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Time to snub professional snobbery

don_suit.jpgThere appears to be an insidious tension in the massage therapy profession over the legitimacy of spa massage therapy.

In the Registered Massage Therapists’ Association of Ontario Earnings Survey, potential responses to a question about “direct patient care” included, own clinic, multidisciplinary clinic (not defined), working from home, outcalls to nursing homes or businesses, hospitals/other health care institutions, and fitness centres/sports clubs. Working in a spa was not specifically listed as a survey option.

April 8, 2014  By Don Quinn Dillon

Enjoying the benefits of spa massage – relaxation, a sense of wellbeing – are seen as self-indulgent rather than a way to increase range-of-motion or reduce pain, through rehabilitative-focused massage. And this tension runs deep. I regularly meet RMTs who seem apologetic they work in the spa sector, excusing it as a transient position until they work in “a real clinic.”
At the education level, there are some well-meaning but biased teachers discouraging would-be therapists from  working “in one of those spas.” In social media, ideological spats erupt about the legitimacy of spa therapy, and how the spa sector is somehow tainting and pulling down the massage profession from its true place alongside the likes of physiotherapy, nursing or medicine.

I find this ironic because spa massage forms an essential thread in the profession’s identity, as does rehabilitative massage. The popularity of massage therapy received its greatest push with the massive economic boom in post-World War industrial and information eras. The economic boom led to higher salaries, trade unions that negotiated generous benefit plans and more leisure time. These conditions contributed to some key economic drivers for the massage profession, two of which I’ll speak of in this blog post.

i) Rehabilitation – massage was provided among other methods and modalities by physiotherapists and nurses in the treatment of war wounds and conditions affecting skeletal muscles and joints, like polio. After the war, massage continued to differentiate itself as a stand-alone profession, providing rehabilitation for work and automobile-related injuries, and in some cases receiving compensation from insurers.

ii) Spa therapy and wellbeing – with more time and money, North Americans sought services from the European spa, a mecca to nurture oneself beyond the rehabilitative patient’s objective of relieving injury and pain. North Americans swarmed to spas as a refuge from demanding work schedules. Massage is a primary application in spas and includes various forms of hydrotherapies to enhance relaxation and wellness.


Athletic/fitness performance (and treatment of injuries), worker performance and productivity, and the human potential movement also played a role in the growth of massage, chiropractic and other wellness-focused industries. As a result, representation, regulation and education have flourished for these professions and their practitioners.

Despite these inextricable origins of massage therapy, some practitioners continue to narrowly define massage therapy in what appears to be an identity mirroring physiotherapy. But massage therapy’s roots, resources and direction differ from physiotherapy. Massage therapy in Canada, although regulated under the regulated health professions act or equivalent in 4 provinces, does not enjoy provincial health-care coverage for its services and, unlike physiotherapy, chiropractic and now naturopathic and acupuncture, is not exempt from consumption tax (harmonized sales tax).  

Massage therapy does not yet provide a degree-level education, suffers from a dearth of evidence-based practice and, because stakeholders are not yet fully collaborating throughout the profession on common problems, the massage therapy profession lacks essential political clout to move its interests forward. Practitioners who expect an exclusive rehabilitation focus to improve their lot not only underestimate the massive task ahead of them, but ideologically cleave an essential part of their profession’s origins.

Those critical of spa massage therapy may support their argument with media reports of insurance fraud committed by certain spas. However, a closer look would show there appears to be an equal number of reports citing insurance fraud in supposedly legitimate rehabilitation facilities. In fact, auto insurance companies along with the Financial Services Commission of Ontario have stepped up measures to combat insurance fraud in these rehab facilities.

I suggest we be critical of the operations of both spa and rehab facilities acting unethically, but let’s not denounce the direct client or patient benefits provided by legitimate disciplines.

Legitimacy is certainly engendered by evidence-based practice, but legitimacy’s greatest test is in the marketplace. In my previous article on Massage Therapy Canada titled, “Take the spa industry seriously,” I looked at the 2006 Canadian Spa Sector Profile (the most recent available). According to that report, there were more than 2,300 spa locations in Canada, and the spa industry has grown 17 per cent annually since 1996. In 2005, the Canadian spa industry generated over $1 billion in revenue, with 49 per cent of the revenues derived from treatment rooms. As of March 2006, there were an estimated 25,900 people employed by the spa industry, with an estimated 14.1 million visits to Canadian spas in 2005. Commercial real estate benefits as well, with the spa industry occupying approximately eight million square feet of indoor space.

Increased general well-being, relaxation, life-satisfaction and enhanced capacity for transformation and personal growth are therapeutic outcomes. In CK Andrade’s text, Outcomes Based Massage (Lippincott, Williams and Wilkens, 2014, 3rd edition) and in Dryden and Moyer’s Massage Therapy: Integrating Research and Practice (Human Kinetics, 2012), the “domains, definitions and sample outcomes for wellness and whole systems” are presented. Andrade goes on to define the wellness interactions model, which considers not only body structure and function, but also wellness behaviours, environmental factors and ability to participate in society.

It is well within the purview of spa massage therapy to provide relief of post-exercise or arthritic stiffness, muscle tension and headaches, back pain and various sprains and strains. Some of the strongest evidence for massage therapy links benefit to mood disorders, including state and trait anxiety. Surely spas focusing on the therapeutic benefits of relaxation and a sense of wellbeing play a critical role in public health.

Those who argue rehabilitation benefits versus spa therapy should take the time to examine the origins of massage therapy, the marketplace sectors that each discipline serves (clearly quite different) or the value of therapeutic outcomes beyond improving body structure and function. Spa-based therapy is a legitimate and essential thread in the origins and future of massage therapy. The marketplace knows this — let’s stop fighting it.
Let’s put a stop to intra-professional prejudice and snobbery, which attempts to reduce all the populations and market sectors massage therapists serve down to a narrowly defined group.

Let’s instead embrace our heritage and challenge long-held but unhelpful beliefs in moving our profession forward collectively.

And remember to relax — it’s a desired therapeutic outcome.

Donald Quinn Dillon, RMT is a practitioner, speaker and mentor. Reach him at

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