Disc degeneration is a very common problem, especially for people aged over 30. While conventional physiotherapy can help, many patients will seek a Thai therapist (usually after a recommendation), as Thai Massage stretches and balances the deepest muscle layers, and not merely the upper layer which is typically addressed in an oil massage. However, Thai Massage is not a treatment in which the patient lies still on a massage table and does not “participate” – as is the case with the typical Swedish massage – as it contains many elements of kinesiotherapy. The bends and lifts of Thai massage can affect directly the lumbar spine and the discs, and the therapist should be aware of the (many!) aspects of this disorder.
Understanding disc degeneration
Disc degeneration may have many phases. In the beginning, the disc simply protrudes, then it prolapses (this is called “slipped disc”), then there may be disc extrusion, and in severe cases the disc may degenerate totally, to the point that it may actually become non-existent. Of course, there are different massage and treatment protocols, depending not only on the condition of the disc, but also on the phase of the disorder (acute, chronic, etc.).
Depending on the exact spot of the disorder (that is, the specific vertebra where the disc protrudes, possibly irritating / compressing a nerve), the patient may feel the pain on the outer or inner arch of the foot, or on the gastrocnemius muscle. The pain can also be localized on the lower back. E.g. the effect of the disorder will be different if the disc protrusion is located in L3-L4, L4-L5 or L5-S1.
Many Thai Massage stretches have a definite resemblance with orthopedic tests, and may be applied gently and carefully for assessment, in the beginning of the session. Of course, it is best if the therapist is trained, apart from the Thai stretches, in the actual orthopedic tests. Ideally, the patient should show the therapist an MRI, and inform him/her about the MD’s diagnosis.
During the acute phase, no kind of massage is allowed, and the patient should rest. However, Luk Pra Kob (steamed herbal compress / ball) may be very beneficial. Be sure to add lots of turmeric in the ball, as it is a potent anti-inflammatory herb. Apply thermal treatment for 15 minutes, 3 times daily, for 3 days.
After the initial phase of the recovery, some light stretches may be applied. I always recommend the combination of heated herbal packs with the Thai stretches. Apply them before and after the stretches.
In this phase, do not apply any technique that contains bends of the lumbar spine, and avoid altogether the sitting position of Thai Massage, as some of its techniques may apply pressure on the discs (anyway, most of the adjustments of the sitting position target other parts of the spine). Focus on the one-leg techniques of the supine position, and on the prone position.
You may need to place a pillow under the patient’s belly, in order to support the waist and reduce the lumbar curve, especially if the patient also has lordosis. Work gently on the area of the lumbar spine, but efficiently enough as to relax the tension that is sure to exist there… Light back stretches (again, no bending!) will help. The Thai stretches increase the intervertebral disc space, thus decompressing the disc and decreasing the pain.
The therapist may start adding some stretches in the session, after the recovery. Some bends may be applied in this phase. Here is where the MRI can be useful. Generally, the disc protrudes backwards, but this is not the case always.
Before applying any dynamic bends, the therapist could place carefully the patient is some Thai Massage positions. As it can be seen in the McKenzie method as well, the gentle application of Bhujaungasana can be helpful. Of course, it should not be applied if the patient feels pain while in the position. Depending on the characteristics of the disorder, the patient may also benefit from forward bends. I have seen people with totally degenerated discs who can do comfortably any spinal bend, especially devoted Yoga and Pilates practitioners.
Finally, the Thai Massage therapist should remember that a disc herniation may be asymptomatic. Thus, we should never press the patient’s body far beyond its limits. The goal is not to apply an impressive, exotic therapy, but to really benefit and balance the body and the spirit.
Please see the video below for suggested techniques for lower back pain. By Elefteria Mantzorou - an article for Thaimedicinezone.com
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