As massage and bodywork practitioners, it's important to undersand how trauma manifests in the body and how you can use it in trauma massage therapy.

As massage and bodywork practitioners, we are in a unique position to assist clients in their recovery from possibly life-changing effects of unresolved physical, psychological and emotional trauma.

We can do this by understanding how trauma manifests in the body and how the body physiologically releases these trauma patterns.

What do you think of when you hear the word trauma? A deeply disturbing experience? A physical injury? Trauma, which is the experience of or exposure to something perceived as dangerous, can include injuries, car accidents and medical procedures, as well as physical, sexual and emotional assault or abuse.

Trauma can have immediate and long-term effects. In the Adverse Childhood Experiences study of 17,337 adults, the CDC found that people who experienced significant childhood trauma died 20 years prematurely.

Through my studies of the neurobiology of trauma from such leaders in the field as Peter Levine, MD, Stephen Porges, PhD, and Robert Scaer, MD, I came to a deeper understanding of how the body is a key component in recovering from trauma. I realized that we, as Bodywork Practitioners, could participate in the process of trauma recovery.

My desire to know more about the physiological basis for how the body contains and releases emotional tensions led me to Self Regulation Therapy, which is based on the research of leaders in the field of trauma, focuses on the neurobiology of trauma. Using the body’s innate ability to respond to threats, the goal of Self Regulation Therapy is to diminish over-stimulation of the nervous system.

Peter Levine, MD, writes in his book, Waking the Tiger, “The roots of trauma lie in our instinctual physiologies. As a result, it is through our bodies, as well as our minds, that we discover the key to its healing.” I was inspired to bring this model to the greater Bodywork community because it integrates so well into a bodywork session.

Whether we experience or witness a perceived threat, the physiologic fight or flight response is turned on. If we cannot successfully protect ourselves by either escaping or fighting back, we may go into a shock reaction and be immobilized.

In this situation, the body physiology slows, heart rate decreases, breathing becomes shallow, and muscles go limp. Stephen Porges, PhD., creator of Polyvagal Theory, calls this death feigning or a freeze response.

Musculature Hyper-Activation

Guarding or bracing from unresolved freeze-fight-flight reactions locked into the sympathetic nervous system could also result in chronic hyper-activation of the musculature, which is different than tension from poor posture or overuse. When hyper-activation is emotional in origin, it strongly resists release.

Clients presenting with hyper-activated musculature appear stubbornly rigid or unresponsive and do not seem to improve even after multiple sessions. Their symptoms remain the same or perhaps have even increased rather than decreased after a session.

Until I learned that these clients were in a state of chronic bracing from trauma, I thought I was either a bad therapist or the client was being difficult. However, through research and my own practice I discovered that as stubborn or persistent as these symptoms may seem, bracing can release if an understanding of the neurobiology of trauma is included in our approach.

Trauma affects every system of the body. Here are a few signs that may indicate a possible history of trauma. (For a more complete list, the Briere & Runtz Trauma Symptom checklist is a good resource.)

  • Grinding teeth
  • Chronic pain
  • Insomnia
  • Muscle spasm
  • High muscle tone
  • Low muscle tone
  • Headaches
  • Sleep problems

As we help the nervous system slow down and help the client feel safe, the body automatically begins to release the repressed trauma energies. Many experienced practitioners sense that the client is anxious and look for ways to help their nervous system calm down.

We center ourselves or attend to anything that helps the client feel more comfortable. These are great first steps, but there is so much more we can do to effectively help our clients.

Track the Nervous System

Just as many therapists know how to track tension and stress patterns in soft tissue, we can learn how to track the nervous system. If a client has a strong reaction, such as experiencing pain or having strong emotions, we can learn how to best support them rather than feel intimidated.

Because trauma is held in both the mind and body, a skillful Bodywork Practitioner has unique tools at their fingertips. We know how to read the body not only with our eyes but also with our hands.

We can feel tissue resistance in the presence of bracing. Are our clients relaxing or are they withdrawing? Are they becoming more tense? We can also access tension patterns with our hands by exploring which muscle groups are tighter.

When we hear the word trauma we may think of it as a subject to be dealt with only by professional psychologists. So why should massage therapists learn about the neurobiology of trauma? Is it appropriate for the massage therapist to work with a client’s psychological state? How do we do this significant work within our scope of practice?

Whether we are aware of it or not, we are affecting our client’s psychological state and trauma patterns. Having a basic knowledge of trauma neurobiology is a meaningful and very useful addition to a bodyworker’s knowledge base.

While it is certainly appropriate for clients to have psychological support, we are in a unique position to help clients feel better. In my work and studies, I have learned that understanding the neurobiology of trauma makes us more responsible practitioners.

Basic Concepts for Working with Trauma

1. Your Ability to Attune

Become aware when you are dealing with unresolved trauma in a client’s body. Your ability to be present and attuned to your client’s nervous system is the most basic skill in working with trauma.

The fact that you are aware and curious about it makes a difference in your presence and thus in your client’s experience. You provide a great service by being aware enough to consider unresolved trauma as a primary contributor to your client’s symptoms.

This important quality of attention is called attunement. With attunement, the practitioner is aware of the client’s nervous system and tissue tension responses. The intention is to promote the client’s experience of safety.

Attunement is often non-verbal. It is a social and body-based rapport between client and practitioner. Even without conversation about trauma, the client’s body knows of your awareness and your ability to track their tissue response. This awareness promotes the client’s experience of feeling safe and can profoundly increase their responses to your work.

Porges reinforces the concept of attunement when he describes a neurological process that negotiates between physiological defenses and safety impulses.

He calls this neuroception. In his scholarly articles about polyvagal theory for treating trauma, he describes how neuroception triggers the part of our autonomic nervous system that enables social interactions to calm our physiology and to support health, growth and restoration.

2. Assessing Body Tension

When a client presents with chronic pain or tension, such as tight neck and shoulders, be curious about what is causing this tightness rather than simply trying to power through their “resistance.”

Is it caused by too much hunching over a computer? Or, might it be the chronic bracing from unresolved trauma? Has the tension released as you work on the area? Is their feedback indicating that they feel good afterwards and have stayed relaxed for quite a while? If so, then the tension is most likely stress related.

However, if they seem resistant as you work, or the neck and shoulders release but something else tightens up, you might ask yourself if their nervous system is guarding against allowing them to relax.

Has the physiology of trauma affected your client’s body? Perhaps working more slowly would be useful. Or, working on an area of the body where they seem receptive to releasing tension would be an effective choice.

One way to work with this is to invite the client’s curiosity. Ask if they are aware that there is tension in that area. Invite them to notice where the tension starts to ease off. If they are able to do this, ask them to focus on the sensation of the ease.

This redirection to focus on an area of more comfort will affect their entire nervous system, potentially softening the bracing in their muscles.

3. Slow is fast

“Slow is fast” is a useful motto as we work towards helping our clients recover from trauma. Allowing their body to process and recover from trauma requires the basic element of time.

Be patient. Finding a more responsive area and helping it release can calm the entire nervous system. It’s important to remember we are working with the whole person. Bringing ease to any part of the body affects the entire body.

4. Safe Release of Trauma Energy

It is very important that we remember to support the safe release of trauma energies. As the client begins to relax, the body will discharge the stress from trauma. It can be startling to the client when they feel a sensation of heat, mild trembling or an emotional response.

These are normal and expected outcomes of trauma energy being released. While it may be unnerving to either you or the client, learning how to gently support this experience can create a successful and permanent change in their body.

Let the client know this is normal and encourage them to learn how their body responds to the release. You are helping them learn how to manage their experience so that it doesn’t overwhelm them.


  • Crash Course: A Self-Healing Guide to Auto-accident Trauma & Recovery, by Diane Poole Heller.
  • Waking the Tiger: Healing Trauma, by Peter Levine
  • The Body Remembers, by Babette Rothschild.
  • The Trauma Spectrum, by Robert Scaer
  • The Body Bears the Burden, by Robert Scaer
  • The Body Keeps the Score, by Dr. Bessel van der Kolk
  • Engaging Resilience – Heal the Physical Impact of Emotional Trauma: A Guide for Bodywork Practitioners, by Lissa Wheeler

About the Author:

Lissa Wheeler, LMT, has been in the bodywork field for over 40 years. For many years she used solely structural techniques, but found some clients had adverse reactions and did not improve. This led her to explore body-oriented psychology models including osteopathic approaches, CranioSacral Therapy, visceral manipulation, Integrative Manual Therapy and Self Regulation Therapy. She wrote Engaging Resilience – Heal the Physical Impact of Emotional Trauma: A Guide for Bodywork Practitioners. Her desire to combine bodywork with her knowledge of neurobiology lead her to complete a master’s in clinical psychology. Today, Wheeler’s practice is largely working with chronic pain clients who have a history of trauma.