We're All Under (Therapeutic) Pressure
Inner pressure, the nervous system, and proprioception
When the life-changing call came hours before a warm October dawn in Del Mar, California, it went through to voice mail. After several unsuccessful attempts, the caller phoned Ardem Patapoutian’s 94-year-old father in Los Angeles—who was at first a little alarmed to be awakened. Moments later, Sarkis Patapoutian phoned his son and told Ardem to contact Sweden immediately; he and a colleague had just won the 2021 Nobel Prize. Their discovery: several novel types of cell receptors that shape our sense of hearing, touch, pain, interoception, and proprioception.
Patapoutian never imagined a career in scientific research, let alone the awards he has amassed for his work. When he was only 8 years old and living in Lebanon, the civil war began. Ten years later, armed militants captured and detained him for several hours. The incident drove his family to emigrate to the United States. Ardem was unable to attend college at first, and took several jobs. By day, he served as editor-in-chief of the English section of an Armenian newspaper, where his duties included writing the weekly horoscopes. By night, he worked as a pizza delivery person.
Later, Patapoutian received his bachelor’s degree in science from the University of California. While at UCLA, he joined a lab and became obsessed with the elusive touch receptors. Later, he earned a Ph.D. in biology from the California Institute of Technology.
During the Nobel Prize press conference, held virtually, a picture taken by his wife Nancy shows Ardem sitting on a couch with his son Luca. The two are covered with a blanket; Luca’s palm rests affectionately on Patapoutian’s upper arm in a gesture that evokes his father’s research on touch.
Much of what scientists know so far about how cells communicate has involved chemical messengers. In an interview with Nature magazine in 2020, Patapoutian discussed the implications of this discovery. “What we’re realizing now is that mechanical sensation, this physical force of pressure,” he said, “is also a signaling mechanism, and very little is known about it.”
But who, or what, receives this special form of signaling? Understanding just a little of the “little known” about these receptors can point to what makes your body practices therapeutic, and how to amplify their healing effects.
What Piezo Receptors Are And What They Do for Us
The receptors Patapoutian and his colleagues discovered are named Piezo, from the Greek word meaning to squeeze or to press. Piezo1 and Piezo2 are sibling molecules that resemble triple-bladed propellers fashioned from curlicued strands of packing paper. They function in the cell membrane as pressure-sensitive gates that open, allowing ions to pass. Flies, worms, and even plants have these channels—and therefore, have proprioception.
The Piezo1 molecules detect pressure, menthol, temperature, and pain. The Piezo2 molecules, the ones Patapoutian zooms in on, play a central role in proprioception, touch, and even elements of interoception.
Piezo receptors translate mechanical pressure into biological signals; these, in turn, become perception. This process is critical for a wide range of sensory experiences, from exploring a surface with our hands to pricking a finger, from hearing a whisper to sensing an ocean breeze, from hiking a favorite trail to complex feats of athletic grace.
It turns out that we’re all “under pressure.”
But Piezo receptors extend their reach well beyond the proprioceptive capacities of touch, pressure, and the body’s movement and location in space.
Piezo receptors organize you even in gestation. They play a critical role in embryonic development. They help craft your lymphatic and heart valves. They assist your stem cells with the process of differentiation. They sense the stretch in your lungs and help control your breathing rate. They keep your blood pressure stable. They aid in new blood cell development. They help regulate red blood cell volume. They regulate enterochromaffin cell (in the lining of the gut) responses to mechanical pressure. They even empower the inflammatory response of innate immune cells. And they’re a factor in wound healing and the forming of new bone after fractures.
The Piezo receptor discovery has significance for a wide range of functions and diseases, many of which occur together. These include: food intake and eating disorders. Inflammatory illnesses such as Irritable Bowel Syndrome, or IBS. (Think of the way slow intestinal motility is improved by pressurized activities like walking, abdominal massage, or (self) massage.) Neurodegenerative diseases like Parkinson’s that impact movement and proprioception. In this month’s Masterclass on the enteric nervous system or gut brain, I discussed the links between intestinal permeability, motility, inflammation, and neurodegenerative diseases; Piezo receptors supply another piece of the puzzle.
These receptors and the genes that underlie them also affect skeletal anomalies like scoliosis or hip dysplasia that drive many of us to yoga class, yoga therapy, physical therapy, or an orthopedist’s office. (Hip dysplasia is a misalignment of the hip joint which, if not caught in standard infant exams, causes pain later in life and often results in the need for joint replacement.)
The Nervous System Is A Pressure Sensor
Why am I exploring something so technical and minute as Piezo receptors in a column about embodiment? It turns out that these pressure receptors have a hand in how all living things—from flies to frogs and from plants to people—design, intend, calibrate, and change their movement in relationship to the world around them.
Piezo channels play a key role in body mechanisms essential to survival (homeostasis), such as lung function (think asthma and other breathing difficulties). Survival-related functions, and by extension Piezos, are important to the nervous system. The discovery of these receptors sheds light on how the nervous system senses heat, cold, and mechanical stimuli—in other words, on the interplay between our senses and the environment.
This brings us to fascia, which I’ll loosely define as the sentient, living web of tissue that connects every cell in our bodies. Fascia contains four types of sensory nerve endings that respond to mechanical stimulation, tension, or pressure and which are often referred to as fascial mechanoreceptors. Scientific studies have demonstrated that stimulation of fascial mechanoreceptors through bodywork or self-massage catalyzes changes, some slow and some more rapid, in the nervous system.
We tend to imagine the nervous system as an electrical intelligence that communicates mainly through neural signals. But it turns out to be an aqueous system with moving currents of pressure. Noted research scientist and fascia expert Robert Schleip refers to the nervous system as a wet tropical jungle. “This jungle,” he says, “is a self-regulatory field with an amazing amount of complexity, continual reorganization, and plasticity, even in adults.”
The fluid-based nervous system communicates through water, blood, lymph, gases, neurotransmitters, neuropeptides (fast-acting neurotransmitters), endocrine hormones, immune molecules, craniosacral fluid, cerebrospinal fluid, and many other liquid substances.
Fascia, too, is a fluid system. In the span of 48 hours, human connective tissue transports 15L of water, a greater amount than either blood or the lymphatic system. In fact, our lymphatic and immune systems depend on the flow of fluid in our fascia.
Importantly, the nervous system is the vehicle through which more rapid changes in fascial organization and in our emotional experience become possible. For example, deep mechanical pressure to the connective tissue of the abdomen increases vagal activity and produces a parasympathetic (rest, digest, and resilience) response. In a recent study, for example, engagement of the fascial system through self-massage improved symptoms of depression.
I’ll write more about fascia in later columns, because it’s such a central focus of my work; you can also learn about it (and its connection to interoception and emotional health) in this Masterclass.
So we now have a web of interaction between proprioception, interoception, fascia, the autonomic and enteric nervous systems, Piezo receptors, and the element of pressure. Where might we take all this?
Pressure As A Therapeutic Mechanism
In previous columns, I mentioned that proprioception and interoception decrease as we age. And compromised proprioception and interoception are involved in neurodegenerative diseases, but also in emotionally mediated disorders like anxiety, depression, chronic pain, IBS and other gastrointestinal issues, eating disorders, substance use disorders, and more.
I’ve talked about these age-related decreases not simply as results on the micro level of muscle and receptors. They are a body-to-brain communication dynamic. Here’s my take: It may be that in time, we come to understand that some of the age-related decrease in sensory capacity has to do with the way the body and brain both maintain and respond to pressure.
Since learning about the Piezo receptors, I’m reimagining connective tissue self-massage as applied pressure therapeutics, or “APT.”
In studios and conference centers worldwide, I've witnessed the therapeutic effects of connective tissue self-massage. People with anxiety, depression, and chronic pain have felt immediate shifts in consciousness and self-understanding The ability to modulate the level of pressure, to decide how much is enough and when to stop, enhances our sense of boundaries, It also nourishes the dialogue we have with our bodies and our self-to-body relationship. This makes self-massage beneficial for people with PTSD and epigenetic trauma as well as other emotionally-mediated issues.
The nervous system thrives in an environment of robust interoception and proprioception.
And the application of mechanical pressure stimulates our proprioceptive and interoceptive systems. Robert Schleip has pointed out that the effects of working with fascia may be due not so much to applied pressure, which itself does not induce rapid change. Rather, the therapeutic effects may be due to the way the nervous system receives, metabolizes, and responds to pressure. This may play a key role in the observable effects we feel after connective tissue work.
The nervous system needs regular doses of mild to moderate stress in order to thrive. But the world we live in provides a constant barrage of acute stress, most of which is not under our control. In addition, we experience a relative absence of mild stress. The contrast of high amounts of acute stress and low amounts of eustress can create anxiety, depression, inertia, and a reduced sense of motivation and meaning.
Applied pressure therapeutics are a form of eustress, the kind of stress that in small amounts builds nervous system and emotional resilience. (See this column for more on eustress.)
Building in eustress through the mechanical pressure of self-massage allows us to be the modulator of that stress. This can help restore our sense of call-and-response with our environment, and with it, our sense of body agency.
You can also get pressure-based eustress from bodywork, particularly gentle forms of bodywork such as cranial sacral therapy. And it’s part of the reason why I love swimming and dipping so much: water is a form of therapeutic pressure.
Part of how we employ pressure can also be a form of creativity and play, a way to encounter, draw closer to, and ultimately know our deepest self.
With all that the Piezo receptors do for us, their role in creating the way we understand and perceive our place in the world may be the most important one of all.
“I think I would get into trouble if I called proprioception consciousness,” Ardem Patapoutian dared to say in a 2019 interview with Vox two years before he received the Nobel Prize. “But I actually think, at the most basic level, that a physical aspect of consciousness requires proprioception.”
Recommended Practices and Resources:
I highly recommend the innovative work of Jill Miller, whose tuneup balls we’ve been using in our community for well over a decade. Jill’s new website has a wealth of classes and practices to guide you through connective tissue self-massage. I also recommend Sue Hitzmann, who first taught me about fascia, and her Melt Method courses and specially-designed props. Both Jill and Sue have shaped the course of my work.
You can also try this practice taught by me during a workshop at Kripalu to engage, dialogue with, and offer applied pressure therapeutics to the soles of your feet.
Sources:
Unable to attend college at first, Patapoutian took several jobs: Ardem Patapoutian: The journey of a boy from Beirut who won the Nobel Prize - L’Orient Today. (2021, November 6).https://web.archive.org/web/20211106165130/https://today.lorientlejour.com/article/1277723/ardem-patapoutian-the-journey-of-a-boy-from-beirut-who-won-the-nobel-prize.html
“What we’re realizing now is that mechanical sensation, this physical force of pressure, is also a signaling mechanism”: Dance, A. (2020). The quest to decipher how the body’s cells sense touch. Nature, 577(7789), 158–160. https://doi.org/10.1038/d41586-019-03955-w
They function as pressure-sensitive gates in the cell membrane that open: Nobel Prize. (2021, December 7). 2021 Nobel Prize lectures in physiology or medicine.
Flies, worms, and even plants have proprioception: Nobel Prize. (2021, December 7). 2021 Nobel Prize lectures in physiology or medicine.
Piezo receptors extend their reach well beyond touch, pressure, and your body’s movement and location in space: Kefauver, J. M., Ward, A. B., & Patapoutian, A. (2020). Discoveries in structure and physiology of mechanically activated ion channels. Nature, 587(7835), 567–576. https://doi.org/10.1038/s41586-020-2933-1
Remarkably, these pressure-sensitive receptors shed light on how the nervous system: The Nobel Prize in Physiology or Medicine 2021. (n.d.). NobelPrize.Org. Retrieved April 17, 2023, from https://www.nobelprize.org/prizes/medicine/2021/prize-announcement/&hss_channel=tw-2744512442/
In humans, mutations in the PIEZO2 gene which encodes for: Yang, C., Du, Y. K., Wu, J. B., Wang, J., Luan, P., Yang, Q. L., & Yuan, L. (2015). Fascia and Primo Vascular System. Evidence-based complementary and alternative medicine : eCAM, 2015, 303769. https://doi.org/10.1155/2015/303769
Noted research scientist and fascia expert Robert Schleip refers to the nervous system: Schleip, R. (2012) “Fascia as a sensory organ: a target of myofascial manipulation.” In: Dalton, E. (Ed.) Dynamic Body: Exploring Form, Expanding Function. Freedom From Pain Institute, Oklahoma City. See also: Schleip, R. (2003). Fascial plasticity – a new neurobiological explanation: Part 1. Journal of Bodywork and Movement Therapies, 7(1), 11–19. https://doi.org/10.1016/S1360-8592(02)00067-0
deep mechanical pressure to the connective tissue of the abdomen or pelvis: Schleip, R. (2003). Fascial plasticity – a new neurobiological explanation: Part 1. Journal of Bodywork and Movement Therapies, 7(1), 11–19. https://doi.org/10.1016/S1360-8592(02)00067-0
the engagement of the fascial system through self-massage has recently been shown to improve depression: Michalak, J., Aranmolate, L., Bonn, A., Grandin, K., Schleip, R., Schmiedtke, J., Quassowsky, S., & Teismann, T. (2022). Myofascial Tissue and Depression. Cognitive therapy and research, 46(3), 560–572. https://doi.org/10.1007/s10608-021-10282-w
“I think I would get into trouble if I called proprioception consciousness”: Resnick, B. (2021, October 6). Our amazing sense of touch, explained by a Nobel laureate. Vox. https://www.vox.com/science-and-health/22710533/nobel-prize-2021-ardem-patapoutian-touch