The Role of the Heart in Bodywork: The Fifth Dimension of Touch
by David Lauterstein
(excerpted from Deep Massage Book)

In writing on the role of the heart in massage and bodywork at first there seems to be little to say, but much to feel and do. The heart appears to simply call for us to truly care and appropriately act in a caring manner with our clients. I am daunted to speak of or for the heart. It is most eloquent on its own terms. But please accept, ideally as food for our hearts, the following reflections.

To review from earlier chapters, touch, as we explore it, reveals itself to be multi-dimensional. Resting the hand on a body creates a one-dimensional point of contact between us. Our strokes' movement creates the heightened experience of two-dimensional planes of being. Breathing creates three-dimensionality. And our vertical posture harnesses the fourth dimension of touch, the energy that flows vertically through each of us. Clients tell me about receiving touch that is skilled and has integrity with regard to the above four dimensions, but which may not be very heartful. So it is here, beginning with the heart region that the fifth dimension of touch, the power of love, comes to play an essential role in our work. Health-care cannot take place without care in our hearts.

The Living Landscape of the Heart

The heart region is as revealing in its structure as it is in its energy. Anteriorly lies the sternum, the longest part of it called the "gladiolus" from the Latin for wild iris and for sword. Connecting the sternum and/or the vertebrae are our twenty-four ribs. In Western anatomy only the lower two ribs are deemed "floating". However, in real life we notice an important truth about ribs in a freed body - they rise and fall ever on the wings of breath. All ribs are, or should be, “floating” ribs. The perpetual motion of this area is embodied even in the rhythmic undulation of the spinal nerves.

The dance of life is continuous in every part of us and, not the least, in our very core. This core movement is of course in concert with the other key organs' rhythmic movement in this region - the heart’s beating, the pulsing blood vessels, and the risings and fallings of pulmonary respiration. The lower boundary of this region is the diaphragm. Significantly, from the superior surface of the diaphragm arises the fascial ensheathment of the heart, the pericardium. We can envision then the fascial connection of the beating heart with breath. The lungs in turn surround the heart, making this region an unparalleled rhythmic and structural nexus as the lungs and heart respond to ever-changing life needs as interpreted by the neuro-endocrine system. Behind and above the heart lies the trapezius, one of our major musculo-energetic shock absorbers. Deep to it lie other shoulder girdle and back muscles which, when it all gets too much, may suffer from the deeper structural and energetic impingements of life. In front of the heart lives the pectoralis major which may express the desire to reach out and touch or the desire to strike or to push away.

Protection and Intimacy

The heart plays a pivotal role in the inner movement between defense and intimacy. When we imagine we are threatened from without or within, we often tense up the muscles around the heart as if to form a shield. As a matter of fact, Chinese medicine identifies this function as an organ separate from the heart, the "pericardium" or "heart protector". Each of us must develop a healthy capacity to protect the heart. However, as we have felt with so many clients, self-protection can become, to our disadvantage, chronic. We can lock in tensions around our hearts and inhabit defensive postures and attitudes. Posturally fixating our hidden hearts with forward flexion of the spine or an armored rigid shielding - our nervous system may be predisposed to the chronic challenges of our childhood long after we have become outwardly adults. An expression of inner defense is the immune system.

Perhaps it is no accident that nature has placed next to the heart one of the major organs of the immune system - the thymus gland. The thymus gland is the potentiator of B cells, which turns them into "killer" T-cells. Their role, as of the immune system in general, is to distinguish between self and non-self substances and to defend us against the non-self. So we see another way in which the heart region, archetypally, is involved in physiological defense.

When habitually defended, however, we defend even against vital parts of our selves. We learn to disown certain "negative" feelings - anger, lust, envy, grief. We learn to treat them as if they were non-self substances, chronically rejecting certain feelings as surely as we might a pathogen or implanted organ. No wonder that the psychotherapist, Wilhelm Reich claimed that cancer was a result of living in a habitually defended manner.

We can well imagine the physiological consequences of chronically defending against vital parts of ourselves. A vital role of the therapist here then becomes to restore the structural and energetic health of the heart. With our hearts open we can accept previously rejected parts of ourselves and our clients. We can facilitate the safe and timely letting go of the physical and psychic tensions with which we have maintained no longer appropriate levels of defense. The heart's opening moves us out of hyper-immunity, out of the chronically defended life, into community and the enhanced capacity for intimacy with ourselves and others.

Therapeutic Bravery

At first sight it would seem to take little bravery to be a massage therapist. It is not a word one would ordinarily associate with massage or bodywork. But underneath the surface of our work, in our hearts, bravery lives as much as does compassion. Now there are two kinds of compassion. The first, and it is the most common, is niceness. Being nice involves identifying with our sweeter impulses and excluding all others. Bodywork, as do so many helping professions, suffers from an abundance of niceness. The problem is, since being nice involves the repression of all other impulses and feelings, it is somewhat violent. There¹s even something a little sneaky about it in that niceness aims to disarm the outside world, while allowing all the sourer sides of ourselves to remain in hiding.

Bodywork can be extremely frustrating at times. Let it be said! Sometimes the resistance of clients to change drives me crazy. Sometimes, I'm frustrated by events in my life not emerging from the therapy - car trouble, time crunches, my fluctuating self-esteem, dietary indiscretions. Allowing enough space for all of our feelings as well as all movements, thoughts, and spiritual attitudes is to adopt as our therapeutic stance - radical compassion. I say radical because inherent in this is the commitment to receiving all our experiences with kindness. "Kindness" here is meant literally in its relationship to kin. All our feelings – anger, joy, fear, love, grief - are equally deserving and relevant parts of us.

And now comes bravery. Because to walk through this field, in which we commit to accepting all of ourselves and all of our clients, this takes bravery. Bravery not just in the sense of courage, but also in the sense emerging from the very origin of the word. "Brave" comes from the same root as barbarian - meaning "wild". Wildness is necessary in order to be a therapist. It is bravery which then turns out to be the second and a radical kind of compassion. It is the wildness fully to enter into and compassionately accept all of what is real. This is the other side of the universe from niceness.

Committing to radical kindness, accepting that we have to work with hearts widen open to everything there is, just like God doesn't abandon any piece of creation, is perhaps the bravest, the wildest thing we can do.

The Energetic Geography of the Heart

Physics posits a universe of energy and structure. Objects can be conceived as wave forms or as organized particles. In this sense, the denser the matter, the denser the energy flow, the more contained the vibrations. The skeletal system, being the densest matter in the body, may be regarded as the conveyer of the most concentrated energy. And, through the living bones' irregular and curving forms, we can imagine energy whirling and eddying - just as the flow of the river's water whirls and eddies within its curving banks. As the spinal curves turn the corner from lordotic to kyphotic, we have natural places where energy whirls, and these correspond to the chakras of Oriental anatomy. Each of these energy centers functions vitally in life, both structurally and energetically. Let us consider then the nature of the heart region in its relation to other centers in the body.

A striking fact emerges at once. Over half the length of the spine is devoted to the region of the heart! Whereas the root chakra, for instance, primarily corresponds to the region of the coccyx and the second chakra to the sacrum, the region of the heart is expressed through all of twelve large thoracic vertebrae. Underlying its variety of energetic states, one fundamental fact emerges - the heart region is the largest energetic and structural domain in the human body.

Nature, by devoting so much space to the heart center, has allowed it to play the largest role of all in our life. Whereas our culture appears to be head-centered, human biology remains unalterably heart-centered. If spaciousness is indeed its fundamental nature, the essence, of the heart, it is no surprise that this region is the home for so much of the feeling in this world. Bravery resides in the heart because here is literally and figuratively the greatest room. Here move the wings of breath and the pulsating excitement facilitated by our hearts' beating. Here reside the shield and the sword and the wild iris. Here are the floating ribs, the undulating intelligence of the spine and the heart's articulation through the free expression of ribs, shoulder girdle, arms and hands.

Massage and the Imagery of the Heart

In an earlier chapter, we looked at the vertical energy flow and its relevance to life and to massage. Energy flows vertically through us because our anatomic and physiological processes mostly happen in the vertical. In this sense we may say that the major direction of energy flow is between heaven and earth. As it flows, at each level of ourselves, this whirling energy contributes something unique to our lives. Below the heart are the three lower chakras. From the first, we derive stability and grounding; from the second , sexuality, life generativity and excitement; and from the third, our guts, the power for our individual life.

With our entry into the spirit of the heart center, the fourth chakra, something new occurs. The world outside us is, for the first time, related to expansively, not just in a self-centered manner. Basic confidence, having come from adequately resolving one's issues re grounding, sexuality, and power, allows us to grow further. We want to share who we are, not just for our own sake, but because, with our self-support somewhat assured, we have more than enough energy to support others as well. Our cup runneth over.

Into the spacious area of the heart flows our energy like springs into a lake. And just as we have been fed and shaped and just as we have nourished and formed ourselves through our early years, we have the natural inclination now to nourish and to help shape the vast world spread out around us. As we flow into the heart center, we also connect with the sense that life comes not from ourselves. We naturally feel a gratitude for the gift of life. And, out of this gratitude, we want to pass the gift on.

It is the passing on of the gift, the life that has overflown into us, that we call love. And it naturally flows out through our work which helps shape the world. As Pablo Neruda said, "Hands make the world each day."1 Therefore the gift of life flows not only vertically through us but also out through our arms and hands to interact with the world around us. What is especially new with this outflow is - we have an energy current in us which runs not vertically, but horizontally. The heart region, through the intermediary of the ribs, shoulders, arms and hands, flows into both the vertical and the horizontal. In the highest sense, Christianity holds this knowledge for us and gives it to us as directly as could the hands. For, in the symbol of the cross, the horizontal crosses the vertical at precisely the level of the heart in the human body. Through this area runs the living crossroads in each of us, where we are each given the opportunity to balance the vertical energy supporting us and the horizontal flow of energy which connects us. In other words, in ideal balance, through our hearts, we experience a connection with the world of the spirit as well as our kinship with all life.

Above the heart lie three chakras: the throat, entry way for breath and its transmutation into expression of one's own truth; the "third eye" through which we can see the truth; and the crown, through which we connect with the truth from beyond ourselves. And below are the three centers for power, excitement and grounding. So there are three chakras above the heart and three below it. This places the heart at the precise energetic center of our life. The energetic centrality of the heart, its being a living fulcrum between our higher and lower selves, is expressed beautifully in an ancient Chinese classic. It says most profoundly, "Heaven and Earth meet in the Heart. It is their destiny and place of rendezvous."2

The Myth of Back Pain

The light of what we have uncovered here allows us to take a new look at so-called "back pain". With a deeper understanding of inappropriate levels of self-defense or socially enforced restrictions on self-evolution, we can virtually feel the origin of much so called "back" pain. When we restrict movement of the heart region or the lumbar or sacral areas, pain may eventually ensue. Back pain may originate in the heart region because our first line of defense is generally restricted breath. Let us then reconsider this pain then possibly as a respiratory disorder - a malady regarding the free in and outflow of spirit. With the exception of acute physical trauma, pain in this region does not originate in the muscles or ligaments. It originates in the mixed messages we send the heart and pelvis, in restricted breathing, the resulting excessive fixations of ribs an vertebrae, and the lack of movement and energy flow conveyed out through our upper and lower limbs.

“Back pain” is a defended name for what actually is going on here, one which hides more than it reveals. It takes just a moment's pause and a breath to feel that so much pain in the back is often structurally and energetically restricted range of motion within the realm of the heart. To address it then we need to center ourselves, to be brave and to open up to all of ourselves and all of our client. In this manner our touch acquires the compassion which encourages the client's neuro-endocrine system to feel safe in letting go of unnecessary tension. Then, above all, we need to free the ribs whose movement is essential for the influx and outflow of spirit. Once the ribs are freed, we can use breath and bodywork to re-float the clavicles and the scapulae. Through them we can regain the ability to mobilize the heart, to reach out for our hearts' desires through the arms and hands. Through them we can restore the sternum's crystalline role in the production of courage. We may also see each rib, as we free it, acting like a fulcrum on the vertebrae themselves, restoring flexibility, length and movement to the spine. With more freedom to our very core, energy flows more freely vertically as well as horizontally through the body, sustaining us at a higher level and amplifying our connection through all of ourselves to the earth and to heaven. For this difficult pain, our hearts' dreams come true is a most profound remedy.


Our pain points in the direction of our growing edge, our further evolution. Humanity itself is at a crossroads. Wholistic health calls for an ever deepening commitment to grow a more conscious connection to all of ourselves, to each other, to the nature around us, and to the force which gives us life. How can we continue to overcome our defenses against each other and our resistance to change? The heart, being the crossroad for the vertical and horizontal energy flow, continuously poses for us this evolutionary question. It is from its living crossroad that we must make this decision. It is from its vantage point that we make the world anew each day.

We bear conscious witness to a central miracle in our lives - the human heart as the fertile meeting place of Heaven and Earth. This marriage of Heaven and Earth creates our love, the offspring of which is our shoulders, arms and hands. When we touch, with the awareness of the structural and energetic spaciousness of the heart, love grows. When we touch with gratitude and with the bravery to have enough space for everything to be accepted without judgment or comparison, open into a space much larger than ourselves. Heaven and Earth rejoice when we touch a rib with the awareness of its role in love making the world go 'round.

Most deeply it is not even with our hands that we touch. We feel the desire, the energy, and inspiration to touch truly originating in our hearts. In the words of Helen Keller, "The best and most beautiful things in the world cannot be seen, nor touched...but are felt in the heart." 3 In massage therapy we restore the alignment of body, mind and spirit through the miracle of touching heart to heart.

1 Neruda, Pablo, Residence on Earth. New York: New Directions, 1973, p. 2.
2 Larre, Claude and Rochat De La Vallee, Elizabeth, Rooted in the Spirit: The Heart of Chinese Medicine. Barrytown, New York: Station Hill Press, 1995, p. xii.
3 Canfield, Jack and Hansen, Mark Victor, A 2nd Helping of Chicken Soup for the Soul. Deerfield Beach, Florida: Health Communication, 1995, p.38.

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