Fixing Tennis Elbow and Knee Pain with Clinical Thai Bodywork

Amy Carr of TimeOut Chicago magazine came in a few weeks ago for a treatment. She's a tennis player, and wanted help with a persistent pain issue that has been bothering her for almost a year. Her pain was diagnosed as tennis elbow, or lateral epicondylitis, and she had seen several practitioners since last March without getting much relief.

Her report on our session appears in the current (Feb. 5, 2009) issue of TimeOut Chicago, and to quote an excerpt, "Combining his knowledge of anatomy and Western medicine with Thai massage techniques, Duff gives my aching tennis elbow more relief than a year of cortisone shots and chiropractic visits..." Which makes me sounds like a genius, but in truth, cases like this are relatively easy to address by anyone with the right training. We empower our students to have "miracle cures" like this in every Clinical Thai Bodywork class we teach.

It's all about your worldview. Allopathic western practitioners almost invariably assume that pain near a joint (for example, elbow, knee, lumbar vertebrae) is due to injury, dysfunction in the joint, or a mysterious onset of inflammation (tendonitis) in the tendons and ligaments that cross the joint. This often mistaken attitude about joint pain is what leads to the 3 common and frequently ineffective therapies that we hear in a litany from our clients: anti-inflammatory medications, cortisone shots and surgery. While we consider our western medical system to be firmly based in science, one wonders what scientific reasoning is at work in the face of a great deal of evidence that these approaches usually don't work to actually relieve pain.

A simple but profound paradigm shift is what makes cases like this easy to solve. The key is that muscle tissues themselves are in most cases the source of at least some of the pain, if not all of it.

Of course, when we need surgical repair, western medicine is brilliant -- and I do not intend in any way to underestimate the incredible skill and sophistication of modern medicine when it is appropriately applied. The issue comes from our allopathic injury-centric model, which assumes that all pain must derive from injury or degeneration within joints, nerves or connective tissues. Sometimes joints do need repair. But many times joints may show some evidence of arthritis, degeneration or injury, and the surgery fails to resolve the pain. This is because nobody treated the tender points and taut fibers in muscles that cross the joint and refer pain there.

Thai medicine is based on an energetic view of the body. Health and proper function comes from the free flow of energy (Lom) through energetic conduits (Sen). Thai practitioners use compression along the sen lines in combination with various stretches, and we pay close attention to hard, ropy fibers and local tenderness, as this is an indication of imbalance.

I became fascinated early in my career with similarities in practice between certain asian approaches to bodywork and the field of myofascial trigger point therapy, which was developed entirely in the west by medical doctors. While the conception of the body was vastly different in the two systems, the approaches in practice to resolving pain were often quite similar. Out of this early research, I developed a modality that I now call Clinical Thai Bodywork.

Trigger point therapy "discovered" that tender points in muscles can cause referred pain -- generally in parts of the body distant from the tender point itself. Often the pain can be quite severe and feel like it's around or deep in a joint. So it's not surprising that the medical establishment is led to assume that structural injury to the joint itself is causing the pain. One of the mantras we use is "don't chase the pain" -- in other words, the pain is usually not where the problem is.

The approach we use is to investigate and treat the stagnant tender points in muscles that are referring pain to another part of the body. These relationships are predictable and were carefully mapped over decades of clinical practice by Dr. Janet Travell and Dr. David Simons, who wrote the definitive medical textbooks on trigger points.

For example, the complaint commonly identified as tennis elbow is usually caused by a small muscle in the forearm called the supinator, which is a major actor in stabilizing the racquet head each time the ball is hit during tennis. If this muscle gets acutely or chronically overloaded, it develops a point of local metabolic stagnation (trigger point) that sends pain to the outside of the elbow joint -- however the pain can only be addressed by treating the supinator muscle itself.

In Thai terms, we would find tenderness in the sen lines that radiate from the joint and focus on that area during treatment -- which consists of various forms of compression and stretching. A trigger point therapist would know that the supinator muscle is commonly responsible for this ailment and would locate tenderness in the muscle itself. In CTB, I bring the western anatomical knowledge and insights from trigger point therapy to the elegant treatment system of Thai massage. The result is a treatment modality that is not only extremely effective at treating pain, but is actually beneficial for the therapist as well.

Ironically, Drs. Travell and Simons' incredible body of work is not commonly taught in medical school -- this truly is the Great Mystery to me. Consequently, millions of patients each year with myofascially induced pain are prescribed anti-inflammatories, given cortisone shots and unnecessary surgeries, only to find that their pain is still there (at which point it is called "intractible"). Tennis elbow is one of hundreds of conditions with which I could tell a similar story.

On Feb. 27, 2009, we will be teaching another Clinical Thai Bodywork weekend workshop at the school -- on knee, groin and thigh pain. I'm sure you know friends and clients who have struggled with knee pain -- sadly, this is another case where enormous amounts are spent annually on useless procedures. If you are a massage therapist or yoga teacher or know of someone who wants to more reliably address pain, you can find out more about Clinical Thai Bodywork and the rest of our Thai massage training program at www.thaimassageschool.net.

Thai Herbal Compress - A Traditional Treatment for Pain

When Massage Magazine ran a feature article on Luk Pra Kob, or Thai herbal compress treatments last year, it was the first time that many in the US had become aware of this fascinating treatment. While in this country it has been promoted primarily as a standalone spa treatment, in Thailand it is generally integrated with the Nuad Boran, or manual therapy that we in the west call Thai massage. In 2008, Thai Bodywork earned a Critic's Pick review in TimeOut Chicago for our Thai herbal compress treatment.

Herbal compresses are ancient treatments that have been used in India, China, and many other countries for centuries. The idea is quite simple -- fresh or dried herbs are wrapped in cotton muslin and steamed to bring out their essential oils and aromas. The compress is then applied directly to the skin. In Thailand, where the technique has perhaps become the best known, the method of application is to use a rolling style of compression along the Sen or energy lines of the body. The herbal balls are heated while the therapist performs stretches and compressions that are part of Thai massage, and typically used within the context of the massage to treat specific areas of the body.

In Thailand, the herbs used for compress have many beneficial properties, and many of them are culinary as well. Typical herbs used include:

• Lemongrass
• Kaffir lime leaves and fruit
• Galangal - a Thai variety of ginger
• Plai - a yellow ginger
• Eucalpytus
• Camphor
• Turmeric and wild turmeric

Most of these herbs have medicinal qualities for the skin, as well as anti-inflammatory and antiseptic properties. As the herbs are steamed, their essential oils are extracted and absorbed by the muslin, which then deposits them on the skin.

Traditionally, the Luk Pra Kob treatment is used for aches and pains, usually within a Thai massage session. The warming and anti-inflammatory properties of the herbs make Luk Pra Kob a highly effective treatment for pain. The therapist will apply the rolling compression with steamed herbs in areas that are deemed important for the client's pain condition.

In clinical work on muscles, many forms of therapy use heat to warm the muscle and increase circulation in the area of myofascial trigger points, which tend to produce sensitizing chemicals that can be quite irritable and make trigger points tender to touch. There is no better method for clinical application of heat than the Thai herbal compress, because in addition to the moist heat they provide these medicinal effects along with relaxing aromatherapy for the client.

In my Clinical Thai Bodywork classes, I teach the use of the herbal compress to warm hyper-irritable trigger point areas prior to manual treatment. This produces an immediate relaxing effect on taut muscle fibers that are resistant to stretch and release, and allows the therapist to work more effectively with less of the unfomfortable manual work on muscles. In Thailand it is common to apply the herbs after massage in a particular area, but for clinical work I recommend application to trigger points and taut fibers prior to manual release work.

Thai herbal compress, like Thai massage, provides a client experience that is both therapeutic and relaxing. The Thai people bring beauty and enjoyment into all areas of life.

I have had many students who have built thriving practices using this treatment. Thai herbal compress is still relatively rare in this country, even though it is easy to learn and to use in practice. It is extremely easy to market, and clients love the treatment -- so repeat business is common. We import very high quality 200 gram herbal compress balls from Bangkok and always have a stock on hand for students and web sales. We also import Thai herbal oils and balm, both of which incorporate the medicinal properties of the herbal compress herbs in a more immediately usable form.

In our Thai herbal compress certification training, we cover the history and safe use of the herbs, compress construction, herbal properties and the use of the herbs on the energy lines of the body as taught by the Thai Ministry of Public Health, under whose auspices I studied Luk Pra Kob (another of my teachers was Mama Lek Chaiya of Chiang Mai). Our training is open to anyone, and while we do cover typical use of the treatment in combination with Thai massage, the course is suitable for those who wish to perform it as a standalone or spa treatment. Students always love this course, and they bask in the moist heat and wonderful aromas as they learn -- what better way to learn a new modality that could build a vital, successful practice?