Introduction: What Are We Really Touching? As touch therapists, we are used to thinking about muscle and fascia and about tension, weakness and dysfunction. But under our hands, we can’t touch fascia or muscles. Instead, the skin is the first thing we touch and here is where something fascinating is happening. A sophisticated biological process […]
As touch therapists, we are used to thinking about muscle and fascia and about tension, weakness and dysfunction. But under our hands, we can’t touch fascia or muscles. Instead, the skin is the first thing we touch and here is where something fascinating is happening. A sophisticated biological process begins every time we place our hands on someone’s skin, involving tiny sensory structures that allow the body to interpret mechanical input. Among the most important of these are PIEZO1 and PIEZO2 channels.
PIEZO channels respond to mechanical loading or input. Think stretch, compression, vibration, or pressure. PIEZO1 is mostly found in skin cells, blood vessels and connective tissue. It plays a key role in regulating blood flow, skin repair and tissue maintenance. PIEZO2 lives in sensory neurones, especially those responsible for detecting light touch, vibration and proprioception, the sense of where the body is in space. Together, PIEZO1 and PIEZO2 help keep the body informed about what’s happening at the surface and within deeper layers of tissue.
Imagine PIEZO2 channels like motion sensors on a door. They open when a mechanical stimulus, such as touch, is received by a sensory neurone, letting in positively charged ions that start an electrical message. That message travels through the nervous system to the spinal cord and then on to the brain. At the dorsal horn, the stimulus is sampled and scrutinised before it is passed to the brain’s somatosensory cortex. This area acts like a sensory map of the body and helps us consciously perceive where we are being touched, what part of the body is involved, and what kind of touch it is, whether it’s light, deep, sharp, dull or vibrating. PIEZO2 channels help regulate normal touch and proprioception, allowing for connection, coordination and calm regulation.
But when inflammation is present, things change. PIEZO2 can become overactive. Imagine those same motion sensors on a door going off constantly, even if nothing is there. That’s what happens when substances like prostaglandin E2, a hormone-like inflammatory substance, are present in the tissue environment. They make nociceptors, neurones that usually detect actual or potentially damaging stimuli, fire spontaneously. This creates a constant stream of background activity in the nervous system.
When a normal PIEZO2 signal arrives from a light touch, it gets mixed in with this background noise from spontaneously active nociceptors. The brain may misinterpret this safe, gentle input as threatening, and what would usually feel neutral or pleasant can instead be perceived as painful. This is known as mechanical allodynia, a state where non-threatening, light touch is experienced as unpleasant or painful. It reflects a change in how the nervous system is processing incoming signals, not a problem with the touch itself. Allodynia can significantly impact quality of life and therapeutic outcomes, as even well-intentioned contact may be misinterpreted by a sensitised system.
This understanding refines the old Gate Control Theory of Pain. That theory suggested that gentle touch could ‘close the gate’ on pain, preventing it from being felt. But now we know it’s more complicated. Under normal conditions, that gate may help modulate input. But during inflammation, the ‘gate’ can be overwhelmed. PIEZO2 may allow mechanical input to be rerouted or misinterpreted depending on what else is going on in the nervous system.
This emerging understanding may be relevant for therapists. Early research indicates that skilled manual touch, regardless of the technique or approach, can activate mechanosensitive channels like PIEZO. What appears to matter more than the specific method is how touch is applied: the intention, rhythm, pressure, pace and, importantly, the context in which it takes place. In this way, touch becomes part of an ongoing sensory dialogue with the client’s nervous system.
When PIEZO channels are activated in healthy tissues, they may support proprioception, calm regulation and tissue responsiveness. When tissues are sensitised, touch may help recalibrate the system, shifting input from threat to safety. It’s not about forcing change. It’s about offering new information. Respectful, well-applied touch speaks to the nervous system in ways that promote balance, safety and adaptation.
We don’t need a special techniques, protocols or branded approaches. We need understanding. And we need to appreciate that our touch is interacting with some of the most finely tuned sensors in the human body. That’s what makes therapeutic touch so powerful.
This changed everything. It helped explain why people in pain clinics often didn’t fit textbook patterns. Why two people with the same injury can have totally different experiences. Why reassurance, safety, and context matter.
Modern neuroscience now sees pain not as a sensation but as a perception — a brain-generated experience based on prediction, not just reaction.
Some researchers, like Lisa Feldman Barrett, even argue that pain is an emotion constructed by the brain in the same way it builds anger, sadness or joy. This means pain is shaped by our past experiences, emotional state, social environment, and what our brain thinks is going on.
The brain is constantly making educated guesses based on incoming sensory data, but also expectations, memories, and beliefs. So pain becomes less about what’s happening to the body, and more about what the brain thinks is happening a process called predictive processing.
This helps us understand why:
Once you know pain is constructed by the brain, not caused by tissue alone, your role becomes even more valuable. You’re not fixing tissues, you’re helping people feel safe, seen, and supported, which influences their pain experience.
Key points:
How to Use This in Practice
While these mechanisms are supported by emerging evidence, further research is needed. Therapists should avoid making definitive claims and remain grounded in what is currently known and hypothesised from high-quality studies. We don’t need a special techniques, protocols or branded approaches. We need understanding. And we need to appreciate that our touch is interacting with some of the most finely tuned sensors in the human body. That’s what makes therapeutic touch so powerful.
References:
Ghitani, N., von Buchholtz, L.J., MacDonald, D.I., Falgairolle, M., Nguyen, M.Q., Licholai, J.A., Ryba, N.J.P., Chesler, A.T., 2025. A distributed coding logic for thermosensation and inflammatory pain. Nature 2025 1–8. https://doi.org/10.1038/s41586-025-08875-6
Coste, B., Mathur, J., Schmidt, M., Earley, T.J., Ranade, S., Petrus, M.J., Dubin, A.E., Patapoutian, A., 2010. Piezo1 and Piezo2 are essential components of distinct mechanically activated cation channels. Science (1979) 330, 55–60. https://doi.org/10.1126/science.1193270
Lei, L., Wen, Z., Cao, M., Zhang, H., Ling, S.K.K., Fu, B.S.C., Qin, L., Xu, J., Yung, P.S.H., 2024. The emerging role of Piezo1 in the musculoskeletal system and disease. Theranostics 14, 3963–3983. https://doi.org/10.7150/THNO.96959
Murthy, S.E., Dubin, A.E., Patapoutian, A., 2017. Piezos thrive under pressure: Mechanically activated ion channels in health and disease. Nat Rev Mol Cell Biol 18, 771–783. https://doi.org/10.1038/nrm.2017.92
Savadipour, A., Palmer, D., Ely, E. V., Collins, K.H., Garcia-Castorena, J.M., Harissa, Z., Kim, Y.S., Oestrich, A., Qu, F., Rashidi, N., Guilak, F., 2023. The role of PIEZO ion channels in the musculoskeletal system. Am J Physiol Cell Physiol 324, C728. https://doi.org/10.1152/AJPCELL.00544.2022
Szczot, M., Liljencrantz, J., Ghitani, N., Barik, A., Lam, R., Thompson, J.H., Bharucha-Goebel, D., Saade, D., Necaise, A., Donkervoort, S., Foley, A.R., Gordon, T., Case, L., Bushnell, M.C., Bönnemann, C.G., Chesler, A.T., 2018. PIEZO2 mediates injury-induced tactile pain in mice and humans, Sci. Transl. Med.
Established in 1992 and officially recognised by the Scottish Government, the Scottish Manual Therapists Organisation (SMTO) is the foremost and longest-standing association for soft tissue, massage, and manual therapy practitioners in Scotland.
