Originating in India and drawing from Ayurveda, it has inevitably incorporated modalities like yoga. The receiver is put into many yoga like positions during the course of the massage. In the northeren style there are a lot of stretching movements unlike the southern style where pressure is emphasised. It was believed that the massage art was brought over to Thailand by Shivago Komarpaj (Jivaka Kumarabhacca), a contemporary of Lord Buddha over 2500 years ago.

The massage recipient changes into loose, comfortable clothes and lies on a mat or firm mattress on the floor. (It can be done solo or in a group of a dozen or so patients in the same large room). The massage practitioner leans on the recipient's body using hands and forearms to apply firm rhythmic pressure to almost every part of the recipient's body. The massage generally follows the Sen lines on the body-somewhat analogous to Chinese Meridians and Indian nadis. In some gestures, legs and feet of the giver are used to fixate the body or limbs of the recipient. In other gestures, hands fixate the body, while the feet do the massaging action. Oil is not used in traditional Thai Massage. A full Thai massage session typically lasts two hours or more, and includes rythmic pressing and stretching of the entire body; this may incluce pulling fingers, toes, ears etc., cracking the knuckles, walking on the recipient's back, arching the recipient's back in a rolling action etc. There is a standard procedure and rhythm to the massage.

The traditional therapeutic practice of Thai massage should not be confused with the sexual service of the same name that is available in some hotels and brothels. Sometimes the traditional therapeutic Thai Massage, or ancient massage, is referred to as "old lady massage," while the sexual practice, which has nothing to do with therapeutic traditional massage is called "young lady massage."

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