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Candace Mickens-Thai Hip Therapy Course
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Candace Mickens
Hyattsville MD
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January 23, 2018 - 8:34 pm
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Module 1

Module 1 has been very helpful with visual assessment of the hip. We learned this in massage school but I felt like this module enhanced my prior experience and gave me even more to think about when working on a client. I specifically found the detail on the way the feet slant  on a 45 degree angle and naturally push toward the floor particularly useful information.   Here are a few instances where I used some of the course material.

Client 1- This client while laying supine both feet were extremely laterally rotated, from the supine position I could not easily see the hip variance...but during the intake while the client was dressed and mentioned some hip tightness , I did notice the belt slanting toward the right when looking at the client from the back.   While laying supine the left leg seemed more laterally rotated toward the floor.  I did a assessment range of motion on both hips and the left hip (which was the problem hip) was just slightly more tight on the range of motion, while the right hip was more flexible.  When the client was prone the left hip was definitely more hip hiked in the air and higher. It was a noticeable difference.  When looking supine, because the left foot was more laterally rotated I was expecting that to be the more flexible hip but it wasn't. Any thoughts?  I know each body is different. 

I loved that you used anatomy as a teaching tool but made the distinction that thai is more based on energy and energy lines.  From a thai perspective, are there certain reasons energy is blocked in the hips as opposed to simply tight muscles?

Client 2- This client had a very slight lateral rotation on the left foot and that foot was slightly shorter than the right. Less than a inch.  We did some of the stretching moves and the leg gained a inch. The right hip was tighter. My question is, do you have any guidance on when the legs are different lengths as a assessment too for the hip.

Also, how does being valgus and vargus (knock knees and bow legs play into the visual assessment of the direction of the feet?

I have practiced rocking on several clients as it is something we learn in massage school as well and use it as a technique to see where energy or tightness is in the body but I have learned a lot more from your videos. It was very helpful to know that the Thai doesn't rocking traditionally. I think alot of people associate rocking with Thai massage and your comment that it wasn't related was very helpful to me. I think its great that you make the distinctions.

As you can see I have lots of questions but I don't want my posts to be too long..I'll save more questions for my module 2 post.  Thank you so much!!!

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Shama
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January 24, 2018 - 1:20 am
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Hi Candace, welcome to our community and the Thai Hip Therapy certification program. For your reference here is our certification check list to make sure that it is all correctly organized:

Certification Check List

Now to your questions:

"When looking supine, because the left foot was more laterally rotated I was expecting that to be the more flexible hip but it wasn’t. Any thoughts?  I know each body is different."

There are some general rules and assumptions, however there are so many factors that can influence joint ROI and flexibility that we cannot apply our rules to everyone. Sometimes it is a matter of playing detective to figure out what might cause the stiffness.

And sometimes we just have to acknowledge that we cannot figure out and fix everything for every client. Sometimes we just have to be satisfied with gradual improvement of ROI and loosening general tightness without knowing the exact causes.

In some cases we can pinpoint the issue and get good results when working on it, but there will always be some cases where we run into an issue which we cannot pinpoint. After all there are a myriad potential causes like muscle stiffness, old injuries or operations, structural abnormalities due to lifestyle habits, differences in individual bone structures, emotional trauma which is held in certain places in the body, lack of exercise, sitting with bad posture etc. etc...

Sometimes we have to look at the bigger picture instead of drilling down into details and just create more overall balance and well being. I know this doesn't sound very scientific, but in my experience we have to know the difference between doing what we can with specific therapy and knowing when to not be attached to a specific result.

"From a thai perspective, are there certain reasons energy is blocked in the hips as opposed to simply tight muscles?"

Yes, certainly. Actually my answer to your previous question contains a partial reply already. Energy blockages can be caused by trauma, injury, operations, life style habits, emotions, or genetic factors. According to the Thai perspective there can also be more esoteric causes.

"My question is, do you have any guidance on when the legs are different lengths as an assessment too for the hip."

Most people have a slight difference in the length of their legs. If the difference is more than slight, then it warrants a closer look. Actually this is a rather complex topic with all kinds of different possible causes. You can't just look at the hip as the culprit, but you have to look for structural imbalances in the entire pelvis and the upper body. There are quick fixes for this, like certain adjustments, but the problem is that if the underlying cause is a structural imbalance due to lifestyle habits, then the condition will always come back. All this goes a bit beyond a forum post. Smile

"Also, how does being valgus and vargus (knock knees and bow legs play into the visual assessment of the direction of the feet?"

This also goes a bit beyond a simple answer. It can certainly relate to the hip condition, but those types of conditions need to be seen in person, and it depends on the degree or severity of the condition. Thai Massage might help in some cases, and in other cases you won't be able to do much about such conditions.

We are not pathologists or specialists for such conditions, and we need to be careful that we don't expect from ourselves that we can improve or fix any kind of structural condition. Sometimes we can help, and sometimes we cannot, depending on the condition. Anyway, that's a big topic! Smile

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Candace Mickens
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January 24, 2018 - 2:26 am
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Thank you. I wanted to make mention that I understand a lot of these are bigger topics  and that every body is different with different presenting pathologies but when asking I'm really only asking from the perspective of the content of the material presented but I appreciate all of your responses. 

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Shama
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January 24, 2018 - 2:32 am
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Got it! And I am always happy to answer questions (if I know the answer), even if they go a bit beyond the course material.

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Candace Mickens
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January 24, 2018 - 2:45 am
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Module 2:

I practiced rocking and the client was fairly stiff at first. Your teaching about how the hip joint is not tight but it is the muscles that are tight was a profound distinction for me as I recognized that the rocking increased in motion as the quads became more relaxed during the session.  I tried a variety of sitting techniques especially when working the far leg..this client was fairly large so I had to adjust my body several times but was happy that my toes have become more flexible and I can sit on them (hard to explain) a little easier. Prior to this video, I had only been rocking from the outside and never reached crossed to rock from the inside .  I am used to using my elbow in massage but I never had tried rocking with the elbow and I felt it was very effective and I was able to use it in side lying position along the IT band (this was a large person) and a two elbow rocking from the back in side lying. I tried using my knee for rocking but it felt awkward and I couldn't really keep my balance so this is something that I will have to practice. Rocking with the heal and center of the foot was helpful,especially due to the size of this client and he had very tight hips..

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Shama
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January 25, 2018 - 1:10 am
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Knee work requires good balance. Here is a video which can help you to develop such a balance:

Balance Exercises For Thai Massage Knee Techniques

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Candace Mickens
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January 25, 2018 - 8:45 am
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Module 3

I just finished practicing modules 3 & 4 and now I am seeing your knee video..I look forward to watching it...Anyhoo, Module 3  I practiced using my knee and I really liked the varying angles and cross body options to vary the pressure and I felt pretty balanced in my body and my body dynamics were pretty good..I think after I watch the video that you sent I will get even better. I really love the elbow techniques especially the support on the leg to protect the lower back. The client asked about the forearm rolling technique because she couldn't understand how I was doing it. She said it felt good and like a rolling pin.. I showed her the difference without the roll and how targeted and direct it would be and she didn't like it and could understand the rolling.. I didn't try the forearm across the body because the client was too big.. A lot o the techniques in this session I had to adjust do to the person being bigger than me but the videos were perfect because they gave a lot of options. I tried the forearm leaning with elevated leg and I really can't wait to try it on a smaller person. The client felt it and felt the benefit but it was awkward for me and I had poor body dynamics...

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Candace Mickens
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January 25, 2018 - 8:55 am
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Module 4

I liked the range of motions of the hip and the pie concept. In the past I had done maybe 3 slices of the pie but this video showed me more of a range and any to isolate the tight muscles. The client felt a release in the low back during this process.  All of her stiffness was primarily in one direction.  I liked the traction technique with stabling the foot an tractioning of the body the traction worked but the rocking I could not get with this client and honestly none of it felt good on my body even though the client felt the traction release her low back... I just think the client was too big for me to traction in this manner or maybe I just need to get stronger because even using my full body weight it was a struggle or possibly I just wasn't hitting it at the right angle.. On the adductors with the hands in the butterfly position I had used a pillow (bed size) to bolster the leg so getting my body positioned at a 45 degree and navigating the big  pillow was challenging so I definitely need to get some smaller pillows. The technique did relax the  adductors and again helped with opening the hip and low back which the client liked.. Overall the client felt fully stretched and good.

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Shama
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January 25, 2018 - 8:00 pm
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It all sounds good, like you are seriously working with it. No doubt that you will be successful with it.

Regarding the traction technique - the trick is to angle your body back far enough so that your body weight is doing the pulling. If you are not leaning back far enough, you will be muscling the client's body and struggling with it. Try to increase the angle of your body from your knee to your head. The heavier the client, the closer you need to get to a 45 degree angle with your body.

And then there are clients who are so much bigger than you might be that there is nothing wrong with simply skipping a technique.

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Candace Mickens
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January 27, 2018 - 8:53 pm
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Module 5

The stretching techniques were good but I am still working on body dynamics because the clients foot on my hip does not always seem to fit. I'm still working on the angles. Sometimes I use my shoulder or hold the foot in my hand.. The blood stop using the elbow is very interesting. I have been doing the blood stop in a few positions during the past year but not with this technique which I am still eager to try.  I did not do it with this particular client because they have high blood pressure and a heart problem and I was taught not to do it as those things are contraindicated. I am clear that there are differences between western and eastern methodologies and in massage therapy the blood stop would never be done because the femoral artery is in the endangerment zone but I have done the blood stop plenty of times in thai. What is your thoughts on High Blood pressure/heart problems and the blood stop? Also what is the recommended time to hold?

 

Module 6

I will be revisiting and revisiting this module especially when I can have the computer right next to me. I really had difficulty with the foot in the hips and the angles. This module really had a lot of information and when I worked on the client I was doing it from memory as a part of a full session and it just felt awkward so I will do it again probably this afternoon and just practice each position step by step. I did love the double leg hip stretch as I have been doing it in the past but applying the concept of the hip pie really made this a more dynamic and complete range of motion technique.. I really love these videos...

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Shama
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January 29, 2018 - 9:38 am
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In the case of high blood pressure and heart problems it is always best to be safe rather than sorry. I know the 'blood stop' technique scares some western therapists, however as you know it is routinely done in Thai Massage, and it doesn't cause any problems under normal circumstances. Just the opposite, it feels good to receive and it has a beneficial effect.

As responsible therapists we of course need to know if our clients have issues that might be a contraindication for any kind of technique. There are so many techniques in Thai Massage that we can easily skip one if we feel that it might not be totally safe due to a problem.

The issue with the 'blood stop' is the scary name. It doesn't stop the blood at all, but only reduces the flow a little. The recommended time to hold it is between 10 and 20 seconds. You can tell when it is time to release when you feel your hand getting warm and you feel a strong pulsing.

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Candace Mickens
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February 3, 2018 - 9:55 am
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Module 7

The client was very flexible and the hips were loose and open. I did the extended leg stretch with one hand holding the hip and the foot on my leg from the opposite side of the body.  It took a little adjusting but it worked out...the client was very flexible and I should have tried to put the achilles on my shin but I forgot about that part but will definitely try again with a more flexible client.  Hip slice #8 was pretty effective but in hindsight I don't think that I blocked the bent leg enough although the technique seemed to work and the leg didn't slide.

 

Module 8

I enjoyed the side position and tried almost all of the techniques from the back and the front. The gallop method was very well received by the client I used two pillows to bolster but I still felt like she was sliding down and that the hip was not rigid and erect but the client said she was comfortable.   The squeeze and pull wonder bread move was my favorite but with this client there was little muscle tone and it felt like just soft tissue, nothing was stuck all. Everything was hydrated and fluid so it felt like i was kneading dough and she didn't have many knots except for some tightness on the IT band.

 

Module 9

the forearm rolls at the hip joint were great to release the attachments in that area. The forearm roll up was much easier than I thought. I use a lot of two hand stacking with palm circle and finger tip circles because I am hyper mobile so I have to be very mindful of my wrist and hand joints..thats why i love thai and watching your videos because it is imperative that I save my hands...I love doing the knee presses into the piriformis because it is much broader than my elbow but is very effective pressure. i did not get up to the level of standing up and putting full body weight more so because I forgot but i think this will be effective with some of my larger clients...I didn't try any of the figure four lock moves but will practice that soon...

Headed to thailand in two days so I may get another session in before I go....otherwise Ill look forward to more videos upon my return...

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Shama
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February 3, 2018 - 1:28 pm
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True, Thai Massage, at least my style, is designed to be as therapist and hand friendly as possible. To take this even further, I even created a 'Hands Free Massage' course. The 'Body Mastery for Massage' course is also very useful in this regard. (This is included as a bonus course with the 'Hands Free Massage' course).

You are headed to Thailand - great! Where exactly are you going?

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Candace Mickens
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February 3, 2018 - 7:35 pm
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Thanks for the info.

 

I will be taking a course at the Wat Po Chetawan school in Chiang Mai. I know you mentioned that you are about 40 mins outside of Chiang Mai....I'll be in bangkok a few days and phuket a few ...its a short trip...

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Candace Mickens
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February 21, 2018 - 3:39 pm
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Module 10

I really love the circular hip rotation as I always have tight hip flexors myself. I like the way you use your thigh to knee lock the clients knee and the half circle that only goes in the medial direction.  The prone opposite leg lifts I do by moving the hand in two places for the stretch on gluteus max and median..you mentioned don't place hand on the bone which i was mindful of ...i really like the alternate version that can be done with flexible people and your use a "leg lock" for lack of a better descriptor instead of your arms...that is very helpful.  On the prone angled leg stretch, the explanation of coming down on the angle makes so much sense rather than coming straight down..

 

Module 11

The double foot stretch was so helpful because Ive been doing this stretch but not able to modulate according to flexibility and pressure and by changing the second leg position made all the difference.

I love the transition from prone to side lying...as I find it helpful to not have to ask the client to move them selves in position all the time..I'm still trying to remember which ways to move the arms and head...but that is just because I easily confuse myself in real time but your explanations are starting to stick and the more I do it the easier it becomes.  Overall the summary was very helpful and the rocking is a aspect that I'm sure that I will continue to incorporate.

My time at the Chetawan school in Thailand these past few weeks was amazing and I received my  General Thai certificate...The course really helped me to define my use of the sen lines and of course as expected is very thumb and palm oriented which I know that I needed as a foundation...I like supplementing with your courses because it allows me to modify as needed and to incorporate the rocking...I now will use intuition and good judgement on doing the way po protocol as a primary go to but I have tools in my basket from you and my other US teacher to be a very dynamic practitioner as I continue to grow in the thai healing arts..

After I get over the jet lag I will try to re-read the emails to take the necessary tests to finish this hip module...and  i definitely will be doing more of your modules as they have been amazingly helpful.

 

Thank you.

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February 21, 2018 - 8:52 pm
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I am glad to hear that you enjoyed your time at the Chetawan school, and I am happy to hear that you find the hip therapy course so helpful. I appreciate your in depth comments and enjoyed reading them! Smile

You had wanted the CE and the international certificate. You did what needs to be done for the international one already. So I will send you this one now. When you do the test questions which the NCBTMB requires, I will send you the CE one as well.

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