Massage Therapy Canada

Features Collaboration Practice
Opportunities & Challenges: Part II

Kailee Kline, massage therapist and past president of the Association of Premier Spas of Ontario, is excited about the growth of the spa industry. Kline sees the spa industry as an important provider of health maintenance and illness prevention programs in our society, a trend that has existed in Europe for centuries.

October 1, 2009  By Donald Dillon

Good News For A Change!
In the previous article, we looked at some challenges the massage therapy profession is facing, including income levels below expectations, the regressive changes in funding of massage therapy services by auto and extended health insurance plans, and how low professional association membership and limited research literacy affect our leverage in advocating our interests to health care and government leaders. In this article, we examine opportunities that massage therapists can act on, and truly create, as David Suzuki coins, some “good news for a change.”

Higher Standards For Spas
Kailee Kline, massage therapist and past president of the Association of Premier Spas of Ontario, is excited about the growth of the spa industry. Kline sees the spa industry as an important provider of health maintenance and illness prevention programs in our society, a trend that has existed in Europe for centuries.

opp1.jpg“In some European countries medical benefits provide coverage for an annual visit to the spa,” she says. “Medical doctors are present to prescribe and oversee the treatment program. In fact, travel for the benefit of your health has been such an important part of the European culture that a viable industry known as ‘Health Tourism’ has been prominent for centuries, although not labelled as such, until recently.”1

Kline explains that the Association of Premier Spas of Ontario was established to encourage quality standards in an industry experiencing rapid growth. It has 39 members that apply a number of high standards, including the employment of only registered massage therapists to provide massage at their spas. All spa members must fill out health history forms to ensure treatments are “appropriate, safe and productive.”


At the launch of the association in May 2000, Elizabeth Witmer, Health Minister of Ontario, stated the Ministry was redirecting its focus away from illness towards wellness, and that the association could play a role towards achieving that goal.

The Canadian Tourism Commission (CTC) has been monitoring the growth of the spa industry, and
is examining “the feasibility of positioning Canada internationally as a destination for Health and Wellness Tourism.”2

Kline states that the baby boomer generation plans to maintain a high quality of health as they age. They are also introducing aging parents to the spa experience, necessitating further the need for highly trained health professionals to staff the spas.

Kline reports that there is a need for the current curriculum to prepare these professionals for spa work,
as the current shortage directs some spa owners to turn business away, or to hire individuals with lesser qualifications and then train them in the spa methods. Qualified individuals wishing to learn more about the Association and its standards can visit

However, not all spas in Ontario appear to be operating at the high standards of the Association. In the May 2004 issue of The Finger Print, Debra Curties, Academic Director of Sutherland-Chan, shared several complaints from recent graduates regarding their experiences as spa employees. She cited examples of therapists being docked 10 minutes pay for taking case histories, and that in some cases taking case histories and keeping files was strongly discouraged. This was, in effect, seen by the spa’s management as a way to lower their liability – to hide the evidence if adverse reactions occurred.

Curties described the work environment, where registered therapists provided services concomitantly
with non-registered practitioners, and the “trend toward salarizing massage therapy jobs at levels well below $20 per hour.”3

Corinne Flitton, assistant registrar to the College of Massage Therapists of Ontario (CMTO), explained that the College has no jurisdiction over spa owners, unless of course they themselves are massage therapists. The CMTO were present at the 2004 International Spa Show in Toronto and welcome questions from anyone wishing to understand the regulations regarding massage therapy.

Flitton noted that therapists are sometimes faced with difficult choices as they balance the standards of practice with the business systems employed by the spa.

Flitton encourages therapists to be clear on the terms of employment before accepting any position with a spa, and that these terms should outline the requirement by the therapist to follow the Standards of Practice and the Code of Ethics. She also encourages therapists to support each other in this constantly changing and ever complex environment. Flitton encourages therapists who are having difficulty to call their professional association, which advocates the interests of its members.4

It appears the spa industry will continue to influence the massage therapy profession, creating more opportunities for massage therapists to be employed in providing spa services. We may see dramatic
shifts from self-employed massage therapists to spa employees, with increased need for skills in spa
treatments, communication, and team-building to effectively work within this burgeoning industry.

Integration into Mainstream: Massage Therapy in Hospitals
A 2003 survey, conducted by the American Hospital Association on the use of complementary and alternative medicine (CAM), showed that 82 per cent of hospitals utilizing CAM included massage therapy as
a form of treatment for patients. 

An article in the Los Angeles Times reports: “Hospitals and medical clinics around the United States are beginning to integrate massage into patient care. Massage is currently the most common non-traditional therapy offered in U.S. hospitals, according to an American Hospital Association survey in 2003. The most common uses for massage in hospitals: helping patients cope with pain and stress, and as a therapeutic service for cancer and maternity patients.”5

“At Martha Jefferson Hospital in Charlottesville, Virginia, patients are offered therapeutic massage by one of eight trained therapists. Longmont United Hospital in Colorado has a therapist on staff around the clock for patients who need or request it.

At Memorial Sloan-Kettering Cancer Center in New York, 11 therapists on a staff team work with hundreds of patients admitted to the hospital or seen at its various clinics. And, at the UCLA Center for East-West Medicine, a team of four therapists uses massage to alleviate pain and symptoms for patients suffering from illnesses such as fibromyalgia, migraines and back pain.”

Ninety-five per cent of the 50 massage patients reported massage was a “very important” part of their recovery, Fontana said.

Dr. Ka-Kit Hui, director of UCLA’s East-West Center in Santa Monica, California, goes further: “Massage
is a very important therapeutic approach which is underutilized and under-appreciated. A lot of people think massage is good for aches and pains. But what we have found is that massage activates the body’s own healing system.”6

opp2.jpgAs our Canadian government opens the door to a combination private and public health care delivery system that is cost-effective, there may be more opportunities for therapists to work in an integrated medical system.

Workplace Wellness: The New Funding Model?
If the funding for massage therapy through extended health care and auto insurance rehabilitation plans continues to decline, how will massage therapists be reimbursed for the services they provide? One answer may lie in perhaps the world’s most abundant source of funds – the corporate world. 

According to Working Mother’s annual “100 Best Companies to Work For,” 77 per cent of these companies provided massage therapy treatments as a benefit of employment.

Massage Therapy Journal looked further to find the highest users of corporate massage are the finance industry (24 per cent), followed by the high tech industry (21 per cent) and the insurance industry (19 per cent). Most programs were set up on-site with table and chair massage, where the company negotiated a reduced rate for employees.

Unfortunately, 60 per cent of companies reported that less than one-third of employees took advantage of the services. For those that did, few booked appointments after work hours, and instead preferred treatments during mid-day.7

Interestingly, of the companies that did initiate these benefits, only 18 per cent reported initiating the programs because they were approached by a massage therapist. Thirty per cent were generated by employee interest, and 39 per cent were generated by the company without any consultation with a therapist.

Michael Leahy, chiropractor and the originator of Active Release Techniques™, has found that many large companies embrace the idea of using effective on-site intervention to lower employee rehabilitation and compensation costs while improving the bottom line.

“There have been several instances where corporations, insurance companies and professional sporting teams have contacted (the ART head office) for lists of providers. Obviously when such situations arose we referred them to the most accomplished provider in their area. We realized that we could help more patients
and ART providers by handling these situations differently. So we formed the ART Elite Provider Network (EPN). This is a clinically integrated network of the most experienced ART providers in each state and province. The EPN was formed so that ART can guarantee the highest quality of soft tissue care to large private industries, insurance companies, and sporting organizations.”8

Leahy adds: “Never before has a provider network been formed with a focus on quality of care. Traditionally physician’s groups negotiate contracts by cutting their fees. We feel that ART already saves companies a tremendous amount of money, so we do not reduce our rates to acquire business.

We focus on savings through outcomes. We have and are successfully negotiating contracts with many large corporations and we are placing providers in these companies to treat employees for a fixed number of hours a week. Each contract is different and compensation amounts may vary, but in all instances the ART providers are re-imbursed well for delivery of care.”

One company cited an 81 per cent reduction in worker’s compensation costs. “The ART program was recognized by OSHA (Occupational Safety and Health Administration, US Dept. of Labor) as the best practice for treating strain/sprain injuries as a preventative measure.”9

To provide a sense of this problem in Canada, we reference a research paper at the Stats Canada website.  The author reported: “in 2000/01, 10 per cent of Canadians aged 20 or older, an estimated 2.3 million, reported having had a repetitive strain injury (RSI) in the past 12 months.  Work-related activities were most often the cause. People with RSIs had more contact with health care professionals and higher levels of chronic pain and psychological distress than did those without an RSI.”10

Our industry can create new opportunities by providing services to businesses, reducing their health care claims and improving employee quality of life. With the evaluation of these practices and their benefits, more opportunities may become available to therapists, including educational opportunities in postural and movement re-education and workplace ergonomic evaluation.

But there’s a price to pay for these opportunities. We must show efficacy with evidence-based outcomes, and utilize pooled resources to advocate interests.

The question is not: Do we need research in massage therapy? The question is: How quickly can we get it?
Improving research literacy and evidence-based practises would open a number of doors for massage therapists. Research showing positive correlations between massage therapy treatment and a variety of common health disorders could create salaried positions in hospitals and acute care clinics.

The increasing growth and need for private health care may contribute to a re-shifting by extended health plans to actually increase massage therapy coverage. Treatment approaches could be debated and improved upon.

The Canadian Massage Therapist Alliance has “embraced a new strategic position for the massage profession – the adoption of evidence-informed, outcome-based massage practice as a core value.” To this end, the Canadian Massage Therapist Alliance Research Network (CMTARN) has been created.

Trish Dryden, one of the driving forces behind research in massage therapy states: “The purpose
of the task force is to create a shared vision among all key professional and licensing stakeholders on what outcome-based practice is, to assess current organizational and educational needs, and to create a common strategic plan on actualizing the shared vision in a cost-effective manner.”11 

The task force has met with the primary stakeholders in this initiative, including the CMTA provincial leadership, the Federation of Massage Therapy Regulatory Authorities of Canada (FOMTRAC), and with a number of the education institutions.

The task force’s objective is to create infrastructure to facilitate evidence-based standards and competencies and curriculum development.

A number of benefits would be created for stakeholders and their members/students including: evidence-based guideline development and access, a national research website, e-learning and instructional resources, and program survey and evaluation.

An additional benefit to the profession is stakeholder vision and consensus building – the leaders in our industry would have opportunity to build relationships and tackle the big issues, together.

What if an increase in research expanded opportunities outside the treatment of traditional musculoskeletal complaints? Cardiovascular, palliative, pediatric, psychiatric … massage therapy could be incorporated in broader applications, serving more people in countless settings. Think about that.

Professional Associations Provide Leverage
When people ask why they should be a member of a professional association, my short answer is “leverage.” Leverage is the ability to use current talents, abilities and resources and generate larger gains by combining with the resources of other people. My longer answer speaks to five key areas that, as a sole practitioner, I would have a great deal of difficulty initiating myself. These are:

A professional association can provide accurate and prompt information about the issues I need to know about. Better information means I can make better decisions that affect my business.

I want my professional interests brought effectively to allied health professionals, the insurance industry, government, and any other organization that I and my fellow practitioners encounter in their day-to-day practice. My professional association has the time and resources to do this much more effectively than I do.

Public Relations:
I want my association to actively educate the general public and health care providers on a regular and consistent basis, regarding my scope and the benefits of my care.

Expansion of opportunities – by investing in research and building alliances, my association can open new doors for me and my colleagues.

Professional Development – I want high-calibre, international experts brought centrally to association events so I can learn straight from the masters. My professional association can do this for me.

Many professional associations in our industry may be struggling to find and keep active members. Membership dues finance the above-mentioned initiatives which, on an individual practitioner basis, would be difficult or impossible to do.

By joining your professional association you secure information and necessary services, create greater leverage in the profession to advocate on your behalf, educate your market for wider appeal and access, expand your business opportunities and provide high-calibre professional development close to home.

If all massage therapists across the country took this one initiative, it would have a dramatic effect on the profession … join your professional association.

Align with Complementary Industries And Pool Resources
Of course it’s not necessary to do all the work alone. There are many complementary industries, such as the health and fitness, competitive sports or the anti-aging industry, occupational health and rehabilitation industries that serve the same markets as our profession.

By taking advantage of co-marketing and education efforts, we can effectively serve these markets better, with costs associated with education and research apportioned over a greater number of service providers.

In her article “Welcome to Wellness: An Opportunity for Fitness and Medicine,” Dr. Julia Alleyne, says: “Perhaps the time has come to connect the fitness and health care industry together in a joint action plan of education, service delivery and preventative medicine.”

She adds: “I would like to see a Wellness Package that includes a monthly fee for health services that would be used over the year for prevention, performance or treatment.

A wellness co-ordinator would meet with all clients and set out a plan for achieving an improved state of health and wellness over the year.

Services such as massage therapy, dietary consultations, injury prevention assessments, stress management strategies and ergonomic assessments are a few of the gems that would be included in the package. A seamless transition from fitness to health and back again.”12

According to a 2001 Health Canada study, companies that invest and encourage in-house fitness and
wellness programs experience a direct economic benefit as well.

The study found that employees in these programs experienced:  improved fitness and health, increased productivity and better morale, higher job satisfaction and team spirit, less absenteeism from work or the desire to seek employment elsewhere, and less work-related injuries, which reduced WSIB and group insurance claims.

A study by national health insurers showed a return of $1.64 for every dollar a business spends on improving the health of its employees.

Husky Injection Molding Systems Ltd. of Bolton, Ontario knows this.  Husky’s employee benefits include an on-site fitness centre with fitness classes, a healthy-choices cafeteria, daycare services, and an on-site health clinic providing naturopathic, physiotherapy, physician and massage therapy services. 

Husky’s absenteeism, turnover rate and injury claims are significantly lower than the industry average,
with a 1998 estimated savings of $9 million from recycling, energy reduction, lower injuries, absenteeism and insurance claims.

Thinking outside the box, our profession may entertain questions such as: “Who can we align with to meet our objectives? What would partners gain in aligning with us?” By aligning with complementary industries, we may be able to get more work done, faster, at proportionately less cost.

In closing
I believe great opportunities exist for the massage therapy profession in health care and social services. There are also tremendous challenges and pitfalls if our profession does not take initiative to create new inroads for itself. We are at a critical fork in the road, and the decisions we make now, and continue to make will determine our potential in truly serving humanity at our highest capacity. Where would you like to put your intentions?


  1. Kline, K: presentation to the International Spa Show, Toronto.  May 3, 2004
  2. Ibid
  3. Curties, D: On the Other Hand, The Finger Print, Volume 7, Issue 1.  pp 3-4
  4. personal phone conversation by the author with Corinne Flitton, Assistant Registrar, College of Massage Therapists of Ontario, in June 2004.
  5. MacGregor, H.E: Los Angeles Times, 12-28-2004. Hospitals Getting a Grip: Massage Therapy Finds Place in Patient Care for FM and More
  6. ibid
  7. ves, J: Massage is in Business. AMTA Journal, Spring 2004. pp 57-63
  8. Leahy, M: from the Active Release Techniques website at
  9. Betsch, M: Active Release Techniques – One Company’s Solution for Solving Strain/Sprain Injuries. The Leader, Autumn 2004
  10. Tjepkema, M: StatsCan Vol. 14, # 4
  11. Dryden, T and White, M.: The Canadian Massage Therapist Alliance Research Network (CMTARN): National Task Force on Outcome-Based Massage.  Journal of Soft-Tissue Manipulation, Vol 12, # 3 (Spring 2005), pp 3-5
  12. Alleyne, Dr. J: Welcome to Wellness.  Fitness Business Canada  July/August 2005, pg 70

Donald Quinn Dillon, MT is a therapist, writer, seminar leader and business coach. You can contact him at .

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