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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:

Matching Massage with Societal Trends


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.


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

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Last updated: April 25, 2011
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