There are as many as seven to ten regional variations of Thai massage. Many of these traditions claim exclusivity and compete with the others for students and notoriety, although today the Royal Thai Government is seeking to establish parity and common standards between all of the various schools.

The receiver is put into yoga-like positions during the course of the massage. In the northern style there are a lot of stretching movements whereas the southern style emphasis is given to acupressure. It was believed that the massage art was brought over to Thailand by Jivaka Kumar Baccha, known in Thailand as Dr Shivago, a contemporary of Buddha some 2500 years ago.

The massage recipient changes into pajamas 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 giver leans on the recipient's body using hands and forearms to apply firm rhythmic pressure to almost every part of the receiver's body. The massage follows the Sen Energy lines on the body (the Sen are comparable to Chinese meridians). In some gestures, the legs and feet of the giver are used to stabilize the body or limbs of the recipient while in others, the giver's hands remain still on the recipient's body, while the feet do the massaging action. No oil is applied, but sometimes a hot herbal compress is used to warm and soothe the receiver's body. A full course of Thai massage lasts two hours or more, and includes pulling fingers, toes, ears etc., cracking the knuckles, walking on the recipient's back, arching the recipient's back in a rolling action. There is a standard procedure and rhythm to the massage. Sometimes in a large group massage, the practitioners do the procedures in unison.