Unlocking the Brain’s Predictive Power in Bodywork

In the January/February 2024 issue of “Massage & Bodywork,” Til Luchau and Jeffrey Bramhall introduce a captivating concept in the field of bodywork: the brain as a prediction machine. This idea, central to their article “The Somatic Edge,” highlights the significant role of predictive coding in shaping our sensory experiences during bodywork sessions.

Your client’s brain functions as a continuous prediction machine. This doesn’t mean it’s constantly generating predictions about the weather or the stock market during a bodywork session. Rather, it’s actively forecasting every aspect of their experience, from the sensation of your touch to their comfort level on your table and their overall perception of the session’s effectiveness.

Predictive coding theory posits that the real-time sensory information your client receives plays only a minor role in how their brain forms perceptions and impressions of your work. Instead, the bulk of our internal experience is shaped by the brain matching brief pieces of current sensory data (like the pressure of your touch) with past experiences and contextual cues, all influenced by their autonomic state (such as feeling relaxed or alert).

A prime example of this process is visual perception. The eye transmits detailed information to the brain from only a small part of the retina. Consequently, the brain clearly “sees” just a tiny area – about the size of a dime held at arm’s length. However, this limited vision from the fovea centralis is sufficient for the brain to extrapolate and form a subjective view of the entire visual field. This is achieved by the brain recalling details from other visual areas it has seen or expects to see, and then reassembling these into what we perceive as our complete field of vision, both central and peripheral.

What’s more, the brain also predicts the sensory information it expects in your retinal blind spot—the portion of your visual field where the optic nerve exits and where there are zero light-sensitive cells. If our brains didn’t do visual predicting as well as they do, we wouldn’t be able to drive a car, find our keys, or read an article.

In his book The Body Keeps the Score, psychiatrist and trauma researcher Bessel van der Kolk writes, “The most important job of the brain is to ensure our survival . . . everything else is secondary.”1 Though he was writing about the brain and trauma, the concept applies to predictive coding as well. Predictions are our brain’s way of preparing us for what might happen next, so we can be ready to keep ourselves safe.

Chronic pain may be an example of this preparation going tragically wrong. In her book How Emotions Are Made, neuroscientist Lisa Feldman Barrett makes the case that chronic pain may result from our brain’s (predicted) present-day sensory predictions based on past injury or stress.2 When the brain fails to update its predictions, those attempts at preparatory protection based on our past can become self-perpetuating and self-fulfilling sources of real pain in our present-day lives.

HOW YOU CAN USE IT
As bodyworkers, we can use these ideas to introduce a sense of possibility and relief to our clients. For example, clients with shoulder pain will often feel better when a practitioner gently, skillfully, and patiently moves them through a pain-free range of motion—you can think of this as disrupting their brain’s prediction habits. The clients’ brain now has a new piece of information about their shoulder movement—that it is possible to move without pain. When this learning is integrated, this new possibility becomes part of the set of expectations that inform their ongoing shoulder experience. This may be one reason why clients report significant improvements in their pain, kinesiophobia, and guarding as a result of the “simple” interventions we typically perform as hands-on therapists.

Interventions that actively involve the client can even more powerfully disrupt and rewire habitual sensory predictions. Inviting your client to slowly and actively explore the range of motion that doesn’t cause them pain, within the safe context of your hands-on work, helps add new, nonthreatening options to their repertoire of movement predictions. A practice example: Clients often respond well to the invitation to gently “explore the corners” (the places they don’t usually go) of their usual movement range. Each time a client goes into one of these new kinesthetic “corners” with curiosity and attention, the experience refines their proprioceptive awareness and provides more possibilities for safety and ease.

Following are a few more ways to bring the power of predictive coding into your treatment room.

Pre-Session: Your Assessment Can Also Be a Treatment
When a client tells you about a movement limitation during your intake conversation, ask them to demonstrate the limited movement. Often, they will move quickly as they show it to you. If we invite them to slow down and describe the sense of limitation using sensory language (bony, muscular, sharp, dull, etc.), not only can we get intuitive clues about how to “get hold” of that limitation, but their experience itself will often change because of their exploration and description.

During Session: Recruit Your Client as a Partner
A client’s feedback and active participation during your work can give you clarity on what has been effective so far and what still needs to be done. Something as simple as drawing a client’s attention to a side-to-side comparison of proprioceptive sensation (“What difference do you feel between this and that?”) can enrich and refine their felt experience and help them take on new information.

Post-Session: Integrate the Changes
This could be the most important tool in your toolbox. Save a few minutes at the end of a session to help your client register and integrate their new experiences. This could mean returning to any movements discussed during your intake conversation or suggesting a slow walk around your treatment room, letting whatever has changed come to light.
In each of these cases, we draw our client’s attention to how they feel right here and now. This attention causes the brain to update its predictions based on new information. These updated predictions can then become part of what our client experiences as available and possible.

BRINGING IT TOGETHER
Predictive coding gives us a framework to understand one way that our work offers the benefits it does. It also invites us to bring our clients on board as active participants in the work we do together. By shifting our orientation from doing things to our clients in order to change them toward working together with them to shift their habitual predictive coding, we help our clients feel empowered and at ease in the felt experience of their lives.

1. Bessel A. Van der Kolk, The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma (New York, NY: Penguin Books, 2015).
2. Lisa Feldman Barrett, How Emotions Are Made: The Secret Life of the Brain (Boston: Mariner Books, 2018).

Til Luchau is the author of Advanced Myofascial Techniques (Handspring Publishing), a Certified Advanced Rolfer, and a member of the Advanced-Trainings.com faculty, which offers online learning and in-person seminars throughout the US and abroad. He and Whitney Lowe cohost the ABMP-sponsored The Thinking Practitioner podcast.

Jeff Bramhall developed and practices nervous system-centered bodywork at Just Breathe Manual Therapy in Arlington, Massachusetts, and is Certified in Advanced Myofascial Techniques. He is on the faculty of
the Massage School in Boston, where he finds great joy in introducing our profession to the next generation of therapists.