Trends in the Profession

Insight and Opportunity

By Karrie Osborn

While the days of frenzied exploration and moments of connection within the massage and bodywork profession may be long gone, there remains a wealth of insight and opportunity that still await this field and the practitioners and educators within it. What does the future hold for the profession? Tethered growth, unity, divisiveness? Let’s take a look at what might be on the horizon, as a shaking of the bodywork tree, a push toward supplements as a spa specialty, and a focus on a healthy geriatric client are just some of the trends coming to pass in the massage and bodywork profession.

Times of Change

It’s been a good ride for the massage and bodywork profession of late, with consumer acceptance at an all-time high and validation within the medical community continuing to gain strength. And the party is hardly over. But there is going to be a shift, according to some veterans in the field, and we might do well to heed the warning signs now. For some, it might prove a difficult time of the wheat being separated from the chaff, but for others it will be a confirmation of their valuable skills and important contribution to the field.

“The biggest trend I see at the moment is contraction,” says Thomas Myers, author, educator, and creator of Anatomy Trains. “Sorry to sound the warning gong, but that’s what I see. The boom is over, the tree will be shaken, and those with strong connections will survive.” Myers says the signs are everywhere: from school owners talking of declining enrollments to increased competition within the profession, change is in the air. Myers believes the economic impact from the U.S. war efforts will create a downturn resulting in less disposable income, by which spas and massage providers will be affected. “There will be a pruning, and the resulting tree will be stronger, but it will take a while to recover and find its direction again.”

In contrast, another veteran expects expansion. “I think the touch therapies will have continuing, substantial growth for the foreseeable future. Life is increasingly stressful, so the demand for stress remedies will expand and diversification will continue,” says polarity therapy practitioner and educator John Chitty, the tree will only get stronger.

“My perception is that two branches are growing vigorously, and that the main trunk supporting them is also flourishing,” he says. “The main trunk is generic bodywork organized primarily around massage for feeling good and relieving stress. The two branches could be called medical/scientific and esoteric. The medical group is more and more evident as insurance companies appreciate good results and clients love the experience. The esoteric group (my area of interest) has fundamental problems: the presence of scientifically indigestible ideas and the absence of scientific research.”

Regardless, Chitty says the esoteric touch therapies are becoming increasingly popular because of their effectiveness. “Many clients don’t really care about modality titles or the blessing of science, they just want relief, few questions asked. I don’t think that science is going to be able to help very much in getting the esoteric branch to be more accepted, for many reasons, but I think the branch will continue to grow anyway. As Randolph Stone (the founder of polarity therapy) said, ‘Whatever works, works!’ I think effectiveness alone will keep the subtle esoteric approaches in the game, defying the gravity of financial, scientific, and political forces.”

Chitty expects, however, that regulatory forces will continue to shape the industry landscape. “I continue to think that the desire for more and more regulation of touch, justified by the need for consumer protection, elevation of professional prestige, differentiation from sexual professions, and reciprocity between jurisdictions, has some seriously bad consequences in the real world,” he says. “These consequences include monopolistic educational and right-to-practice systems (‘No touch without a massage license!’), reduced innovation and fewer choices, higher costs for students, and pressure on the smaller modalities to come under the umbrella of massage and lose their identity and deeper values.” And it’s that final aspect that worries Chitty most. “It is a sad commentary on our modern era when the McTouch Inc. and MassageMart phenomenon homogenizes education and the right to practice for the financial benefit of the biggest players. Something subtle, precious, and wise is reduced by the regulatory process.” Still, Chitty thinks the esoteric side of the bodywork tree will survive, as it always has, through even more restrictive times than the field faces today.

On Consumers’ Terms

When we look at the growth of the massage and bodywork profession, we have to give a big nod toward consumers’ loss of faith in a medical profession and an insurance marketplace that has historically ignored them. The solution: consumers who want healthy results and will pay to get them on their own terms.

It wasn’t long ago that the medical community was always held in the highest regard, with patients taking their doctors’ words as gospel. But this was also a time when family doctors made house calls, could crack a back if need be, and delivered babies at home with families surrounding them. With today’s seven-minute, insurance-mandated physician protocol being added to the effects of an already wary patient population, it’s no surprise that people are seeking out better answers, or at least better options.

Enter the world of medical tourism, the latest in healthcare trends. More than one hundred fifty thousand Americans traveled abroad for healthcare in 2007, and that number is expected to double in 2008, according to Josef Woodman, author of Patients Beyond Borders. He says that patients can save up to 80 percent of the cost of a medical procedure, including the cost of travel and lodging, when they schedule it out of the country. The most common medical tourism procedures include orthopedics, heart surgery, and cosmetic services, as well as those procedures with a short track record.

“Amidst an increasingly bleak U.S. healthcare landscape, medical travel is a viable option for Americans who find themselves priced out of the domestic health market—those forced to choose between debt and discomfort or facing long-term financial insecurity due to challenging medical conditions,” Woodman says.

“Healthcare has become out of reach in this country for many,” says Wouter Hoeberechts, CEO of WorldMedAssist, a medical tourism company that arranges all the details for its clients’ healthcare abroad. “Health insurance premiums have gone up 87 percent since 2000, resulting in more than 46 million Americans that have no health insurance. There are even more with deductibles and co-pays that exceed what they can afford.” And as those numbers continue to grow, medical tourism offers options the patient might not otherwise have. It’s a sadly interesting twist in the healthcare debate and undeniable evidence that the problem is only getting worse.

“The best part is there’s no compromise on quality,” Hoeberechts says. “The hospitals we partner with are internationally renowned and typically have strategic partnerships with leading U.S. medical institutions, such as Johns Hopkins and Harvard Medical.” For international spas, this becomes an opportunity to market themselves as pre- and postoperative respites for the medical traveler.

For massage therapists and bodyworkers, consumers’ loss of faith has meant greater potential for manual therapies. Chitty says unease with the medical system has brought people knocking on bodyworkers’ doors. “I think discontent with mainstream medicine and ‘Big Pharma’ is still increasing, for a host of reasons explored by Michael Moore and others, and touch therapies are the beneficiary of this discontent,” he says. “I think it’s a great time to be in the touch therapy profession, and opportunities are proliferating in every category.”

Mind-Body Markets

Whether it be a significant halo effect from success of Rhonda Byrne’s The Secret (and the reawakening to quantum physics it’s created), a growing answer for those needing something more, or an inevitable path of exploration for the self-aware, mind-body therapies are picking up steam. An impromptu poll of new modalities added to the Associated Bodywork & Massage Professionals modality library shows mind-body therapies have led the way. People are continuing to seek out wholeness, and these therapies offer the tools in which to achieve that goal.

Longtime therapist and educator Suzanne Nixon says she’s had more clients gravitate over the years toward her mind-body work, a combination of psychotherapy and energy work. “These individuals are either trying to reduce stress and anxiety or are searching for understanding and meaning with the self.” She says for those looking to alleviate stress, the energy work aims to provide relief through releasing excess nervous energy and balancing the body's frequencies toward well-being. “And for the latter, the energy work is a vehicle for them to deepen and connect with the authentic.” As massage clients begin to discover all the benefits traditional touch therapies offer, it makes sense that they’d be curious to go a step further along this healthful path to see what the mind-body connection might afford them.

The trend doesn’t stop with private practitioners; it has become especially prevalent in the spa world where clients want to feel deep and significant change from their experience and want more than just a fluff-and-buff massage and pedicure. According to the International Spa Association (ISPA), clients expect more from their spa visits than just feeling pampered. Already more than one in ten spa-goers treat the experience as part of a larger health and wellness lifestyle. As a result, spas are incorporating things like fitness and diet into the traditional spa menu, along with wraps and facials, much like the early spa days of John Harvey Kellogg and the Battle Creek Sanitarium in Michigan.

Savvy Spas

As a yin to the trendy medical spa’s yang, wellness is the buzzword for today’s spas—both big and small. “With the tremendous growth of medical spas, day spas are starting to counter this with wellness programs that do not necessarily need an MD or healthcare professional on staff,” says Hannelore Leavy, founder and director of the Day Spa Association (DSA). “The wellness movement is an established fact in most parts of the world, but especially in Europe and Asia,” she says. In fact, that’s what “taking the waters” has always been about. “We here in the United States are just starting to realize the benefits of prevention through regular spa treatments ... Day spas are now offering wellness treatments, such as acupuncture and acupressure, weight management, and more.”

Some spas have figured out how to get consumers to take the spa experience home with them. Canyon Ranch Living in Chicago is the perfect example. Akin to buying a home on the golf course, Canyon Ranch in Chicago is about living a healthy spa lifestyle in a spa community. While Las Vegas and Florida coasts have long been a part of this trend, this newest entrée on Chicago’s famous North Michigan Avenue is the first of its kind. The 257-residence, 67-story elliptical glass tower will house a 75,000-square-foot wellness center where an integrative team of physicians, behaviorists, therapists, nutritionists, exercise physiologists, and nurses will help residents take charge of their health. Marketers tout it as living the vacation lifestyle every day.

A more general lifestyle spa trend, however, is about living the spa life in simpler ways than buying an expensive condo. According to ISPA, in 2005 more than two million spa-goers took part in lifestyle classes, such as healthy cooking, managing stress, even customizing spa treatments to use at home. This trend will continue, no doubt, as consumers search for the “aaaah” effect at home.

Following are some other trends to watch from the spa world.

Supplements. With a recent study from the Dietary Supplement Education Alliance (DSEA) showing that a strategic use of certain dietary supplements could save more than $24 billion in U.S. healthcare costs, it’s no wonder spas have identified this as part of an overall wellness offering. “I am excited about day spas offering nutritional products that complement different spa treatments to enhance the internal healing of their clients,” Leavy says. In fact, the DSA and the International Medical Spa Association (IMSA), of which Leavy is executive director, are in the process of developing a nutrition supplement certification for day spas, allowing therapists to advise clients on any supplement needs for maintaining health and vitality. It follows the concept of beauty from the inside out. “The consumer is so confused and the medical profession is in most parts totally ignorant [about supplements],” Leavy says. “We may know how much vitamin C and A and B12 we should take, but do we know how and when? Do you take it in the morning, at night, on an empty stomach, with meals, after meals? So many questions and really no answers.” Leavy says her organizations are working with two nutritional companies to develop the course that will then be introduced to the industry in early 2008.

Sleepy Time. Whether as a result of our modern-day sleep deprivation, or the sheer state of exhaustion we all walk around in, spas are finding ways to incorporate sleep into their offerings. Where sleep specialists might work with clients’ sleep apnea or insomnia issues at a destination spa, hotel and day spas will likely incorporate all their tools into creating sleep environments for clients. Leavy says clients typically enjoy a spa treatment, then have to dash off to their next appointment without “letting the body truly absorb the healing benefits of the treatment.” She says the best thing is a nap, especially after a detoxifying treatment, so the body has time to renew itself. It’s this concept that has prompted spas to work sleep into their menu of services.

De-staffed or Customized? According to, be on the lookout for more “de-staffed” treatments as spas try to watch their bottom line. What does that look like exactly? Same-sex groups of spa guests cover each other in mud and go through a prerecorded, guided meditation, without a therapist. On the other side of that coin, we see customization as a highly relevant, evolving issue in the spa world. “One size no longer fits all when it comes to the spa experience,” according to ISPA. What this has meant is a change from clients booking treatments to booking time, with the spa staff creating a treatment especially for them based on their needs that day.

Socialization. In their latest set of predictions for the spa industry, says the social butterfly will overcome the wallflower in the spa experience and that the search for “spa solitude will be trumped by the natural desire for community and a growing awareness that social interaction is an important aspect of health.” While
“spa-ing” in groups has always been a
big part of the spa scene—bridal showers, girls’ day out, baby showers—one aspect of this trend has the potential to become problematic and that’s playing up the singles’ scene. This latest marketing trend has singles venturing to the spa for treatments and then mixing and mingling with other spa guests in the lounge, before and after treatments, with a glass of wine. While marketing to couples has been a widely popular hook, this new trend might stretch professional boundaries in that it flies in the face of the issues private practitioners deal with on a daily basis. This will be an interesting trend to watch.

More than Green. Spas have been going green for years now, often touting organic, energy-friendly ways. That trend hasn’t backtracked any and, in fact, is spreading out into the private practice arena as well. From the type of oil, lotion, and assorted product they put on clients, to the promotional materials they send, therapists are thinking green. Meanwhile, in the spa world, the green trend is moving beyond the basics and is today including the eco-buzzwords sustainable and responsible. This fits well for clients who could be considered part of the LOHAS (lifestyle of health and sustainability) movement. This is something to consider as you think about providing/selling product in your practice and what your clients, who are already seeking health and respite, will demand from any product they buy to bring home.

Convenience Massage

One of the results of greater massage acceptance is supply keeping up with demand. And that’s what convenience massage works to fulfill, with opportunities for massage showing up now in the strangest places—the brake shop, the luxury car dealership, even a car wash. While many of these massage services are offered as a way to woo and please the high-end customer, the concept is now broadening more to the Average Joe (or Josephina if you will). “It’s become more democratic,” Mary Gilly, professor of marketing at University of California at Irvine told Los Angeles Times reporter Leslie Earnest in a recent article on this one-stop shopping that now includes spa services. Gilly told the Times that businesses are “introducing another socioeconomic class ... to these [spa] services by providing them in a retail environment where they feel comfortable,” instead of forcing them to seek out the experience on their own.

Massage franchises are selling fast, too, with Massage Envy now sporting more than 140 operating clinics and 430 franchises across the country and imitators quickly following suit. People are no longer shocked to see massage at the airport, at the farmers’ market, or at the mall.

Other “Natural” Trends

The Natural Marketing Institute (NMI) recently identified several trend categories that have relevance to those in the massage and bodywork marketplace and anyone falling under the CAM umbrella. Consider these when setting up shop, revamping your current business philosophies, or refocusing your work.

Age of the Individual. NMI identified this trend as a reaction to mass marketing and a “declining trust in the traditional authorities of church, government, and the corporation.” What does it mean for the massage therapist? Customize it. Clients want personalized service, and you can make it just that much more special by personalizing the care—whether it be offering them a choice of which essential oil to be added to the massage lotion or working with other healthcare practitioners to create a particular client’s health protocol. Some hotels are even creating spa suites where the client no longer needs to move from room to room for various treatments—the treatments are all brought to her.

A Deeper Values Experience. This trend falls in the footsteps of the green category, where consumers are extremely interested in knowing where that product came from that you’re putting on her face, as well as what’s in it. Trade practices, social causes, and sustainability issues are all tied into this trend, which NMI says goes hand in hand with the consumer’s willingness to pay a 20 percent premium to have healthier products. According to NMI, product manufacturers have a “significant” opportunity to build market share through trust and reassurance. The same must surely be true for massage therapists and bodyworkers.

Back to the Future. This is all about simplicity and authenticity. Consumers’ desires for natural and simple is not only evident in the foods they buy, but also in the decisions they’re making when it comes to what they put on their body, too. According to, “As female consumers become more critical about beauty manufacturers’ complicated marketing strategies and ingredient lists, many are now looking to have the same simplicity as they receive in their natural food product.” As the European market for natural and organic products grows 20 percent each year, according to analysts at Organic Monitor, the North American market for organic product continues to build steam, with nearly two-thirds of U.S. consumers having purchased organic foods and beverages in 2005, according to the Organic Consumer’s Association. What does this mean? Consumers are spending more to get exactly what they want and right now that’s simple, uncomplicated, healthy products and services.

Not Your Mother’s Geriatric

While baby boomers might be losing consumer clout with cosmetics companies in favor of their younger counterparts, their value as a massage client grows, no matter how gray they get. These days, geriatric massage is about much more than working with the frail and dying, according to Sharon Puszko, owner and director of DayBreak Geriatric Massage Institute in Indiana. Today’s geriatric client may well need to fit her massage therapist in between an early morning game of golf, an afternoon swim, and evening dance lessons. More than not, the geriatric client of today is living a full and productive life and sees massage as a tool to help her continue to do just that. “I’ve seen such an amazing change in the senior community,” says Puszko, who’s been working with this population for fifteen years.

People are aging more gracefully, she says, as a result of better nutrition and medical technology that keeps the body working longer. NMI confirms it by identifying the emergence of the age one hundred and over consumer group as a relevant trend to watch. As the boomers age, they will continue to influence this trend, resulting in vigorous, robust geriatric clients beginning to outlay significant consumer dollars for massage time.

As a result, opportunities to work with the geriatric population grow, Puszko says. She says it’s important to remember that even though you’re working on a robust elderly client, there is still a specific protocol for working with this aging consumer. From thinning skin to pharmaceutical interactions, massage therapists need to know a lot more than gentle touch when working on the elderly—whether they are frail or fit for the Olympics. Their changing bodies warrant specific considerations either way. And the message is being heard far and wide, Puszko says, as she took the institute’s training program to Nova Scotia and Singapore in 2007. Spas are even getting into the action as they cater to the older traveler who ventures abroad.

Systemization, Integration, Fusion?

There is no doubt that the work within the profession continues to meld, divide, and find rebirth, just as it always has. According to author, educator, and industry expert Keith Eric Grant, what we’ll likely see in the near future is a systemization of sorts within the profession. Grant has been working for nearly two years with other industry experts to create a framework for establishing massage best practices, or clinical guidelines. “I think eventually to gain credibility with stakeholders, the massage profession and states will have to decide exactly what knowledge, skills, and abilities an entry-level license guarantees,” he says. While exploration and discovery within the field is certainly not over, the Esalen days of “making connections” has made way for a more linear time of thinking about the work, he says. “I think that massage education will also become more of a standard career college/community college/corporate thing ... We’ve moved more into a period of systemization, integration, and maturing than one of development—much like many tech start-ups have to do as they grow.”

On a more direct level, something we’ll definitely be seeing more of in the near future, according to Myers, is an integrated therapist: “A practitioner with both movement and manual skills, verbal and nonverbal cuing, the specificity of stretch and release of a bodyworker or yoga therapist combined with the shortening and stabilizing skills of a sharp-eyed coach or trainer. This could truly be the new practitioner/teacher of spatial medicine.” Myers’s thoughts on a synthesis between fitness, personal training, Pilates, yoga, and bodywork, follow in line with the blending of practices like Pilates and yoga, or “yogalates,” which is finding ever increasing adoption among fitness folks. It’s also the paradigm so many have called for in truly integrative care. Maybe we’re closer than we think.

Within the bodywork community, Nixon says she’s seeing therapists expand their training and add to their repertoire. “Some are becoming personal trainers, in addition to being a massage therapist, or are learning more about nutrition. Of course, the question becomes, ‘How do you ethically practice?’ What I’m seeing is multitalented individuals with multi-trainings.” The result, she says, is people finding ways to expand their practice for greater longevity.

Debra Howard, president of the American Organization for Bodywork Therapies of Asia (AOBTA), says her organization, which already subscribes to working within a medical model that “unifies the whole human being (body, mind, spirit),” sees a future of collaborative medicine. It’s what she describes as “a cooperative blend of modalities that respond to the whole of human experience.”

Whatever lies ahead, we know there is good work to be done. When the oncoming educational and political issues work themselves out, there will remain a fleet of massage therapists and bodyworkers ready to do good work. And, according to Virginia Postrel of The Atlantic Monthly, that good work, subtle as it may be, is indicative of even more: “The massage industry’s product is invisible, less ‘real’ than a hamburger or a video game. It doesn’t contribute to national power or prestige the way semiconductors or aircraft do. It doesn’t create world-famous stars like sports or the movies. Its establishments are small, often run by a single individual, and most of its practitioners lack a college education. It is literally touchy-feely. When Americans think about the economy, we tend to focus on familiar, ‘serious’ businesses—computers or autos or high finance. We don’t notice Starbucks until there’s one on every corner, changing not only what we drink but also how we live and work. Massage may not be the biggest new industry or the most influential, but it’s a microcosm of how commerce and culture interact. The same creativity and resilience that built the industries of the past, and the ways of life that evolved with them, are still at work, spinning out new enterprises serving new values.”

  Karrie Osborn is the contributing editor for Massage & Bodywork magazine.