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The Practice of Massage in the Millennium

The practice of massage has greatly evolved over the past three decades. In the seventies, most massage practitioners worked in a solo practice with a high number working out of their homes and/or going to clients' residences. Although some therapists worked in the medical field or in the sports arena, the majority of work was geared toward wellness and stress reduction.

Currently, private practice is the most prevalent option. Most therapists are sole proprietors either with an in-home office, a private office in a professional building or they rent space in a salon or primary care provider's office. Group practices (with massage therapists or other allied providers) are gaining popularity. Employment opportunities are still limited with the largest employer of massage therapists being the hotel/spa industry. Massage therapists are becoming more business savvy and are exploring a wide variety of career opportunities. Approximately 30 percent of therapists work at least part time in a spa, clinic or corporate setting.

The current range of approaches and modalities is immense. The last time I counted there were more than 40 specific modalities not including all the variations of each major modality. While massage is still considered a luxury by most (even those who acknowledge and appreciate the benefits), it is continually increasing its role in health care and interfacing with the mainstream medical world.

Today massage therapists can be found almost everywhere in home offices, group practices, clinics, hospitals, cruise ships, spas, gyms, hotels, salons, corporations, airports, malls and sporting events. Some therapists travel with clients who are professional athletes or in the entertainment business while other therapists can be seen driving around town with "Mobile Massage" signs stuck to their cars.

The estimated number of active massage practitioners in the United States is between 125,000 - 200,000. There are more than 800 massage and bodywork schools churning out 35,000+ practitioners each year. Not all of these graduates pursue a career in this field and many only practice part time. Nonetheless, even with the high attrition rate we have in this profession, the number of therapists will increase exponentially. The good news is that plenty of people are awaiting to be introduced to massage. A survey taken by the AMTA showed that 13 percent of Americans received a massage in 1998 (up from 8 percent in 1997). This leaves tremendous growth potential.

To gauge the spectrum of practices in the millennium we must consider the internally-driven direction the profession is taking and the needs of the future consumer.

Trends Driven by the Massage Profession

The massage profession is experiencing what can best be described as "growing pains." In the past we have enjoyed the conglomeration of philosophies, styles and modalities. A desire for homogeneity and standardization has arisen now that our numbers are substantial and the public's awareness of the benefits of massage is increasing. Much has been done to coalesce the numerous touch therapies under the umbrella of massage therapy. Unfortunately, this has not been an easy process and many practitioners are feeling angry and alienated. Distinct factions are developing. As hard as we've tried, we just can't lump everyone in the same group.

Basic standards of professionalism and scope of practice are important for massage to continue its growth and integration into the world of health care. I envision the future practice of massage as being distinct from other touch therapies and utilizing a tiered system with the types of modalities performed and level of required education commensurate with the appropriate tier.

The core issue most people do not want to acknowledge is that massage as an art can be, and is, practiced by anyone without training. For instance, parents have been massaging their babies and friends have been rubbing each others' sore necks throughout history. Witness the dozens of massage books and videos aimed for the layperson; author Steve Cappelini is penning a book titled Massage for Dummies. The ability for anyone to give a massage is a major factor in keeping our profession from garnering the respect it deserves. For example, most people would not consider themselves capable of doing physical therapy, administering acupuncture or practicing medicine without training, yet everyone is able to touch. If you survey people, you will find that most of them have given some type of a massage. Even though massage can theoretically be done by anyone, we know that training makes an immense difference in the quality of work and the results. (It's too late to change the name of our profession, but it certainly would make things easier if we had a different title.)

The range of hours required to practice massage varies greatly. Many of the training programs are in the 100-300 hour range, others at 500 hours and some as high as 1,000 hours of training. Instead of forcing everyone into a cookie-cutter description, a tiered profession allows for these differences in training as well as intended scope of practice. This approach grants practitioners the right to choose their education level and the environment in which they desire to work. For example, a massage practitioner who does corporate seated chair massage does not need the same degree of education as a practitioner who is doing injury rehabilitation work in a medical clinic.

The massage profession itself will fuel this change for stable, well-defined tiered levels. It's one that many other professions such as nursing and physical therapy have incorporated. Yes, it can be somewhat confusing for the general public, but they're already baffled when it comes to describing a typical massage or a model massage therapist. A tiered level of proficiency allows us to embrace our differences and serve the wide variety of consumers' needs.

The Future Massage Consumer

The Stanford Center for Research in Disease Prevention recently conducted a survey titled "Understanding Consumer Trends in Complementary and Alternative Medicine." Massage was rated as one of the most widely used and most effective alternative health care modality. A total of 22 percent of respondents stated that their insurance coverage included massage. Although we would like massage to be covered under all insurance policies, 22 percent is quite an accomplishment! The disturbing data from the survey is that the average annual out-of-pocket expenditure for non-insurance-covered massage was only $137. This implies that the average consumer receives less than four massages per year. At this rate, a full-time therapist seeing 20-25 clients per week would need a client base of more than 300.

To better understand the future massage consumer we must consider the societal trends in culture, business and lifestyle. Faith Popcorn, chairman of BrainReserve, explores future trends in her book Clicking: 17 Trends That Drive Your Business And Your Life. [1] She asserts that for any business to be successful, it needs to click with at least four of those trends. The following is her overview of those trends:

  • Cocooning: Consumers are shielding themselves from the harsh, unpredictable realities of the outside world and retreating into safe, cozy "homelike" environments.
  • Clanning: Consumers seek the comfort and reinforcement of those who share their values and beliefs or even their interests.
  • Fantasy Adventure: As an escape from stress and boredom, consumers crave excitement and stimulation in essentially risk-free adventures.
  • Pleasure Revenge: Tired of being told what's good for them, rebellious consumers are indifferent to rules and regulations. They're cutting loose and publicly savoring forbidden fruits.
  • Small Indulgences: Busy, stressed-out consumers, seeking quick-hit gratification, are rewarding themselves with affordable luxuries.
  • Anchoring: Reaching back to their spiritual roots, consumers look for what was comforting, valuable, and spiritually grounded in the past, in order to be secure in the future.
  • Egonomics: Feeling unconnected in the depersonalized Information Age, consumers are drawn to customized, individualized products and services.
  • FemaleThink: The way women think and behave is impacting business, causing a marketing shift away from a hierarchical model toward a relational one.
  • Mancipation: Rejecting their traditional roles, men are embracing newfound freedom to be whatever they want to be.
  • 99 Lives: Consumers are forced to assume multiple roles to cope with the time pressures produced by ever busier lives.
  • Cashing Out: Stressed and spent out, consumers are searching for fulfillment in a simpler way of living.
  • Being Alive: Recognizing the importance of wellness, consumers embrace not only the concept of a longer life but a better overall quality of life.
  • Down-Aging: Nostalgic for the carefree days of childhood, consumers seek symbols of youth to counterbalance the intensity of their adult lives.
  • Vigilante Consumer: Frustrated, often angry consumers are manipulating the marketplace through pressure, protest, and politics. They cannot be taken for granted.
  • Icon Toppling: Skeptical consumers are ready to bring down the long-accepted monuments of business, government, celebrity, and society.
  • Save Our Society (S.O.S.): Concerned with the fate of the planet, consumers respond to marketers who exhibit a social conscience attuned to ethics, environment, and education.
  • AtmosFear: Polluted air, contaminated water, and tainted food stir up a storm of consumer doubt and uncertainty. How safe is anything?

Matching Massage with Societal Trends

  • Cocooning: Mobile massage is an excellent answer to this trend. Not only are people becoming more reluctant to leaving their fortresses, few want to get into a car (or public transportation) and battle with traffic after receiving a soothing, relaxing massage. Mobile practitioners will be in high demand. Unfortunately, those same practitioners might experience conflict with their own increasing need to cocoon.

    For those therapists who do not want to be mobile, it will be important that their offices are designed as a safe refuge. Create an atmosphere where clients will feel at home. The ideal "cocoon office" has the following: comfortable furniture; soft ambient lighting; a beverage dispenser (complete with juice and hot tea in the winter); ample reading material; a television; a VCR; and a stack of health-related videos.

  • Clanning: The two major approaches to addressing this trend are to get involved in groups and to create a center where people like to hang out. Ample opportunity exists to connect with like-minded people given the thousands of special interest organizations (ranging from hiking clubs to quilting guilds) and the 500,000+ different support groups in the United States. People are more inclined to book a massage session with "one of their own" or at least someone who demonstrates genuine concern for people in the group. Therapists will become more involved in special interest organizations attending meetings and activities and being board members. Think about the types of people you want as clients and the specific conditions you would like to work on. Contact the appropriate support groups and offer to give presentations and write newsletter articles on health and well-being and how massage can address the needs of that specific population.

    Websites for individual massage therapists will be more common in the future. In addition to posting notices about open houses, classes and product specials, these sites will contain articles on general wellness as well as articles on how massage can assist specific conditions. These sites will have links at the special interest groups' sites so members of those groups can directly connect with the therapists.

    Healing centers can foster a sense of clanning. Imagine a center with an array of practitioners, a healthy restaurant or juice bar, a bookstore, a health food grocery store, a community room and workshop space. People can spend the whole day there! The community room is an integral component being designed like the cocoon office and is an open place where people know they can come to relax, read, look at notices on the bulletin board and meet others who share similar beliefs.

  • Fantasy Adventure: For some people the act of receiving their first massage is an adventure in itself. Theme rooms and state-of-the-art equipment, products and modalities will help meet this growing desire for the advante garde. Therapists in group practices won't have their own room anymore because each office will have a different theme. Clients could choose from a range of total massage experiences. For instance the "jungle" room decor would be tropical, complete with lush plants, jungle music, warm, balmy air, and an indoor waterfall fountain. Other complementary services would be available in this setting such as a Vichy shower and body wraps. Therapists who have a solitary office can design theme specials that rotate throughout the year.

    Therapists will continue receiving advanced training in a much wider spectrum of services. Clients will no longer be content to receive a "regular" massage each session. In addition to receiving the therapeutic benefits of massage, they want to experience something novel. They will also expect therapists to have the most current equipment and gadgets and to use top notch products. The side benefit to addressing this need for fantasy adventure is that it will generate a lot of word-of-mouth promotion for therapists.

  • Pleasure Revenge: This is one of the most difficult trends to address with massage since massage by nature is good for people. Perhaps an option would be to offer an occasional treat such as bringing in freshly baked chocolate chip cookies or double chocolate brownies.
  • Small Indulgences: The key to meeting this trend is offering services and products that are easily obtained, relatively inexpensive and provide consumers with a feeling that they are doing something special for themselves. Seated massage addresses this need perfectly. The numbers of store-front chair massage establishments will continue to rise. Massage kiosks will be commonplace in major public locations such as shopping malls and airports as well as private facilities (e.g., amusement parks).

    Massage offices will stock a variety of products for clients to purchase for pampering themselves at home. These products will include specialty oils and lotions, aromatherapy supplies and equipment, bath salts, music, small waterfall fountains and self-massage tools.

    Therapists will offer packages of services, some with specialty products such as hot stones. An example of a package could be the "Total Health Session" which would include several services besides massage (e.g., a paraffin treatment for the hands and feet, a ginger fomentation and an aroma-steam). Clients would also be given a small bottle of the same essential oil used in the treatment and an herbal eye pillow to take with them so they could continue their experience at home.

  • Anchoring: The key to anchoring is feeling connected and massage is a wonderful technique to assist people in feeling connected to their bodies and emotions. Massage has a spiritual nature and the massage practices of the future will extend this aspect by creating an environment that allows clients to experience that quiet oneness (see Clanning). Many practices will focus on the spiritual aspects of massage, offering other healing modalities such as Reiki and holding classes on personal growth topics as well as classes on movement and wellness. Many of these practices will also have a counselor available on the premises.
  • Egonomics: Going beyond basic customer service is the best way to address this need. Currently some therapists utilize computers in their businesses; in the future the majority of practices will be computerized. Therapists will use software programs (which are currently available) that provide easy access to client information. Therapists will meet clients' needs to feel respected and special by knowing their clients' personal preferences for things such as modalities, music, scents, temperature, oils and lotions. These programs will also alert therapists when to send greeting cards. Therapists will surf the web on a regular basis to find articles on subjects of importance to individual clients.
  • FemaleThink: In general, women prefer a relationship marketing approach, which is handy given that most massage therapists operate from that perspective. Women are more inclined to become long-term clients as long as they feel that they have a partner in their wellness goals. To appeal to this trend massage therapists need to do thorough intake interviews with new clients, co-design treatment plans and follow up with information and support. In the future we will see more therapists who focus their practices specifically to women.
  • Mancipation: This trend will be the key to an increased number of men receiving massage. Not only are men more free to express all aspects of themselves, they are becoming more interested in taking care of themselves and even getting pampered (as is evidenced by the increasing numbers of men visiting day spas and health resorts and purchasing beauty products). Massage offices will need to be designed so that men feel comfortable and special packages of services that cater to the needs of men will need to be developed.
  • 99 Lives: As the years roll by consumers will experience a heightened sense of being out of control in terms of time. The massage practice of the future needs to demonstrate how massage assists people in being more productive (through reduced stress, increased energy and enhanced focus). Mobile massage, seated massage and the one-stop health center are three avenues to pursue in meeting this trend.
  • Cashing Out: A popular bumper sticker states, "Live Simply So That Others May Simply Live." This trend for quality of life is gaining tremendous popularity. Many massage therapists have always embraced this philosophy it's actually one of the major drawing factors to this profession. Massage therapists in the 21st century will incorporate these values into their practices. Home offices and mobile massage will appeal to the cashing out crowd.
  • Being Alive: People are becoming more concerned with the quality of their lives and their overall well-being while a distrust of allopathic medicine is brewing. People are shifting their definition of what it means to be healthy and taking responsibility for their wellness through nutrition, exercise, herbs, vitamins and alternative therapies. This trend is ideal for the massage profession! To best meet this trend, massage therapists will need to diversify their practices by offering a variety of services and products and providing wellness literature.
  • Down-Aging: This trend is not simply limited to the senior population. People want to be treated like they were in the "good old days," even if they are technically too young to have been in that era. The nostalgic elements that fuel this trend are rooted in exceptional customer service. The management of massage practices will need to address these desires. Clients will be greeted by their name when they walk in the door and therapists will shake their clients' hands (or give them hugs if appropriate). Therapists will implement customer service action plans to ensure that clients feel taken care of. The biggest shift will be with medical practices. Currently these offices tend to be sterile and impersonal.

    For therapists who do target seniors, their waiting room decor will reflect the bygone era complete with old movie posters hung on the walls and music from the past decades lilting through the air.

  • Vigilante Consumer: The major impact of this trend will be with insurance reimbursement. Vigilante consumers will continue to force insurance companies to increase their coverage of alternative therapies. As this takes place, massage therapists will need to learn how to fill out and file insurance reimbursement forms. Medical-oriented massage practices will be fully computerized and the insurance billing done electronically.
  • Icon Toppling: One of the biggest icons to come tumbling down is the American Medical Association. People have lost faith in doctors and distrust the medical system in general. The flip side is that people are clamoring for alternative therapies. Massage therapists in the future will need to authenticate their treatment results, demonstrate their knowledge, honesty and compassion, and work with their clients to develop long-term treatment plans.
  • Save Our Society (S.O.S.): Consumers want to do business with those whose concerns go beyond making a profit. Massage practices will increase their involvement in social issues and become more ecologically responsible. Massage therapists will regularly sponsor activities to raise awareness and/or funds for special interest groups (e.g., selecting one day each month and donating all the proceeds to a specific charity). In the near future every city will have a group comprised of massage therapists and other allied practitioners who've joined together to provide assistance in emergency conditions.
  • AtmosFear: Hygiene is the major consumer concern. Therapists will need to take extra care with their appearance (e.g., tie back straggly hair and bandage cuts on hands). Massage offices will be clean without appearing clinically stark. Therapists will make clients feel safe by offering bottled water to drink and providing each client with his/her own container of lotion/oil.

Predictions

The spectrum of practices will greatly shift in the 21st century. The numbers of therapists working in group practices and clinics will multiply. Seated massage will be available and highly visible in all major public places Instead of the traditional coffee break, people will utilize that time to exercise, nap, meditate or get a massage. Employment opportunities will expand and therapists will be able to work in multiple settings. Massage therapists will be hired by corporations as an integral part of employee wellness programs and by owners of retail stores that sell complementary products (e.g., the Relax the Back store). Spas will increase the type of massage modalities offered. More therapists will work in medical settings and be paid directly by the primary care providers or the hiring institutions. Insurance coverage for massage will continue to rise that is until the whole insurance industry is revamped; then it's anybody's guess what will take place. Cooperation between therapists and other allied professionals will grow. Mini health centers will sprout all over. The number of therapists receiving grants to be actively involved in massage research projects will escalate and numerous research studies will be published that verify massage's efficacy. More people than ever will be receiving massage! Plus the income level for the average massage therapist will be considerably higher.

Ultimately, the key to future success relies not so much on where therapists will work, but how they will adapt their practices to meet the societal trends.

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1. Faith Popcorn and Lys Marigold. Clicking: 17 Trends That Drive Your Business And Your Life pages 7-9. HarperBusiness, New York, NY, 1997.