Where Are We Now?

Wisdom From Three Leaders: The Maturing of the Massage Profession

By Art Riggs

A few months ago, some of us old-timers were reminiscing about the good, and not-quite-so-good, old days of massage and bodywork, and how the profession has evolved. I decided to contact three longtime bodywork luminaries to get a broad picture of how things were, where we are now, and where they think we are heading.
Rick Garbowski is the co-owner of Georgia Massage School. He has trained more than 150 massage instructors, has been closely involved in the education of many thousands of students, and was a member of the Entry Level Analysis Project (ELAP) to provide a blueprint for consistent standards of training excellence.
Tracy Walton is one of the foremost teachers of oncology massage and, among other contributions, author of Medical Conditions and Massage Therapy. I love that her background in the trenches of massage in both private practice and a spa setting bridges the sometimes-divisive dichotomy between “therapeutic” and “relaxation” massage.
Thomas Myers is a world-renowned anatomist, writer, educator, and philosopher who describes himself as an expert in spatial medicine, as seen in his theories of organizing and integrating the body along fascial meridians in his modality Anatomy Trains and subsequent books and videos.
To some of the newer and (and perhaps younger) therapists out there, it may be difficult to imagine that back in the Neanderthal 1980s, one could receive a diploma with slightly more than 100 hours of (often surprisingly good) training, using Anatomy Coloring Book as the gold textbook standard, and classes conducted without PowerPoint or three-dimensional anatomical videos. Since the Internet was not in existence, to have a successful practice, a lot of work was needed in word-of-mouth promotion, flyers, and beating the pavement, sometimes offering free massage. Private business offices were a rarity, and most depended upon a home or apartment with a less professional ambiance, sometimes offering such new age accoutrements as a lava lamp, incense burning in front of a bubbling fountain, and a boom box to play sitar music in the background. That said, there was excellent work being done, as evidenced by so many longtime experts who were drawn to the profession after experiencing massage.
All of our experts agree that we have come a long way from the infancy of massage and that most of the changes could be considered an extremely beneficial evolution. However, few things in life are free, and along with all the progress, many of the changes have come at a cost, both to consumers and therapists.
Probably the biggest change in massage is the respect bodywork now has as an extremely worthwhile part of a healthy life for our clients, and as a full-fledged profession rather than a fun hobby. When Myers changed his career path to massage, his family was disappointed and bemoaned “all that education wasted.” He feels the general perception was that massage was something old ladies did, or was for entertainment, titillation, or an expression of the alternative scene.
With my own background in graduate study in both literature and exercise physiology, my abrupt march to the beat of a different drummer in my career path caused similar well-meaning concern for my well-being, if not my sanity, and reactions in the form of what Walton describes as raised eyebrows. Like Myers, however, when friends and family saw the happiness and fulfillment—as well as the financial rewards—I got from my work, and the benefits to my clients, they quickly changed their views.
Thirty-five years ago, not only was the public unaware of the therapeutic and medicinal benefits of massage (partly because of the misperceptions that Myers mentions), but bodywork also faced downright hostility from ill-informed local governments and other therapeutic modalities who either feared competition or possibly felt it their duty to protect the public’s health and morality. It was not easy to establish an above-board practice through official channels.
Garbowski recounts that in Georgia the stiffest resistance came not from local officials or concern over sexual massage, but from physical therapist organizations. In formulating licensing requirements in California, the chiropractic lobby attempted to prohibit massage therapists from ever moving limbs past the active range of motion—something that would have made it very difficult for me to work on a favorite paraplegic client. Early in her practice, Walton was called to testify in support of allowing massage therapists to practice without a physician’s order—typical of the quagmire of local, state, and national licensing and regulation that is still not resolved today. Some therapists today are hesitant to provide massage to medically complex populations, such as people with cancer, without physician approval. Walton teaches MTs how to do the work safely and well, relying on their own reasoning rather than shifting responsibility to the client’s physician. She devotes a whole chapter of her book to effective communication with physicians when their involvement becomes necessary.
In spite of the obstacles, it is difficult to suppress a good thing for long, and public awareness moved massage to mainstream acceptance for both relaxation and therapeutic benefits. Now, of course, spas abound, massage is increasingly seen in hospital settings, and chiropractors regularly employ massage therapists in their offices. Even physical therapists are now having massage therapists perform manual therapy on their patients.
Massage is now considered a legitimate career. Just look at Massage & Bodywork’s publisher’s name: “Associated Bodywork & Massage Professionals.” Interestingly, as bodywork becomes mainstream, Myers notices a difference in the nature of today’s therapists. When he began, someone pursuing a career in massage had to be a bit of a rebel making an actual cultural choice. He feels most therapists had to be very strong in their commitment and willing to confront a somewhat condescending or adverse public opinion, but that many therapists today don’t have the same “verve” and drive to excel. Looking at massage as more of a trade rather than a craft or art, some are content to work for the security of meager wages and poor working conditions that may cause injury and burnout. Rather than expressing their excellence, some therapists are hampered by assembly-line routines or rigid, unimaginative protocols of generic massage that shackle creativity and feelings of fulfillment. Many new therapists I speak with are unaware of their potential for financial and emotional fulfillment if they challenge themselves and learn more sophisticated techniques.
The success of our profession is much more than a word-of-mouth grass roots movement. Unlike in its infancy, massage now has an abundance of well-documented studies demonstrating its therapeutic value. All of our experts agree this is good, but that many more studies need to be conducted. Myers especially mentions the increasing connection between physical therapy and bodywork and that as the two fields grow closer together, we will need more studies and verification.
Conversely, Walton points out that many of our widely accepted claims about the effects of massage are either not supported or are contradicted by research. We must come to accept newer, sturdier information in our work. She feels we need a “systematic parsing” of some of the old myths concerning massage and endorphins, cortisol, cancer, and immunity. She is preparing an ebook on this subject for the Massage Therapy Foundation. It will be offered along with other free resources for massage therapists on www.massagetherapyfoundation.org.

Effect of the Internet
Our experts agree that the Internet may be the biggest influence on the explosion of popularity of bodywork with the masses, both for marketing of private practice and also on continuing education training. In the 1970s and ’80s, the major marketing tools were word of mouth, flyers tacked on telephone poles or left at cafés, and ads in local weekly counter-culture newspapers. It generally was accepted that one had to work for three years to establish a full practice, so many supplemented their massage profession with other work, often relegating bodywork to an avocation and never making the leap to full-time work.
Now Yelp, LinkedIn, and other social media are a tremendous help and almost a necessity for a fledgling bodywork practice to hope to thrive. However, it takes more than an attractive website to be successful; Myers and Garbowski agree that many therapists finish school without sufficient training in marketing or running a business and don’t even consider the great rewards of a private practice.
In the old days, the slow progression of practice building not only allowed time to refine biomechanics and tactile skills, but also gradually allowed the body to adapt to the physical stresses as one’s practice evolved. Nowadays, with the growing numbers of people looking to massage, one can get a job immediately out of school working five days a week in a spa—essentially being thrown into a marathon race without a proper buildup of training. Every spa that brings me in for in-service trainings places injury prevention as a high priority, and I see a large and unfortunate increase in massage injuries and burnout.
The Internet has also revolutionized teaching. Before the advent of online training and the explosion of commercial video trainings, the only way to improve our skills was to take classes at schools. This was a huge obstacle to the progress of therapists living in out-of-the-way locations, depriving them of the excitement and fulfillment of growth. Now, with webinars, online continuing education trainings, and video instructional materials, fantastic information is available to virtually everyone, and our profession has greatly benefitted.
Myers points out another advantage of video training that is helpful in his classes. Different folks learn at different rates, and being able to play back video demonstrations for clarity allows students to learn at a more profound level, or conversely, skip over material they are skilled in or which is not of interest. He often has students watch recorded lectures of anatomical or philosophical discourse on one of his favorite topics: evolution. This leaves more time in class for training in manual skills and more table supervision.
A downside of this proliferation is that not all teaching is of the highest quality, and some therapists choose the most inexpensive and least challenging material simply to fulfill yearly requirements for continuing education without the “verve” Myers speaks of to constantly improve in a profession they love.
No matter how good the quality of distance instruction, there is no substitute for attending a class and seeing work performed in real time with a chance for questions and the all-important benefit of feeling the work in one’s own body and performing with personal supervision of the teacher. The Internet makes it easy to forego this important experience, and I highly recommend at least one hands-on class a year to jump-start your enthusiasm and broaden your horizons.

The Big Business of Bodywork
Myers and Garbowski concur on the huge effect of corporate takeover of the bodywork business. Both agree that this phenomenon is a natural economic reality for something as beneficial and successful as massage. Garbowski bemoans the effects on education, while Myers regrets what he considers the inevitable “massage industry and franchising” drawing a different kind of individual and different working conditions now.
The popularization of massage and large spas making massage available to the masses has been a phenomenal benefit in many ways. Large numbers of therapists who may not have the experience or interest in a private practice can find rewarding employment; the downside is limited maximum income, often giving 50–70 percent of a reduced competitive spa marketplace fee to their employers. I hear of frequent injuries and burnout, and complaints from consumers that they find it difficult to get quality therapeutic work as some spas seem satisfied to offer cookie-cutter routines. Often, because of restrictions from corporate lawyers fearing litigation, some therapists shy away from needed work in areas such as the chest and anterior neck, abdomen, gluteals, adductors, and other important areas, or refrain from extremely useful side-lying work because they’re not comfortable with overly restrictive employer draping protocols.
Garbowski points out that the single largest complaint from consumers in general is that their therapist didn’t listen to requests for specific areas needing work. When all of our experts and I began, there was a sort of Darwinian survival of the fittest for a successful practice. Of course, that still holds true, especially in private practice, but also in spa work—one therapist told me of always being booked more than two weeks in advance at a large corporate spa because she listens to clients and gives them what they want rather than just performing routines. However, I hear countless complaints about the inconsistency of spa massage and the perception that many therapists are satisfied just getting by with performing essentially the same massage on all clients. The popularity pendulum may be swinging back toward private bodywork practices, as I recently heard from three different therapists in private practice that new clients complained they “didn’t want a ‘spa’ massage.”
Garbowski is happy that “massage franchises have driven the cost of massage services down dramatically, making massage affordable for the middle-income family. But this also has made it more difficult for the small businessperson operating a private practice to compete.” Walton points out that comparing hourly wages of corporate employment to hourly rates in private practice can be misleading. There are a lot of nonpaying promotional hours necessary for independent therapists, especially in building a fledgling practice. Maintaining a website (pretty much a necessity today), paying rent, doing laundry, and other expenses must be taken into consideration. Firm numbers on income, expenses, hours, benefits, and taxes in all massage settings are badly needed. These will enhance the dialogue in our profession about the viability, sustainability, and real work of massage therapy.
Garbowski pulls no punches in saying that the explosive growth and increased profits have led to a proliferation of large schools led by  “investors with no experience in the industry (who) recognized the potential for profit in the burgeoning massage market and stepped into a profession that had been led by individuals who cared more about their students, their clients, and the profession itself than their return on investment … degrading the overall quality of training and leading to an increase in the overall turnover rate in our profession.”
I speak with educators offering advanced continuing education classes who comment that many of the newer students have no idea of their potential, having had unimaginative routines stressed in their trainings, sometimes just to qualify them to pass tests, or to prepare them for generic spa massage, even if that generalization may be unwarranted—excellent spa massage is, of course, available.
Of course, there are excellent large school programs turning out highly skilled therapists, but I must agree with Garbowski on many of his points. Even the much-needed licensing requirements have a downside. Myers says, “Teaching to pass licensing tests is a very poor way to get across knowledge.”

The Great News with Education
To me, the explosion of knowledge and teaching of more advanced therapeutic techniques is the most exciting and beneficial progress. In the ’70s and ’80s, most training was relaxation based, often for nonprofessionals. Myers is happy that there is much more diversity and clarity today, but still feels there is confusion between sensuality and sexuality that should be clarified. I would add that excellent therapeutic work for serious conditions need not conflict with a comforting, even sensuous, experience. One of the nicest compliments I’ve received was from a woman with serious low-back pain that I was working deeply on who commented, “You have such a kind touch.” For someone in constant pain, a warm and nurturing touch can stimulate the parasympathetic nervous system for serious therapy.
It is so good that we, for the most part, have escaped from the sexual stereotypes of the past; but as many therapists emphasize the therapeutic and medicinal benefits, I feel there can be an overreaction to the sexual stereotyping, which removes the very crucial nurturing aspects of touch. Some therapists become so clinical that they appear to mimic the cold and dispassionate demeanor that is so often a criticism of doctors’ or physical therapists’ offices. I love that Walton teaches advanced clinical skills, but also emphasizes the personal warmth that distinguishes massage therapists from some of the stereotypes of strictly medical approaches. She adds, “I don’t like the dichotomy, especially the denigration of relaxation work from lots of ‘experts’ doing ‘serious’ work.”
That said, the incredible gifts of therapeutic strategies from practitioners such as Ben Benjamin, Erik Dalton, Whitney Lowe, Til Luchau, Myers, Walton, and countless others were simply not in existence 40 years ago. There is no doubt that high-quality educational opportunities in many different modalities are exponentially more available in continuing education classes, videos, and webinars; and many more therapists today are more highly skilled than in the past, particularly in therapeutic bodywork. Thankfully, the misinformed small local policing of our profession that Walton and Garbowski have commented on has diminished, and we are moving toward state and national certification, often based on our own professional licensing groups.
Still, a multitude of problems remain with competing accreditation groups, conflicting rules, spotty acceptance of continuing education classes, and online study, thus making it difficult for therapists to begin practice or relocate. Some states, instead of examining therapeutic specialization, simply continue to require more and more hours, both in initial trainings and continuing education. For example, in California, a therapist’s rating is automatically upgraded from “practitioner” to “therapist” based on the number of educational hours, without consideration of what classes have been studied.
Myers points out that more specific categories need to be delineated so consumers can choose appropriate treatment. Garbowski feels a tiered system would be helpful. There are pros and cons to a tiered system too complex to examine in detail in this article, but Walton feels that is not the answer. Certainly more study can imply greater skill, but not necessarily, and arbitrary boundaries that imply superior skill based solely on hours of study may be misleading. A problem with policing inside our profession is that some large schools, vying for more students and higher tuition fees, lobby certification groups to simply continue to require more hours. Many excellent smaller schools without a large population base to draw from have had to close.
Already, many potentially excellent therapists are prevented from entry to our profession by massive hour requirements and expense. Much of the skill of any therapist is not quantifiable or measured simply by hours of study. Several famous teachers admit that they would probably not have entered the field 30 years ago with such daunting requirements. Many argue that real skill can best be achieved by getting out and working with fewer initial hours; that practice on the public combined with continuing education workshops are a better answer, both for getting experience and to find passion for areas to specialize in.
Great progress has been made since the accreditation chaos of 30 years ago, and it is hoped that Garbowski's and others’ work with ELAP will solve many of these issues and make life easier for both therapists and clients. The great news is that massage and bodywork has had phenomenal success in the last few decades and will continue to grow. As some problems are solved, new ones will undoubtedly spring up. For instance, will massage begin to be covered by health insurance? Myers feels this would expand the availability to a wide range of clientele. This plan works well in Canada, where all citizens are granted a certain number of massages per year with a minimum of red tape, simply having to submit a receipt from the sessions.
With his interest in evolution, Myers has noticed changes in the structure of clients over the years just from the environmental changes in posture as we spend more time hunched over computers and commuting. I find an increasing need for bodywork for the fit generation who spend large amounts of time exercising in many forms, sometimes causing injuries from over-exercise—especially in the burgeoning market of extreme exercise classes with minimal supervision. For success in whatever venue we work, in the future, we need to adapt to the changing environment of new technology, business models, and evolving needs of our clientele, including an aging population.

The Tangibles
Having the benefit of our longtime experts’ advice, I asked them what suggestions they would have for therapists.
For his suggestions, I see a connection in Myers’s comments about the early confusion defining massage and his desire for clarity in present-day therapists’ self-perception and self-definition. One needs to decide just where one’s niche lies in the continuum of an art, a craft, a science, or a skill. Myers feels the divisiveness between different modalities is counterproductive. As a profession with so many different approaches, we need to make allies, not competitive separations.
Walton emphasizes good body mechanics and to keep moving, relaxed, and breathing, and to explore different forms of movement training including dance and sports to shake things up and keep the body from resting on habit.
Garbowski is in agreement, suggesting getting into the habit of stretching, strengthening, and continually perfecting your mechanics: “I have yet to meet a healthy massage therapist who does not enjoy what they do for a living.” Most importantly, he says, “Listen intently to your clients. Massage therapy is a customer service industry driven by repeat business and referrals from existing clients.”
I would agree with all of our experts, particularly the suggestions to stay healthy in our physically demanding work with flexibility, strength, and using gravity and core energy rather than muscling. However, I would emphasize the mental and emotional aspects of our work to stay focused, interested, and passionate. Rather than resting on my laurels, I find I am learning and improving at bodywork as much now as in my early years. Make each client an experiment in learning and giving.
Whether your stay in the bodywork profession is a transitory chapter or a lifelong profession, I urge you to make your work a creative art form. Be curious and continue to aspire to improve, and the work will always be exciting, fun, and rewarding.

Art Riggs is a Certified Advanced Rolfer and massage therapist who’s been practicing bodywork since 1988. He sells myofascial release videos and manuals, and teaches continuing education courses worldwide. Riggs is the recipient of the 2012 Lifetime Achievement Award from the American Massage Conference. For more information about his work, visit www.deeptissuemassagemanual.com.