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The efficacy of traditional Thai massage for the treatment of chronic pain: A systematic review.

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The efficacy of traditional Thai massage for the treatment of chronic pain: A systematic review.

Complement Ther Clin Pract. 2015 Jan 31;

Authors: Keeratitanont K, Jensen MP, Chatchawan U, Auvichayapat P

Abstract

RATIONAL AND BACKGROUND: Traditional Thai massage (TTM) is an alternative medicine treatment used for pain relief. The purpose of this paper is to provide a systematic review of the research about the effects of TTM on pain intensity and other important outcomes in individuals with chronic pain.

METHODS: We performed a systematic review of the controlled trials of the effects of TTM, using the keywords “Traditional Thai massage” or “Thai massage” with the keyword “Chronic pain.”

RESULTS: Six research articles met the inclusion criteria. All of the studies found a pre- to post-treatment pain reductions, varying from 25% to 80% and was also associated with improvements in disability, perceived muscle tension, flexibility and anxiety.

SUMMARY: The TTM benefits of pain reduction appear to maintain for up to 15 weeks. Additional research is needed to identify the moderators, mediators and to determine the long-term benefits of TTM relative to control conditions.

PMID: 25682523 [PubMed – as supplied by publisher]

Pichest Boonthumme

Guest post and photo © Ananda Apfelbaum
www.thaimassagesacredbodywork.com

I feel honored to have been asked to write about Pichest for this website. Pichest has been my teacher since 1992. He is amazing. It is hard to put to words just how amazing he is.

Pichest was born on June 19, 1958 to Bauw and Bauw Jan Boonthumme in Hang Dong, a small village in northern Thailand. They named their baby son Narin. Narin’s father, Bauw, was a traditional Thai doctor and herbalist. His mother, Bauw Jan, was a cook. When I asked Pichest when he had started to learn massage, he told me that as a young child he used to walk on his father’s back to help him relax before going to sleep. Later, when he was seven or eight years old, his father started to teach him massage, herbs and traditional medicine. Pichest said he really did not understand much of what his father taught him until years later, but that, at the time, it taught him patience.

One day when Narin was twenty-three or twenty-four years old he accompanied his father to the Old Medicine Hospital in Chiang Mai where his father needed to pick up some herbs. At the time, Narin was hoping to find any kind of work as he had recently gotten married and needed to support his wife. It so happened that he was offered work that day at the Old Medicine Hospital. He gladly took the job and learned the hospital’s Thai massage techniques. Then, in 1983 he was asked to become a staff member and went on to become one of the hospital’s lead practitioners and teachers.

After some years of teaching at the Old Medicine Hospital, the daily commute from Hang Dong to Chiang Mai (about twenty minutes) got to him and in 1990 Pichest decided to quit.

A couple of years later I found myself studying Thai Massage in Chiang Mai. I studied with various teachers and then wound my way to the Old Medicine Hospital. While studying there, I asked who the great local teachers and practitioners were and Pichest’s name came up.

I soon set out to find him. It wasn’t so easy to find Pichest’s place in Hang Dong, but eventually the driver of the sam-lor (three wheeler auto rickshaw) I was in, did. Pichest warmly welcomed me into his home and sat me down in the main room. Somehow he communicated with me that in order to start studying with him I had to come back with lotus buds, incense, fruit and the class payment. At that time, Pichest spoke no English, so I can’t remember how we communicated.

I soon returned to Chiang Mai with the driver and the next day went shopping for all the required offerings. Then, since I now knew where to get off in Hang Dong, I took a songthaew (open bus) to Hang Dong and then walked down a dirt road that ran along a rice field to Pichest’s house.

Pichest lives in his ancestral home, which is an old two-story building. Upstairs there is a large shrine room where Pichest meditates. It seemed very magical to me the few times I was up there.

When I first started studying with Pichest, he had only one other student. He taught each of us individually. Class was held in the main room, which had a raised section with a Thai mat on it at one end of the room. Even though Pichest and I couldn’t talk to each other, I was able to learn by feeling what he was doing. At that time he was still teaching a sequence that covered techniques in the supine, side lying, prone, inverted and seated positions.

Pichest told me and the other student that he wanted more students, but it seemed hard to get people from Chiang Mai to his house. We tried to help him by making posters, but things really did not pick up. At the time, he was giving sessions to Thai people. There were no “farangs” (westerners) coming for treatment, as no one knew about him.

After I had studied with Pichest for a while, he told me I should leave and practice what I had learned. So I left.

About a year later I returned to Thailand and was taking some very boring classes elsewhere. One of the students there told me she was going that afternoon to get a massage from someone outside of Chiang Mai. She invited me to accompany her. I had no idea where she was going. When we arrived in Hang Dong, I realized we were going to Pichest’s! As I watched Pichest work on her, I realized how greatly his work stood out from the various other teachers and practitioners I had been meeting in Thailand. His every move seemed ergonomic, precise, powerful, fluid like a dancer’s and magical. He seemed to have an uncanny sense of what was needed and seemed directly tuned into her. After the session, she and I decided to quit the boring school in favor of studying with Pichest. That was a turning point for me. From that time onwards, whenever I have been in Thailand, I have only studied with Pichest.

By this time, Pichest knew a little more English, so we could converse some. That was when I found out how he got his name Pichest. When he was twenty-seven years old, he had massaged a monk who was so moved by the treatment that he told Pichest that it was time for a name change. At the time Pichest was still called Narin. The monk then blessed him with the name Pichest which means special, unique, extraordinary. Pichest also explained that Boon, which is the first part of his last name, means good or merit. His name is so apt as he truly embodies a special, extraordinary giver of healing.

While studying with Pichest this second time around, I had my first massage session with him and I remember that his pressure seemed very intense. I also recall the experience of drifting away into a profound state of relaxation when he sat on my leg in the side lying position for a “blood stop” (arterial compression). During consequent treatments I thought that his pressure was less and less intense, but then I realized that it was me who was changing as my body was becoming more and more open; not his pressure lessening!

Pichest told me he hoped to find a place nearby to teach. He wanted to teach in a temple and then confided in me that he really had always wanted to be a monk, but, now that he was married and had a son, couldn’t. The search for a temple for Pichest to teach out of was underway when one day Pichest suddenly announced that he was going to build a school on the land in his garden next to the house. A few days later, construction of his school began.

Before long a building with two rooms was completed. One room was for Pichest’s wife’s spirit work; the other room was for classes. About a third of the classroom became a shrine area filled with statues and pictures of saints, Buddhas, Ganeshes, Jivaka, Kruba Srivichai (Chiang Mai’s patron saint), the Thai royal family, flowers, incense, fruit and beautiful hanging decorations.

From then on, I went annually to Thailand to study with Pichest. His English got better and more students started to come. We decided to run the classes every two weeks starting on the first and third Monday of every month. On these days students were expected to bring offerings – flowers, incense, fruit, money. Pichest would then draw on the top of our heads with a sharp object as if inscribing a blessing.

Classes were from nine to four Monday through Friday. There was a break for lunch, which we took at a little nearby restaurant. Sometimes Pichest would join us there, but more often than not, he ate food prepared by his wife at home. In class, he was often busy reciting prayers and making candles with prayers wrapped inside them. At times, local people came by for his blessings. Many families who were loosing a family member from Aids came to him. He would pray for them. It was very sad.

Pichest, however, didn’t seem to get saddened. I learned that he believed this life was just one in a series of reincarnations so there was no need to be too attached to this incarnation. This really came home one rainy night when we were driving in his car. There were many little frogs on the road and I was so worried we would run them over. Pichest tried to console me saying, “No problem, another life coming.” He has this detached side even though he is so alive and so involved with life.

I think Pichest’s larger view has to do with his meditation practice which he stresses is the most important practice in his life. He explained that meditation has taught him so much, including ways to improve his teaching and massage practice.

Pichest also relies on his dreams a lot and often gets dreams which he says are direct transmissions from Jivako. When he gets these dreams he follows through on the instructions. I remember at one time he was teaching us three inside leg lines. Then one day he told us that from now on we would be thumbing two inside leg lines. When I asked him why, he said he had received instruction from Jivako to change to two pathways in a dream the previous night.

When I asked Pichest who his teachers are besides Jivako, he told me they are the Buddha, the yogi spirit and his father. He also often mentions Kruba Srivichai and Professor Dol Jai who taught at Wat Po and the Old Medicine Hospital. Sometimes he also brings up Lung Ta, a man who used to live in Hang Dong who taught Pichest how to read the old northern Thai language.

Whenever, there was a student in class who had a professional background in some modality such as osteopathy or chiropractic, Pichest wanted to learn from them. After understanding these new techniques, they became a part of Pichest’s work.

Learning with Pichest is much much more than learning Thai massage techniques. It is about learning to be present without preconceptions. He tells people again and again, “Too much thinking” and tries to get them into feeling. Sometimes, when he felt I had a particularly “thinking” question he would raise his cane over my head, but then with a smile lower it.

One of his first words in English was “connect”. He would say connect, connect over and over again while pointing out how each part of the body was connected with the next. He would have us feel areas of tension and show us how they connected to places of tension above and below that area. He always seemed to know exactly what to do to relieve the tension.

In those early days at his school, he did not give Dharma talks in the morning, nor did we recite Om Namo, but I have heard that he now does that. In those days, we just started practicing under his guidance or, if he was busy or sleepy, which he often was, he would nap on his couch and have me teach. I was always amazed how he would wake up and know just who was making what mistake and would then correct them. At the time, we practiced a routine flow over the course of two weeks, which was more or less repeated every two weeks.

Sometimes, I got upset that I was there in Thailand hoping to study and paying for classes, but instead I was teaching and Pichest was sleeping! Finally Pichest and I had a talk about this and he agreed to give me private lessons after class was over. It was during this time that my practice started to get refined and to deepen even though Pichest often was dozing off when I worked on him.

Every day after class, Pichest had clients. His treatments were incredible and I was blessed to have several sessions with him as well as to be able to observe him treating others. His psychic ability would shine through especially when he did blood stops (arterial compressions), as he then seemed able to access hidden information about the person he was working on. Often, after the treatment he would advise the person as to what prayers and offerings they should do to remove certain negative entities or energies.

Whenever, there was a student who had a professional background in some modality such as osteopathy or chiropractic, Pichest wanted to learn from them. After understanding these new techniques, they became a part of Pichest’s work.

Pichest is a master. Years later, I can still “feel” his touch and remember his predictions, advice and care. Pichest’s mastery is from his complete union with his work, with his body and with the person before him. He tunes in to them and knows exactly where they need help and just how to release them.

Eventually, as Pichest was teaching full time and seeing clients every day after class, except Sundays, it became too much and he had a melt down which landed him in the hospital. He was there for quite a while, but finally to everyone’s relief, he came home. After that, Pichest no longer gave treatments after class and the class structure changed. He stopped teaching sequences and instead focused on therapeutics. There was no special format for this. He would work spontaneously on whomever he felt needed to be worked on, using them as a demo for the class. Sometimes he worked on outside people who needed help but they were treated within the context of the class. His teaching continued to emphasize “non thinking” and being present.

My book, Thai Massage Sacred Bodywork, which is dedicated to Pichest, came out in 2003. I went to Thailand to specially give him the book in person. After the book’s release, the number of students finding their way to Pichest rose dramatically and I recently heard that sometimes he has as many as seventy-five students in a class. Gone are the days when Pichest needed students!

Every now and then Pichest sends me a blessing via one or another of my students who is over in Thailand studying with him. Recently, he sent me a little Jivako statue that sits on my windowsill watching over my treatments. It seems as if Pichest is in the room then.

In closing, I pray with folded hands, that Pichest continues to be there for all of us who seek his blessings. May he be blessed with long life, good health, joy, loving kindness, peace and ease.

Lek Chaiya, Revered Healer and Founder of “Jap-Sen” Nerve Touch Herbal Thai Massage

Guest post by Janice Gagnon

I met Lek Chaiya on my first sojourn to Thailand in 1997. At that time I had no idea that she would come to mean so much to me. Lek Chaiya, affectionately called “Mama Lek,” began to learn Thai massage and healing medicine at a young age from her mother, a healer and a practitioner of midwifery and massage in the village of Jom Thong, Chiang Mai. Lek’s given name was Lek Thiwong. The name “Chaiya” was handed down to her later by her teacher when Lek was made the lineage holder prior to her teacher’s death. Lek also studied herbalism and traditional massage in northern and southern Thailand, raised 2 sons, and eventually founded her own style of Thai massage, called “Nerve Touch” or Jap-Sen (meaning “to grasp” the Sen lines).

Jap Sen is a deep tissue approach that improves joint function and mobility by restructuring and aligning muscles, tendons and bones, and by stimulating pathways in the nervous system. This unique style of Thai massage works to stimulate the flow of energy or “lom” throughout the body by “twanging” or thumb rolling over the intricate system of sen lines and the ridges of muscles. This creates a deeper release of blockages in energy flow and a resonating affect through dense or tight muscles, tendons and nerves. Lek’s style is a very specific approach with the intention focused on relieving painful and even debilitating conditions. Lek Chaiya refined her technique to especially benefit people with numbness and paralysis.

lekandjan

I was fortunate to have private study with Lek in 1997, as she did not advertise to tourists at that time. I learned by workingside by side with her in sessions that treated conditions like persistent back and knee pain, or easing andfacilitating a smooth pregnancy, as well as more serious cases such as paralysis. With regular treatment, a manwho was paralyzed and in a wheelchair was able to walk and even to garden once again. I was fascinated andmoved by Lek Chaiya’s knowledge, confidence and trust in her own abilities. I came toappreciate the nearly miraculous therapeutic changes that took place in her clients, and I began to understandthe potential of Thai massage to evoke deep healing on all levels; physical, mental, and spiritual. I observed one of her clients, an elderly man hunched over with pain and walking with a cane, after only two sessions with Lek (3 days apart) he was able to stand straight and walk unsupported. In another case, a recent stroke victim, 95% paralyzed on one side, was restored to 100% functioning after just a few months of weekly sessions. Witnessing Lek Chaiya and working closely with her gave me a lifetime of inspiration for this work.

lekinclassincali

The impact of watching a master working in their element is both fascinating and emotionally moving. What is it that makes her a “Master?” A refined and polished sense of touch, lead by purity of heart and excellent intuition. An intention for healing with the focused guidance of an ancient foundation and tradition. She begins and ends each day with prayers to the Buddha, the ancestors and the founder of Thai massage, Shivaka Kumarabhacca. To her, this healing art is an integral part of her everyday life.

I brought Lek to California seven times from 2002-2010, we co-taught together several trainings Basic to Advanced Levels of Nerve Touch Herbal Thai Massage. One night when we were in San Francisco for a sightseeing weekend, I couldn’t sleep. She advised me to recite the traditional mantra “Om Namo” until it calmed my mind. I realized that the spiritual foundation of this ancient healing art is available at each moment. These teachings are handed down through the generations from an early age. I hold dear to me the beautiful image of Lek in the mornings with my young daughter sitting at her side with hands in prayer, eyes closed and hearts open. When Lek Chaiya is giving a Thai massage, she holds this consciousness, this prayer in her movements with a child-like curiosity. This type of mindfulness and confidence clearly evokes change and facilitates deep healing.

Lek Chaiya dedicated most of her life to the study, practice and teaching of Traditional Thai Massage. She developed a style that has helped tens of thousands of people within her lifetime and through the transmission of her work in her teachings will continue to benefit the world.

LEK CHAIYA PASSED AWAY ON APRIL 19, 2013 at the age of 74 years. Lek Chaiya became a mentor, teacher and motherly figure in my life. I know that she has touched the hearts of so many people. She has truly graced us through her loving stewardship of the tradition of Thai massage.

 

Lek Chaiya LEK CHAIYA’S CERTIFICATES AND AWARDS

Special Training: Herbs Royal Project Committee,
Lampang Thailand, December 1982

Special training : How to use herbs  Royal Project Committee,
Chiangmai, September 1985

NerveTouch Massage Basic Training, Committee of Northern Herbs Association.
Chiangmai, January 1987

Special Curriculum for Using Herbs, Committee of Herbs Center of Thailand.
Chiangmai, March 1993

Special Curriculum for Using Herbs, Committee of Herbs Center of Thailand
Chiangmai, January 1996

Award, Special Herbs Training Course, Mae Rim District,
Chiangmai, January 1996

Training of advanced study for masseurs, Project of Rehabilitation of
Thai Massage, Foundation of Health Development,
Bangkok, December 1996

Training of advanced study for masseurs, Foundation of Health Development.
Bangkok, December 1997

Appointed: Lecturer of Thai Massage,
The Project of Rehabilitation for Thai Masseur(s), Foundation of Health
Development, Bangkok.

******

MOTHER LEK CHAIYA PASSED AWAY ON 19TH APRIL 2013, aged 74 years.

 

bali2011c Janice Gagnon is the founder of Spirit Winds School of Thai Massage located in Nevada City, CA. She has been studying throughout all regions of Thailand since 1997. She studied at the Institute of Thai Massage and The Old Medi­cine Hospital in Chiang Mai, Thailand. Janice has also studied extensively one-to-one with Master Lek Chaiya in “Jap-Sen” or Nerve Touch Thai Massage. Janice has hosted and co-taught with Lek Chaiya at Spirit Winds since 2002, Lek has been a primary influence in her therapeutic work. Janice is recognized as an Advanced Instructor and Therapist.

Spirit Winds School of Thai Massage
Nevada City, CA
www.spiritwinds.net
530-263-3181

A Thai Approach to Constipation

©2006 Laura Hoge

Laura Hoge, RYT, CMT is the owner of Peaceful Edge Yoga, LLC offering private yoga instruction, western and Thai massage to the Central/Northern NJ area since 2003. She currently teaches Thai massage within the Tao Mountain Network. Prior to her current profession, Laura worked as a New Jersey State Licensed Funeral Director and spent years helping clients process grief and grief related complications. Her current practice is based on a similar heart centered approach to well being. Aside from her study and practice of Asian energy work, Laura has recently completed her second album and devotes her time to musical composition, creative writing, spiritual research and philosophical study. For information regarding Thai massage instruction or upcoming concerts, please visit her websites: www.peacefuledgeyoga.com or www.laurahiggins.com.

Definition, Symptoms and Causes

Constipation, or a lack of proper frequency in bowel movements, can be frustrating on many levels. Though it is more commonly associated with the aging community, most people have been constipated at one point or another due to situational stress or an unhealthy diet. It has also become one of the more frequent side effects of both anti- depressant and chemotherapeutic therapies here in the west.

Some of the symptoms of constipation include, but are not limited to, difficulty starting and/or finishing bowel movements, infrequent passage of stool, passing hard stool after prolonged straining, cramping, abdominal pain, excessive gas or the inability to pass gas, and in the cases of obstruction, nausea and vomiting, distended abdomen, headaches and loss of appetite.

Aside from the physical discomfort it creates, identifying causative factors can vary from person to person. Many times, constipation is a result of improper nutrition. For example, eating foods that are highly refined or high in animal fat content can be to blame. Insufficient intake of fiber is another known trigger. Other causes include, but are not limited to, medications such as antidepressants, chemotherapeutics, antispasmodics, iron supplementation tablets, overuse of antacids, and painkillers. Many people find that traveling causes lackluster bowel functioning as well. Unfortunately, some of the more insidious, and thankfully rarer causes for constipation include blockages resulting from hernias, intestinal tumors, damage to nerves within the intestine, gallstones, and/or thyroid or metabolic disorders.

Though it is always necessary to identify the cause of constipation, especially to root out some of the more serious conditions or blockages, Traditional Thai Massage can be an effective means of alleviating some of its discomfort and help the client to stimulate his/her own healthy flow of digestive energy and proper intestinal peristalsis.

Treating Constipation – Western Style

Just as causes for constipation vary in severity, so do treatments. In most cases simple lifestyle and dietary changes will suffice. When conditions are more severe, additional regimens of medications, enemas, colonic irrigation and/or surgery may be necessary.

In cases where improper nutrition is the cause, apposite intake of nutrients is often the remedy. By increasing one’s intake of water and natural liquids, fiber, fresh fruits and whole grains and at the same time decreasing the intake of highly processed foods, dairy and animal fat, a person’s digestive tract can return to an effective homeostasis. In Thailand, some of the more commonly ingested foods and herbs that treat constipation include galangal, ginger, lemongrass, basil, hot herbs such as black pepper, cayenne, cloves, red and green curries, etc. Papaya, banana and tamarind are also added to the diet to stimulate digestion and an increase in exercise can also prove helpful. Included in this article you will find a recipe for what has essentially become the “chicken soup” of Thailand. It can be a helpful remedy for constipation because of its inclusion of galangal (or ginger) and other hot tasting herbs. Also included are directions to make Som Tam, another therapeutic dish that features both papaya and green chili, two effective supplements for treating constipation.

When dietary treatment proves ineffective, allopathic doctors often recommend an over- the-counter laxative or regimen of enemas to stimulate peristalsis. Unfortunately, this type of treatment can carry contraindications for those taking certain medicines since it impedes the body’s natural absorption of supplements, minerals and nutrients. These therapies also carry addictive concerns when used to often, sometimes leaving the body reliant upon them to maintain what should be a natural bodily function.

For those who are constipated because of an obstructive mass, hernia, nerve damage, etc., surgery to remove the tumor and/or correct the condition may be required. In these cases, Traditional Thai Massage is not the best course of treatment.

How Thai Massage Can Help

When a person is experiencing discomfort as a result of mild to moderate constipation (where obstructions, hernias, etc. are not the cause), Traditional Thai Massage can be a highly effective means of treatment. According to Thai belief, all of the energetic meridians in the body, or sen, originate at the navel. Because of this, a significant amount of emphasis is placed upon manipulating and removing energetic imbalances in the abdomen. A common byproduct of this is a regular gastrointestinal response.

Aside from abdominal manipulation, many of the yoga stretches performed during Traditional Thai massage can have a great impact on the constipated client. The use of herbal compresses can stimulate the body’s digestive responsibility as well, especially when using hot herbs such as ginger, galangal and/or turmeric.

Below is the traditional series for abdominal manipulation as is taught at the Shivagakomarpaj Traditional Medicine Hospital in Chiang Mai.

1. The practitioner applies moving pressure to the abdomen in the direction of the colon (clockwise).

Within any traditional Thai massage sequence, a practitioner will circle the abdomen once or twice, applying pressure at the points shown below. However, when treating issues of digestive stagnation it is therapeutic to increase the number of repetitions. It is also important to note that the abdomen may be a sensitive area for the client both emotionally and physically and careful consideration must be taken into account in order to ensure comfort during treatment. Each person will respond differently to levels of pressure.

2. Thumb pressure (jap sen) is applied on the eight points surrounding the navel. This pressure is often applied to two points at the same time, beginning with those directly lateral to the navel. Then the top left and bottom right points are addressed, followed by those above and below the navel. The circle is then completed with jap sen to the upper right and bottom left points. By completing the treatment in this sequence, the practitioner is always working in a clockwise fashion, complementing the body’s natural digestive flow.

The above step will not only treat constipation, but since all of the traditional Thai sen originate at the navel, it is not unusual for a client to experience a subsidence in symptoms associated with unrelated energetic imbalances.

3. Palm pressure on abdomen

The Shivagakomarpaj Traditional Medicine Hospital in Chiang Mai offers a variety of different techniques that can be employed when administering step 3 on a client. For those that are experiencing minor symptoms of constipation, a combination of gentle palm pressure (on eight points illustrated above in step 1) and cued exhalations of breath is quite effective.

For clients presenting with more advanced constipation, alternate and/or adjuvant therapies might be suggested. For example, a deeper application of pressure on the aforementioned eight points followed by alternating pressure on either side of the navel can be deeply therapeutic. This latter technique is administered by placing both palms lateral to the navel and then applying pressure alternately in combination with cued exhalations of breath.

Thai Yoga Stretches

In addition to abdominal manipulation, the following stretches may be useful in treating constipation.

  1. Pulling the client’s knees into his/her chest while in the supine position performs the first yoga stretch that is often employed during traditional Thai massage. The practitioner will then add additional pressure by leaning his/her own body weight into the stretch.The benefits of this stretch are in its ability to relieve gaseous accumulations in the intestines. This is largely due to the fact that pressure is applied directly to the ascending, transverse and descending colon. The digestive system responds in a similar fashion to that of a person “squeezing a tube of toothpaste.” The pressure alone inspires the bowels to loosen and move more efficiently.
  2. When mobilizing the joints during traditional Thai massage, practitioners often stretch the hip flexors by alternately bringing a client’s knee to his/her chest. This can also be an effective treatment for constipation as the stretch applies pressure to the ascending and descending colon, eliminates gas and inspires movement within the intestines.*Though traditional massage asks that a woman’s left side be treated first, a more western approach, and one that I find most therapeutic, would suggest that in cases with constipation, the right side be treated first regardless of gender. This is because of the natural clockwise movement of energy and substance through the intestines.
  3. Part of the traditional seated posture sequence, as taught by the Old Medicine Hospital, places the client into a forward bend with legs fully extended. From this posture, the practitioner then applies pressure from behind; the result increases flexibility in the entire back body (i.e. hamstrings, erector spinae, etc.). The byproduct of this stretch, however, can be seen in its additional pressure to the internal organs of the lower abdomen. The result is similar to that of both aforementioned steps.

For clients who have difficulty sitting upright with legs outstretched, the same stretch can be approached in the passive manner seen pictured above. In this instance, the practitioner places the client’s extended legs against his own and using a double grip technique and proper body mechanics, passively lifts the client into the stretch.

Dietary Supplementation

In Thailand, Thai massage is used to address energetic manifestations of illness. Herbs and dietary supplementations and/or restrictions are also important treatments. When addressing issues of constipation, the following recipes are tried and trusted methods for relief.

Ginger Tea

Ginger is a widely used ingredient when treating issues of gastrointestinal distress, constipation, nausea, flatulence, etc. Below is a traditional recipe for tea that is quite soothing to both belly and spirit.

Ingredients

3 cups water
3-5 inches fresh ginger root (washed) sugar (to taste)

1. Remove barky parts of 3-5 inches of fresh ginger root. Crush with mortar and pestle. (Keep in mind that the potency of the taste and the intensity of treatment depends upon the amount of ginger used in this recipe. It is always advisable to seek the help of a doctor or naturopathic practitioner prior to any self-medicating.)

  1. Place ginger with water in pot and boil.
  2. Allow mixture to simmer for 8-9 minutes.
  3. Strain mixture into mug.
  4. Stir and serve with sugar (or substitute honey, stevia, etc.) to taste.

Tom Yum (Koong)

Tom Yum can be made with chicken (kai), shrimp (koong) or for a vegetarian option, substituting vegetable stock and tofu for the base and protein portion of the dish will maintain its efficacy and taste.

1/3 lb shelled shrimp (for more authentic Thai preparation, leave tails on) Approx. 20 straw mushrooms (halved)
2 cups stock (chicken or vegetable)
1/2 lemongrass stalk (cut into 1 inch pieces)

4 kaffir lime leaves
4 slices galangal or ginger (remove barky portions) 10 small green chilies (halved lengthwise)
2 Tbsp. fish sauce
5 sliced shallots
2 Tbsp. lime juice
1/2 tsp. sugar
1/2 tsp. chili paste
1/2 tsp. soy bean oil
cilantro (as desired)

  1. De-vein the shrimp. Rinse, drain and set aside.
  2. In a large pot, combine chicken or vegetable stock, lemongrass, kaffir lime leaves,galangal or ginger, chilies and shallots. Bring to a boil.
  3. Reduce the heat to medium and add mushrooms, fish sauce, lime juice, sugar,chili paste, and soy bean oil and cook for 3-4 minutes.
  4. Add shrimp and continue to cook until shrimp changes color (approximately 2-3minutes)
  5. Remove from heat and serve with sprinkle of cilantro.

Som Tam – Green Papaya Salad

3 cloves of garlic
2-4 green chilies
1/2 Tbsp. sugar
4-5 green beans
2 small tomatoes (quartered) 2 cups grated green papaya 2 Tbsp. lime juice

1 Tbsp. fish sauce (or salt) 2 Tbsp. peanuts (optional)

  1. Shred papaya and set aside.
  2. Combine garlic and chilies in a pestle. Pound until thoroughly mixed.
  3. Add sugar and green beans. Pound again.
  4. Gently mash tomatoes into mixture.
  5. Add papaya. Pound again.
  6. Add lime juice, fish sauce and peanuts. Pound all ingredients together for 1-2minutes.
  7. Serve with a ginger based tea for extra digestive support.

Spiritual Practice

According to Thai tradition, any imbalance that presents in body and/or energy is bound to express itself within the spirit (citta) as well. It is because of this that both client and practitioner must cultivate positive intentions during all treatments whether they be physical, energetic or spiritual. By doing so, the natural healing response becomes inspired in all levels of life; body, energy and spirit.

Sources

“Constipation in Adults: Constipation Symptoms.” http://www.emedicinehealth.com

©2003-2005 eMedicine.com, Inc.

Salguero, Pierce. Encyclopedia of Thai Massage. Scotland: Findhorn Press, 2004, pp.87-93.

The author would like to thank Prathuang (Tim) Impraphai and all of her many guest house teachers for their classes in Thai cookery. The above recipes could not have been created without my initial studies at Thai Chocolate Cookery Center in Chiang Mai.

 

A Thai Approach to Rounded Shoulders

First published in Jivaka Journal, by Jeffrey S. Thompson and Laura Hoge

“Every day we sit, stand, read, work and exercise in positions that are detrimental to our posture. Posture is an aspect of training that is often overlooked; however, improving your posture is just as important

to your regular fitness routine as proper nutrition, exercise and stress management. Improving your posture can help improve your health.”1

What is Rounded Shoulder?

Rounded Shoulder, or Protracted Shoulder Girdle, is a chronic condition which is defined as “an increase in the convex [curving or bulging outward] nature of the curve”2 of the upper back. A person suffering from this condition may take on a ‘hunched’ or anterior compressed posture, which, if left untreated will increase in severity with age. Currently, this disorder affects over two thirds of the population in the United States.3 As our increasingly sedentary society continues to ignore proper posture when behind the wheel, while watching television and/or working at a computer,4 and at the same time, continues to adopt exercise routines that over- focus pectoral muscles and neglect opposing muscle groups in the back, incidents of Rounded Shoulder will continue to increase over time.

Physiological Effects of Rounded Shoulder

The physiological effects that are often attributed to Rounded Shoulder vary in incidence and severity from person to person. Compressed nerves in the shoulder girdle are common and in some cases cause numbness, tingling or even pain which may radiate down the arm. Since the pectorals are in a continually contracted state “Rounded shoulders can restrict rib cage expansion”5 and as a result, may lead to difficult or labored breathing. Tight pectoral muscles can also pull the shoulder girdle forward, out of its anatomical plane of movement, and cause a decreased Range of Motion,6 discomfort or even pain. Continued contraction over an extended period of time will eventually lead to a shortening of the tight muscle, lengthening/weakening of the opposing muscle group in the back, and leave a person vulnerable to knots and/or permanent muscle damage.

Treating Rounded Shoulder – Western Style

The list of contributing factors for Rounded Shoulder is long. Because of this, there is no one set method of treatment, no silver bullet that will eradicate pain, pinpoint cause and erase existing muscle damage. That being said, an assessment of possible causative factors and a change in lifestyle can eliminate the suspected cause(s) of the disorder and stop its progression.

The aforementioned change in lifestyle often takes the form of a prescribed set of stretches and/or exercises that are specifically designed to elongate the pectoral muscles, release tension in the shoulder and allow the chest, shoulders and back to return to their anatomically correct position. Other exercises that are also suggested are those that strengthen the over-stretched and weakened back muscles to create a more stable operating environment for the free-floating shoulder girdle. Of course, the success of these stretches depends primarily on the determination of the client, so progress is reliant upon strict adherence to one’s prescribed stretching regimen.

How Thai Massage Can Help

When a client receives a diagnosis and calls upon a Thai Massage practitioner to help with recovery, the initial response must be to translate the patient’s needs from ‘Western’ concepts of disease into a traditional Thai approach. Since Thai massage works primarily with preserving and/or re-establishing energetic balance to the body, the most sensible place to begin treatment would be to first ascertain which of the sen line(s) (aka. energy lines, meridians, etc.) appear to be affected. Once this diagnosis is made, a course of treatment can be designed and put into practice.

According to Thai belief, Rounded Shoulder occurs as a result of energetic blockage in the Kalatharee sen:

Sen Kalathari starts at the navel, where it divides into four lines like an X that travels symmetrically on both sides of the body. The top two lines travel up to the armpits, passing above the nipples on the way. From there, they travel inside the middle of the arms to the wrists. At the wrists, Sen Kalathari splits into five branches, with each branch running to the tip of a finger. They then retrace themselves up the hands and arms, to the collarbones which they run under, up the sides of the front of the neck and face, overt the temples to the end of the eyebrows. From there, they run up over the sides of the head and then down the back sides of the neck. Just below the neck, they branch off to the armpits, where they merge with the aforementioned lines traveling inside the middle of the arms. The main trunks continue down the back to the ischial tuberosities (the bones at the bottom of the pelvis that bear the body’s weight when you are sitting down – commonly known as the “sit bones.”). From there, they go down the backs of the thighs to the backs of the knees. From the backs of the knees, they travel down the middle of the backs of the calves to the feet. At the feet, Sen Kalathari splits into five branches with each branch running to the tip of a toe. Sen Kalathari then retraces itself up the feet and then travels up the fronts of the lower legs to the knees. It goes through the knee joints and then travels up the fronts of the lower legs to the knees. It goes through the kene joints and then travels up the backs of the thighs to the ischal tuberosities. From there, it goes through the legs to the femoral pulses in the inner and upper thighs, where there is a pathway from one femoral pulse to the other, connecting the right and left lines. From the femoral pulses, Sen Kalathari returns to its starting place at the navel.7

Since Kalatharee travels through the shoulder girdle, manipulating it with acupressure, joint mobilization and yogic stretching can effectively locate the source of the blockage and encourage a more healthy flow of energy through the body. Salguero supports this theory and offers further advice in the treatment of Sen blockages in his book Encyclopedia of Thai Massage. He says that it is important to:

“Apply strong presses to the site of the blockage, and then to move along the sen away from the site, as if ‘flushing’ the blockage away” Travel all the way to the ends of the meridian or meridian segment, and finish by returning to the site. This encourages the disposal of stagnated energy, and then encourages the flow of fresh energy.” 8

In some cases, the client may be experiencing numbness, tingling and pain radiating down the arm. In such an instance, it is advisable that the practitioner begins treatment with this “flushing” at the point where the Kalatharee travels through the shoulder. This is most commonly the site of the blockage and the altered sensations in the arm are often referred pain brought on by the lack of proper energetic flow. It is also effective to apply heat, hot compresses and direct acupressure to the site of injury in order to break any energetic obstructions in the area that may be impeding proper flow of energy and, as a result, causing pain and impinging movement.

According to Thai medical theory, if the client’s shoulder girdle is anatomically misaligned, it is also believed to be a result of energetic blockage in the Kalatharee sen. Despite this similarity, the actual causes and site of the blockage are quite different. The location of the energetic blockage is often situated in the pectoral muscle itself, and as a result, the client frequently presents with difficulty breathing. When this occurs, administering pressure to the site of blockage is difficult as it is often uncomfortable for the client. Symptoms of the condition are best alleviated by treating the correlating Sumana sen which “runs from the navel to the base of the tongue.”10 This, combined with intentional acupressure and joint mobilization to the Kalatharee Sen will effectively treat Rounded Shoulder.

Specific Thai Yoga Massage Stretches for Rounded Shoulder

*Please note that the following stretches should only be performed by qualified Thai Massage Practitioners and should not be attempted otherwise. These exercises require knowledge of proper body alignment in order to reduce the risk of injury for both client and therapist.

WALKING BACK STRETCH

Have your client sit in front of you on the mat with legs straight or in a cross-legged position. Ask the client to reach both arms toward you with palms facing up and thumbs rotated towards each other. Reach forward and grab both forearms. Position your feet so that your toes are just beneath the client’s scapula. Your knees should be bent. From this position, use your body weight to pull back on the arms, rotating toward you slightly (medially). At the same time that you pull on the arms, apply a small amount of pressure with your feet while the client exhales. Hold for a breath or two before releasing. Repeat the stretch a few times, dropping your feet an inch or two with each adjustment. This stretch elongates the pectoral muscles and helps maintain and/or re-establish proper vertebral alignment. It also applies pressure to the rhomboids, which may be damaged, and/or have “knots.”

BACK STRETCH

Have your client sit cross-legged in front of you with both arms extended skyward and palms together in a prayer like fashion. From a standing position, take hold of your client’s forearms and place your knees just between his/her shoulder blades. Gently lift the client’s arms up and toward you, while at the same time, applying pressure to the upper back with your knees. This stretch will lengthen the pectoral muscles and open the chest to inspire deeper breathing and proper energetic flow along the Sumana sen.

COBRA

Have the client lie face down in a prone position. Situate yourself on top of the client with your knees just above the iliac crest. (This is important so as not to force extreme compression in the lumbar spine.) Hold the client’s forearms in the same manner as seen above in the Walking Back Stretch. Gently lean back with your body weight to lengthen the pectoral muscles and encourage the chest to open.

For clients that are suffering from more severe forms of Rounded Shoulder, Cobra pose may be difficult and/or too intense to perform. It can be supplemented by hooking your fingers under the client’s shoulders and manually drawing the scapulae together by leaning your body weight back. This will open up the chest and inspire proper energetic flow on both Sumana and Kalatharee sen.

SHOULDER MOBILIZATION

From a side-lying position, have your client bring the back of his/her hand to the sacrum, creating a 90 degree angle at the elbow. Using thumb presses, finger presses, and/or a bladed hand, apply gentle pressure just below the scapula. At the same time, use the other hand to pull the front of the shoulder, just lateral to the deltoid, toward you in a rotational motion. Repeat on the other side to lengthen the pectoral muscles. From this position, you can also address knots and/or energetic stagnation in the rhomboids with finger presses and/or thumb presses.

MODIFIED FISH POSE

Fish Pose may be too intense for clients with Rounded Shoulder, so this modification is more appropriate. Have your client sit with his/her legs extended forward. Place a bolster or firm folded blanket behind his/her hips. Support the head and thoracic spine as the client leans all the way back to lie flat. Sit behind the client’s head and from this position, gently hook your fingers underneath the skull at the occipital ridge. Lightly pull to lengthen and align the cervical vertebrae. You can also encourage further chest expansion by pulling the armpits open and out.

Endnote

While it is always important to address specific issues that a client brings to the mat, it is equally important to practice mindfulness for the well being of your client, to trust in the knowledge of the Father Doctor and to respect the lineage from which this energetic healing has been passed down through generations. “The true practice of the art of healing – be it nuad boran (Traditional Thai Massage) or any other type of medicine – is in the compassionate intent of the healer.”11

1 Vlach, Stephanie

2 McPeck, Christopher

3 Christman, John Ph.D (right rounded 73%, left rounded 66%)

4 International Chiropracters Association

5 Vlach, Stephanie

6 Vlach, Stephanie 7Apfelbaum, Ananda, pg 45

8 Salguero, C. Pierce

9 Salguero, C. Pierce

11Salguero, C. Pierce

Works Cited

Apfelbaum, Ananda. Thai Massage: Sacred Bodywork. New York: Penguin Group, Inc, 2004, pgs. 39-45.

Christman, John Ph.D. “The Prevention of Posture Related Problems in Orthodontists, Their Staff, and Their Patients.” Presentation at III Barcelona Orthodontic Meeting 13- 15 March 2003.

Gray, Henry F.R.S.. Gray’s Anatomy. New York: Barnes & Noble Books, 1995, pp. 222 – 226, 356 – 360.

International Chiropracters Association. “Perfect Posture Guide.” [online] Available http;//www.chiropractic.org/chiroinfo/posture.htm

Salguero, Pierce. Encyclopedia of Thai Massage. Scotland: Findhorn Press, 2004, pp.177 – 189

Vlach, Stephanie M.S.. “Stand up for Health.” [online] Available http://www.honoluluclub.com/pulse.php?ID=26

McPeck, Christopher. “The Cause of Internet and TV Addiction.” [online] Available http://www.causeof.org/posture.htm

Note: The information presented in this article is in no way intended to be used as a tool for diagnosis and or treatment. It is meant only to compare Eastern and Western approaches to a specific physical condition.

Adapting Thai Yoga Therapy for the Neurologically Involved Client

First published in Jivaka Journal, by Ann Airey

Neurologically involved clients (and their families) have been through an incredible trial physically, emotionally, mentally, and spiritually. Thai Yoga Therapy can be a medium for teaching clients to feel pleasure in their body again, and to show clients that they can still move their body in meaningful ways. When clients are taken passively through the stretches, they are able to relax and let go of the frustration caused by their body no longer moving like it used to. The gentle, rhythmic motions reduce tone and muscle tension, allowing clients to enjoy the therapeutic movement provided by this form of massage. Most clients find the sessions to be an oasis of calm in their tumultuous lives. Thai Yoga Therapy is often referred to as a “meditation of compassion,”1 and when done in the spirit of metta it is a beautiful dance between giver and receiver.

Case Study

In order to best illustrate the use of Thai Yoga Therapy as an adjunct treatment for neurological clients a case study is presented.

Patient History

The patient is a 72-year-old male with a history of cervical spinal stenosis (narrowing of the spinal canal causing compression on the spinal cord and spinal nerves). The patient underwent a cervical fusion in January 2003 with good initial results. After discharge from the hospital, however, the patient lost consciousness while getting up one night and fell to the floor. As a result of the fall the bony fusion became unstable. Additionally, the patient tore his left rotator cuff muscles (which had been surgically repaired two times previously), and he sustained a mild head injury.

Once medically stable the patient underwent a second surgery to have metal rods implanted along his vertebrae to stabilize the joints. After the second surgery the patient underwent intensive inpatient and outpatient rehabilitation to regain ROM, strength, balance, and functional mobility.

His recovery was complicated by many medical issues, including respiratory difficulties requiring supplemental oxygen, difficulty with bladder control requiring a catheter and eventually surgery, feeding problems that necessitated placement of an N-G Tube, increased tone and spasticity that impeded functional mobility, stiffness of the left shoulder due to the injury to the rotator cuff, loss of fine motor control in both hands, digestive difficulties, and loss of appetite. Additionally, the client experienced nearly constant pain, which prevented him from sleeping.

When I met the patient, he required assistance to stand up from a wheelchair, and he walked with a rolling walker. He required assistance to roll from one side to the other and to move side to side in bed. When seated, he could not reach outside his base of support without losing his balance, and he had fallen to the floor several times at home. The combination of tone, weakness, and joint stiffness caused him to walk with a rigid, shuffling gait. Because of pain in the left shoulder, stiffness in his joints, and muscle weakness, the patient had great difficulty transitioning from standing to tall kneeling or quadruped position. These factors initially made it difficult for the patient to get to the floor mat for sessions.

Treatment Modifications

I initially treated the patient in an outpatient rehabilitation setting in the hospital, where we were able to use a raised mat table to avoid the floor transfer. The client simply walked to the mat using his walker, sat down, and then came to supine. This technique is helpful for most neurological clients who have loss of balance and decreased functional mobility. It is also useful in working with clients with spinal cord injuries who may be unable to transfer to the floor—they can transfer directly from their wheelchair to the mat table. This is the safest and most comfortable way to adapt the Thai Yoga Therapy session for those clients who have difficulty getting to the floor.

In settings where a mat table is not available the therapist must adapt the floor transfer. Once this patient was discharged from therapy at the hospital I worked with him in his home. We were able to adapt the process of getting to the floor by having the patient first come from standing to tall kneel in front of a coffee table. Once he was steady in tall kneel I was able to help him transition to his elbows and knees; from there I assisted the patient into prone position, and then slowly to supine.

In my opinion, a bed is soft and yielding, so it is not an ideal surface for energy line work. It is, however, a safe option for those clients who are unable to get down on the floor safely. One session, after this patient underwent surgery, I treated him bedside with a modified session to decrease pain and to work specific acupressure points and energy lines for the bladder, kidneys, and prostate. The patient experienced almost immediate reduction of pain and anxiety from this session.

When working on the floor we made adaptations to accommodate the stiffness of the patient’s joints. The patient’s neck ROM was limited because of the cervical fusion. For comfort we used a pillow under his head to keep the spine in alignment. Once the patient was comfortable he was able to relax, and we started each session with gentle rocking motions of the trunk and extremities to reduce tone. This was followed by working the foot sen and marma points and kneading the feet with oil. Over the course of treatment the muscles in the patient’s feet relaxed, allowing the toes to extend and the arches to spread; as a result, the patient’s standing balance improved once more of the foot was in contact with the ground.

Once the feet were relaxed the inner and outer leg lines were worked to stimulate the balanced flow of energy to the spine and organs. The compression from palming along the lines also kneaded the tight muscles. Stretching postures for the lower extremities, hips, and low back were performed gently and slowly. Over time, the patient gained range of motion in the legs and spine, which increased functional mobility and decreased his back pain.

In Thai Yoga Therapy, the back of the body is worked with the client prone. Since the patient was unable to remain prone for any length of time because of the cervical spine fusion and pain/stiffness in the left shoulder, I worked the back sen and back muscles with the client in side- lying position with a pillow supporting his head. I also stretched the chest muscles and mobilized the scapula with the patient in side-lying position. Another alternative for clients with limited neck ROM is to use a “prone pillow,” which is a firm, spongy pillow with a cutout for the face, similar to a face rest on a massage table.

After the work done in prone (side-lying in this case) the middle arm line was worked with the client supine, followed by hand massage and wrist/finger stretches. Since this patient had a history of pneumonia and emphysema we worked on diaphragmatic breathing and abdominal massage in supine to free up the diaphragm. Abdominal reflex points for the organs were also worked during this section of the massage to stimulate digestion and peristalsis.

The sessions were concluded with massage to the upper back and neck muscles in supine position, followed by facial massage with essential oils. The client was visibly more relaxed, and his breathing was deeper and easier by the end of each session.

Results

This patient has attended a total of 13 sessions since November 2003. His overall level of health, vitality, and functional mobility has improved tremendously. The patient now transitions from standing to supine on the floor with only standby assistance. He turns from side to side and scoots up and down independently. He has regained a significant amount of active movement in his lower extremities and has regained some degree of fine motor control in both hands. He can balance in tall kneel and quadruped positions, withstanding minimal challenges to balance, and can reach six inches outside his base of support in sitting. He walks independently with a quad cane (four-pronged cane) and is able to get into and out of a car with standby guarding for safety. He can rise to standing position from a low surface independently and his posture is more upright. He can stand independently without his cane, maintaining his balance against minimal challenges (light nudges/pushes). He has regained some of the weight he lost over the course of events, and his skin tone and skin quality have improved. He enjoys the increased independence and mobility he has gained, which allow him to attend family events and resume a modified work schedule.

Conclusion

Thai Yoga Therapy is a powerful healing art suitable for the treatment of clients of all ages and ability levels. The skilled therapist, working with the client’s physician, can adapt sessions to meet each client’s needs. The results stated in this case study illustrate the complimentary effects of Eastern and Western healing. I encourage Western-trained physicians and therapists to go beyond treating the physical body to treat the patient as a whole. The most wonderful aspect of Thai Yoga Therapy is that it is healing for body, mind, and spirit for both the practitioner and the client, providing a space for healing in the midst of our chaotic lives.

References

1 Raye, op cit.

Resources

O’ Sullivan, S., and T. Schmitz. Physical Rehabilitation: Assessment and Treatment. 3d ed. Philadelphia: F. A. Davis Company, 1994, pp. 491-508.

Umphred, D. Neurological Rehabilitation. 3d ed. Baltimore: Mosby-Year Book, 1995, pp. 375- 420.

Adams, R., and M. Victor. Principles of Neurology. 5th ed. New York: McGraw-Hill, 1993, pp. 749-775.

Taber’s Cyclopedic Medical Dictionary. 17th ed. Philadelphia: F. A. Davis Company, 1993.