, it might be humming, it might be lots of things, might be slowing down, might be repeated interventions, might be drawing their attention to it. But all those are ways to essentially refined interoceptions so that someone can tell, am I relaxed or not?

Whitney Lowe:
Yeah. And though all those different things may not be specific outcomes that they came looking to improve. But I think those are things that will all play a big role in their mutual lived experience of feeling better and feeling that that treatment was successful, that practitioner does really good work that helps me feel different and wonderful when I come out of there.

Til Luchau:
Absolutely. Now something you said too about some people just seem to come in with a lot of interoceptive talent or something like that and others less. So made me think of athletes. I'm working here in the Boulder area, lots of high level athletes and well, all different levels of athletes, including myself. I'm just totally going to make this up. First time I ever thought it, first time I've ever said it. So I don't know if it's going to stand the test of time at all, but I bet it's possible to be interoceptively refined, but proprioceptively not, and the converse. You can be proprioceptively a genius and interoceptively tuned out.

Til Luchau:
And so extreme event or athletics to any level, requires some degree of overriding your impulses to stop. Overriding your unpleasant assessments you're getting from your body or reframing those, is like, this is really going to help me push that time or something like that. So at some point that can go too far where you can really... And the question of what is too far is going to mean something really different to a marathon runner than to me and to you. And I don't know about where you are in that continuum, but everyone has their own definition of what too far is. And so it's classic. You're going to be working with high level athletes and say, "Whoa, they are so in touch with their body in a way."

Whitney Lowe:
Right. Yeah. Because there might be such a hyper focus on a certain aspect of that. Like the capability to be able to make that basket from half court out has been practiced so many times. That's a super, highly refined proprioceptive type of skill. Maybe that there's a certain amount of brain capacity that has said, well, at a certain point we have to give up something else to be able to have that kind of tune in to the proprioceptive channel maybe.

Til Luchau:
Just to put in as many thousands of hours of practice means I had to override some basic functions there. As well as probably based on being a certain amount of joy in there too, of actually following some sort of interoceptive wellbeing, but that game as well.

Whitney Lowe:
Right. Yeah. And the educator part of me is also curious about this and I don't know, that it's just a question that I'm curious about, using a framework like Howard Gardner's multiple intelligences theory. And it looked at the different types of intelligence that people have. I'd be curious to know if those people who have a highly developed kinesthetic intelligence are more interoceptively tuned in. They're the ones that we would say, really tuned in or is that something that just doesn't have any correlation whatsoever? I'd be curious to know that.

Til Luchau:
Great question.

Whitney Lowe:
Yeah.

Til Luchau:
No idea. You've been studying this for a few decades now, but maybe more formally, more in depth in the last decade. I know just in that time, there has been an enormous amount of new research coming out. 10 years ago, I could say, there are no studies on this question. Now there's some that are actually starting to build up where we have measures for interoceptive refinement, and we have ways that we're starting to correlate that thing and seeing relationships that we didn't understand before.

Whitney Lowe:
Yeah. Wow. Fascinating kinds of things to chase ourselves into here down the interoceptive rabbit hole. And for those of who have not seen, or I'm not sure if it's going to be out by the time that this episode comes out, do take note.

Til Luchau:
Yeah. Will be November, December issue, which I think comes out sometime in October for Massage and Bodywork.

Whitney Lowe:
Yeah. Do take a look at that article and there's a great piece. And I thank you very much for delving into this. I was really happy that we had a chance to explore this in a little bit greater detail here.

Til Luchau:
Yeah, me too, Whitney. I'm glad you were open to the conversation because I had a lot of fun writing the article. It helped me for myself summarize and articulate a bunch of different ideas. And your questions really got me thinking too. I got to go back and stick in that asterisk. I know we're here at the end, but maybe it's a footnote and that's the sensor question. I said, "Yeah, it's a network. It's not a sensor." I realized the exception might be C tactile afferents, which are...

Til Luchau:
There's been some interesting research, again, in the last decade that shows that there are specific nerve endings and nerve pathways that evoke a pleasant response in the brain. And those were originally identified more on hairy parts of the body, the back of the arm, things like that, where a gentle touch, or the head, a gentle touch, they got it calibrated down to exact pressure, exact speed evokes more of this pleasantness sensation.

Til Luchau:
So there does seem to be a neck is a mechanical trigger to that. But even there, where it was a study just out in the last six months or so that says, "Oh, we found some tactile afferents in deep tissues too." So it's not just the surface, which was the first ones that were mapped out pretty extensively, but it turns out that there are these types of receptors all through the body that tend to produce that affective touch, which has got its own class of nerve fiber and its own class of reaction too. But basically it tends to trigger that positive affect or positive valence in the insular. One more, this is like the double footnote. We switched from asterisk to little crosses or something like that.

Whitney Lowe:
Yeah. Right. The double cross.

Til Luchau:
That's right. The distinction between pleasantness and intensity is a really useful one in sensation in general. And some of the early THC research of THC in pain, the active ingredient in cannabis, suggested that cannabis was really good at reducing the unpleasantness, but it didn't have a significant impact on intensity.

Whitney Lowe:
Oh, interesting.

Til Luchau:
Yeah. Now that research is inconclusive, but basically there's an interesting thought to think we can reduce someone's unpleasantness of experience even when it's just as intense. And I think our work does that a lot. I think our work reconceptualizes or reframes how people respond to a sensation, even if the sensation is still just as strong.

Whitney Lowe:
Yeah. Which might be some of that hurt's good thing that people like with certain types of body work that they feel like really benefits them. I know I have that sensation know when my back is really tight and I've been doing a bunch of work in the yard and things like that. And I work on myself with a massage tool or something like that. I'll put pressure on there that I would say it is painful, but it hurts good in a way that feels like it gets a good therapeutic in there.

Til Luchau:
Yeah. Could be, or it could be triggering some descending modulation, but it's also what happens when we understand pain a little better and understand that pain isn't always tissue damage. And so we're just not as upset by that soreness we get after working in the garden or whatever. We just know, okay, is my body getting used to that activity? Just as intense, not as disturbing.

Whitney Lowe:
Indeed.

Til Luchau:
Whitney, thanks for the conversation today.

Whitney Lowe:
Yes, absolutely. Well, thank you sir. Wonderful to have this. And again, I encourage people to go take a look at that article and explore these ideas a little bit with yourself and explore some methods that you might use in your own practice to help enhance your own interoceptive awareness. Because I really honestly believe this will have beneficial impacts on your client results too in the things that you'll be doing with them.

Til Luchau:
Absolutely.

Whitney Lowe:
Tune in.

Til Luchau:
And thanks to our sponsor Books of Discovery for the opening sponsor. Our closing sponsor today is Handspring Publishing. And when I was looking for a publisher, I was fortunate enough to have had two offers, one from a large international media conglomerate and the other from Handspring Publishing, a small press in Scotland, run by four great people who love great books and who love our field. To this day, I'm glad I chose to go with them, Handspring, because not only did they help me make the books I wanted to share, the advanced myofascial technique series. But their catalog has emerged as one of the leading collections of professional level books written especially for body workers, movement teachers and all professionals who use movement or touch to help patients achieve wellness.

Whitney Lowe:
And Handspring's Moved to Learn! webinars are free 45 minute broadcasts featuring their authors, including one with you Till. So head on over to their website at handspringpublishing.com to check those out. And do be sure to use the code TTP at checkout for a discount. And thank again, Handspring for sponsoring the podcast.

Til Luchau:
That's a 20% discount, I just realized. That's significant. That's cheaper than Amazon, when I go look at that, that's cheaper than Amazon.

Whitney Lowe:
Indeed. So we would like to say a thank you to all of our sponsors and a special thanks to all of our listeners for hanging out with us as well. Hope you've enjoyed the conversation today and learned a few things. You can stop by our sites for show notes, transcripts, and any extras. You can find that well with me on my side at academyofclinicalmassage.com. And Til, where can they find that through you?

Til Luchau:
advanced-trainings.com just on the blog link or the podcast menu item there. If you've questions or things you want to hear us talk about, guests you'd like us to interview, et cetera, email us at info@thethinkingpractitioner.com or look for us on social media, just me and my name Til Luchau. And you Whitney?

Whitney Lowe:
Also on social, under my name @whitneylowe on Twitter. You can also follow us on Spotify, rate us on Apple Podcast or wherever else you happen to be listening. Please do tell a friend about that. Does help get the show noticed and spread around a little bit. And of course, as always, if you're unable to find us in any of those locations, you can synchronize your body's interoceptor with the aurora borealis and you can hear us there.

Til Luchau:
Wow. I'm going to do that.

Whitney Lowe:
Yeah. Do it.

Til Luchau:
Thanks, Whitney.

Whitney Lowe:
All right. So that'll do it for us here. We'll see you again in two weeks. Enjoy the conversation. Thanks again so much.

Til Luchau:
Likewise. Bye for now.

Whitney Lowe:
Okay.