Thai traditional massage: Issues causing possible adverse effects.

Thai traditional massage is a widely used massage technique in Thailand and is presently accepted by local Thai Ministry of Public Health. The technique is promoted but not well accepted internationally. There is a concern about the effectiveness as well as safety of this local wisdom. After a recent episode of concurrent acute heart attack and Thai traditional massage in a patient, the issue of possible adverse effects of Thai traditional massage is being widely discussed.

INTRODUCTION

In the recent report on Thai traditional massage, Yoopat et al. reported their observation on three varieties of Thai traditional massage and concluded that “some forearm fatigue was decreased significantly among the three massage techniques.”[1] In fact, Thai traditional massage is a widely used massage technique in Thailand and is presently accepted by the Thai Ministry of Public Health. The technique can be described to be a kind of acupressure massage. Kumnerddee noted that Thai traditional massage was effective in bringing about muscle relaxation but that the technique was inferior to the worldwide well-known Chinese acupuncture.[2]

The technique is promoted but not widely accepted internationally. There is a concern about the effectiveness as well as safety of this local wisdom. After a recent episode of concurrent acute heart attack and Thai traditional massage in a patient, the issue of possible adverse effects of Thai traditional massage is being widely discussed.

INDEXED DEATH CASE OF A PATIENT WHO UNDERWENT THAI TRADITIONAL MASSAGE

In May 2015, there were reports of a death case of a patient who had undergone Thai traditional massage.[3] The patient is reported to be a 37 year old Thai female who underwent Thai traditional massage and subsequently developed acute heart attack. The same was confirmed by the final autopsy report which indicated the cause of death to be myocardial infarction. The publicity led to a debate as to whether the death was due to Thai traditional massage. The Director General of the Department of Thai Traditional and Complementary Medicine (DTAM) stated that this was only a coincidence.

POSSIBLE ADVERSE EFFECT OF THAI TRADITIONAL MASSAGE

The possible adverse effect of Thai traditional massage is an issue to be discussed. The question to be addressed is whether Thai traditional massage could cause any problem to cardiovascular system. A recent report by Buttagat et al. found that Thai traditional massage “was associated with significant increases in hear rate variability (increased total power frequency and high frequency).”[4] Hence, it is no doubt that the massage might alter some cardiac function and can be problematic in the patients with underlying cardiovascular disease.

There may be other possible adverse effects which need to be focussed upon, such as the risk of fracture due to rough massage. One example is a report from Malaysia on serious spine fracture resulting in spinal cord compression due to traditional massage (Malaysia is a country geographically close to Thailand and shares a few traditional medical practices).[5] There can also be neurological side effects due to massage and need investigation. Although there has never been any official report about this, the problem of brain hemorrhage in infants due to traditional massage applied to the mothers during pregnancy has been reported.[67] In fact, application of traditional massage to infants can directly cause testes hemorrhage and such other internal hemorrhages in infants.[8] Finally, the risk of embolism due to applying massage to carotid area needs to be mentioned.[9] This can be the cause of cardiac arrhythmias and cerebrovascular accidents[10] that can further result in sudden death (in the latest indexed case, this cannot be rule out to be a cause). It will be of interest to note that in the present clinical practice, there are no guidelines for the practitioners for history taking and monitoring of vital signs of the patient before, during and after massage.

CHALLENGES IN THE PRESENT CLINICAL PRACTICE OF THAI TRADITIONAL MASSAGE

Although there is a standardized system of training Thai traditional medicine in Thailand the control of medical practice is not well guided by local governmental agencies.[1112] This has led to a situation where laypersons without degrees are practising Thai traditional massage. Although a legal framework to control of Thai massage medical centers and massage shops is available, the massage is also widely conducted in other settings without control. Also, since Thai traditional massage has ethnic and cultural connections, people tend to accept it out of belief, not knowledge. Standardization of the massage is an issue and when done, it can bring about greater acceptance of the massage system.

CONCLUSION

Similar to any other medical practice, there may be adverse effects of Thai traditional massage and it is an issue which needs to be studied further. Strict control of Thai traditional massage governmental agencies is needed and there needs to be standardization of the practice.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.