Introduction

Medicine in the United States has historically been associated with the treatment of disease by medical doctors—usually with prescriptions or surgery. More specifically, the tradition has been to respond to specific symptoms, rather than viewing the individual holistically. Headaches suggested the use of analgesics to stop the pain. Muscle spasms prompted prescriptions for muscle relaxants to bypass the nervous system. Frequently little, if any, effort was devoted to seeking the cause of these common types of symptoms. The quickest, shortest answer was assumed to be the correct one, and stress or aging could be blamed for almost anything. Patients exhibiting symptoms without convenient blanket explanations, such as chronic fatigue syndrome, might find themselves referred to a psychologist for counseling. Even such basic preventive measures as vaccinations are largely ignored after childhood.

In recent years, this mindset has begun to thaw somewhat. I believe there are a variety of reasons for changing attitudes, but I want to mention some of the more important one. First, thanks to the internet and various forms of targeted publications, those with an interest can find much more information on alternative forms of treatment. Second, Western medicine has lost the sheen of inevitable victory in the treatment of certain conditions. Some strains of bacteria have become resistant to all of the major antibiotics. Years of research and millions of dollars have not yielded cures to persistent illnesses, such as AIDS and cancer. Third, medical care through a medical doctor/hospital has become prohibitively expensive for a large segment of the population. Finally, for purely business reasons, some health insurance providers have realized that “alternative” medicine can effectively treat many conditions cost effectively and without the side effects of drugs. For example, it is less expensive (and more effective in the long term) to treat stress-related issues with acupuncture or massage than to take prescription drugs. This same business reality encouraged the rediscovery of preventive measures as a cost-effective way of avoiding expensive treatments of diseases in full bloom.

All of this means that the United States is finally catching up with much of the rest of the world.

In Thailand, and in many other Asian nations, the healthcare tradition has been to treat the body holistically, with a focus on maintaining balance or helping the individual to regain it once lost. Illness is considered an indication of imbalance, either within the client or between the client and his external world. In sharp contrast to American medicine, the client is considered on multiple levels, physical, energetic and spiritual.

More specifically, Thai traditional medicine combines herbal treatments, proper nutrition, physical exercise and hydrotherapy with massage practice. Thais believe that “’the absence of illness is the best blessing.’”[1] Until dislodged in the late 19^th and early 20^th centuries, this combination constituted the primary healthcare regime for Thailand, rather than an alternative viewed with some skepticism as it has been in the United States.

History

The historic origins of Thai massage are not entirely clear, but they extend up to 2500 years into the past. Thai traditional medicine, of which Thai massage is one part, owes a great deal to Ayurvedic traditions from India. However, like the Chinese and the Japanese, Thais built their own unique systems upon the Ayurvedic foundation.

Ayurvedic Tradition

Much of the belief system and practices which developed eventually into Thai traditional medicine can be traced to Jivaka Kumar Bhaccha—Shivago Komarpaj in Thai—a renowned Indian physician. One of the leading centers for Thai traditional medicine bears his name: the Foundation of Shivago Komarpaj, Traditional Buntautuk Hospital in Chiang Mai, Thailand.[2]

This physician was a friend of Buddha who used yoga postures, massage, healing herbs and steam to treat Buddha and his other royal patients.[3] All of these elements are still present in Thai traditional medicine. In addition, other Ayurvedic concepts have been preserved in Thai medicine.

The word ayurveda roughly translates as life knowledge. In this tradition, prana is the life energy; this word is present in both India and Thailand. Prana travels through sen lines, which are equivalent to prana nadis in India or meridians in China. It is this flow of energy throughout the body and the universe that is central. The prana can be absorbed from air through breathing and food through digestion, but it must continue to flow. Anything interfering with the free flow of the energy will result in imbalance; imbalances create symptoms and may result in illness. [4]

Thai medicine, like Ayurveda associates the universe with five elements—ether, air, fire, water, and earth. Everything is composed of these five elements, and all five elements are present in all others. Understanding how various individuals relate to the elements is crucial to treating them. The five elements and their proportion in various individuals are central to the treatment of the sen.[5] Despite their common roots, this differs slightly from Chinese medicine. In China, energy lines are referred to as meridians, and each meridian is associated with a specific organ.[6]

Buddhist monasteries have always been centers of learning, and the other leading center for traditional Thai massage is Wat Phra Cheptuphon, commonly known as Wat Po, in Bangkok. The monasteries, Wat Po in particular, gradually assembled medical knowledge over the centuries. To honor their own beliefs, the monks shared their medical knowledge to help alleviate the suffering of others.[7] The collections of medical texts and presence of statues depicting Thai massage positions and the treatment of sen lines at Wat Po are cited as evidence that Thai traditional medicine developed there. [8] The mere presence of this collection of knowledge at a Buddhist monastery further emphasizes the historic ties to Buddha and Ayurvedic tradition.

These two centers are associated with two variations of traditional Thai massage. The northern method is believed to have originated at Chiang Mai and begins each day with a chant asking Jivaka to inspire the day’s work. The southern method associated with Wat Po in Bangkok.[9] This division recognizes the Ayurvedic traditions, while allowing for the evolution of those teachings in a unique way that is Thai. While traditionalists may adhere to strict methodologies from either school, increased communication is beginning to erode the distinctions between the two schools.

Development of Thai Massage

Beyond the Buddhist monasteries, Thai traditional medicine was developing in its own way. Even now, most of Thailand is rural, leaving the populace with limited access to central medical facilities. This forced the development of home remedies, with family members providing medical care for one another. As the knowledge and skills of particular individuals grew, neighbors and friends sought them out. Originally, this knowledge passed verbally from one generation to the next, but by 1240 or so, experts started preserving the information in written form.[10]

Various kings of Thailand guided efforts to preserve and expand this body of knowledge. One of the most visible royal influences was King Rama III (1824-1851), who served as a benefactor to Wat Po. Information in many fields of study, including medicine, was assembled at Wat Po, creating a virtual university. Much of this information was carved into marble walls and can still be viewed today.[11]

Also at Wat Po can be found a series of 24 statues, depicting yoga-like postures. Originally 80 in all, the 24 are all that remain after the ravages of time and thievery. These statues are said to be representative of “ruesri dut ton.” Ruesri dut ton is believed to have been developed by religious hermits, or “ruesri,” who used the stretches to restore circulation and mobility after having meditated in the same position for long periods of time. In some of the statues, an individual is working on himself; in others, a practitioner is assisting a recipient in treating areas beyond the reach of self-healing. These postures are precursors to many of the positions and movements present in Thai massage today.[12]

To understand the historic importance of massage in Thailand, it is interesting to refer to royal documents. For example, in a registry of nobility from 1455, the massage department was divided into two departments and encompassed more practitioners than any other medical department. Later, professional Thai practitioners were accorded ranks equivalent to senior military officers under King Trailokanart.[13]

As Thai massage developed, a new distinction was added. Since most massage occurred at home, Thai massage historically used elbows, knees and feet, as well as hands, to apply pressure. When massaging a wife, a brother, an aunt or a close neighbor, this method seemed entirely appropriate. However, during the Ayutthaya period (1350-1767), Thai massage enjoyed popularity at the highest levels of society and the favor of the royal court. Royal patronage prompted some modifications to traditional practices. The royal court considered it inappropriate for practitioners to touch members of the royal family with elbows, knees and feet. To adapt to royal protocols, practitioners modified the steps to apply pressure only with the hands and thumbs. This strain came to be referred to as “royal massage,” with the more common techniques called “folk massage.” Practitioners of royal massage were naturally expected to exhibit the highest levels of skill and decorum.[14]

Western Influence

With the introduction of Western medicine and its disdain for traditional healing, Thai massage declined. The courts of King Rama V (1868-1910) and Rama VI (1910-1925) did not support royal massage, although this apparently did not diminish folk massage in the countryside.
Further reducing the visibility of traditional Thai medicine was a restriction from the Rockefeller Foundation. In the early 20^th century, the Foundation helped fund western-style medical facilities, under the condition that the teaching of traditional healing methods be supplanted by western methods.[15]

During the Vietnam War, the presence of American soldiers prompted the opening of “tea houses,” known as Rong Num Cha. There, soldiers could find tea, a bath and sexual services. In these and other locations, Western visitors were offered “Thai massage,” but what they experienced had nothing to do with traditional Thai massage. In this way, much like with the British sex scandals, massage gained an undeserved reputation that hurt the credibility of the profession.[16]

In 1993 traditional Thai medicine enjoyed rehabilitation, thanks to the patronage of the government. Within the Ministry of Public Health, the Institute of Thai Traditional Medicine was created to “restore and preserve the ‘ancient wisdom’ of Thailand, and integrate it with modern medical services.” The director of the institute is Dr. Pennapa Subcharoen. She is uniquely qualified to lead the department. The daughter of a “traditional folk doctor,” she also has a medical degree. Dr. Pennapa has led the charge for restoring credibility and professionalism to the practice of Thai massage.

This government endorsement of traditional medicine has had a dramatic impact on Thai society. When browsing Thai news sources, I found numerous articles promoting traditional herbs and treatments as viable alternatives to western medicine for some ailments. Other stories profiled traditional healers who had been ridiculed before and are now enjoying successful practices. Still others talked about treating chronic stress and other ongoing assaults on the body through balancing lifestyle regimes, rather than hit and run style treatments. There were even debates about what therapies insurance companies should pay, and examples of people who paid traditional healers out of their own pockets, rather than bill insurance for western-style medicine which they found less effective.

The Energetic Basis

As mentioned above, Thai massage is usually attributed to an outgrowth of Ayurvedic tradition. Thai practitioners see the body as an energetic body with a physical manifestation. According to this tradition, the body contains approximately 72,000 energy lines. Of these, 10 are of primary importance. They are not exactly equivalent to Chinese acupuncture or Japanese Shiatsu meridians, but there is a great deal of overlap. For example, sen lines are found on the tops and bottoms of toes, whereas meridians begin and end on the sides of toes.[17]

Other parts of the energetic body are called “marmas” in Ayurvedic tradition. Thai massage considers 13 of the total of 108 significant. Seven of the primary ones are the chakras, with another six also of importance. Gulpha marma is associated with the feet. Zusanli is located just below the knees and imbalance can manifest as tired legs. Kshipra is located in the web of the thumb and links with tired hands and arms. Kupara is inside the elbows and can create stiffness in that joint. Amsa coincides with the traps and can generate pain in the shoulders and neck. Vidhura can be found at the base of the skull and may create headaches.[18]

Understanding these energetic structures is the foundation of Thai massage. Physical illness is believed to be an expression of imbalance or blockage in the free flow of energy. Under normal circumstances, energy flows freely into the body from the universe, throughout these systems, and back out to the universe. Because the energy always seeks an outlet, any blockage will force it to seek another outlet. As it struggles against the limitations to its movement, symptoms will manifest on the physical body. In its simplest form, disease is a direct byproduct of blocked energy flow.

As can be seen above and in the captioned illustrations throughout this paper, physical problems are linked with blockages in specific energetic bodies. In this sense, symptoms are treated in Thai massage, but in a way far different from western medicine. While a doctor in the United States may ask for a list of your symptoms, he is considering only the physical body and his treatment will seek the physical origin of the symptoms. If the physical origin is not immediately apparent, he may treat your symptoms to mask their discomfort or he may ask for additional tests to find the cause. He will always look for direct physical associations between the symptoms and a system or an invading organism.

Because the Thai practitioner will see your symptoms as manifestations of energetic blockages, he will treat the appropriate energy channels (sen) or centers (marmas). They may or may not have any direct physical link with the affected area. He may, in fact, appear to be ignoring the affected area altogether. However, since the lines run throughout the body, he may treat energy lines on the feet or legs to address symptoms in the chest. Depending on the level of physical discomfort in the affected area, it may be much more practical and effective to work somewhat removed from it. In this sense, Thai massage is not at all different from acupuncture, acupressure, Shiatsu or reflexology.

Basic Techniques

As with most other modalities, there is a physical expression of the treatment on the recipient’s body. Even a first-time recipient can recognize Thai massage as a massage modality. To treat blockages, the practitioner applies pressure directly to the lines and executes stretches to allow freer movement. Contracted muscles can block energy flow, just as they block the flow of blood. Stretches can allow your body to reposition itself into a natural balance—habits of posture and holding patterns can also create blockages.[19]

In order to perform a Thai massage, the practitioner must be prepared to direct significant force into the client. Traditionally, it is a deep treatment. Some sources did not consider it a true therapy unless tears were brought to the recipient’s eyes. This does not require the practitioner to be especially physically strong. Instead, it requires good body mechanics. Posture must be erect at all times. Energetically, this prevents blockages in your own body from inhibiting the work. Physically, it allows the force to pass through skeletal, rather than muscular systems. The goal of the practitioner should be to pull energy/force from the earth at all times, rather than expending his own energy/muscular strength.

From my own experience, Tai Chi provides an excellent model for the ideal balance.[20] For myself, Tai Chi helped me to improve balance and flexibility. That gave me some endurance for physical challenge of the practitioner positions. It also helped me understand the concept of pulling force from the earth, staying grounded, and directing that force outside myself, without depleting myself.

The two most common methods for applying pressure to energy lines are called palming and thumbing. Both are methods of compression. In palming or palm walking, the practitioner walks along the recipient’s body, applying pressure with the palms of his hands. The force of the compression comes not from muscular strength, but from the gradual shifting of the practitioner’s weight from one side to the other as he works along the recipient’s body. As the weight is shifted, the force is directed into the recipient through the palms. This shifting from side to side is referred to as bamboo rocking. This movement often appears as a warm-up, preparing the tissue for deeper work. The movement itself is also soothing to the recipient, helping him to enter a meditative state conducive to healing.

In thumbing or thumb walking, the same principles apply. Force has nothing to do with muscular strength. It is the weight of the practitioner shifted and directed into the recipient’s body which creates the force of the compression. Thumb walking is characterized by the same bamboo rocking, with force exerted through the lead thumb, then the following thumb and back to the lead thumb as it moves along the energy line.

To address blockages or specific pressure points, one thumb may be placed on top of the other, concentrating the force. At times, small, almost imperceptible circles may be made while pressing with the thumbs.

Beyond these two, Thai massage (outside the royal chambers) encourages the use of other body parts. Rolling may be done on muscles with the forearms, preparing the muscles for deeper work. Elbows and knees may also be used to exert stronger force on the recipient than hands or thumbs would permit. Finally, feet may be used. With them the entire weight of the practitioner can be directed into the recipient. [21]

The Practice

Kam Thye Chow, more of the more visible international teachers of Thai Massage, wrote one of the more elegant descriptions I have seen for the practice of Thai massage. He compares Thai massage to a tango:

“Linked together in a graceful dance, the principal dancer (the practitioner) and the follower (the recipient) perform a series of yoga positions. The practitioner uses her hands, feet, arms, and legs to gently guide the recipient into various yoga postures while remaining focused and centered. The more skillful and fluid the practitioner, the more the recipient is able to relax and trust her as the principal dancer. As the dance becomes more beautiful and harmonious, it also becomes more healing and beneficial to the receiver.”[22]

This one analogy provides a good foundation for understanding the practice of Thai massage. As in the first part of the statement, the practitioner and the recipient are working together to achieve a common goal. Thai practitioners see themselves as facilitators and guides. They seek to build your own awareness of blockages. You should not visit a Thai practitioner to be “fixed,” like you might seek a sports massage after a big event. You may very well leave the Thai session feeling significantly better than when the session started, but it was a joint effort.

The second part refers to yoga postures. Thai massage is often called Thai Yoga Massage. It can be likened to passive participation while the practitioner places your body in various yoga positions—assisted Hatha Yoga. For those without the training and practice, or with physical limitations, having the assistance of the practitioner makes a difference in your range of motion and flexibility. With assistance, most people can go far beyond their own habitual limitations, and Thai massage takes full advantage of that fact.

My own experience has been a dramatic improvement in my overall flexibility through receiving Thai massage. Certain joints now bend beyond what I always assumed was a physical limitation. In fact, I had allowed habit to become a limitation, and it was Thai massage which demonstrated to me my own role in creating the limitation. Again, the practitioner did not fix me; he merely showed me where I was limiting myself.

The massage is performed using “hands, feet, arms, and legs.” As this suggests, good body mechanics is a fundamental part of the practice of Thai massage. The use of various body parts achieves multiple goals. Some of the positions of the massage make it more practical to use parts of your body other than your hands. Using various body parts allows you to distribute the work of the massage more effectively, limiting the likelihood of strain on your body. It also depends on where you are working—for a specific point, you would apply pressure with only a thumb, as on the energy lines. For broader work, you would use the palms or arms. In many positions, your legs give you leverage to hold the recipient in a position while you apply force.

It is also significant to note that the yoga is being performed together. Some of the positions require the practitioner to be in uncommon positions, as well. This is the more tangible foundation for the requirement to be “centered and focused.” Because the practitioner is the guide, he bears the responsibility for maintaining the physical balance of both. During a Thai massage session, you will project significant portions of your own body weight into the recipient in focused movements. It is critical that you maintain your own equilibrium to prevent collapsing into the recipient and so that you may withdraw promptly if the pressure becomes too much. This equilibrium is constantly changing as the recipient’s body responds to your pressure. You do not want the recipient to make conscious adjustments to his own body because that would derail the therapeutic benefits of the treatment. In order to achieve your common goal, you must maintain balance both within yourself and between yourself and the recipient—internal and external homeostasis.

This challenge means that Thai massage can take a distinct physical toll on beginning practitioners. The first few times I performed Thai massage practice, I was not sure I would ever be able to perform a complete therapy. My body was unaccustomed to the strain placed on it by the kneeling and some of the leveraging postures. My thumbs rebelled against the force I projected through them when working on energy lines. However, despite these physical reactions from my body, I found myself energized and content after performing the massage. As with many other physical activities, your body can adjust to the new demands. The key is maintaining constant awareness of body mechanics. That helped me make sure I was only teaching muscles new movements, rather than straining less forgiving structures.

This need to maintain two levels of homeostasis during the massage is only one reason the practitioner must be centered and focused. Because Thai massage focuses on intangible energies, the practitioner must remain calm and focused within while observing intently for subtle messages from the recipient. The energy lines are not physically visible on the body, though certain landmarks can help guide you to them. In order to work on the lines, you must be aware enough to sense them. When blockages are present, you need enough awareness to notice, rather than working around or too superficially. On a more physical level, the stretches are challenging to the average recipient. By the time he could give verbal feedback, you may have already pushed beyond a reasonable level and triggered a stretch reflex.

For all these reasons and more, traditional Thai massage always begins with a prayer or meditation. Historically, this fits in with the centuries of association between Thai massage and Buddhist temples. Practically, it provides a way for the practitioner to focus and center himself, set his intent for the session, and allow the two energetic fields to synchronize.

Thai massage is thus an artistic fusion of several traditions. From Ayurveda, it gets the energetic basis—body types, energy lines and the tradition of seeking balance both within yourself and between yourself and the universe. Failure to maintain either balance is unhealthy and causes illness. From yoga, Thai massage adopted stretches to challenge holding patterns and unnecessary limitations. Buddhism brought the concepts of meditation and centeredness, so necessary for working energetically. From Buddhism and its centuries as a home remedy, Thai massage enjoys a tradition of relieving the suffering of others as an honor for the practitioner. And, out of necessity, Thai massage developed an acute sense of good body mechanics. That term was never used, but the practice of Thai massage forced a strong awareness of physical positioning in a way that was beneficial to the recipient without doing damage to the practitioner.

Physical Effects of Thai Massage

Despite its roots in the energetic, Thai massage offers specific physical benefits to the recipient, regardless of his acceptance level of the energetic foundations. Many of them coincide with typical benefits associated with other modalities.

For example, Thai massage helps to alleviate stress on the skeletal system caused by inefficient postures. Through the compressions and stretches, the recipient’s body may find a way of carrying itself with less effort. The space between the vertebra may also be increased, allowing freer movement of cerebrospinal fluid. Synovial fluid is increased by the joint mobilizations, giving the joints better lubrication and decreasing wear at the joints.[23] Due to lifestyle differences, including receiving Thai massage, older Thais are likely to have significantly greater range of motion and better functioning joints than Americans of equivalent age.

In the muscular system, the compressions help flush metabolites out of muscles, decreasing soreness. Fresh blood, rich with nutrients can then enter the muscles, helping them rejuvenate and retain/regain their tone and health.

Lymph is also moved, stimulating the immune system.[24]

Not only does the movement of blood help the muscular system, it also assists the circulatory system. The return of metabolite-rich blood back into circulation allows the toxins to be flushed from the body. As a general effect, the compressions help push blood back to the heart, increasing venous flow. Work on the extremities stimulates the flow of blood to those areas, while certain positions promote the rapid return of depleted blood back to the heart. A Thai session provides a thorough cleansing of the circulatory system, allowing it to operate at peak efficiency for a while.[25]

As for the nervous system, the meditative state that is part of Thai massage activates the parasympathetic nervous system. With this, the heart rate decreases, breathing comes deeper and slower, the muscles relax and the brain enters a peaceful healing state of well-being.[26] Because it is so peaceful, I have seen recipients fall asleep while receiving Thai massage. This is somewhat disconcerting when working as deeply as you are in Thai massage, but it is indicative of the level of relaxation it promotes. If a recipient can sleep while being manipulated into yoga postures, stretched beyond normal range of motion and receiving the force of the practitioner’s weight through thumbs or elbows, they are definitely in a deep healing state.

Thai Massage in the Modern World

Thanks in part to the patronage of the government of Thailand, Traditional Thai Massage is enjoying a renewed respect at home, and skilled practitioners are willing to share their knowledge around the world. Courses of study for foreigners wishing to learn Thai massage from a Thai teacher are common, and the scheduling takes into consideration the difficulty of making extended visits to Thailand.

Where a Thai practitioner studies anywhere from 800 to 1000 hours or more to become proficient in Thai massage, programs that allow study in blocks of one to two weeks are readily available to foreigners. Many who study in Thailand bring their knowledge back to their home countries, and institutes of Thai massage can be found in the United States, Canada and the United Kingdom, for example. In many cases, those were founded by massage therapists who were introduced to Thai massage as a recipient and realized the effectiveness of the modality. After studying in Thailand, they returned to their own countries and began sharing their knowledge with others who might not be able to visit Thailand.

One of the fundamentals of Thai massage is the expectation that each practitioner will adapt the basics and that each session requires a different application of techniques. Over the centuries, this has allowed the expertise of masters to become part of the body of knowledge shared by others. As practitioners of other modalities learn Thai massage, they naturally adapt its techniques to fill their own needs. As a result, many of the non-Thai practitioners develop their own variations on the traditional Thai treatment.

For example, Maria Mercati opened the Bodyharmonics Centre in Cheltenham, England and wrote a book containing her own vision of Thai Massage. Like many western practitioners, she did not content herself with just studying Thai massage. She also studied Tui Na and acupuncture, so her center teaches all three. This allows her to move between Chinese and Thai techniques, using the most appropriate at a given time.

Kam Thye Chow, to whom I previously referred, developed his own version of Thai massage, which he refers to as Lotus Palm Thai Yoga Bodywork. He practices in Montreal and also wrote a book about his techniques. His background also contains Chinese training, but after studying in Chiang Mai for six years, he has a strong foundation in “pure” Thai massage. His contribution in bringing the techniques west was an adjustment for lifestyle difference. In Thailand, walking and biking are primary forms of transportation. Must of the country is rural and tied to agriculture, and the methods require a great deal of manual work. For these reasons, among others, traditional Thai massage usually begins with work on the feet and devotes a great deal of the session to work on feet and legs. Recognizing that westerners spend far less time walking and a great deal more time sitting at desks, he places more emphasis on back and shoulder work and begins with the sitting position. This does not mean that a native Thai practitioner would not work more on a westerner’s back, in the tradition to adapting to the client’s needs, just that the movements and elements of a “routine” Chow presents are already pre-adapted to western needs.

Some practitioners modified Thai traditions even more radically. Margie Meshew of the Florida College of Natural Health concocted a blend of Thai and Swedish techniques which she calls “Swe-Thai Massage.” She conducts training and sells videos demonstrating her blend. This is an even more radical departure from Thai traditions. Thais are accustomed by tradition to sitting in the floor and sleeping on mats on the floor. True Thai massage is performed on a mat on the floor. Westerners are typically less acclimated to sitting in the floor and may not have the flexibility to readily get down onto a floor mat and back up again. In fact, for many the floor is a place for children; “refined adults” belong in chairs. To ask them to receive a massage while on a floor mat would not be well received, or practical if their range of motion was truly limited. Meshew keeps the client on the table, receiving a massage reminiscent of Swedish massage, so the client would feel comfortable. She then includes techniques from Thai massage, creating a hybrid with the intent of achieving the best of both worlds.

One of the more interesting projects is Asian Spa Therapies, a sister company to Echo Valley Ranch and Spa in British Columbia, Canada. The owners are Norm and Nanthawon Dove. He is British, and she is Thai. The spa draws heavily on her Thai roots, while melding into the ranch theme. Not content to just offer traditional Thai services at the spa, the couple signed an agreement with the Thai Traditional Medicine Foundation to offer 800-hour professional Thai massage certification at locations throughout North America through Asian Spa Therapies. Graduates of the program will receive the same type of certification as Thais studying under the auspices of the Thai Ministry of Health.[27]

The program with Asian Spa Therapies is indicative of the interest Dr. Pennapa has in increasing international awareness of traditional Thai medicine. She is actively involved in international efforts, under the World Health Organization, to recognize and promote traditional healing methods.

The Asian Spa Therapies project is also interesting for what it says about the activism of the Thais in maintaining the purity of their traditions. They look at their own history and see that traditional Thai medicine was first derided as superstition that should be replaced with western medicine. They also realize that certain “tea houses” advertise “That massage,” hurting the reputation of legitimate massage. Despite making it easy for westerners to study Thai massage for relatively brief periods, they fear allowing under-qualified practitioners to bastardize the practice and damage the credibility of the art. At present, they appear torn between making the training for Thai massage more visible and accessible and maintaining the quality and purity of traditions. The program with Asian Spa Therapies seems to be their answer – anyone can talk about Thai, but only graduates of Thai schools or Thai-blessed schools, like Asian Spa Therapies, will receive the certification from the Thai Traditional Medicine Foundation.

In another planned project, a “Thai Village” would be constructed in Constanta, Romania, at the edge of the Black Sea. The area is already known as a spa retreat. For the Romanians, the project offers an opportunity to increase the spa audience from the current three months out of year to an ongoing draw. For the Thais, it further spreads the influence (and profitability) of traditional Thai methods for healing.[28]

Anatomy Trains

Having personally both witnessed and experienced the benefits of Thai massage, I began this process hoping to find statistical or scientific evidence recognizing its efficacy. I wanted the same scientific establishment in the west which had ridiculed traditional methods to have to admit that maybe, at least in some cases, the traditions were valid and useful methods of treating clients. I do not think I was overly optimistic in this intent, perhaps just a little ahead of my time. Statistical comparisons between Thai healthcare/health statistics and U.S. ones are virtually impossible to find. The two nations have different methods of recording useful data, and few nations keep the level of statistics the U.S. does. Of those who do, it is not necessarily available outside government agencies.

Given this, I took a different tack. I looked for western-style scientific approaches that mirrored aspects of Thai massage. I found one that I will present here as a case study.

Thomas Myers trained as a Rolfer, so his background is structural. In his book Anatomy Trains, he points out that for the last century or so, western massage has focused on drilling into the details of individual muscles and attachments—looking at the microcosm. His goal is to start building a framework of the macrocosm of a human. Everything is related, and the cause of a physical problem may not be in the immediate vicinity. Without negating the small scale, he recognizes the benefits of looking at the broader picture to see what imbalances in the body can affect other areas. [29]

Since fascia is present throughout the body, he presents the case that it is through fascia that the body relays balance/ imbalance throughout the body. That part of his work is not unique. His unique contribution is the construction of the actual paths of transmission through the body. He refers to these lines of transmission as anatomy trains. After setting guidelines for the construction of the trains, he delineates 11 of them, demonstrating the exact mechanism by which force, imbalance or healing can travel through seemingly unconnected systems of the body.[30]

He refers to the lines as meridians, with the caveat that they are not to be confused with energetic meridians used in acupuncture. However, the reason I found his work so intriguing was the fact that his myofascial meridians overlap so significantly with the energy lines followed by Thais, Chinese, Japanese and Indians. Here is an example of western science recognizing the connections and therapeutic aspects of lines that easterners have treated for 2500 years. Of course, his lines diverge from Chinese lines, just as the Thai lines do. But, many of the more important areas are shared by all of the traditions.

In outlining his 11 myofascial meridians, Myers provides his criteria, expecting that others will contribute additional lines in the future. The short version of his rules is as follows:

Follow the grain of the connective tissue, maintaining a fairly steady direction without jumping joints or levels or crossing through intervening layers of fascia
Note the stations where these myofascial tracks tie down to the underlying tissues
Note any other tracks which diverge or converge with the line
Look for underlying single-joint muscles that may affect the working of the line[31]

I provide his guidelines to show that he follows western-style scientific thought and procedures in his method. Yet, his rules could offer overlap for similar rules for energetic merdians, if they existed.

Thai sen lines flow in consistent directions, without radical jumps, and a given line is worked at approximately the same intensity, implying a consistent depth.
Though the lines do not match skeletal structures, bony landmarks can often be used as guideposts for the locations of the lines.
Lines do overlap and are worked through; you do not jump from one line to another while working. Certain stretches benefit multiple lines at once, but they are each considered to have been worked as unique structures.
Thai practitioners are aware of the muscles but maintain focus on the line, rather than the muscle.

To avoid an anatomy train tangent, let me just refer to two of the illustrations I have included. If you compare the Superficial Back Line from Myers with the Sen Kalathari, you can see remarkable overlap. Immediately noticeable is the lines on the foot. Both show lines from each toe converging somewhere near the heel of the foot. These foot lines are the starting point for traditional Thai massage because of their interaction with the rest of the body. Both show lines running up the laminar groove and on to the skull. These lines are worked in multiple positions in Thai massage because of their importance in back, postural and shoulder problems. By expanding the comparison to consider the other sen lines, you would find even more overlap.

Myers considers this work a starting point. He is building on it himself, and encourages other practitioners to contribute their own expertise to expanding the model. The model itself shares another fundamental with Thai massage – the intention of balancing the body. Myers is more focused on internal homeostasis, but he does acknowledge that achieving the right balance results not just in improved posture and reduced pain. The right balance in his system leads to better long-term health and sense of self, just as it does in Thai traditions.[32]

Conclusion—My Practice

I already incorporated a great deal of Thai massage into my bodywork. I feel a connection to the energetic aspect of the work, and I see the benefits expressed in those who receive my work. I sometimes do “true” Thai massage on floor mats for friends and family, especially when addressing specific and deep pain or mobility limitations. On the floor, I can work very deeply without compromising my body mechanics. I also have adapted many of the things I learned from Thai to table work. The stretches are a natural complement to Swedish mobilizations and allow me more options to adapt to different clients with varying degrees of mobility. So far, I have encountered no one who disliked the foot work that is so important in Thai massage. In fact, I like to begin sessions by treating the energy lines of the foot, just as in Thai tradition because it significantly calms and relaxes the client before I proceed to more direct local work.

The trend right now in the United States is to embrace eastern knowledge and traditions. For a variety of demographic and cultural reasons, we have suddenly “discovered” the ancient wisdoms, and a growing segment of the population recognizes their value and seeks eastern-style treatments. Even some of the western medical establishment is open to these therapies as a method of maintaining overall health and managing stress. It has become quite possible to find medical doctors with complementary oriental medicine certifications and experience. Thai traditional therapies are benefiting from this cultural shift, and I believe will continue to do so for the foreseeable future.

Thai massage is providing a building block for my practice. To further enhance my teacher training, I will be going at the end of May/04 to be certified in some of the herbal aspects of Thai traditional medicine. One method of treatment in Thailand is massaging the client with steamed bags filled with herbs chosen to address specific ailments. I will learn the herbal mixtures and applications of the bundles to treat my clients. This is one of the hydrotherapy aspects of Thai traditional medicine, and I believe these skills will help differentiate me from other Thai practitioners and enable me to more effectively treat my clients.

From Myers, I found one additional quote of particular interest, because it encapsulates much of what we have been learning through TouchAbilities:

“The heart of healing lies in our ability to listen, to perceive, more than in our application of technique…All therapeutic interventions, of whatever sort, are a conversation between two intelligent systems. It matters not a whit to the myofascial meridians argument whether the mechanism of myofascial change is due to simple muscle relaxation, release of a trigger point, a change in the sol/gel chemistry of ground substance, lengthening of collagen fibers, resetting of the muscle spindles or Golgi tendon organs, a shift in energy or a change in attitude.”[33]

By leaving out just a couple of words referring to the myofascia, we have a beautiful summary of effective bodywork. The body can be effectively treated with an endless variety of techniques from constantly evolving modalities. What matters is the intent to heal, the ability to perceive and respond to what your client’s body tells you and the fundamental knowledge and skill necessary to transmit your intentions and responses to the client’s body. Thai massage is just one way of interacting with a body. Its traditions resonate with me, because it is not about “fixing” clients, just about providing them some assistance in fixing themselves. The connection I feel with its traditions helps make it effective for me. It will never be my one signature modality, but it will always be part of my repertoire.

Dennis Stovall, LMT, NCBMTB, RM

Certified in Traditional Thai Massage by Sacred Bodywork LLC
Certified in the Art of Classical Thai-Yoga Bodywork by Michael Buck at the Vedic Conservatory
Certified Thai Yoga Teacher in the Art of Classical Thai-Yoga Bodywork by Michael Buck at the Vedic Conservatory
Certified in Thai Ayurvedic Herbal Massage by Tao Mountain School of Traditional Thai Massage and Herbal Medicine

Asian Spa Therapies. “Traditional Thai Medicine.” 2003. Asian Spa Therapies. 4 Apr. 2004
<http://www.asianspatherapies.com>.

Avraham, Beatrice. Thai Massage. Hod Hasharon, Israel: Astrolog Publishing House, 2001.

Bentley, Richard, Editor. The Art of Traditional Thai Massage: Energy Line Charts. Bangkok, Nai Suk’s Editions Co. Ltd, 2001.

Chow, Kam Thye. Thai Yoga Massage: A Dynamic Therapy for Physical Well-Being and Spiritual Energy. Rochester, Vermont: Healing Arts Press, 2002.

Chow, Kam Thye. “Thai Yoga Massage.” Massage, September/October 2003, 77-80.

Kapke, Barry. “Massage, Movement, Meditation with Insight Bodywork.” Massage & Bodywork, April/May 2003, 127-132,

Mercati, Maria. Thai Massage Manual. New York: Sterling Publishing Company, Inc., 1998.

Meshew, Margie. Swe-Thai Massage. Deerfield Beach, Florida: Holistic Educational Services, 2004.

Myers, Thomas W. “Anatomy Trains.” Massage & Bodywork, May/June 2003, 60-66.

Myers, Thomas W. Anatomy Trains—Myofascial Merdians for Manual and Movement Therapists. London: Churchill Livingston, 2001.

Ongdee, Sasithorn. “Black Sea deal eyed by Thais.” The Nation, 8 October 2003. 4 April 2004, <http://www.ttr.thaigov.go.th/kan_news9.htm>

Rynerson, Kay. The Thai Massage Workbook. Seattle, Washington, Kay Rynerson, 2001.

Subcharoen, Dr. Pennapa, M.D. “Authentic Thai Massage and Foot Massage.” 4 April 2004, <http://www.thaifloriade.thaigov.net/hort_cd/tour_info/HTML/Authentic_Thai%20_Traditional%20_Massage>

Young, Leslie A. Asian Influence: Ancient Therapies Address Modern Issues. Massage & Bodywork, April/May 2003, 19.

[1] Asian Spa Therapies. “Traditional Thai Medicine.” 2003. Asian Spa Therapies. 4 Apr. 2004
<http://www.asianspatherapies.com>.

[2] Avraham, Beatrice. Thai Massage. Hod Hasharon, Israel: Astrolog Publishing House, 2001, page 9.

[3] Avraham, page 9.

Figure 1: Chow, page 9.

[5] Chow, Kam Thye. Thai Yoga Massage: A Dynamic Therapy for Physical Well-Being and Spiritual Energy. Rochester, Vermont: Healing Arts Press, 2002, page 16.

[13] www.asianspatherapies.com, page 3.

Figure 2: Chow, page 14.

[17] Avraham, page 9.

Figure 3: Chow, page 10.

[20] Chow, page 32.

Figure 4: Chow, page 12.

[24] Chow, page 25.

Figure 6: Chow, page 11.

[28] Ongdee, Sasithorn. “Black Sea deal eyed by Thais.” The Nation, 8 October 2003. 4 April 2004, <http://www.ttr.thaigov.go.th/kan_news9.htm>

[29] Myers, Thomas W. Anatomy Trains—Myofascial Merdians for Manual and Movement Therapists. London: Churchill Livingston, 2001, page 2.

[30] Myers, page 5.

Figure 7: Myers, page 63.

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