One of the biggest controversies in the massage profession has to do with the licensing and regulation of massage therapy. There are 38 states in the US that require massage therapists to have some type of licensing. Each state differs in the amount of education, classes and definitions of massage therapy which makes it very confusing to understand. The non-licensed states also have varying requirement to practice massage with the biggest problem in CA where each city has different requirements.
The groups that advocate licensing state that the reasons for wanting licensing are to protect the public from harm, create more professional standards of education, reduce the number of prostitutes doing massage to name a few. The thing is that there is no proof that massage has caused significant harm to people. Keith Grant has done an initial survey of medline on the cases of harm that are done to massage clients. How much harm can be done in doing massage? What is the definition of harm? Is it harmful to have a massage therapist who says they are doing deep tissue massage when it is really swedish massage? Is it harmful when a client leaves feeling more sore than when they came in? Will any amount of education really influence the massage therapists skills and reduce the ability to do harm?
If there were a high degree of harm being done, wouldn’t our liability insurance rates reflect that? And how much harm do over the counter drugs do? I just recently had a friend who had excruciating back and abdominal pain for over a year and it turns out it was an over the counter drug causing it. Is that harmful?
What list of side effects could be created to inform the public and teach the public to take responsibility for what happens in their massage?
The number of hours of education varies greatly as well as the topics of courses. I for one started in 1987 doing massage after having 250 hours of massage school. I was the last year of students to become a massage therapist at that number of hours. The number of hours of training was going up to 500 hours in a few months and for no reason at all as far as I could see – no testing to see if it was needed… no research…no case studies, no statistics that showed that having more education would help create a more successful massage therapist. The one thing I did notice was that once they did raise the number of hours, the massage schools increased their hours of training to exceed that 500 hours so that they could get more grant and loan funding for students. I would love to see if the number of students/graduates jumped at that exact time! The thing is that we have no information on what it does really take to be a successful massage therapist. It is more than just doing a good massage. You also have to be a business person. But massage can be learned in a basic 100 hour massage class. Keith Grant also has some information on that topic in his white paper “Issues in Massage Governance” (pdf). He also noticed the same coincidental increase in the number of hours and the number of grants/loans. He also talks about how people learn and sites that people learn better in smaller training programs and the preferred method is apprenticeship programs. There are a few states that do allow apprenticeship programs to be counted as massage training – WA State being one of them. It was actually the whole reason I started this website -www.thebodyworker.com but the thing is that you can only teach one student at a time unless you want to make it into a formal school, which doesn’t make it profitable.
This is the only information that I have seen that gives any insight into the issues that we are dealing with. If there are some other studies, information, proof that more hours of education are needed to be a successful massage therapist then I would love to see it.
CA also has the highest number of massage therapists despite them having this licensing problem. I think that most can become a massage therapist with 100 or 250 hours of training – correct me if I am wrong. So is it the number of hours of training that make a successful massage therapist?
The thing is that when people hear that after taking 1000 hour training classes I think that they somehow think it to mean that they didn’t need to take that many hours or that it is implied that they aren’t knowledgable or that more training is not beneficial. It could be beneficial to people who take it but it is not needed to be a successful massage therapist – that is all that it is saying.
The idea that massage therapists need all this medical training etc is really not true. It doesn’t mean that it could help to have extra classes and training. It does not mean that more training can give you more confidence and skills but they are just not needed to do a basic relaxation massage which is also very therapeutic. After 20 years of doing massage and learning structural integration, triggerpoint therapy and many other things I actually am going back to studying the affects of touch on healing. I once thought as an overzealous massage student that if everyone got a massage once a week (now I would say 3 times a week!) there would be world peace and now I would add – a great reduction in the number of diseases and health conditions that are on the rise.
So I actually don’t care much about licensing these days anymore despite this long post. I just write to hopefully inform someone and to inspire others to seek the truth. I am more than open to hearing any more on this topic, but quite frankly – I just want to do massage! (and write about it!) I sometimes get tweaked and think I should join AMTA or get ABMP more involved especially when I think about the state of insurance billing for massage therapists here in WA State – which talk about a mess! That’s a whole other category here.
So do you think you could do a really great massage just having 100 hours of training just on doing massage? I have lots of friends who have that number of hours because it used to be that number a long time ago. They are all still in business but it seems the more recent grads with 1000 hours can’t seem to make it. What does it take to be a successful massage therapist? Is it the number of hours of training? Is it some secret method? Is it just about the person and who they are and what they want in their lives?
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Hello Julie,
I am glad that I found your site. It is pretty interesting and filled with good information. I was reading this post asking whether more education is the answer to making a good massage therapist.
I am not a LMT. I am a PT. However, I did receive massage technician certification through the Pacific College of Oriental Medicine in San Diego.
I have observed similar trends in the profession of physical therapy. When I started University back in ’88, all you needed to practice PT was a bachelor’s degree. This basically meant 2 years of medical background training.
Now, even the post baccalaureate Master’s programs are being phased out and the only degree that will be granted will be a Doctorate (not PhD.) So all those wanting to practice PT will now be required to get a DPT.
Now, some of the best therapists that I have known have been those with the ‘lowly’ bachelor’s degree. Some of my classmates who received their MSPT are not even practicing any more. Not because they didn’t have the training, but because they were not good therapists, or they couldn’t figure out how to make it work for them. So, for them, more training was not the issue. I suspect that it is similar for those training in massage therapy.
I personally fell in love with manual therapy during one of my clinicals while in school, but didn’t become a manual therapist until about 8 years after graduating. For me, it was a matter of ‘finding myself’ in the profession, and learning many different techniques.
I do have to say that it all fell together for me only after I took a class by a Massage Therapist name Stuart Taws. After his “British Sports Therapy” class in 2000 I came into my own. I used his technique as a foundation and began to apply Osteopathic or other mobilization techniques ‘on top of’ the soft tissue release technique and my results were phenomenal at reducing pain and correcting articular balance in my patients.
I, personally, am not a member of my professional organization currently. I suppose that if I were very active in the profession and attending meetings, then it would be more important to me. However, while I would have access to lots of resources and materials, it isn’t imperative that I be a member. It wouldn’t make my practice be any better or worse that what I do now.
To be fair, in the PT profession, I see the added requirements of education to be an attempt to lift up the standards of the profession. Also, I can see that, while our profession has fairly consistent standards and practice acts from state to state (there are some exceptions)there is a need to standardize some aspects of any helping profession. And rightly so. Massage and Body work are such an intimate profession that I would think that those who practice it would like to protect it at all costs from those who may use it as cover for something less legitimate.
I understand that this is not the norm and that states such as California have taken steps to limit the number of charlatans that would use Massage as a cover for their own immoral gratification rather than the helping profession that it has become known to be. But, as a legit body worker,I think that it would be to your advantage to draw as wide a divide as possible between the therapeutic brand and the sensual brand.
For what its worth, I think that you can’t go wrong with additional training. Will it make you a better therapist? Possibly. Indirectly though. A person will have to be able to integrate any technique into their own personality and their own touch. If after a certain time ‘trying it out’ and not feeling a good vibe from it, then it should not be used or at least not at that time. There may be an opportunity to employ or glean from the technique or special knowledge, but it you can’t get it started after determined effort, then just put it aside.
But some classes I think are indispensible for the massage therapist or bodyworker. A good gross anatomy class with cadaver dissection should be required in every Massage Class graduating. Sure, it may be one of those things that bumps up the hours in your program. A good kinesiology/physiology class is also good. Then there are theory courses in Qi and 5 element theory. The psychology of touch as well as the effect of touch should be a class also. In addition to how to market to MDs, classes that are specific for medical complications and disease states should be taught. Not because the massage therapist is ignorant of the condition, but so that the massage therapist can speak intelligently to the mainstream medical professional. I tell you that if this was a reality, LMTs would be overwhelmed with work from MDs, DOs, PA-Cs, LNPs, as well as other prescribing providers. Would this mean that you have sold out your princinples? No, not at all.
Hey, I live in California. Dreadlocks, flip-flops, mid rift or dirty t-shirts ( I know, not everyone). Its not that the MDs don’t want to be cool and hang out. They may be a little tired of the whole button down collar thing and jealous of the body worker’s freedom. You never know.
But, they deal with a section of the public that some if not most massage therapists simply do not come in contact with.
It could be your challenge to meet them and their clientele and be able to offer your services. This is not going to happen if you can’t speak the language. Don’t give me that. You can speak french without being a frenchman and you can speak spanish without being spanish. So, you can speak doctor too.
So, I would encourage LMTs to continue doing what you are doing because its working. And also, to improve, in some way(s)the standards of the profession.
Thank you for listenting
As a graduate of a 500 hour program, successful business owner and one who has practiced actively since 1999, I see no reason for licensing other than institutions like AMTA making money by making “us” PAY for the right to say we aren’t prostitutes and giving a select few a warn fuzzy feeling by giving them a title that makes them feel more important or qualified than they really are.
Fact is, I have seen more LICENSED MT’s diagnosing, and treating (not within their scope) than unlicensed bodyworkers.
I , for one, let my license expire and will never again pay the government or these organizations to state what I already know…I am not a prostitute. No other professional has to pay for that right, and I shouldn’t have to either.
Kris
Hi Julie,
Well, this is all so interesting. In the courses I teach, many students, including physical therapists and exercise physiologists, tell me I am teaching the exact opposite of what they were taught in their schools, which includes university level training. Yet they say what I am teaching makes much more sense, and when they try it out in the treatment room, it works so much better. Then, when I show them the sciences behind what I teach, its like, how can we argue against THAT? Especially since those sciences come right out of orthodox medical research textbooks? (Job’s Body by Deanne Juhan does an excellent job of summarizing much of this kind of research as applied to bodywork.) … So, since I do not agree with nor teach nor practice what is being taught in those schools, should I be outlawed? … If so, by whom?
Then, there are those people who somehow keep getting confused with a prostitute. Well, if you ask me, that’s a marketing or personality issue. If you do not know how to communicate or present yourself in a way that people do not confuse you with a prostitute, I suggest you need to learn a little more about who you are and how to present, explain and market it. Using licensing to overcome a personal growth issue, or a business/marketing issue, is against the original principles of American government.
Of course, the medical profession, in the 1800′s, discovered they could circumvent and pervert the original principles of American law and use licensing as a way to secure their quest for monopolistic power, privilege and profit. They masqueraded under the ruse of Protecting The Public, and the gullible public bought the lie. Massage therapists have, probably unknowingly, followed in the footsteps of perverting and circumventing American Law. Of course, their leadership will never inform them of such, if they have even bothered to dig into philosophical, historical and legal principles at all. Expediency, privilege, power over others, and artificial profit is the name of the game.
People should read Transformation of American Medicine by Paul Starr. This might show them that protecting the public is the LAST legitimate thing on the list of priorities for those seeking to get licensed. And you are exactly right. If massage was so dangerous to so many people, it would be reflected in insurance rates. But the insurance actuarial knows far more about how these things work than most. Otherwise, their company goes broke and they are out of a job.
Contrary to popular opinion, licensing does an excellent job of insulating so-called professionals from the results of their mis-deeds. The court cases in the early 20th Century illustrate the deceit of the licensed medical profession all to well. … But who will take the time to study and learn the lessons of history and philosophy? … My experience is no one really cares about First Principles and the long-term good of society. All they care about is their own narrow, relatively short-term interests.
Many massage therapists, like the medical profession, whether they realize it or not, are using licensing to cover for their inadequacies in marketing and education of the public and in sound business practices.
But the REAL issue, if you ask me, is do you believe in violence, or peaceful interaction? … If you advocate state licensing, then you BY DEFINITION advocate violence. Because it is the threat of violence (arrest, jail, fines, or worse if you resist arrest) that The State uses to enforce its licensing laws. This is, of course, an unpopular view. But even George Washington stated that government is not reason or eloquence, but force, and a fearful master. ANY legal encyclopedia will tell you that the foundation of ALL state laws, regulation and licensing is based on the state’s monopoly on the Police Power — force and violence. In fact, to further reinforce Paul Starr’s writings, medical licensing is a “quo warranto” action. That is a legal principle that protects an office of the King’s Court. And that is one of Paul Starr’s point: the medical doctors in America in the 1800′s were jealous of the prestige and position of the physicians of the royal court of the kings and queens of Europe. They wanted a way to artificially inflate their status and wealth.
So like it or not, believe it or not, those who pursue professional licensing are really using the law to achieve an elitist status that takes us backward in time to a social system — feudalism anyone? — that works AGAINST The People, and to the benefit of The State and those Special Interests who cannot make it on their own skills, knowledge and value without protection from The King.
If a person cannot do business, cannot market themselves, without using the violence-based power of The State, I suggest they are in the wrong business, and probably are not good enough at it to make it in their chosen profession. Yet I have had many massages from people who had NO training that I would gladly pay for their time if they were in the business.
If you really believe that more training is the answer — and it certainly is for certain kinds of therapy, and even I offer advanced trainings for those who are interested — then get that training, and PROMOTE and EDUCATE the public why what you have learned and what you are doing is superior to others with peaceful, non-violent means. If your message is clear, and you market it well, you will find those people who need and want your services. Except, of course, you will be competing against people who are using The State — The King’s Court — to give them an unfair, artificially inflated advantage. So it’s much easier to become like them, to get the blessings of The King or The State, than to stand on principle and one’s own two feet.
Sorry for the Diatribe.
David Scott Lynn
Since the purpose of requiring a license is to set the minimum level of knowledge required to protect the public from harm, that should be were licensing is set. Just what level of knowledge that is, stirs the controversy.
Some want a massage license to demonstrate the ability to solve certain problems (i.e. a tight QL) but this is not the legal purpose of licensing. (Personally, I’d like my therapist to know there is NO scientific evidence demostrating toxins are released from muscles after a massage, nor is there any that you should drink plenty of water after a massage, but old massage myths are hard to break).
Overall, massage is safe to the medically stable public, with little chance of harm if basic contraindication education is combined with common sense. We are all legally bound by a state scope of practice, but additionally, all states incorporate general “personal scope of practice” statutes which basically say that even if your state scope of practice allows you to do such and such, you can not perform such and such, unless you have been trained in such and such and know you are competent.
Where I differ is to the degree of entry level knowledge required to prevent harm to the medically unstable or complex, something few of us see in a day to day massage operation. As a general rule, you could say that anyone driving to your office and walking through your front door independently probably does not fit into this category.
Different populations with multiple co-morbidities could present oppourtuities for harm. Those with low cognitive states stuck in bed may not be able to provide the feedback to a massage, but they are definitely in need of our services. Teaching “coma” massage is not an any syllabus as far as I know, but should be.
Additionally, post surgical therapy is an entirely untapped field of massage, but probably justifibly so because of the fragile nature of tissues after surgery, however, this is another field waiting for our hands–just if we knew what we were doing so as to not undo a micro-sutured tendon repair.
Two level massage licenses? I don’t know if it’s an answer. Most MT’s have already been awarded the title of Therapist and are unlikely to give it up for ‘Massage Provider’.
That’s really interesting… I don’t remember the OIA of hardly any muscles after 20 years of full time practice and I never heard about angel statues and I never took any business classes what so ever but my customer service skills are excellent from working in customer service before I went to massage school.
Separating ourselves from sex workers won’t be solved with licensing. It has more to do with having more research to support our profession. Licensing just says that someone studied enough test questions to know how to pass a test. I probably couldn’t pass a test today but I am a very successful massage therapist. Most of what I also learned later in my career in structural integration is also contraindicated by massage school standards so I would probably fail there too.
Julie
I agree that all positive touch can be therapeutic. Senior ladies love to get their nails done, for instance, because it often means the cosmetologist will be touching their hands for an extended time. Likewise, gentle relaxation massage is also beneficial because it promotes the parasympathetic state, which promotes a feeling of well-being via hormones and other body chemcials, in addition to letting the body digest, allowing circulation to improve, and allowing toxins to release from muscle tissue. However, if I have a specific concern, say a tight quadratus lumborum, I want my therapist to know the OIA (origin, insertion, action) of the QL itself and those around the QL that move or affect it. If I have high blood pressure that cannot be controlled with medication or a stent in my heart, I want my MT to know that I shouldn’t be lying prone on the table. I also want my MT to have background in business ethics and interpersonal ethics. I want my MT to know that little angels and cherubs in the room were commonplace in 19th century brothels, which could to some send an unintentional mixed message. I want my MT to have had some business classes that shows them how to have effective customer service beyond the massage table. Ethics, business, pathology, physiology, and anatomy are, to me, essential elements in separating what I will call our “new” profession from those who are unskilled or incognito sex workers.
I won’t say that 1,000 hours is necessary (though Canadians have a 2,000 hour requirement), but 500-600 is a good beginning. I also think having more than one instructor is essential, because no MT has the market cornered on education. In addition, I live in a state (Michigan) that has no licensing requirements. It has been amazingly difficult to separate the opinion of my work as an educated professional from those who give sexual services because of the sheer history we have yet to overcome. To me a well-rounded education and at minimum national certification is essential in constructing and maintaining this barrier, flawed or politicized as the current national certification system may be. I want all MTs and bodyworkers in the U.S. to be more than, “rub, rub, rub,” as my teacher Irene Gauthier (co-founder of myomassology) is fond of saying. We are striving for acceptance from the medical community (including insurance carriers), other allied health professionals, and more importantly, the community. I want my MT to know how and why they are affecting my body. It shows committment, dedication, and more passion for the profession rather than making the quick buck. It’s time for a change.