Ticklishness and The Trauma Reflex | Clinical Assessment

Remember a time when someone tickled you.

You wriggled and squirmed all over the place, didn’t you?

Remember a time when you got hurt.

You tightened up and pulled in the injured place, didn’t you?

The two actions are related and very similar.

Very often, an injury leads to a long-term muscular contraction action.  People think it’s only momentary, as in limping when you sprained an ankle or as in pulling your hand back when inadvertently touching something hot.

But everyone’s familiar with the lasting change of movement an injury can provoke, the limp that never goes away, the postural change that occurs after a whiplash injury.

Physical therapists do their best to eliminate those after-effects, but they tend to persist, anyway.  One reason is that medical practitioners tend to focus on the site of pain or restriction, without taking whole-body patterns of contraction into account. Without dealing with the entire pattern, the parts of the pattern
left untouched by therapy tend to re-create the entire pattern.  That’s
why therapy so often fails to produce a complete result or takes a long time.

When a somatic educator works with such muscular tension patterns, we look beyond the site of pain; we look to the whole contraction pattern, which spreads out from the site of pain the way the fracture lines of a damaged window spread out from the center of damage.

The quandary therapists (and somatic educators) face is, “How do we identify the entire pattern?”

One common way used by somatic educators and therapists to assess patterns of injury is to listen to the client/patient’s report of pain and to correlate it with the report of injury.  They may (and should) go further:  to watch the client/patient walk and otherwise move, to examine by touch (palpation), and to move the client/patient passively to discern restrictions to movement — all useful.

However, there is an assessment technique that goes beyond palpation:  to observe he client’s response to being touched, namely, to wriggle and squirm.

Even with sensitive palpation, touch elicits that response.

It’s very revealing — because the way someone wriggles exactly reveals his pattern of trauma reflex.

Thomas Hanna outlined what I call, The Spectrum of Reaction, in response to touch (found in The Handbook of Assisted Pandiculation, available to Hanna somatic education practitioners). 

It goes like this.

  1. ticklishness without pain
  2. pain upon being touched
  3. intermittent pain without being touched
  4. ongoing soreness
  5. spasm 

If a person is ticklish, he is contracted (tight) at (and around) the site of ticklishness.  You can’t tickle a person who’s relaxed.  There’s no “tickle” there.

If a person is sufficiently contracted, muscles are fatigued but below the threshold of pain, and mere touch is sufficient to surface them above the threshold of pain.

If a person is more contracted, muscles are fatigued but below the threshold of pain, and mere movement using those muscles is sufficient to fatigue them enough that they hurt.  Since movement is intermittent, pain is intermittent.

If a person is yet more contracted, muscles are sufficiently fatigued to be sore all the time.

And if a person is yet more contracted, muscles are sufficiently sore to trigger a cringe response, which tightens the muscles further, makes them burn more, triggers an even heavier cringe response and the person goes into spasm.

Touch at even the “ticklish” level of contraction is sufficient to trigger the cringe response which, known by another name, is The Trauma Reflex.  At that level, it may not hurt, but the protective movement action is there, the very action that, like the fracture lines of a broken window, spreads out in a pattern from the site of injury.

In assessment, we can use the “tickle response” to show us that pattern.

Therapists may use that information to address the complete pattern using whatever modalities they choose.

Somatic educators may use that information to coach the client to contract in that pattern, deliberately, as part of a pandicular maneuver — the “omni-yawn” we use to free a person from the grip of muscular contractions maintained by muscle/movement memory in the condition we call, Sensory-Motor Amnesia.

What is “Sensory-Motor Amnesia”?


First, let me touch on the “amnesia” part.

When people first react to injury (cringing in Trauma Reflex), we may, if we pay attention, notice the entire way our movements change from that instant.  The limp is obvious.  The pain is obvious.

However, as with all sensations that persist for sufficient time, those sensations fade.  The change of movement, the change of coordination, fades from our awareness.  We may believe we have recovered from the injury.  However, the changes of movement persist, un-noticed.  Meanwhile, we also have forgotten what it feels like to move freely.  The new, cringe pattern has displaced the free movement we had — and we may not (and often don’t) notice it (except for the pain, which may seem mysterious, or seems to portend some serious disease).  That’s the “amnesia” — a change of muscle/movement memory — and it may persist for decades.

“Sensory-Motor” merely means “the combination of movement and the sensation of that movement”.

So, “Sensory-Motor Amnesia” is the loss of the memory of what free movement feels like (and ability to do it) — and its replacement by altered sensation, movement and coordination.


The “tickle response” allows us to recover awareness of how our movements have changed; it’s a first step to recovery from Sensory-Motor Amnesia, recovery of free movement, comfort, and fitness for activity.

Use it judiciously.  Save yourself some trouble in your assessments and get better results with your clients/patients.

an example of multi-contraction Sensory-Motor Amnesia (article on sciatica)

an example of a clinical somatic education procedure that involves a multi-contraction pandiculation
Notice the moment of “tickle”.


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