Thai Folk Medicine Wisdom of Coconut Shell Stepping Exercise: A Case Study of Mrs. Chivaporn Deeburi, Loei Province

Abstract

Introduction and Objectives: Thailand has transitioned into a complete-aged society, leading to increased problems of falls and mortality among the elderly. Strengthening lower limb muscles and improving balance are critical preventive measures. Coconut shell stepping therapy is a Thai folk medicine wisdom that has been used to enhance lower limb muscle strength and improve balance. A folk healer from Loei Province, Mrs. Chivaporn Deeburi possesses unique coconut shell stepping therapy, which was passed down through generations. This study was therefore aimed to: 1) compile knowledge of her coconut shell stepping exercise routine, 2) examine multidisciplinary perspectives on its alignment with physiotherapy principles and advices on ways to improve its therapeutic effects and safety, and 3) evaluate preliminary outcomes from her service recipients.

Method: The research team conducted in-depth interviews with the folk healer and facilitated focus group discussions with 30 multidisciplinary professionals, including rehabilitation physicians, physiotherapists, occupational therapists, nurses, and Thai traditional medicine practitioners, and traditional Chinese medicine practitioners. Additionally, three service recipients were interviewed. The study was conducted from May to July 2023.

Results: The folk healer's technique, inherited for over 105 years, comprises five postures performed while standing on coconut shells. Position 1: Forefoot on shell, heel on floor; lean forward and backward (10 repetitions), Position 2: Rise on forefoot, performing heel raises on shell (10 repetitions), Position 3: Midfoot on shell; lean forward and backward, maintaining pressure (3 minutes), Position 4: Midfoot toward heel on shell; lean forward and backward, holding pressure as tolerated, and Position 5: Heel on shell; rotate left and right alternately (10 repetitions). The multidisciplinary team viewed that her coconut shell stepping exercise routine aligns with physiotherapy principles – stretching, releasing, pressing , and massaging – serving as an alternative form of muscle pain management. Safety recommendations include using non-slip mats and handrails for support, performing continuous exercise routine 5 days a week for no longer than 8 weeks, and inspecting coconut shells for appropriate curvature and integrity before use. Service recipients reported significant benefits: alleviated foot and leg pain, and notably improved toe numbness.

Discussion: This ancestral wisdom of coconut shell stepping exercise aligns with the principles of Thai traditional medicine and physiotherapy for musculoskeletal care. The exercise routine helps alleviate foot pain, relax lower extremity muscles, build strength, enhance balance, and reduce fall risk. This traditional therapy offers a beneficial healthcare alternative for individuals experiencing lower limb muscle tension and pain. It provides accessible, cost-effective care using locally available materials, and enables community self-care practices.

Conclusion and Recommendation: The practice routine and specific postures of coconut shell stepping exercise of this local folk healer can serve as an alternative method for developing therapeutic interventions aimed at musculoskeletal disorders and fall prevention in older adults. This practice is observed to alleviate muscle aches, enhance postural balance capacity, and increase walking speed, which are critical factors in mitigating fall risk. Furthermore, it represents a cost-effective application of indigenous wisdom for self-care. To substantiate these benefits, future research should scientifically investigate the physiological effects on muscle function and proprioception (position sense) to establish empirical evidence. Concurrently, efforts should focus on systematic data collection to establish a database of local traditional medicine wisdom, serving as a valuable knowledge resource for Thai traditional medicine practitioners and interested parties. Research is also needed to develop and standardize the coconut shell stepping postures to ensure that they are anatomically aligned with the musculoskeletal system. Finally, it is imperative to disseminate and transfer this body of knowledge to foster further research in Thai traditional medicine and alternative medicine.