Each Person of the Month who we select for our Journal has a unique personal experience or contribution to the massage therapy field. This issue ofJMS¬†introduces to our readers our first international guest, Mr. Paul Clifford. He is an educator, author and practitioner from Canada and I was honored to review his great textbook ‘Outcome-Based Massage. From Evidence to Practice’. In difference to many publications which are frequently based on the author’s personal experience rather than on science, this excellent text presents the theory and practice of the clinical application of massage therapy only through the lens of science.

Dr. Ross Turchaninov

Here is our interview with



JMS: Please tell our readers how you got into the field of massage therapy education.

Mr. Clifford: After working as a government biologist for five years, I decided that I wanted to work with people more directly. For about a year I investigated a lot of different kinds of bodywork including massage, Shiatsu, Rolfing, and Trager. By the end of that year I had begun Trager training and was enrolled in massage school with the intention of eventually studying at the Rolf Institute, which I later did.

JMS: There are significant differences in the massage therapy educational standards here in the USA and in Canada. Can you describe for our readers the pros and cons of massage education in Canada?

Mr. Clifford: I teach in a 3-year, 2200-hour (Community College) program, the typical length for massage education in Canada. The main “pro” of this program type is that there is enough time for students to develop high levels of manual skill, while learning to address a wide spectrum of client groups and medical conditions. However, the length, the level, and the amount of science, are all very challenging. The stress level is high, and attrition rates over the length of the program can approach 50%.

JMS: There are voices here in the USA who wish that massage practitioners would have better access into the medical field while claiming that 400-500 hours of initial education is more than enough for the practitioners to practice massage in the clinical setting. As a matter of fact, several very well positioned educators and administrators have bluntly stated that the simple fact of practicing massage in the hospital gives the practitioner full credibility to call it medical massage. What is your opinion on this?

Mr. Clifford: I think that it is a mistake to equate relaxation massage performed in a medical setting with medical massage! Recent research shows without a doubt that massage can be used to relax people with various medical conditions in different medical settings. This is an important effect, but it does not represent comprehensive treatment. Practitioners of medical massage need to be able to assess and treat 20 or 30 common impairments such as edema, reduced venous return, muscle tension, trigger points, spasm, adhesions, postural shortening, and spasticity. They need to know how these impairments manifest in different medical conditions. They may have to balance treatment of several impairments within one session and throughout a plan of care. This requires a lot more than the ability to relax a client.

I think 400-500 hours of training is enough education for a therapist to perform selected basic tasks (e.g. performing a sedative regional massage) with appropriate supervision in a clinical setting. Frankly, I think it would take training at least two or three times that long to prepare clinicians for independent practice in medical massage.

JMS: You are familiar with the educational approach in both countries. In your opinion, does the Canadian educational system give massage practitioners a better chance to build a successful practice in the medical massage field or this is an irrelevant factor?

Mr. Clifford: Well, I am biased, but I think the longer programs here will prepare people much better for practice in the medical massage field. Not all of our graduates go that way – a lot will work in spa settings, for example – but they do have the ability to address many treatment issues without taking more training. Shortly after graduating, I moved to British Columbia and worked in a practice that was 90% medically-referred orthopedic conditions. I also know of newly-licensed therapists here who have been hired by hospitals to work with patients that have had catastrophic accidents or burns.

JMS: How can you describe the relationship between traditional medicine and massage therapy in Canada?

Mr. Clifford: The relationship between traditional medicine and massage therapy is much the same in Canada as in the United States. We don’t have the traditional support for massage that exists in some European countries like Germany or Russia. Of course attitudes are changing, but many physicians are skeptical about the use of massage for anything other than ‘relaxation’. Few physicians know much about what massage treatment can do for people with medical conditions. The good news is that a lot of physicians are pragmatists: if they see that something works, then they will make referrals.

JMS: We know that Canada has single payer medical system. Is medical massage reimbursed in Canada?

Mr. Clifford: Largely, no. In one province, British Columbia, patients can be referred for medical massage by their doctors, and they will be reimbursed up to $230 annually for a group of services that might include massage. No other provinces do this, as far as I know. Specialized clinics (for example for chronic pain or cancer) in very large urban hospitals may have full or part-time massage therapists on staff, but this is the exception. Almost all institutional funding for massage in Canada comes through private health insurance plans. Many plans do not require a physician’s referral, so it would be hard to tell why massage is being done; I would guess that a lot of it is simply stress-related. Given the current concern over rising health care costs, it is almost certain that reimbursement for massage will continue to come from private plans for the foreseeable future.

JMS: What is your favorite type of bodywork?

Mr. Clifford: That depends on whose table I am on! I have experienced dozens of types of bodywork, and have been certified in several. If I had to pick one it would be Rolf Structural Integration. The work has a wonderful logic and can have profound effects. It has also had a huge influence on how mainstream massage is now practiced in North America.

JMS: What advice can you give to our readers?

Mr. Clifford: Cultivate thinking about your clients in an orderly and thorough way. Many massage therapists are compassionate and marvelously intuitive right from the start. Manual competence is routinely acquired in training and quickly grows in practice. Where massage therapists sometimes lag in their development is in the ability to analyze clients and to think critically about their care. Clinical reasoning is another tool that will help in the treatment of all clients, and it will multiply the positive effects of a therapist’s other strengths. But it does take time to learn, and it takes time to do.

JMS: Thank you Mr. Clifford for your interview and we wish you good luck with your important work!

After working as a professional biologist, Paul Clifford studied massage therapy at the Sutherland-Chan School in Toronto and was licensed to practice in Ontario and British Columbia in 1984. In 1986 he was certified by the Trager Institute. In 1988 he was certified by the Rolf Institute, with whom he maintains certification. He has worked in a variety of clinical settings which include a medically-referred practice, a multidisciplinary clinic, a spa, and in private practice. He has co-authored two editions of Outcome-Based Massage with physiotherapist C.K. Andrade. Since 2001 he has taught massage therapy fulltime at Fleming College in Peterborough, Ontario. For 30 years he has studied various movement disciplines that include gymnastics, Tai Chi, Hatha Yoga, and modern dance.

Category: Person of the Month