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Thai Massage and Stretching-- Brian's question and instructions

Posted by alan k on 1/05/02 at 10:56 (068806)

I am pasting Brian's thread from ESWT to the treatments board for the benefit of others interested, since it is not about ESWT

Alan --

My question was whether your Thai therapy included a stretching regimen. If so, what stretches did you do and how often?

In any event, congratulations on making such great progress. It must feed wonderful to have your feet back.

Brian --

Yes, Brian, It is wonderful to have my feet back. Ironically, I got a different painful injury shortly after! Eventhough the new condition is much more threatening to my livelihood and even prevents me from practicing meditation in the normal way (which is the most important thing to me), it hasn't effected me emotionally the way pf did. There is something about losing mobility-- even if it is not absolutely essential as in my case of a sedentary worker-- there is something very distressing about it in a way that surprised me and still astonishes me. By contrast now, everytime I think of how I can use my feet again I get a little bubble of happiness, and there seems to be no end. Please everyone look forward to this reward at the end of these trying times-- a lifetime of little bubbles of happiness whenever you want them! It may take months, one year, two years (not that unusual), or several years (as in some cases here) but it will happen. Even those with a 'permanent' condition can find relief if they keep searching. I still have a 5% condition in one of my feet, and so I still experiment, although with such a little condition I am no longer a good test subject.

Now, about the stretching. This cannot replace the advice of a doctor and may not apply to you if you have any medical condition, including pf and other conditions. Read at your own risk.

Stretching was an important part of my treatment, with two caveats:

1) I was only helped by non-weightbearing stretches. I am not a fanatic about that-- in my case, worsening my pf at first during moving house and carrying heavy objects, I think weightbearing was never going to be good for me as a therapy. Also, I already had very flexible calves and was in good condition (I am also a yoga practitioner but not a teacher like others on the board). So there was not much to expect from simply elongating the calve muscles, which is one theory of why stretching is good. Which brings me to point two, which may help you.

2) A big part of Thai massage is stretching and acupressure, alternated. Some people say a Thai massage is like a yoga workout, only you just lie back and let someone else do all the work. Thai self-massage works similarly but you do have to do the work. If you have a partner to help that's great, but best if you do both self 'massage' (stretching and acupressure) regularly and sometimes with a partner.

My wife, who is a certified massage therapist in Thailand (Dept. of Public Health), used to have a website (www.acutai.com) in English with all the techniques described and photographed, all especially for foot health. That was all free and we also sold a device for strengthening, conditioning, and stretching the feet in a non-weightbearing manner. All that will be back again sometime in the future, and also revised based on her further research and training over the past year (if she wasn't revising it I would put it up on the web today). But some simple instructions can be put here:

When your body is warm due to exterior heating and gentle warm up exercises, sit in a position where you can access your calves with your hands, such as sitting with one leg crossed over your knee at the ankle.

Hold yourself steady with one hand, and with the other grasp your shin bone with your fingers, positioning the thumb to press into the calf.

Imagine the back of your calf has three long lines drawn down it. One in the center, and two on the edge of the calf but still on the back side. Gently, then firmly, press your thumb at the top of the middle line, and hold for 5-7 seconds. Move down about 3/4 inch at a time till you get to the achilles. Then do the same down the other two lines, which will take you lower since you go past the side of the achilles. You can also use both hands to do this if comfortable: put your thumbs together and 'walk' them down the line, one going first, then the other joining it, and so on.

If there is any particularly sensitive spot, stick with that spot for ten seconds and even be firmer with it. If being aggressive about the acupressure, be sure to let up slowly.

After the calf has been massaged, NOW is the time to stretch the muscle. If you are okay with weight-bearing streatches that might be fine. Otherwise do a towel stretch, the point being not really to be aggressive here but to simply let the muscle relax in a stretched position: this educates the acupressure points and creates proper muscle condition, rather than simply 'stretching' it out. Actually stretching here is more about letting the massage 'sink in' rather than really about trying to stretch the muscle so much. In addition to towel stretch, or as a replacement for it, cup your heel in one hand and fold back your toes with the other hand, and gently put your foot in a comfortably bent position and rest there for 20 seconds. Remember that stretching should be done in both straight knee and bent knee positions: different calf muscles are engaged depending on the position of the knee. Obviously the foot cradle stretch can't be done with straight knee ulness you are super flexible.

Also try massaging the tendon lines on either side of the lower leg (i.e. not the back of the calf anymore). The outside line is easy to find, claw and flick with the fingers. It is in the soft spots right next to and under the shinbone. Do not press on the shinbone. It should be easy to find, sometimes actually being able to feel the tendon, and should feel good to massage, though tender at the top if you have pf. If it is tender near the bottom you might have tendonitis and should see a doctor, and only continue massage in that spot under surpervision. Massage the outside line and the inside line from near the knee down to the ankle. The inside line is similarly below the shin, though you might not feel an actual tendon.

Follow these inside/outside lines with slow foot circles to stretch and let the massage sink in. Other stretching techniques for these lines are difficult to explain and best done with a stretching tool.

Two to three times a day was very helpful for me, though it is not important to be too strict about it. Sometimes intuition about 'time for resting it and letting it do its own healing work' gets mistaken for 'laziness' in our success-driven culture.

This is just a start-- actually Thai massage (i.e. acupressure plus stretch-alignment) emphasizes both specific areas for healing (i.e. calf for pf) plus total body and integrated (i.e. at least also upper leg, groin, and hip for pf) work. Both are essential, so try to find some exercise where you are not thinking about helping your feet but just the whole system.

Finally, you may notice that I did not mention massaging the heel. Not all Thai therapists agree, but the line we take and our recent teacher took with me was not to aggravate the injured part, period. This is how it works in our system-- you get the surrounding areas in shape and then it flows through the injured part. This is not to say that other massage techniques which are very aggressive-- like ART or cross-friction massage-- do not work. They probably do, but that's another approach.

Anyway, I hope we'll be back up sometime soon (not likely though). Since no doctors took me up on pharmeceutical interventions that might mirror the effects of Thai medicine, I will also be posting about alternatives that are available here in the U.S. that might provide some of the same benefits, many of which are commonly available.

Another morning gone and I haven't started working...

alan k