What does a massage license mean?

When Pennsylvania announced in 2010 that it was going to pass legislation to grant licenses to massage therapists, a friend remarked, rather cynically, “They’re just looking for a way to make more money.” I couldn’t have agreed less. I had wondered why it had taken so long for the state to treat massage as something other than a recreational activity.

When I first started practicing in 2002, Pennsylvania was one of 19 states that did not offer a state license to practice massage. What that meant was anyone could hang a shingle and claim to provide massage services – having taken no classes, having no credentials, and having no requirement to conform to oversight regarding their conduct or qualifications. This hurts the consumers, the legitimate therapists, and the practice of massage in general.

My first endeavor in this profession was opening a small practice in a local health club. There were five or six personal trainers employed, and the owner was looking to provide massage services as an additional benefit to the members. I set up shop, and soon had another therapist working with me – both of us having recently graduated from a nationally recognized institution for massage study.

I was soon contacted by the local yellow pages rep trying to sell me an ad, and I asked to see the other listings to get a feel for what the massage practitioners in the area were doing. I was frankly shocked at what I found.

There were two headings, one for “Massage Therapist” and one for “Massage.” The listings under “Massage Therapist” all looked like legitimate businesses, with language and offers that were in line with credible therapeutic massage offerings. The “Massage” listing, on the other hand, contained offers that were mostly thinly veiled escort services. And that’s giving more credit than is deserved. It was sex trade, and I couldn’t believe these ads were legal, much less sanctioned by the publisher. I guess they were hurting for business.

There was no way I was going to list my service in a book that wouldn’t make the distinction between a legitimate health care service and something that was another thing altogether. It was a major red flag, and as there was no one governing what could and could not be called “massage,” I took this as standard practice.

Then, not two months later, one of the personal trainers approached the owner of the gym claiming to be a massage therapist. The best we could determine, she had taken a weekend course in the Poconos on some massage-related topic. Unfortunately, this passed as qualification in the eyes of the owner, and she was allowed to use our room and solicit massage business.

She was, at least, performing some variation of a legitimate massage, but in addition to being underqualified (by any reasonable standard), she was actively soliciting business from the clientele base the other therapist and I had begun to build! The impropriety of this was too much for me. I was all for creating a community of therapists who would work together, but it became clear to me that the ethics and business training I had received in massage school was not just to fill the national requirements, but a necessary part of the massage curriculum.

So what does it mean to have a license? It means you have attended an accredited school that devotes hours of class time to clinical massage techniques, anatomy, physiology, ethics, business, alternative therapies, and practical clinics to ensure you have a sturdy knowledge of what massage therapy is and what its scope of practice includes. It means that every two years, a practitioner has earned at least 24 hours of continuing education credits and is showing some degree of growth and maintenance in his or her practice.

There is also a national certification program with similar benchmarks and requirements – including minimum hours of massage work performed – needed for recertification every four years.

Having a license doesn’t ensure any given therapist is the greatest in the state, but it’s a far cry from having zero qualifications other than printing a business card. This goes a long way toward informing the public, protecting legitimate therapists, and promoting the legitimacy of this profession. For that, I consider it money well spent.

Post-exercise massage helps muscles heal

One of the themes we heard a lot when I went to massage school was how the “West” and “Western Medicine” was slow (or completely unwilling) to admit that massage, and most of the complementary alternative medicine / alternative healing therapies, actually DID anything other than make the receiver feel good.

A year ago, a study, titled, “Massage Therapy Attenuates Inflammatory Signaling After Exercise-Induced Muscle Damage,” set out to determine what, if any, physiologic changes occurred as a result of sports massage after exercise. The study took 11 men and had them exercise on a stationary bicycle to exhaustion. One thigh received post-exercise therapeutic massage and the other was left to recover on its own. Multiple biopsies were taken of each leg before exercise, immediately after exercise, and then 2 1/2 hours later.

According to a New York Times article, “How Massage Heals Sore Muscles,” the scientists “found that massage reduced the production of compounds called cytokines, which play a critical role in inflammation. Massage also stimulated mitochondria, the tiny powerhouses inside cells that convert glucose into the energy essential for cell function and repair. ‘The bottom line is that there appears to be a suppression of pathways in inflammation and an increase in mitochondrial biogenesis,’ helping the muscle adapt to the demands of increased exercise, said the senior author, Dr. Mark A. Tarnopolsky.”

The Times article also mentions Tarnopolsky asserted that “massage works quite differently from Nsaids and other anti-inflammatory drugs, which reduce inflammation and pain but may actually retard healing.” Tarnopolsky is quoted as saying, “There’s some theoretical concern that there is a maladaptive response in the long run if you’re constantly suppressing inflammation with drugs… massage can suppress inflammation and actually enhance cell recovery.”

Immediately after graduating massage school in 2003, I met, by pure chance, the Philadelphia Eagles’ Head Athletic Trainer, Rick Burkholder. I thought I had struck gold. I asked how many massage therapists they had on staff, and he said, “we have one part-time massage therapist.” I was stunned, I figured a professional sports organization like the Eagles might have four or five full-time staff massage therapists. He went on to say that if they really needed someone, they would call on the Flyers’ guy, but after having polled the players, they preferred a female therapist.

I sent him a package a few weeks later, magazine articles I had found touting the benefits Olympic athletes gained from pre- and post-event sports massage. I didn’t expect to get a reply – and I didn’t – and I don’t know if the Eagles have changed their tune by now and have a staff of MTs employed. My point in bringing it up is that even the folks you think would recognize the true benefits of massage don’t always get it. But a lot has changed in the 10 years that I’ve been doing this work, and all of it for the better. Science and research are catching up and proving that massage and other complementary alternative therapies have measurable, beneficial value – on emotional, physical, and even physiologic levels. Keep the research coming… it’s all good news.

Is organic broccoli alternative medicine?

I recently learned that in 2008, the National Center for Health Statistics (a division of the CDC) reported that nearly 4 out of 10 Americans had used Complementary Alternative Medicine (CAM) within the calendar year. Not bad.

Massage therapy, yoga, chiropractic work, and acupuncture (among many other therapies) all fit into the CAM category, but so does the use of “natural products.” So if you’re eating organic broccoli, does that make you a practitioner of alternative medicine?

Looking a little deeper, I found the list of natural products, and broccoli wasn’t on there, so I guess the answer is no. But things like fish oil, Echinacea, herb pills, garlic supplements, green tea pills, cranberry pills, milk thistle, and other fine whole food-sy stuff was, and in my opinion (hardly scientific, I’ll grant you) greatly skews the numbers – particularly as “natural products” tops the list when they ranked the use of CAM by the numbers. In 2007, the top 10 CAM therapies go like this:

1. Natural Products (17.7%)
2. Deep Breathing (12.7%)
3. Meditation (9.4%)
4. Chiropractic and Osteopathic (8..6%)
5. Massage (8.3%)
6. Yoga (6.1%)
7. Diet-based therapy (3.6%)
8. Progressive relaxation (2.9%)
9. Guided Imagery (2.2%)
10. Homeopathic treatment (1.8%)

I found it interesting that massage ranked above yoga, I would have guessed that to be the other way around. It was noted that massage use had increased rather dramatically in the five years of the study, and that in 2002 it ranked behind yoga. Another tidbit of info is that women were more likely to use CAM therapies than men. That isn’t too surprising, though I find that my own practice is split fairly evenly between male and female clients.

For any of you who want to check out the gritty details, the report is here. For any of you who want to help massage move up the list, you know where to find me.