Key Point 

• While our work often revolves around deeper tissues, special attention should be paid to the skin, the first responder to our touch.

Skin is the first thing we touch in every massage, even if our intentions and pressure run deeper. Though skin is a mere 1–3 millimeters thick in most areas,¹ it’s the largest organ in the human body and accounts for 15 percent of our body weight. Richly supplied with lymph and blood networks and packed with sensory nerve endings, skin serves as a key player in the immune system and easily ranks as one of the body’s most sensitive organs. 

But perhaps more importantly, the 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 well-being. Let’s explore the skin’s rich anatomy as we consider how to make the most of every inch.

Two Types of Skin

Regardless of age, ethnicity, pigmentation, or lifestyle factors, skin on every body comprises two types that are consistently found in the same specific regions: hairy skin and glabrous skin.

Hairy Skin

Hairy skin covers 90 percent of the body.² In some areas, the hair is coarse and obvious, but in others, it is so fine that it’s barely visible. 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 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, providing very subtle information about the environment. 

Glabrous Skin

Glabrous skin covers approximately 10 percent of the body. It’s 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 can 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. This might explain why so many clients often say, “Why does that feel so good on my hands and feet?”

Skimming the Surface: Epidermis 

Hairy or not, all skin is organized in two distinct parts: the more superficial epidermis and the deeper dermis. The outermost layer of skin is the epidermis. It’s what you touch first on your clients and what you touch with first (remembering that your skin as the therapist is also part of this story). Over most of the body, the epidermis is barely as thick as a sheet of paper, yet it serves as an almost impenetrable barrier that protects us from invading microorganisms, dehydration, and damaging ultraviolet (UV) light, as well as from the first impact from any bump, scratch, or cut. Made of layers of tightly packed 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 and 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, 1–4 millimeters where the real action happens in the skin, the dermis. This 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 that 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. Nestled among the interwoven collagen fibers, we find specialized sensory mechanoreceptors, including Ruffini corpuscles, which perceive skin stretch, and Pacinian corpuscles, which 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 highly perceptive skin!

Why We Care

As massage therapists, our primary focus often revolves around the deeper tissues—the muscles, fasciae, tendons, and joints. It’s easy to forget about the skin itself, aside from 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. 

AnatomySCAPES Meets Rebel Massage

AnatomySCAPES is joining forces with Rebel Massage therapist Allison Denney for “Journey into the MATRIX: the Fascial System.” This multidimensional learning experience includes three full days in the dissection lab, in the classroom, and at the massage tables. Join them February 27–29, 2024, in San Diego and start developing the “X-ray vision” that comes from seeing real fascia anatomy. Go to anatomyscapes.com/MATRIX to apply today.

Notes

1. Skin thickness varies over the surface of the body, as well as from person to person, ranging from less than 1 mm on the eyelids to up to 5 mm on the upper back. Skin thickness changes as we age, reaching maximum thickness at around age 20 and thinning over time as we continue to age. Environmental factors such as sun exposure and smoking create damage and accelerate the thinning of the skin. (Pawlina 2023, Wong 2015).

2. Amanda Zimmerman, 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.

Resources

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

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

Wong, R. et al. “The Dynamic Anatomy and Patterning of Skin.” Experimental Dermatology 25, no. 2 (February 2016): 92–8. https://doi.org/10.1111/exd.12832.

Zimmerman, A., Ling B., and D. D. Ginty. “The Gentle Touch Receptors of Mammalian Skin.” Science 346, no. 6212 (November 21, 2014): 950–4. https://doi.org/10.1126/science.1254229.