NOTICE:
The following questions were asked by TMC students and responded by Assist. Prof. Sulibhorn Cheewapanich (TMC Academic Director/Principal). The school, website owner, the responder or any one working at TMC and the website disclaim all responsibility for any liability, loss, injury, or damage incurred as a consequence, directly or indirectly, of the use and application from reading information or following instruction in any of the contents in this section. The answers contain information relating to general principles of medical care on particular conditions and provide some suggestions to such conditions or situations. However, the questioners and the readers should consult a physician or health care provider to ensure the safety and the wellness of the recipients prior to engaging them since the responder can only answer in the general term without being able to examine the recipient.

Case study I

Question: I want you to ask you something about to massage a patient who got a few years ago breasts cancer had she is fine now but she lost the breasts and only one has been reconstructed by a silicone (artificial) breasts. Is anything that I should avoid to massage in special? She has also big tension on shoulders.

Answer: Mastectomy (Breast surgery) more than two years is in the stable stage that we assure to give Thai massage without any contraindication. I'd like you to ask and observe client for additional information as following;

1) Does an arm of an affected breast have swelling compare to the other side? 
If yes, all positions are allowed. In addition, we emphasize the back lying position, an affected arm needed to stay higher than the heart by supporting it on the pillow, massage is then given. The mentioned position is very effective to help diminish the swelling.
If no, all positions are allowed similar to normal clients.

2) Does she have the shoulder joint limitation range of motion?
If yes, especially the motion of abduction or external rotation or internal rotation, we can use Thai massage level 3 - shoulder blade stiffness combine to relaxed Thai massage. Most clients often have inner range of movement limitation which causes muscle guarding, painful movement and joint limitation. TM is benefit to help decrease tension and can increase range of motion if combine to exercise as tolerate.

         An artificial breast is such a good thing she needs because it keeps in balancing of both sides of her body and preventing scoliosis (asymmetry of the T and/or L-spinal curve that may deviates to the right or left side).

Case study II

Question: Could you send me some information about lumbar discopathy massage?What should we avoid?

Answer:  I would like to share my experience about the lumbar discopathy with you. Lumbar discopathy is a spine disease manifested by degenerative changes of the lumbar intervertebral discs. Pain caused by lumbar discopathy is usually located in the lumbo-sacral area. In most cases the pain distributes on one leg. If the pathology is in severe degree, pain may cause the patient to go limp and weakness.

         Intervertebral pressure disrupts the blood circulation, nerve endings enter a necrotic process. Muscle tone and the ability to control the limbs are decreased. These reasons are why the physicians always provide surgery and/or injection to help restoring the intervertebral space, regain permeability and return to better vascular function. 

         I do not wish to suggest that massage is able to help decrease discopathic pain or not. However, I expect Thai massage you have learned from TMC can help restoring blood flow that may rehydrate the intervertebral discs. You can give relaxed massage from book 1 only to help increase blood flow. For patient who has lumbar and sacral pain, we can apply massage book 3: Lower back pain. We should keep in mind for the pressure we give, should be in patients tolerance. Elbow press on hip pressure point and sustain holding technique should be avoid using with your client.

         In addition, overweight body may give excess weight that causes more disc rupture. If possible, you should advice him/her to meet physiotherapy help for exercise program and appropriate posture. In my opinion Thai massage ought to be the combination therapy with other treatment.