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Randy's Thai Hip Therapy course notes
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RJonBryan
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November 2, 2013 - 8:42 am
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Hello--I have been through the introduction module for the hip therapy course. Last night I viewed the video, and today, I did the hip assessment on three clients. The first two presented no tightness of the muscles, and in fact, no complaints about the joint itself. The third client when assessed presented tightness as described in the video, right and left. I suspect much of the tightness is in the periformis, also the gluteus maximus, and probably even the medius and minimus. I watched the video again this evening, and I believe that I did the assessment correctly and arrived at the appropriate conclusion.

Now here is the part that I should explain. I am working on a table (in my small studio, I do not have room to deliver therapy on the floor). I tried to do the first assessment by standing and placing my knee on my adjustable stool, and it seemed to work okay. With another client, I found that because I have an electric table that goes low enough to be ADA compliant, I could lower it to about 12-14 inches from the floor. I found that I could just about replicate the kneeling demonstrated in the video to perform the required assessment. I have attended sessions at the World Massage Festival where Thai for the table was demonstrated, and learned that many of the wonderful techniques could be adapted creatively.

I am sorry this post is so long, but I am excited to be able to work in the course. I have sooooo many clients who present with chronic hip pain. I fear that many of them suffer from the alternation of way too many hours of sitting and vigorous intense exercise. Any thoughts regarding this idea will be greatly appreciated.

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Shama
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November 2, 2013 - 11:47 am
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Hi Randy,

welcome to our forum and the Thai Hip Therapy course. There is no problem if your posts are a little long, that's much better than too short with no information. Smile

You are correct, most of the techniques can be adapted to the table. Since you have an electric table, that makes it even much easier.

I am glad that you are excited about this course, and you have every reason to be. By the time you complete this course you will have an amazing repertoire of hip techniques to help your clients. Your conclusions as to the cause of hip problems is exactly right, and Thai Massage has the perfect tool set to deal with them.

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RJonBryan
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November 4, 2013 - 10:56 am
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I appreciate receiving the second installment of the hip therapy course. I reviewed it yesterday, and today I was able to utilize some of the techniques. As mentioned, I am utilizing the table but my table is ADA compliant and goes quite low. The only difficulty I had was that to move from one side ot the other, I had to walk around the table.

I utilized the hip rocking techniques with three male clients all of whom are long term and regularly scheduled. I used draping and the clients wear undergarments. The rocking with the left hand on the thigh and the right above the knee worked well and I believe was effective. As you stated, the rhythmic rocking motion takes a combination of appropriate strength and relaxation. I tried the hand over hand rocking as well; the rhythm of the rocking seems to make the client enjoy the experience. I appreciated the description of how the weight is delivered in the push and released with the retreat. With the table lowered, I also used the foot. Although clients are used to my being on the table with them, they were not sure at first about using the foot, but it seems to work well. After the third client, I felt much more confident about utilizing the rocking to release tension held in the hip.

The circling technique works well, but of all the techniques, the movement with the heels of the hands on both sides of pelvis was most effective. The clients felt release and relaxation from that technique. My table at the waistline is 36 inches wide, and so I am able to kneel on the side of the table.

I assume that during the Thai massage on the floor that you do move from one side of the client to the other. True? I assume that for the video, you are doing only the one side. I am looking forward to the next module.

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Shama
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November 4, 2013 - 11:52 am
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You certainly jumped right in with your practice, applying it on your clients. That's great, you obviously have experience and confidence in your work. And you are adapting it to your table work effectively. 

You are right, I mostly demonstrate the techniques only on one side. Later in the course you will see how I move from one side to the other. However that doesn't work for the table where you just have to walk around. No problem with that.

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RJonBryan
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November 4, 2013 - 8:13 pm
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Thank you professor for your comments. I do want to learn more about the hip and why so many clients have such troubles with it. Thus, I am eager to utilize the techniques you suggest. I utilize techniques learned from other workshops, classes, and online events, but I seek a somewhat less invasive approach and one that will help the client to eliminate the pain. Therefore, I also seek answers as to why the client presents with so much pain.

Of course, the first situation I have found is too much inactivity--sitting for periods too long without any movement. I have clients who sit in their chairs at a computer all day, others who drives hours and hours for their work, and others who when they get home sit in their recliners for hours in the evening and fall asleep. Then the other side is that many clients are sedentary during the weekdays and work hours, and then they become "weekend" or "evening" athletes; their level of activity is really too much, often without proper stretching or warm-up. I have some fellows in their 50s who do taekwando a couple of times a week, and both have limiting hip pain. Usually, I can watch a client walk down the hall, observe her/his gait, and tell if there are problems in the hip. Thus, I also work on posture when walking, a la Alexander method. For drivers, I go to the car, look at the accelerator pedal, and instruct them on the posture of the right foot while driving (in many cars the elevated drive train and the position of the pedal cause the foot and leg to turn to the right) as well as how the seat is positioned.

By the way, I will see my first large male client tomorrow afternoon, and I am eager to try the methods you suggested with him. 'Yes, he suffers both from hip, knee, and ankle pain. I will document the progress of that session. I appreciate your suggestions for large clients. I have many very large (tall and heavy) male clients.

I am very hopeful that your method will be able to help my clients (mostly male and many who are referrals from chiropractors) to live with less pain and more freedom of motion. Thanks for reading this. Please do not feel you must respond. I just wanted you to know that I appreciate the interaction and suggestions.

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Shama
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November 4, 2013 - 10:09 pm
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"I do want to learn more about the hip and why so many clients have such troubles with it."

It sounds to me like you have it pretty well nailed down when it comes to identifying causes for hip problems. I use the same approach. I try to identify what causes the problem in client's life style habits and then I suggest remedial action. Otherwise you might work on hip issues forever without much result since the offending cause keeps recreating the condition.

I know I don't have to respond, but I enjoy doing so and hearing what works for other therapists. Plus it would not be very enlivening for you to keep posting in a vacuum so to say. Smile

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RJonBryan
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November 6, 2013 - 7:08 pm
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Hello Shama--I have gone through the third installment, but I have not yet been able to integrate it into my work with clients yet. I will begin to do much of this today and tomorrow, but I did not want to get behind. I wanted to be ready for the next Module 4. Is is appropriate that I include my notes (following) from this module?

Module 3--Hip Joint Pressure Techniques

Method 1--Leg straight on the floor. Avoid hand to keep pressure off the wrist. Use forearm and lean in using body weight. Keep hand on knee to straighten up to avoid back strain. Lean straight down or roll the forearm--lean and roll. Use left arm for right and vice versa. Next use knee as before, right knee on mat, left knee goes just below where the bone is and muscle tissue (quadricep). Move the knee around, up and down and across. Work with flat, wide area below the knee cap. Outside of the knee, use the kneecap--push forward--the knee moves forward to the client. Works well with large clients. Keep right knee on client and left knee on the floor, you can do gentle work. Also can rock side to side. Want more weight, lean forward. To add much more weight--lean forward and add entire body weight. Stand--right foot 45 degrees--outer part of left foot--lean forward. Keep right foot to the side to keep balance. For the other side, do the same thing with the right foot. Straight pressure=put more weight on the hip than when you do more rocking. Feels more deep or powerful, rocking is lighter and more fluid. Both have function and both feel good. Start with the rocking, and then do more by straight leaning in.

Method 2--Forearm leaning with elevated leg. To get deeper and have more of an effect with same pressure, create an angle. Muscles will relax. Be careful--don't lean into hip bone. Lean at 45 degree angle to address the quadricept using body weight. Works well for woman, but not as much for a man.

Forearm leaning with crossed thighs. Sit between legs. Working on the left leg. Lift one leg, slide left leg under and push as far forward as you can. Left leg up with thigh supporting the hamstrings--foot under left calf. The leg rolls outward; this works on the inside of the quadriceps. Turn the leg in and block the foot with your leg (back of the knee), rotate the leg towards you, and now you are working on the outside of the hip area. Angle the forearm down. Small change but works on an entirely different area.

Another approach: Totally on the outside. Lean forward, reach over client thigh, forearm resting on my thigh (cannot slide away, pull in with the right hand against thigh, lean forward and create the sandwich effect. When working include the whole length of the thigh. Sink in softly. If you use muscles, pain will result. Roll the leg in and rock the foot. Creating the angle allows therapist to really go deep. Must understand, just because you use another body part, does not mean more strength or power--primarily to save hands. Other body parts can give you more power and also can save hands.

interesting technique with the knee: direct pressure, sideways, wiggling, circling, back and forth rocking all work. One more--left knee in the hip joint area. Angle the left angle--not 45 nor 90 but follow the natural shape of the area--follow the group. Move the knee in that direction. Right knee on the mat, left knee on the hip joint. Support yourself with hand. Very slowly put pressure and move knee forward. Roll over the area and then roll back. Substantial pressure needed. For large client, support with both hands over the body to get more pressure. Avoid touching the hip bone; stay on muscles--that is why you use the angle--not 90 or 45. Do this in different spots. Move in or move back, and continue the back and forth rolling motion. it is a very deep technique. You don't have the pinpoint pressure in one spot. A warming and relaxing move.

Also consider the mindset. Western--moving anatomy, bones, muscles, tissue, tendons, etc. Eastern--moving energy. Energy lines run throughout the body, and when the energy gets blocked it gets stuck, there. The result is that the blocked energy keeps muscles do not function properly. We are not only moving anatomy but also energy. Should feel in the mind that the whole area softens, and the feeling of relaxing and moving the energy. Energy is centered behind the navel. Move the energy, allow it to flow, unobstructed. Not a physical change but rather a feeling. Open the flow of energy through the body. Two energy fields connect, not just two portions of anatomy.

Comments: I have many clients who will benefit from the techniques you have demonstrated. As stated before, my practice includes about 80% men, so I appreciate the warnings. With many of them, I believe i will have to begin very softy, because they present with pain. My client range is wide, from early 20s to 80s and most of whom fall into the age range of 55 to 70. Older clients appear to be more frail, and the muscles around the hip have not continued to be strong and well developed. I appreciate your statement especially at the end about sinking into the tissue, and I believe that can be very effective. Earlier suggestions in Modules 1 & 2 have worked well with some of the larger clients--one yesterday was 350 lbs. and one on Saturday was about 325 lbs.--very large men indeed. Your ideas will help me save my own body, and I look forward to learning more about other areas of the body as well. Thank you. Randy

 

 

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Shama
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November 7, 2013 - 2:29 am
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You sure can include your notes, however you don't have to make such a huge effort with writing very long posts. What I am most interested in is hearing about how it works for you when you are implementing it. The recap of the video content is not required, but your actual experience with the material is the interesting part. 

You really have some heavy duty clients there! The 300 pound range is hard to work on and you will need every strategy to preserve your hands and your body! Just keep in mind that you should never try to push yourself beyond your comfort level with Thai Massage. When I work on large and heavy people I become very selective with my techniques and I use my forearms, elbows, knees and feet a lot.

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RJonBryan
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November 8, 2013 - 7:46 pm
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The Hip Therapy Module 4--Stretching has been so helpful. I was able to apply many of the techniques in practice with a client who has dealt with hip and joint pain. At age 68, he has been treated by a chiropractor and a physical therapist for problems (as identified by them) with the periformis. He has been coming for sessions on a more or less regular basis and has experienced noticeable improvement through massage. In fact, he (and several others) is the reason I enrolled in this course. Thus, he is a perfect candidate to utilize the techniques studied thus far. This client knew I was going to try this new approach, and therefore, we extended his session to allow for the implementation of the techniques.

Basically, I worked with him through the rocking and relaxation methods in the first two modules, and then the pressure techniques studied in the third. The idea of the pie for me was so very helpful because I can envision my pattern of work and keep track. I also found the idea of the positions, 1 2 3 2 1, to be very useful in my mind's organization. This client was very tight and very stiff, so some of the ideas in Module 4 were too much for this first session, but the alternatives suggested, especially the rocking motions, and just working with one side at a time proved to be particularly effective. I also regularly use the 1-10 method of pain to determine discomfort, and surprisingly enough, the client rarely indicated above 4 or 5.

Bottom line, I believe this is the most effective hip therapy technique I have studied thus far. I believe this will make a huge difference with my many clients who present with such hip pain. It is much less invasive than the orthopaedic techniques I have studied and learned, and long range, I expect this approach to be more effective. Your suggestions for feedback during the massage is the modus operandi in sessions with my clients, and I also write to them afterward to thank them and ask for the day-after feedback. The client has already written that the hips feel much more relaxed, without pain this morning, and the adductors also are much more relaxed.

Problems: envisioning all of the lesson in mind mind and remembering everything! Adapting your methods on the mat to my table (so far I have been able to make everything work because of the size of my table). Remembering and implementing the pattern of your approach to avoid causing client discomfort. Avoiding placing my hand too close to the groin.

Thanks the feedback and comments. Wow!

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Shama
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November 9, 2013 - 1:03 am
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Great post - very informative and shows exactly what you are doing, how you apply it and how it is working for you. Apparently it is working very well for you even though you are adapting it to your table. Your post also shows that an experienced therapist is perfectly able to learn new massage material via a good video training. This is always welcome feedback for me since I have put a huge amount of time and effort into creating all my courses.

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RJonBryan
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November 11, 2013 - 7:08 pm
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Hip Therapy 5--Stretches. The clients I have selected to practice this new technique all had adductors that were tight. All were male in their late 40s and into their 50s. Both the hand and the heel of the hand work well in Slice Three as does the forearm roll. For me the adjustment of the heel and pointing the knee toward the crotch was easier for me to accomplish. Particularly I appreciate your word suggestions: artistic, whole body, rocking gracefully, sinking into the muscle, heavenly feeling, etc. I have always tried to proceed this way with massage, but your reminders reinforce this for me. I have many large clients, but I have not yet been able to try the approach you suggested with any of them. I did try the leaning in a rolling forward while moving the leg back and forth, and that seemed to be easy for me to do and received positive client response. I have not tried the blood reduction. Most likely I will try that with someone other than a client.

Working with Slice Four is more intense for my stiff clients, and so I did more of the relaxation techniques using the circling and rocking motions. Working at that 45 degree angle really challenges my clients who typically present with tight adductors. I do believe that in working with some of them on a regular basis, that we can arrive at a point when I can try the more challenging method. I am eager to work with one of my regular clients who owns, operates, and teaches a yoga studio to see how he will do with these techniques. I did not stabilize one side while moving the other to the mat.

Comments: I have come to the point where I am unable to complete everything in the course before the next installment arrives. The arrival, however, of each subsequent installment does keep me focused upon going through the video in the evening and selecting clients for practice. In my work, I have found that for practice, I contact a client or two (they know when I am focusing upon learning new techniques) prior to their scheduled session and tell them what my focus is, and I simply extend their schedule session time for practice. Of course they are quite eager to participate because not only do they receive additional time but also they enjoy feeling of the new methods I am learning.

Thanks for reading through all of this. Unlike other classes/webinars I have taken, I do feel I am writing and reporting to someone and not just flying solo. I am amazed at how consistent your videos are--the pacing, the demonstration, the review, etc. I cannot imagine how much preparation and time this has taken. Having been a therapist for a long time, I have taken many classes (in person, live online, DVDs), and this presentation in this format is really one of the most logical and understandable. I just have to work hard to keep up.

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Shama
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November 11, 2013 - 10:20 pm
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Few people are able to keep up with the schedule, I know that. With a couple of my larger courses I do a one-video-every-three-days delivery. The thing is in the beginning everybody is super eager to get the modules and they think that it is all too slow, but then after a few modules everyone realizes that there is no way to go faster. 

However it doesn't matter if you get behind the scheduled delivery since you keep the videos and you can always catch up with the material. It is still much better than having it all dumped on you in one big DVD.

Especially this hip therapy training does take some time to absorb since there are many options to choose from, and it will work very differently on different kinds of clients. The picking and choosing and adjusting part is where the art comes in and that's something that only comes with practice. This does take some time and cannot be learned by going through the material once.

This is where the video training with support works great. Unlike live training where you get one chance to absorb it while the training is happening, you can watch the video as many times as necessary. And the fact is that it is necessary to watch them several times to really catch it all. Some of it will only really makes sense after you have practiced it a bit and run into a couple of challenges along the way.

For example I regularly work on a large, well muscled client who has a very dense and solid feel. However what I do on him does not work at all on my wife who has a totally different type of body. That's why I am always stressing that the techniques are options to choose from and the art is to figure what works on whom and then do the exact right thing for a particular client. 

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