The practice of Thai Yoga Massage is said to be thousands of years old but it is still part of Thailand's medical system due to its perceived healing properties at both emotional and physical level. There are differences in certain practices associated with the massage when performed in the Western and Thai contexts. Western cultural sensibilities might be different in terms of accepting shamanic healing practices such as increasing the intensity of the massage or the giver jumping around the massage table like the Hindu god Hanuman. Traditional Thai massage uses no oils or lotions. The recipient remains clothed during a treatment. There is constant body contact between the giver and receiver, but rather than rubbing on muscles, the body is compressed, pulled, stretched and rocked.The concept of metta (loving kindness), based on Buddhist teachings, is an integral part of this practice. Well known practitioners also emphasize meditation and devotion on part of the practitioner as integral to the effectiveness of this practice.

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The recipient wears loose, comfortable clothing and lies on a mat or firm mattress on the floor. In Thailand, a dozen or so subjects may be receiving massage simultaneously in one large room. The true ancient style of the massage requires that the massage be performed solo with just the giver and receiver. The receiver will be positioned in a variety of yoga-like positions during the course of the massage, that is also combined with deep static and rhythmic pressures.

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The massage generally follows designated lines ("sen") in the body. The legs and feet of the giver can be used to position the body or limbs of the recipient. In other positions, hands fix the body, while the feet do the massaging. A full Thai massage session may last two hours and includes rhythmic pressing and stretching of the entire body. This may include pulling fingers, toes, ears, cracking knuckles, walking on the recipient's back, by palm-press, thumb-press, fingers-press and forearm-press in many different positions including HDS. There is a standard procedure and rhythm to the massage, which the giver will adjust to fit the receiver.