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State of the Massage Therapy Industry

Your practice is a cellular reproduction of the entire massage industry – a microcosm of the macrocosm. As our health is determined by the health of the entire biosphere, so the health of your practice is affected in large part by factors acting on and within the industry.

September 8, 2009  By Donald Dillon

Your practice is a cellular reproduction of the entire massage industry – a microcosm of the macrocosm. As our health is determined by the health of the entire biosphere, so the health of your practice is affected in large part by factors acting on and within the industry.

Funding for massage therapy, education quality, employment practices and income levels are influenced by government legislation and taxation, relationships with the insurance industry and gatekeeper health-care providers, evidence-based practices, workplace practices of clinics, spas and massage franchises, the strength of massage professional associations, accreditation and quality of teaching colleges and, of course, the health of the economy in general.



To carry on day-to-day business practices without heed to these influences is to try to bail water from the Titanic as it sinks. The good news is, the more we understand and work with the influences on the industry, the stronger the industry can become and the more available we can  make massage therapy to the public.

Since the industrialization during and following the Second World War, massage therapists have benefited from a strong economy – particularly the industrial illnesses this industrial age has manufactured. Conditions such as workplace-related musculoskeletal disorders (WRMDs), repetitive strain injuries and job-related stress syndromes were born of our industrial – and then information – revolutions. In this strong and sustained economy workers have had access to generous employee benefit plans, comprehensive health care and workers’ compensation plans, and auto-insurance funding for rehabilitation.


Add to this a rise in popularity of massage therapy and other forms of complementary and alternative medicine practices and the increased regulation of massage therapy in more states and provinces, and we see the potential for tremendous growth and demand for massage therapy.

However, there are storms emerging, metaphorically, at the borders of the massage therapy industry. There is rising demand by the public and government agencies for health professionals to work from evidence-based best practices; economic recession affecting the value of the dollar and significant consumer debt load signal problems for our economy; regressive changes in extended health plans and other work benefits; struggling massage therapy professional associations, where low membership equals hamstrung advocacy and promotion; the advancement of other health professions towards degree-level education and the peer pressure created by this; and the emerging strength of the spa industry and massage franchises impacting how massage therapists practise.

There are intrinsic struggles that contribute to our industry’s strife as well. Some massage therapists oppose degree-level education and see research as onerous and expensive, especially if the therapist is practising part time and not interested in fulfilling the necessary educational and regulatory requirements. Some practitioners may perceive regulation as an intrusive government cash-grab, unconvinced of the benefits of becoming a self-regulated profession.  Yet it may be these very therapists who insist we should be recognized as a legitimate health profession and should have the same access to funding as chiropractors and physiotherapists.

The marketplace is confused. Is massage relaxing, pampering and luxurious, or rehabilitative, curative and
restorative? Our industry suffers an identity crisis, and in trying to include such a broad range of practitioner methods and modalities we effectively diffuse and confuse our marketplace. Further, this leaves the practice of massage open to commoditization, providing a base level of skill for bottom dollar and losing the inherent, apparently highly valued intention of bodywork- – personal transformation and embodiment. Patients or clients?  Relaxation or rehabilitation? If we don’t decide what we’re about, the marketplace (including government and insurance funders) will do the pigeonholing for us.

The schools are largely unaccredited, with program quality and entry-level standards varying considerably. There appears to be a disconnect between the school experience and working in the profession. Therapists look to their
professional associations or regulatory college for answers, which may be insufficient to fill the gap between school knowledge and everyday practice.

Because many massage therapists appear inexperienced in creating sustainable business models and are unaware of their financial bottom lines, they operate by the seat of their pants. Looking for the next hot method or modality to fill their appointment books, they fail to realize it’s their business model that needs the tuning. Any significant changes in the economy dramatically affect a practice where the practitioner is just holding on.

Despite these problems, there are opportunities too. Potential for integration into complementary and
alternative medicine wards in hospitals; the stress and strain of the information age and what onsite therapies can provide; greater regulation and training in the spa industry; movement by massage therapy professional associations and regulatory bodies to pool knowledge and resources and improve cross-country standards; the advancement by dedicated colleagues towards increasing research literacy and practice; and the opportunity to tag along with complementary industries – such as health and fitness – that add quality to the lives of citizens and will be well funded by the baby-boomer generation.

My best guesses for emerging trends in the massage therapy industry:

More massage therapists will become employees. Spas and massage franchises offer solutions to many of the business problems of sole practitioners: recognized brand, high-traffic commercial space, existing operations/administration and management systems, co-ordinated marketing campaigns, equipment, supplies and leasehold improvements already provided, and the opportunity to work with others to cover all needs of the business. Many sole practitioners will see the clear time- and money-saving advantages of working in an established business.

Massage therapy will make gains in health care funding. Even in provinces where massage therapists are regulated, there are barriers to funding in provincial health care, auto insurance and workers’ compensation. The reasons stated by the powers that be are i) lack of degree-level education and ii) insufficient research. Massage therapy is seen as helpful yet lacks credibility to receive full health-care funding. We are, therefore, reliant on gatekeeper health professions to gain us access to this funding.

There is a trend to download more duties and responsibilities to lesser trained, lower salaried positions in health care. What physicians do, now nurse practitioners or registered nurses do.  Nursing assistants do what nurses formally did, dental hygienists and assistants do what dentists used to do themselves and there is a new position…physio- and occupational therapy assistants to perform some of the tasks previously only provided by PTs and OTs.

On the professional trajectory, massage therapy has advanced past skilled trade but has not yet arrived as a regulated health profession (with associated access to funding) and we may recall massage has roots in nursing and physiotherapy. I predict we’ll see massage therapists as skilled workers providing care alongside nurses and physiotherapists as adjunctive to their care – not fully arriving as an independent profession but adjunctive to their care – and it is here where massage therapy will make inroads to health-care funding.

In a technology-saturated world, massage therapy will be more important than ever.  Massage, like anything good, has attracted the opportunists and has become more commoditized, to the chagrin of many therapists. However, once people receive the power of bodywork and become more informed they will seek ever higher forms of it. Remember the human potential movement? What happened to that? I think we’ll see a renaissance, with more people seeking embodiment in a culture that continuously disembodies.

Stay tuned as we explore, in detail, emerging industry developments that directly impact you and the way
you practice.

Don Dillon, RMT, is the author of Better Business Agreements and the self-study workbook Charting Skills for Massage Therapists.  More than 60 of his articles have been published in industry publications including Massage Therapy Canada, Massage Therapy Today, AMTA Journal, Massage Magazine (on-line), AMTWP Connections, Massage Therapist (Australia) and various massage school and professional association newsletters.  Don has presented in six provinces to massage therapy schools and associations, and his website, , provides a variety of resources for massage therapists.

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