by Noel Norwick, LMT, NCBTMB, MBA

For several years, I have resisted suggestions that I publically share my opinions regarding how our profession and its clients are being harmed by our leadership’s efforts to force students, teachers and practitioners into supporting what have become increasingly dysfunctional and expensive academic and healthcare provider models. The situation in metropolitan Los Angeles has become so challenging that I have decided to find out if others share my concerns and are sufficiently motivated to call upon our industry leader to more effectively address them.

As a retired MBA, NCBTMB certified continuing education provider and ABMP instructor level member who (between 2000 and 2009) supervised the Shiatsu Massage School of California’s intern clinic while teaching ethics, legal, licensing and clinical practice classes, I have witnessed a significant decline in the quality of the average practitioner’s work environment along with the return on her/his investments of time, money, labor and emotional energy.

I believe our field needs a nationally accepted legal scope of practice and a three track educational model. This model should be based upon what can be proven to work in the field by: those providing preventative stress management therapy for the relatively healthy general public; those providing complementary therapy for diagnosed medical conditions, and; those performing academic/scientific research. In order to effectively do these things, I believe that the following issues must be considered and then appropriate actions taken to resolve them:

* Despite positive announcements/projections from the US Department of Labor & AMTA the massage industry has not developed a salaried career path for massage practitioners. From the feedback I get from past students and current practitioners, it seems that they are coming to recognize just how badly they were misled about the potential to earn a satisfactory and enjoyable living by practicing massage. 

* Despite the information provided by K. Anders Ericsson in his internationally recognized book, Development of Profession Expertise – Toward Measurement of Expert Performance and Design of Optimal Learning Environments, Cambridge University Press, 2009, our massage industry leaders are increasingly pressuring us to follow the same path as has/is Physical Therapy. This path greatly increased legal liability for physical therapists along with the price that must be paid for their services. Sadly, as with chiropractic, it has not helped them to gain significant respect from the general public, regulators or medical doctors. It’s an unquestionable fact that the general public along with third party payers are beginning to seriously doubt that physical therapy is worth what it costs [see, “Delivering the Physical Therapy Value Proposition: A Call to Action” by Dianne Jewell, Justin Moore & Marc Goldstein in the January 2013, Volume 93 Number 1 issue of Physical Therapy Journal of the American Physical Therapy Association). Because of this and our troubled economy, the general public is being driven to do without care or to seek relief from “non-medical” and much less expensive providers for their chronic stress, movement/postural related physical discomforts, impairments and disabilities. 

* A nationally accepted massage scope of practice doesn’t yet exist and there is great confusion and disagreement regarding what constitute valid evidence based foundational practice principles, protocols & techniques ( In light of this, teachers face many obstacles regarding how to properly instruct students in the most efficiently and effectively means of providing stress management massage to generally healthy people. Much more serious obstacles confront teachers when instructing students planning to work within the healthcare mainstream on M.D. diagnosed patient conditions. 

* Small practitioner owned massage schools [with self-funded students] are being replaced by more expensive corporate schools [with tuition paid by government grants/loans or foreigners seeking student visas]. Additionally, the number of successful continuing education seminar/workshop programs is declining. 

* What motivates our industry leaders’ continuing failure to focus their efforts and our money on developing salaried career paths based on clearly defined minimum bodies of knowledge of specific protocols and practice skills that have long been proven to safely and consistently result in positive client outcomes? 

* Who benefits as our industry leaders greatly raise the cost of entering the field, fund poorly designed pilot study research, and divide practitioners into those who: a. Work in relatively inexpensive franchised mall operations; b. Work in day spas; c. Work in the financially troubled medical mainstream and; c. Rent office space and/or make house calls to provide care for relatively wealthy private clients? 

* The average price paid for a massage, the number of massage schools, Day Spas and the average age of massage school students are all declining. While the bad economy undoubtedly plays a part, our industry’s efforts to improve our lot is clearly failing to convince the general public that our services are highly valuable and worthy of respect. As industry leaders and massage schools strive to introduce new teaching methodologies, graduates are increasingly finding themselves unable to repay the costs of their education. 

* The educational requirement to enter the field has been raised from 150 to 500 hours and efforts are being made to increase it further. Five hundred hours of education seems more than sufficient for one to learn how to perform basic stress management massage. There is no credible evidence that additional increases in entry level requirements will improve the average massage practitioner’s client outcomes/satisfaction, increase their income, improve working conditions, increase public safety, and/or help reduce human trafficking/prostitution. I have observed that regardless the massage modality that one practices when providing basic stress management/feel good massage, it rarely matters if one follows Asian/Eastern or Western/scientific practice guidelines. That’s presuming one knows how to accurately identify (and safely address) risk factors and absolute contraindications. Additionally, I agree with a past FSMTB statement that at the entry level, our government’s sole interest in educational matters should be limited to protecting the public safety/welfare (rather than to increase regulatory revenues). 

* The educational requirements for those wishing to work with clients suffering from diagnosed disease and/or orthopedic complaints are the ones who do require more than 500 hours of instruction (in basic anatomy, pathology, physiology, trauma and highly specialize treatment protocols). Despite the troubling lack of agreement regarding what constitute effective practice principles, protocols and techniques; it’s indisputable that those who practice within the medical mainstream require highly specialized and scientifically based training (likely including a supervised internship period). Even so, they don’t need to know about biochemistry and biology at the cellular/molecular level. Only those very few practitioners who wish to pursue careers in academic/medical research are likely to benefit from or need a college, masters or Ph.D. level education. 

* Efforts are now being made to require vocational massage instructors to become certified/credentialed in the currently recommended American public high school teaching methods. Additionally, there is a drive to further regulate topics and content that may be legally offered by continuing education providers. These efforts appear seriously misguided in light of their generally recognized past failures to effectively prepare America’s public high school graduates and/or licensed practitioners to enjoy greater success in their subsequent academic, commercial and/or family activities. 

* An increasing amount of trade association money is being diverted into pilot study research seeking correlations between having received massage and positive medical outcomes and/or physiological changes. Such studies are unhelpful and often damaging because most researchers display an abysmal lack of knowledge regarding what successful clinicians have found to be effective practice protocols. This failure to test clinically proven therapeutic principles, practice protocols and techniques inevitably produces invalid and misleading data that masquerades as scientific findings. These poorly designed small research studies will never support a legally defensible “Evidence-Based” form of practice. The current research focus should be redirected towards objectively identifying specific, beneficial and replicable massage protocols & techniques that produce measurably beneficial physiological changes/outcomes. 

* Given the multi factorial nature of human physiology, research into single factor effects will never satisfactorily explain/justify massage practice. Sadly, it’s unlikely that there will ever be enough money generated by massage practitioners in a “free economy” to fund sizable medically acceptable qualitative/quantitative research studies. In the meantime, it seems most of the published research on massage is designed and conducted by people who appear to know little about massage protocols/techniques that have proven clinically successful for decades. What passes for “evidence based research science” among many of our massage industry leaders is an embarrassment and those who try to educate them on the subject are generally ignored, vilified, “flamed” or “trolled”. 

* Despite past efforts by AMTA, ABMP, COMPTA, NCBTMB, MTBOK, FSMTB, AFMTE, MTF, etc., the average massage school graduate increasingly struggles between trying to serve the general public at affordable rates and the relentless pressure to support an increasingly dysfunctional and expensive academic and medical mainstream. Hopefully, before it’s too late, practitioners will figure out effective ways to convince our industry leaders to: a. Establish a national and legally recognized massage scope of practice; b. Identify the minimum amount of medical information that has practical application for specific types of massage practice; c. design credible/valid research studies; and, last but not least; d. Promote and support truly effective ways to develop professional expertise sufficient to provide a satisfactory and enjoyable livelihood for the average massage practitioner. 

Noel Norwick, LMT, NCBTMB, MBA
Noel Norwick, LMT, NCBTMB, MBA

Category: Letter From The Editor