Skin: the First Millimeters of Every Massage

Skin is the first thing we touch in every massage even if our intentions and pressure run deeper. Though skin is a mere 1-3mm thick in most areas, it is the largest organ in the human body and accounts for a full 15% of our body weight. Richly supplied with lymph and blood networks, it serves as a key player in the immune system. Packed with sensory nerve endings, it easily ranks as one of the body’s most sensitive organs which helps us orient ourselves to our surroundings.

But perhaps even more importantly, skin is the canvas upon which we paint our strokes, the first responder to our touch, and the primary vehicle for our clients' experience of relaxation. If we fail to consider how we attend to those first few millimeters of touch in the skin, we might be missing out on one of the most accessible ways to positively affect our clients’ health and wellbeing.

Let’s explore skin’s rich anatomy as we consider how to make the most of every inch!

2 TYPES OF SKIN

Regardless of age, ethnicity, pigmentation, or lifestyle factors, every “body’s” skin has two different types that are consistently found in the same specific regions: hairy skin and glabrous skin.

Hairy Skin

Hairy skin covers 90% of the body.In some areas the hair is coarse and obvious, but in others it is so fine it is hardly visible to the naked eye. Body hair can sometimes seem like it gets in the way of bodywork, but when we look at the anatomy, hair plays an important role in our sense of touch due to the sensory nerves that wrap around each and every hair follicle. Like a cat’s whiskers, the hair extends beyond the surface of the skin and mechanically relays any movement — from a breeze, a wandering ladybug, or a light massage stroke — directly to the sensory nerve at its root. Even if the skin itself is not touched, the nerve fires, giving very subtle information about the environment.

Glabrous Skin

Glabrous skin covers approximately 10% of the body. It is smooth and non-hairy, and therefore can’t rely on the movement of hair to sense the world around it. But the good news is that it doesn’t have to; glabrous skin is densely packed with a much higher concentration of sensory nerve endings than hairy skin which helps with proprioception and coordination. Located in the regions that we use for discriminative touch – including the fingertips, palms, soles of the feet, and lips – glabrous skin’s higher concentration of nerve endings provides needed sensitivity for object recognition, texture discrimination, and sensory-motor feedback. As a result, your clients will be able to perceive your work in these areas with incredible detail. Nuanced touch with varied pressures, speeds, and contact surface area; varying textures of lotions, oils, and butters; or the use of hot towels can all evoke fine-tuned sensations in these regions, which might explain why so many clients often say, “Why does that feel so good on my hands and feet?”

Hairy or not, all skin is always organized in two distinct parts: the more superficial epidermis and the deeper dermis.

SKIMMING THE SURFACE: EPIDERMIS

The outermost layer of skin is the epidermis. It’s what you touch first on your clients and what you touch withfirst (remembering that YOUR skin as the therapist is also in this story). Over most of the body the epidermis is barely as thick as a single sheet of paper, yet it serves as an almost impenetrable barrier that protects us from invading microorganisms, dehydration, damaging UV light, as well as protecting us from the first impact from any bump, scratch or cut. Made of layers of tightly packed together cells, the epidermis is avascular and is filled with the tough protein, keratin.

The protective epidermis may keep the dangers of the world out, but it lets in your massage touch. It is where the initial perception of your massage begins. The epidermis is rich in different types of nerve endings; Merkel’s cells that can sense the slightest distortion of pressure, thermoreceptors that sense changes in temperature, and nociceptors that can sense potentially damaging stimuli are all residents of the epidermis. Remarkably, this incredibly thin part of the skin’s surface serves as the sensing, feeling bridge that connects your touch to your client’s underlying tissues and is your first opportunity to promote relaxation and well-being.

DIVING DEEPER: DERMIS

Just beneath the epidermis lies the busy 1-4mm where the real action happens in the skin, the dermis. The thicker, highly vascular, and lymph-rich dermis serves as the lifeline to the paper-thin, avascular epidermis by keeping it nourished and physically anchored to the body.

The deepest part of the dermis is densely packed with strong collagen fibers and stretchy elastic fibers which allow the skin to be stretched and compressed with resiliency as we move, touch, and are touched. Every deep compression, skin rolling, or shearing massage stroke relies on the resilience of the dermis, the mechanically tough deeper layer of the skin. Nestled among the interwoven collagen fibers, we find specialized sensory mechanoreceptors including Ruffini corpuscles that perceive skin stretch and Pacinian corpuscleswhich detect vibration, texture, and pressure. Connecting strokes that soothe, push, and pull the skin activate these nerves. No matter how deep your focus, remember you are ALWAYS touching the highly perceptive skin!

WHY WE CARE

As massage therapists, our primary focus often revolves around the deeper tissues –  the muscles, fascia, tendons, and joints. It's easy to almost forget completely about the skin other than how much lotion or oil is needed to get the glide or grip we want. However, the skin is an integral part of every massage, influencing the overall impact on our client’s experience. Skin deserves our attention.

*If you like what you read and want to read more content like this, head over to Associated Bodywork & Massage Professional's website to read their latest issues of Massage & Bodywork magazine.*

Further Reading:

Lyman, Monty. Remarkable Life of Skin: An Intimate Journey across Our Surface. S.L.: Black Swan, 2020.

Pawlina, Wojciech. Histology: A Text and Atlas. Lippincott Williams & Wilkins, 2023.

Wong, Richard J, Stefan H Geyer, Wolfgang J Weninger, J.-C. Guimberteau, and Jason Wong. “The Dynamic Anatomy and Patterning of Skin.” Experimental Dermatology 25, no. 2 (October 13, 2015): 92–98.

Zimmerman, Amanda, Lijun Bai, and David D Ginty. “The Gentle Touch Receptors of Mammalian Skin.” Science 346, no. 6212 (November 21, 2014): 950–54. https://doi.org/10.1126/science.1254229.