Is Thai Massage Really Good for You? History, Risks, Benefits

One of the huge benefits of living in Thailand is the very affordable cost of getting a Traditional Thai massage (TTM). I am of course talking about the therapy type, not the more saucy type, you may be disappointed to read.

For a mere 200-400 Baht, depending on the area and decor of the business, you can melt away the stress and tension in your body with a one-hour Thai massage for a fraction of the 50-100 Pounds/Dollars/Euros it would cost you back home.

As an avid fan, and someone who believes it does me the world of good, I recently thought – after having a masseuse who performed some twists and turns on my body that I had to question as potentially dangerous –  is Thai massage actually good for you? I mean, what are the purported benefits and is there any scientific evidence to back them up?

Before we jump into the science, let's have a quick look at the history of this popular therapy.

Thai Massage: A Brief History

Traditional Thai massage, also known as Nuad Thai or Nuad Boran, has a rich history dating back thousands of years in Thailand. Its origins can be traced to the Indian Ayurvedic and Yogic practices, as well as traditional Chinese medicine.

The history of Thai massage is closely intertwined with the history of Buddhism in Thailand. It is believed that Thai massage was developed by Jivaka Kumar Bhaccha, a physician and friend of Gautama Buddha. Jivaka Kumar Bhaccha is revered as the “Father Doctor” in Thailand and is credited with creating the foundations of Thai massage based on his knowledge of Ayurvedic medicine.

Thai massage was initially practiced by Buddhist monks as a form of healing therapy to alleviate physical ailments and promote overall well-being. Monks would use Thai massage techniques to treat fellow monks and travelers, incorporating elements of acupressure, yoga, and passive stretching into their treatments.

Over time, Thai massage evolved and became more structured, with various techniques and sequences being developed. The practice was passed down through generations, often within families or Buddhist monasteries, and eventually became ingrained in Thai culture.

In the late 19th century, King Rama V of Thailand (also known as King Chulalongkorn) played a significant role in promoting and formalizing Thai massage as part of Thailand's cultural heritage. He established the first public medical school in Thailand, where traditional Thai medicine, including massage therapy, was taught alongside Western medicine.

20th Century Popularity

In the 20th century, Thai massage gained popularity beyond Thailand's borders as travelers and tourists discovered its therapeutic benefits. It became a sought-after treatment in spas and wellness centers worldwide, contributing to its global recognition and dissemination.

Today, Thai massage is practiced and appreciated around the world for its holistic approach to health and well-being. It is often regarded as a form of passive yoga, as it combines stretching, compression, and pressure point techniques to release tension, improve flexibility, and restore balance to the body's energy pathways (known as Sen lines in Thai medicine).

While Thai massage has evolved over the centuries and adapted to modern times, its underlying principles remain rooted in traditional healing practices and cultural heritage. It continues to be passed down from teacher to student, preserving its authenticity and significance in Thai society.

Thai Massage Accreditation

But how do you know that your friendly massage lady, or man, knows what they are doing? I mean, it seems just about everyone in Thailand knows how to give a massage!

Well, in Thailand, there isn't actually a centralized accreditation system for traditional Thai massage practitioners similar to those found in Western countries for other types of massage therapy. Instead, Thai massage training and certification are typically conducted through private schools, massage institutes, and traditional medicine institutes, many of which are approved by the Thai Ministry of Public Health or affiliated with reputable organizations.

Thai massage certification courses vary in length and depth, ranging from short introductory courses to comprehensive training programs that span several months. These courses cover various aspects of Thai massage techniques, anatomy, physiology and traditional Thai medicine principles.

Many Thai massage schools and institutes are affiliated with professional organizations such as the Thai Traditional Medical Services Society or the Thai Healing Alliance International. Affiliation with these organizations may indicate that the school follows specific guidelines and standards for training and certification.

Unqualified Therapists

A significant portion of Thai massage training involves hands-on practical experience, where students learn and practice various massage techniques under the guidance of experienced instructors. However, some Thai masseurs have no formal qualifications and have not undergone any regulatory examination. Many simply learn from elders and receive knowledge passed down through generations.

You can usually identify the qualified, experienced masseuse/masseur from the “just doing it for some cash” worker, because the latter tends to steer clear of any complex stretches and twists that can result in injury if performed incorrectly. That said, those who regularly have massages in Thailand will have at one time experienced some questionable neck-cracking followed by naive giggling, not dissimilar to that of a child finding out that something works for the first time – leaving you thanking Buddha that you didn't end up in a neck brace!

Health Risks

Given the lack of standardized certification, there is a risk of injury if you receive a Thai massage from an under-qualified practitioner. Here are some potential risks associated with receiving a Thai massage from an under-qualified practitioner:

1. Muscle Strain or Sprain

Improper application of pressure or stretching techniques can result in muscle strain or sprain, especially if the practitioner applies excessive force or uses incorrect body mechanics.

2. Joint Discomfort or Injury

Over-stretching or applying excessive pressure to joints without proper technique can lead to joint discomfort, inflammation, or even injury, particularly in vulnerable areas such as the knees, shoulders, or spine.

One example is a report from Malaysia on serious spine fracture resulting in spinal cord compression due to traditional massage

3. Heart Rate Variability

A report by Buttagat et al. found that Thai traditional massage “was associated with significant increases in heart rate variability (increased total power frequency and high frequency).” Hence, Thai massage might alter some cardiac function and can be problematic in patients with underlying cardiovascular disease.

4. Nerve Compression

Poorly executed techniques, such as compressing nerves or applying pressure to sensitive areas, may cause nerve compression or irritation, resulting in numbness, tingling, or pain.

5. Bruising or Soft Tissue Damage

Rough handling or excessive force during massage strokes or compression techniques can cause bruising or damage to soft tissues, including muscles, tendons, and ligaments.

How to Minimize Risk of Injury

To minimize the risk of injury during a Thai massage, it's essential to seek treatment from qualified and experienced practitioners who have undergone comprehensive training and certification.

Look for practitioners who have completed accredited courses, received certification from reputable schools or institutes, and have a proven track record of professional practice.

Additionally, communicate openly with the massage therapist about any pre-existing medical conditions, injuries, or areas of concern before the session. This allows the therapist to tailor the treatment accordingly and avoid exacerbating existing issues.

10 Scientifically-Proven Benefits of Traditional Thai Massage (TTM)

In this section, I explore 10 research studies, focused specifically on Traditional Thai massage (TTM), that highlight the potential benefits of this alternative therapy.

It should be noted that while the following outcomes are quite impressive, assessing the efficacy of Thai massage is somewhat problematic because conducting a double-blind study is almost impossible. A double-blind study is a research design where neither the participants nor the researchers involved know who is receiving the treatment and who is receiving the placebo or control. This helps minimize bias and ensures that the results of the study are objective and unbiased.

Thai massage involves direct physical contact between the practitioner and the recipient, making it challenging to conceal whether the participant is receiving the intervention or not. Unlike a pill or placebo, it's difficult to create a convincing sham massage that mimics the therapeutic effects of authentic Thai massage.

Nevertheless, Traditional Thai Massage has shown positive results in a number of areas of health.

* Each study is linked in parenthesis for further reading at the end of each section.

1. Stress

A study aimed to investigate the immediate effects of traditional Thai massage (TTM) on stress-related biomarkers. Twenty-nine healthy participants underwent a mental arithmetic test to induce stress before a 1-hour TTM session or rest. Results showed that both TTM and rest reduced psychological stress, evidenced by decreased salivary alpha-amylase levels (sAA), increased parasympathetic activity, decreased sympathetic activity, and decreased plasma renin activity (PRA). However, TTM had a modest effect on stress reduction compared to rest, as indicated by reduced sAA levels (1).

2. Office Syndrome

Office syndrome, also known as desk syndrome or computer syndrome, is a collection of symptoms that occur due to prolonged periods of sitting and working at a desk, often in front of a computer. It encompasses various musculoskeletal and psychological issues commonly experienced by individuals who work in office settings. Symptoms may include neck and shoulder pain, back pain, headaches, eye strain, wrist pain (from repetitive typing), and mental fatigue. Poor ergonomics, prolonged sitting, repetitive movements, inadequate rest breaks, and psychological stress are among the factors contributing to office syndrome.

One study aimed to develop a standardized Thai Traditional Massage (TTM) protocol for treating office syndrome (OS) diagnosed based on myofascial trigger points (MTrPs) in the upper trapezius muscle. A 90-minute TTM protocol with 25 steps was created and tested by 11 therapists on three patients each. The therapists and patients reported high satisfaction scores (>80%).

The treatment resulted in a significant reduction in pain intensity (measured on a Visual Analogue Scale) and an increase in pain pressure threshold. The protocol will be further refined and tested in a randomized controlled trial comparing TTM with conventional physical therapy for treating OS (2).

3. Pain Relief

A paper conducted a systematic review of controlled trials assessing the effects of Traditional Thai Massage (TTM) on chronic pain. Six research articles were included, all demonstrating reductions in pain intensity post-treatment, ranging from 25% to 80%. Additionally, improvements were noted in disability, perceived muscle tension, flexibility, and anxiety. The benefits of TTM for pain reduction were observed to persist for up to 15 weeks. The paper also concluded that further research is warranted to explore moderators, mediators, and long-term benefits relative to control conditions (2).

In a specific study, researchers looked at effectiveness of traditional Thai massage and joint mobilization for treating chronic nonspecific low back pain (LBP). Conducted at Lerdsin General Hospital in Bangkok, Thailand, the trial involved 120 outpatient participants randomized into either treatment group. Both groups received treatment twice weekly for four weeks.

Results showed significant reductions in pain and disability scores post-treatment for both techniques, with no significant difference between groups. Both traditional Thai massage and joint mobilization were deemed safe and effective for short-term pain relief in this patient population (3).

4. Immunity

A study aimed to explore the effects of traditional Thai massage (TTM) on immune status, particularly in elderly individuals. Twelve volunteers aged 61-75 with senescent CD4+ T cell subsets were recruited. Participants received six weekly 1-hour TTM sessions or rest in a randomized controlled crossover study.

Flow cytometry analysis revealed that TTM attenuated senescent CD4+ T cell subsets, particularly CD4+28null NKG2D+ T cells. After TTM sessions, the high-risk group showed significant decreases in cell population, suggesting TTM's potential to promote immunity in elderly individuals (4).

Thai massage has been linked with Muay Thai for as long as the art has been around. Why? Well, the robust massage is excellent for limbering up limbs for athletic performance and relieving deep muscle tension afterwards. Useful for both martial artists and stressed out civilians.

5. Autism in Children

A randomized controlled trial aimed to assess the therapeutic effects of Thai Traditional Massage (TTM) on behavioral and emotional disturbances in autistic children. Sixty participants aged 3-10 underwent either standard sensory integration therapy (SI) or SI combined with TTM treatments.

Results from Conners' Rating Scales and Sleep Diary indicated significant improvements in conduct problems, hyperactivity, inattention-passivity, hyperactivity index, and sleeping behavior in both groups. Additionally, the TTM group showed improvement in anxiety compared to the control group. These findings suggest that TTM may be a beneficial complementary therapy for autistic children in Thailand (5).

6. Constipation

A study evaluated the efficacy of Court-type Thai traditional massage and Senokot (a laxative treatment) in relieving chronic constipation, a prevalent gastrointestinal issue globally. Forty subjects with constipation were randomized into two groups: massage and drug. Over a 7-day period, the massage group received regular Thai traditional abdominal massage, while the drug group received Senokot treatment.

Both interventions were found to effectively increase defecation frequency and the sensation of complete evacuation. However, the massage group exhibited a superior outcome, with a higher likelihood of normal defecations compared to the drug group. These findings suggest that Court-type Thai traditional massage could serve as a viable option for managing constipation in primary healthcare settings (6).

7. Physical Fitness

A study investigated the impact of Thai massage on physical fitness in soccer players. Thirty-four players were randomly assigned to receive either Thai massage or rest over a 10-day period. Physical fitness tests were conducted before and after the intervention, including sit and reach, hand grip strength, agility, sprint, sit-ups, push-ups, and VO2 max.

Results showed significant improvements in all tests following Thai massage, while only sit and reach and sit-ups improved in the control group. These findings suggest that Thai massage may enhance physical performance in soccer players.

8. Urinary Tract Symptoms

A study investigated the cellular-level mechanisms underlying the alleviative effects of Thai traditional massage (TTM) on lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia. Forty-three patients were randomized into Tamsulosin and TTM groups. Urinary levels of monocyte chemotactic protein-1 (MCP-1) and interferon-gamma (IFN-γ), as well as gene expression levels of MCP-1, chemotactic protein receptor 2b (CCR2b), IFN-γ, interleukin-1 beta (IL-1β), and transforming growth factor-beta 1 (TGF-β1), were evaluated before and after a four-week treatment.

TTM treatment led to a significant reduction in urinary MCP-1 levels and modulation of inflammatory gene expression, suggesting its potential as an effective therapy for LUTS in elderly men.

9. Shoulder Injury (SCS)

This study was undertaken to assess the effects of traditional Thai massage (TTM) and Thai boxing exercise (TBE) on pain intensity, pressure pain threshold (PPT), and cervical range of motion (CROM) in patients with scapulocostal syndrome (SCS). Seventy-eight patients were randomly allocated to receive either four-week TTM or TBE.

Both groups showed significant improvements in pain intensity, PPT, and CROM post-treatment and at 1-month follow-up compared to baseline. However, TTM demonstrated superior effects in pain intensity, PPT, and cervical flexion and left lateral flexion compared to TBE at both time points (9).

10. Bone Formation

This randomized crossover trial investigated the effect of Thai traditional massage on bone metabolism in postmenopausal women. Forty-eight participants underwent a 4-week intervention of Thai traditional massage twice a week, followed by a control period.

Serum P1NP, a marker of bone formation, significantly increased after the massage sessions, particularly in older postmenopausal women with a smaller body build. No significant changes were observed in serum osteocalcin or CTX. These findings suggest that Thai traditional massage may have a beneficial effect on bone formation, especially in certain demographic groups. Further studies with larger samples are needed to confirm these results (10).

In Conclusion

From stress reduction and pain relief to improving immune function and relieving constipation, Thai massage does have some reputable science on its side to support claims that it is “good for your health”.

While further research is warranted to elucidate the underlying mechanisms and optimize treatment protocols, the collective findings thus far underscore the value of Thai massage as a holistic approach to health and wellness. If carried out by a professional practitioner, its integration into your healthcare routine could well improve your overall well-being and quality of life.

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