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Orsolya Toth - Thai Massage for sciatica course notes
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Orsolya Toth
Sardinia, Italy
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June 12, 2017 - 11:33 pm
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Hello! 1 week after finishing my shoulder course, I am back again! That's how long I can do without studying thai massage and without Sharma's great video courses!

So I just got the first module. Along with the video, I am studying and researching sciatica to understand what it really is and how it works as for me it is a rather 'scary' condition. As a therapist I am always alarmed when my clients mention sciatica and I try to suggest coming back when the pain was gone.

However, I have a client who has regularly and unfortunately quite often sciatica pain so I would like to help her even in the 'heat' period, when she has pain.

She has compressed discs (L4 and 5), this is why she has pain radiating down her legs. I said legs because in her case, she starts with one leg and then when 1 leg is almost painless, the other leg starts with the pain. After your video however I have some doubts. You say that sciatica is always on 1 leg or at least it is very rare. 

Anyhow, what is your advice in case of compressed discs in the period when it is painful? Should we treat the client for that area or we have to wait until the inflammation goes away and treat the clients afterwards as a preventive treatment? (they are coming to us for pain relief, after all)

happy to be back and have a wonderful day, everyone!

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Shama
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June 13, 2017 - 2:01 am
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Welcome back! Smile

Nerve pain can be a tricky issue. I have personal experience with this. My wife often has sciatica issues, and I myself have had a very nasty nerve inflammation due to compression in the cervical spine which first shot intense pain down one arm, and when that was better, it started in the other arm.

If the nerve pain is very intense, indicating a severe inflammation or irritation, then trying to do strong therapeutic work might not help. Actually it might make it feel worse. However it might help to do more gentle and relaxing work to make it feel better and provide some relief.

A severely inflamed nerve can take some time to heal. However with sciatica it is often different. It tends to act up, and then it disappears again. This can happen infrequently or all the time, depending on the case. I am just saying this so that you don't expect miracle cures all the time.

The Thai Massage work will in most cases 

  • Provide relief, even if only temporary
  • Improve the condition
  • And sometimes heal the condition

There is no way to make a blanket statement which applies to all cases. You will learn more about all this while going through the course. But the bottom line is that Thai Massage does generally help. I am saying "generally" since there are cases which don't respond to much anything, especially when it is very acute. The Thai Massage skills are a great tool to have, but like always, there is no guarantee that they will help in every single case.

This is the issue that confronts all therapists, including mainstream doctors. We can try our best to help, and if we have the right tools, we can help in many cases. However if we identify too much with the outcome, we can take it personally if we cannot help someone, and then it effects our mindset.

So the trick is to try our best to help our clients while at the same time having a sense of detachment from the results. This is an important balance to find, especially if we get into seriously therapeutic work.

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Orsolya Toth
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June 14, 2017 - 4:08 am
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Module 2

I really appreciate the theory part of this course as researching on the internet is not always wise, too many info that are not from official sources. It is good to hear from an expert how it really works. The patterns helped me to understand what kind of pain I should 'look for' and the testing methods seem extremely useful, even if I find rather scary, testing clients' conditions or trying to understand the location of the issue when they are already in pain. I don't want to cause even more suffering. I guess I just have to make sure that those testing 'exercises' are not done excessively, only once to know what we are dealing with.

Microcosm and macrocosm - in the shoulder therapy course this concept was already touched even if not specifically. sometimes we have to work on different areas to be able to provide relief to the problematic one. I have a feeling that in case of sciatica, this will e even more important as it is very difficult to provide definitive solution for this condition.

I like how you explain everything, it is 'processable' even by someone who never studied anatomy or never had any kind of education in this area so I just have to repeat you explanations to the clients and they get the concepts immediately. So thank you for that!

Can't wait to see the techniques so I can use them on my client who has pain these days. I already prepared her that it might not be helpful at all but we both agreed that it cannot hurt to try and in worst case scenario, I will give her nice relaxing massages which will definitely change her mood about this rather stressing condition.

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Shama
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June 14, 2017 - 11:00 am
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When it comes to therapy work, we have to go beyond just "doing" massage, and advance to understanding why we are doing it, what the possible causes of a problem are, what might work and what might not work, and how to communicate effectively with the client in order to instill confidence.

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Orsolya Toth
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June 18, 2017 - 11:51 pm
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Module 3

I apologize for being away for so long. I went camping but I am here now and I watched the 2 videos I was sent during these 4 days. I watched the 3rd again now to absorb the info I got.

To be honest, I haven't realized till now that what I needed more is the background information about this condition and less the knowledge of techniques. obviously, new techniques are never enough, healthy clients can benefit from them as well nd I like working with different techniques on regular clients so they dont get bored.

I have always been scared of treating clients with pain similar to sciatica (I mean the pain level) and listening to you and knowing more and more about what this problem means and comes with made me understand that this is what I needed to be able to treat these clients and not sending them away. So I am really happy for these modules with the theory.

I tried the rocking technique on my friend in the camping, she said she liked it more when I was doing it with my foot, even if she is basically only skin and bones. So I think I will use that technique on all my clients. my hands can relax in the meantime. I am doing the balancing exercises from your free videos.

tomorrow I will practice module 4 on one of my friends. I dont have a sciatica client at the moment, my friend who has it inflamed right now is doing physio treatments, so i dont want to interfere in them. I will practice on healthy people, to learn the techniques.

 

Have a wonderful day! Orshi

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Shama
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June 19, 2017 - 11:23 pm
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I am glad to hear that all the background information is helping you. Smile

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Orsolya Toth
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June 21, 2017 - 4:41 pm
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module 4

I'm practising the wiggling movements only on non-sciatica clients as at the moment I don't have a sciatica patient.

For my clients's sake I wont have too many clients with sciatic problems, I keep practising on healthy people, so when the time comes, I mastered all the movements to perfection and I will be able to provide a useful treatment.

My clients find the rocking and wiggling techniques extremely soothing, they say that even if they are not the strong stretchy movements, they are amazed how effective they are for 'putting everything back to its place' (referring to the spine). And I totally agree. I will incorporate these techniques into my 'prevention treatment routine' and also into the sessions for clients with back, lower back problems. 

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Shama
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June 21, 2017 - 7:28 pm
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I have always been battling the perception that Thai Massage is always STRONG work, that it is painful, no pain no gain, that it is all stretches...

However the fact is that really strong work can be counter productive. I have accomplished a lot more with my rocking moves than with massive linear stretches. And in this way you never run into this issue that clients find Thai Massage too strong for them. 

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Orsolya Toth
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June 24, 2017 - 3:57 am
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Module 5

this course is for sciatica but I find it extremely useful also for clients who dont have this condition but want to work on that lower back and thigh, glutes, groin area.

my elbow work is not perfect yet, but Im practising for endless hours, my friends are getting bored of it now 😀

I have feedback however about the thigh area. all of them from female clients/friends: any technique I used, even with light pressure, they found them painful. some more than others but they were telling me that 'it is not really comfortable'. what could be the reason? I was thinking that it might be poor circulation, cellulite, deposited 'fat'. do you think it might be a possible explanation? all of these ladies are in their 40s, not really doing any regular exercises. 

I practised the groin area technique on my female friends, they liked it a lot, as they don't really get massages on that area and they realised how great it is and much it is needed.

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Shama
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June 24, 2017 - 12:17 pm
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You can definitely use this course for more than just sciatica treatments.

Regarding your question about the thigh techniques - in order to answer this, could you please tell me which techniques and which video you are referring to? There are no thigh technique in video 5.

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Orsolya Toth
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June 24, 2017 - 1:28 pm
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Oh I apologise, I was practising module 5 and 6 together, so this is why the thigh question.

I will write about module 6 today as I wanted to practice the other techniques more from this module, before moving on to the 7th.

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Orsolya Toth
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June 25, 2017 - 5:25 pm
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module 6

I'm back, practised module 6 one more day. 

So the thigh question should be here 🙂

I also have another observation - probably I am doing the technique wrong...

the back twist when my leg is over the client's thighs: I started pulling it with rocking to avoid a direct strong stretch. my client is not flexible at all so I was expecting some muscle pulling or strong twisting feeling with even a little bit of twisting. but this is not what happened. I had to pull her way back to arrive to a point where she said that she feels the twisting. Is it expected? or I am pulling her the wrong way or maybe she is not relaxed enough? I would feel that, usually I can tell if somebody is holding or working their muscles and not totally relaxed. she is not a skinny person, not in the obese level though.  

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Shama
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June 26, 2017 - 12:54 am
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Ok, now we can deal with the thigh issue. First of all, which technique is it which is causing discomfort - the hand, forearm or knee technique? Or more than one of them?

Without knowing the answer, I can give some general advice. Any touch will feel best if it is done with a feeling of softness. This comes from your own mind and is transferred into the physical technique.

A good way to practice softness is to hold your hand (or another body part) over the client's body part that you are working on, and then floating your hand down, like a feather falling down. When your hand meets the client's body, repeat in your mind "softness" and imagine you are touching a tiny baby.

Then make sure that your wrist is loose and relaxed, that you are using only body weight and not muscle power, and that your breathing is synchronized with the move. In other words you breathe out when you lean in, and you breathe in when you lean out.

This is how you develop a soft and sensitive touch which does not cause pain even in sensitive people. You can reduce the possibility of discomfort even more by turning a linear pressure movement into a rocking move by either rocking or circling or wiggling instead of pressing on one spot.

Once you have developed this quality of touch (with any body part, not just the hands), then you can go really deep without causing discomfort.

Regarding the leg-over-leg stretch - normally the only way that someone doesn't feel this stretch is if you let the opposite thigh lift off the mat instead of keeping it down on the mat with your leg. There is one other possibility: You might not reach far enough below the back with your hands. The effectiveness of this stretch is greatly increased if you reach all the way down until your fingers are as close to the spine as you can get them.

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Orsolya Toth
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June 27, 2017 - 1:11 am
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thanks for your insights, Shama.

they were complaining for all the versions, forearm, knee, hands - the  least painful was the hands. I was doing it with very light pressure, slowly, I tried also on a guy this morning and he didn't complain about it. I guess it is just matter of sensitivity on that area and us girls are more sensitive around there.

For the leg over leg stretch - I will try it again on a client in 2 days. tomorrow I have a 78 old lady and I don't really wanna try it on her before understanding the dynamics completely.

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Shama
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June 27, 2017 - 1:43 am
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Yes, with elderly people we have to be more careful.

There are people who are very pain sensitive (like my wife). And you might need to refine your touch more. It might be a combination of the two. Hard to tell from a distance. But I am pretty sure that with practice and experience your touch will get better and better.

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Orsolya Toth
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June 27, 2017 - 10:36 pm
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Module 7

I loved the piriformis stretches as I learned only one version during my basic course here in Europe but it is only 1 type and I like alternating the techniques even if the clients have no sciatica issues, so the returning clients wont get bored. and neither am I 🙂

Lately I have some unconformable feeling around my glutes, lower back, so I use these techniques on myself as well. Of course it would be better if someone did it for me but self massage is better than no massage at all 🙂

My 78 year-old client loves these techniques, she is quite flexible, she holds her legs though, cannot really relax them, so today we were focusing on 'letting it go' and I used the rocking versions a lot.

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Shama
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June 28, 2017 - 7:55 pm
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Very true. There is a saying that "If the only tool you have is a hammer, then everything looks like a nail." Much better to have a variety of techniques for better results and for personal inspiration.

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Orsolya Toth
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July 3, 2017 - 1:14 am
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module 8

Information, Education, Advice, Exercise/Homework

I've been using the first 3 elements since I started working as a massage therapist and reflexologist as my teachers taught us the importance of knowing our clients history that is related to reason they come to us for treatments. I always inform my clients about the possible outcomes, what we can achieve with the treatments, what we have to do to try help their conditions. I apply the same method, that you mentioned in the video: I offer a free consultation before the first treatment so we can talk about all these things - the clients appreciate that I take my time to get to know them and try to create a personalized treatment.

I also include lifestyle change advice - this is a bit tricky, at the beginning I had to learn to leave the decision to them: if they want and how they want to make changes, as it is not easy to just give up our habits and at the beginning, I had a hard time to accept that most of my clients were 'just listening' but after that they kept doing what they were doing before and got the same symptoms all over again. (as a client I am just the same though :D)

homework/exercises - the same issue like above, I was teaching my clients some simple movements, positions, exercises to do at home, however almost nobody followed my suggestions, no matter how simple or few they were. But I kept telling them after each treatments and some of the clients came around, started using them and felt real benefits.
Thank you for your exercises, I will add them to my list, and I will (I should) start using them as well. As therapists, we have to take care of ourselves and I rarely have the chance to get massages here, so I have to rely on yoga and these kind of exercises. They will brighten up my routines, especially your special ones 😉

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Shama
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July 3, 2017 - 1:23 am
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Regarding the self help exercises: Recently I sent an article around which addresses this topic in detail. I don't know if you saw it or read it, but since it is pertinent, here is the link:

Thai Massage life style suggestions and self help exercises

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Orsolya Toth
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July 3, 2017 - 1:54 pm
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I sent a PM to Sandra, so she knows that her notes didn't just disappear and so she can copy it to her course thread 😉

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