The Power of Following the Tissue

by Jan Trewartha

I’m a practising therapist, so this article is written from that point of view.  This is on a topic I feel passionately about, that of following the tissue and how powerful something so simple, and so obvious can be.

I had a good, albeit short, training in massage back in 1982. In retrospect, I was always giving someone a massage in that, although I developed on from following the prescribed protocol (five effleurages, such and such tapotement, etc.) and I definitely did work with the body rather than just using that protocol, at the same time I did not truly understand what I grew to realise later in my career. 

About five years after I started massaging, I trained in a form of facilitated positional release[1] where the body is supported to naturally move into the position of damage, while the therapist works on key points.  I could feel ‘knots’ dissolving under my fingers, and after a few treatments (providing the client corrected damaging daily postural/movement habits) those knots didn’t come back; it was a revelation. I had no understanding of fascia in those days!

As I developed my skills over the years, I grew to realise that the lighter I touched, the more I could feel and the more the client seemed to benefit.  Of course, I lost clients – all the ones who liked a brutally deep massage!  But I felt better in myself in that it wasn’t such hard work, not as draining for me, and the engagement with the body felt more profound, effective and long-lasting. This change in how I worked was a major shift towards a light touch, tissue-led approach.

Karel Lewit (1916 – 2014)[2], one of my heroes, lived and worked in Czechoslovakia as a therapist into his old age.  He said: “…no instrument can replace our hand.  Using my hand, I analyse numerous valuable bits of information simultaneously but also as soon as touching the patient I can feel the patient’s reaction – the feedback that cannot be replaced.”[3]

Question: do we listen to the feedback from our hands and work with someone, or do we get caught up ‘doing’ to them? Are we able to put aside our idea of what the body needs, and instead touch and follow the tissue intelligently, allowing it to lead us? Set massage formats and other treatments can lead the therapist to ignore the tissue’s needs.  Having a protocol which is a fixed, body-focused way of approaching certain physical conditions, may work well in many cases but does not allow the freedom to explore what the body and the mind both need in the myriad cases where the condition does not fit the textbook. One size does not fit all.  The best laid treatment plans can go astray!

We are all well trained – we study, do our CPD, practise and work hard. But if we stay in the realm of the left brain then, in my opinion, we do ourselves and our clients an injustice, because there is a whole realm of information and excellence we are not even tapping into if we do not allow ourselves to trust our instincts. Also, if we see the body as a purely physical construct rather than at one with the mental and emotional states, we are severely limited.

I always say to my students “Learn everything you need to learn, study hard but, at the interface with the client, allow instinct, your right brain and, above all, humility to take over.” That can be hard when a new client turns up saying “I’ve seen everyone else and you’re my last hope!”  No pressure then! A sentence likes that can really kick our ego into gear if we are not aware and careful.

By ‘ego’ I am not saying that we are going round telling everyone how wonderful we are – we would hope that our work speaks for itself without us feeling we have to tell everyone!  No, I mean the part of us that thinks we can fix everything and everyone. That which makes us try too hard, draw on all the modalities we are trained in, expend more energy than we really need to…..and which is disappointed, angry and confused when it doesn’t work.  I have actually had these words said to me in the past by a therapist: “But that is the protocol, you should be better.” 

Most of us in complementary medicine do, I believe, see ourselves as a catalyst rather than the waver of a magic wand. We realise that we are facilitators for people to heal themselves of their own unique issues.

Every life is unique, and the body reflects that life. Trauma, injury and accident history, and daily habits (whether they do one-sided sports, hold a baby on their hip, hold a handbag on one shoulder, or have adapted around an old ankle injury or poor healed appendectomy, for example), plus many other factors all affect the body and how it presents.  Not only is each body unique, but so is each mind, each emotional state….when working on someone we are engaging with them at a profound level, resonating with mind and body. To paraphrase what Neil Theise said, when a therapist puts hands on a client, there is no longer one energy field in the room.[4]  How can a strict protocol truly uncover what is held in that client, unless it is one that encompasses all aspects of the person? What traumas are held in their body?  Babette Rothschild[5] and Peter Levine[6], amongst others, discuss somatic memory and how to work with it.

My mantra, as a therapist and teacher, is Tissue will always go home……if it is  facilitated in a way that works with it, that follows it. What I have learned in 30 plus years of practice, is that the more we try to get the body to do what we think it should do, the less effective the long-term results will be.  Light suggestion is often enough for change to start in the tissues and, because of the full fascial continuity and the biotensegral nature of the body, this change is then transmitted body-wide and creates biochemical change in the cells via mechanotransduction.

Full fascial continuity is very well explained at embryological level by Joanne Avison in her book Yoga, Fascia, Anatomy and Movement[7]; the embryo unfolds, forming compartments and tubes that “all remain connected and continuous, although distinct and differentiated”. The surgeon Jean-Claude Guimberteau also demonstrates fascial continuity through his investigations using high-definition endoscopy, and states: “Contrary to conventional teaching, we now discover that there are no spaces, no separate layers of tissue sliding over each other”.[8]

We may, with our protocols, get good short-term results, but if the body is holding the memory of an injury, with all the associated tension and restriction, and possibly emotional traumatic memory, then a short-term adjustment will often simply be reversed, over the weeks or even just the days following, by the body as it reverts to its normal paradigm.  Somehow, we have to find a way to allow the soft tissue to fully let go of the injury, of the damage; when that happens there can be shifts that allow for body-wide, system-wide, and emotional changes, and the effects become long-term.

We can start learning this approach by laying our hands on the body and seeing where the tissue takes us.  A good place to practise is by lying half reclined and placing one over the upper chest or wherever else you feel it is needed, allowing the hand to drop in gently (not push); the tissue will start to move almost straight away, often helping emotions to surface.  Then practise on friends over areas that seem congested, regardless if they are actually pain sites, and see what happens.  Explore with curiosity – you may be surprised.

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A fuller version of this article appears in the Members’ Area. For more details of our membership click here.

This article is extracted from Jan Trewartha’s presentation on The Power of Following the Tissue, British Fascia Symposium, 2020, now held in the Members’ Area.

Jan runs courses in Sharon Wheeler’s ScarWork and in Fascial Unwinding and Energy Awareness: www.bodyinharmony.org.uk

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[1] Biomobility.

[2] https://nydnrehab.com/treatment-methods/dynamic-neuromuscular-stabilization/about-karel-lewit/ [Accessed 30 March 2022]

[3]  Kobesova, A. (2014) Professor Karel Lewit, MD, DSc: an appreciation. International Musculoskeletal Medicine 36(4): 125-127.

[4] Fascia and Resonance, March ’22, The Fascia Hub online event. Available in the Members’ Area from July 2020)

[5] Rothschild, B. (2000). The Body Remembers. Published by W.W. Norton & Co. New York/London.

[6] Levine, P.A. (1997). Waking the Tiger. Published by North Atlantic Books.

[7] Avison, J. (2015). Yoga, Fascia, Anatomy and Movement. Published by Handspring Publishing (Scotland).

[8] Guimberteau, J.C., Armstrong, C. (2015) Architecture of Human Living Fascia.  Published by Handspring Publishing (Scotland).