Deep in the Weeds with Thai Bodywork

I’m into the latter part of my Thai yoga massage training, which I continued this past weekend. Wow, just when I thought I had a good handle on this, my brain flips a 360 inside my skull.

My training to this point was mostly on the poses, sequences, positioning, tempo, and all that goes into a traditional Thai bodywork session. I’m now entering into the clinical aspects of the treatment. There is a chain of events that happens when you feel pain. Its a cascading flow with a network of interrelationships.

It starts with your feet. How do you stand? Is one leg or one pelvis longer than the other? How does that affect your spine? Do you have tendencies toward sway back or hunch back? What activities do you do on a daily basis? Sitting in an office or driving 8 hours a day? Do you do yoga, weight training, or sports? Or are you sedentary? What is your a dominant side? Do you have inherited or other pathological predispositions? All these play a role in treatment.

Then, we begin to describe pain. But what many doctors and therapists aren’t aware of is referred pain. You come in with knee pain, so they work on the knee. They diagnose something physical in the joint itself. They may prescribe strengthening exercises and stretches. But they never really find the source of the pain. For instance, outer knee pain may stem from a tug from the IT band. So the trainer has you roll your IT band (which, btw, does nothing at all). The real problem could be your tensor fascia latae (TFL) is in contraction which in turn pulls on the IT band, which it is attached to. But they don’t think to look there. But the complicating culprit to the TFL is adductor magnus, so you have to work there too. There are so many referrals that don’t start where you would think. You have to study trigger points and referral pain to understand how the nociceptors send signals to your brain to put out bracing or support wires to prevent pain or injury. And those trigger points aren’t always in obvious places. Its really amazing how it all works.

So we were working on protocols to treat pain. Its not “I have knee pain so work on my knee”. There is a whole process that works toward the source of the actual pain. Otherwise, you get a bodypart worked on, the pain returns, and then you have to go back for therapy over and over again. They never solve the source of the pain.

Another interesting thing I found out was about how pairs of antagonistic muscles work synergistically. I worked on someone last week with painful mid-anterior thigh pain. I was able to find trigger points and work through the pain. But now that I look back, a source of the problem is also tight hamstrings, which were present in this client. So instead, I need to open up the antagonistic muscles as well. The same is true with a client with intense inner pelvic pain. But the source likely isn’t the pelvis at all. It comes down to antagonistic muscle groups.

I still have lots of learning to do. I feel like I’m only on the tip of the iceberg with this. Sure, I can therapeutically work and help people. But my full understanding is a long ways away. And I’m super excited about that. Its a never ending process of learning.

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