The power of touch

The power of touch

What a touch is, everyone knows. But are we really aware of the importance of touch in the therapeutic field?
Reio Vilipuu works as a physiotherapist in the Taastusravikliinik in Estonia and shares his experience on the importance of touch in the process of recovering of breast cancer.

My name is Reio Vilipuu. I live in Tallinn, Estonia, where I work as a physiotherapist. Over the years, I have experienced again and again how big the impact of breast cancer can be on the mind of the person who is touched by the disease.

There are women who, even months after a mastectomy,  have not dared to look at themselves in the mirror,  wash or touch themselves. This is a very painful experience, for the women in the first place, but also for the therapists who work with them. It is a very clear sign of the fact that they haven't accepted themselves as being the same person but with the newly changed body without the breast. As an escape mechanism for their body shame, some women rush into new activities, make new resolutions, follow diets or try new sports, change habits or buy new clothes. 

I will write about it as a therapist and also what it means for a patient. I will start by saying that as we talk about breast cancer, there is always an elephant in the room and sooner we get rid of it we free ourselves and others. 
Not everything can be seen from the outside world and the first time someone asks right questions, it opens the box of millions of thoughts about that elephant in the room. Although this can be a difficult process, I recommend friends and family not to shy away from asking these questions and to be there for their loved one who is affected by the disease.   

Normally,  I see the patient a week after the mastectomy or lumpectomy and we talk about the lymphatic system and possible oedema in the arm and chest, scarring, the fascia system, the restoration of the normal range of movement of the shoulder and shoulder blade and the first simple exercises to do. Then if there is a trust between us, I ask them to take their sleeves off, to free the arms, so that I could measure the arm circumferences by every 4 cm. Doing so we can start comparing them and find out the possible swelling of the arm months or years later in time. But it means I will need to see the scar and touch the patient. And this is the scary part.

Most patients will immediately cover themselves with a towel as they used to if there would have been their breast, but now there isn't. It is very difficult for the brain to start accepting the new body. As for the therapy, I need to see the skin uncovered and touch the scar. So the process starts slowly but very often next time or a couple of times later, the patient takes off her top and lays on the therapy table naked and they are comfortable. So what changes them in a way that makes them feel more free?

The patient's trust in the therapist plays a decisive role, that is obvious,  but also the touch.  
Through the touches, the autonomic nervous system receives information about the body.
During the first sessions,  we perform a manual lymph massage, we gently move the scar, the skin, the fascia. It can be painful in some places, but overall it feels good. And the warm touch of someone's hands is so important: it starts the healing process on many different levels. 

Touch has a psychological effect, as it takes away the fear, introduces the scar to the mind and raises an overall new body awareness. Very often after that women ask me information about how to clean the scar, oil it, moisture it and what more can they do themselves to treat the scar.

Touch also has an effect on the autonomic nervous system. After the autonomic nervous system receives information about the body and external environment, it responds by stimulating body processes or inhibiting them, like blood pressure, heart and breathing rates, body temperature, … So mostly people calm down, relax and have an overall better feeling and sense of positivity, they regain their appetite for food and life itself.

Touching and moving the skin and all the connective tissue has also powerful effect on that particular part of the body. It actually has an effect on pain receptors in the skin and makes them less active. Less information to the brain from pain receptors allows all the tissues in that area to relax and loosen up. And all that goes through connective tissue-fascia. So the more relaxed and less restricted is the fascia, the more the fluids can start moving, the easier oedema and swelling decreases and the feeling of tightness disappear. People are now more willing to move and do the exercises which activate the blood and lymph circulation through active muscle pump and increase the healing process even more.

As a therapist, I see the colour and feel the temperature of the skin and scar: is there still a healing process and inflammation or can we start with deeper scar therapy and stretching of fascia and muscles and which exercises to do next. I can feel how elastic the tissue is, also immobile collagen areas and aching connective tissue strands in the skin are felt. We can detect fluid accumulations in the tissue, which require compression clothing,  a special bra or lymph therapy.

You can't rush the patient and do things quicker than the body actually heals and responds. The touch is so beneficial for the patient in so many levels and if done properly in the right order and at the right time, it speeds up the total recovery process.