We've seen the memes, tropes and jokes about massage therapy. There seem to be two major stereotypes at play in the discussion; the large bodied, severe looking woman who inflicts pain on the recipient, and the sleight of frame, “hippy-dippy” new age masseuse waxing maxims about self care. There doesn't seem to be much in the middle ground and neither really serve to create a realistic picture of what a massage therapist is, what a massage therapy appointment is like, who would go to see a massage therapist nor why they would be there.
Culturally, our concepts of massage therapy are vague. We might consider going for massage when we feel stressed, but some might dismiss it if their understanding of massage looks like either of the above. We might consider going for a massage if we have sore achy muscles in our necks or back, but we might not consider a massage if we have been dealing with persistent pain in our knee or shoulder. To make matters more confusing, not every RMT is going to serve every population or demographic in the same way, or with the same efficacy. Choosing an RMT can become a challenge for a public that doesn't have a clear idea of what massage therapy is.
In 2010 a group of RMTs from the U.S., Canada and Europe convened at a World Cafe style symposium to attempt to tackle some of these issues. The plan was to generate guidelines to follow when treating common problems such as low back pain and lymphedema. What happened was the discovery that we have a little more ground work to do instead; one of the major barriers we have is poor or non-existent definitions of massage therapy, across the board. Coming out of the symposium were two definitions; massage was defined as
Massage is a patterned and purposeful soft-tissue manipulation accomplished by use of digits, hands, forearms, elbows, knees and/or feet, with or without the use of emollients, liniments, heat and cold, hand-held tools or other external apparatus, for the intent of therapeutic change.
The definition for massage therapy was much broader, including health promotion, self care education and the construction of a therapeutic relationship.
Massage therapy consists of the application of massage and non-hands-on components, including health promotion and education messages, for self-care and health maintenance; therapy, as well as outcomes, can be influenced by: therapeutic relationships and communication; the therapist’s education, skill level, and experience; and the therapeutic setting.
Based on these two definitions, we can see that massage is definitely a lot more than painfully pressing on someone's body and self help quotes. The type of treatment provided and the results are influenced by the therapist, the setting and the relationship built between therapist and client. And those last bits, the education of the therapist, the therapeutic setting and the structure of the relationship between client and therapist give some clues as to how to identify the RMT. Because the fact is, not every RMT practices the exact same way in Ontario. Some focus on geriatric care, some on post operative care, some on athletics and sports injuries, and some on wellness and stress management. The education pursued by the therapist, how they decorate their treatment room, how they market their services will inform a lot of how they will build their relationships with their clients, and how their clients will come to view them and the services they get. So, what is massage therapy then? The definition I am working with, based on marrying those two above is
Massage therapy is the patterned and purposeful manipulation of soft tissue conducted in a health care setting including both hands-on and hands-off components. Health promotion and self care education and the construction of a trusting, secure, therapeutic alliance are part of the hands-off experience. Hands-on manipulations can range in body areas worked on, depth of pressure, direct skin contact or over the clothes, all for the intent of therapeutic change. This definition would easily include all RMTs in Ontario regardless of their chosen areas of focus. In my practice, my area of focus is on stress and relaxation. The education I have pursued is in alignment with better understanding the basic functions of stress and relaxation, the barriers some may have to the latter, the consequences of too great a stress load, and methods people can employ themselves to assist in stress management, stress reduction and relaxation. My treatment room is pretty neutral (bordering on bland...) with a few posters featuring anatomy and discussion about stress. Massage Therapy with me often looks like treating things like TJMD/jaw pain, headache, and persistent muscle tension. It looks like discussing breath and the basic mechanics of how respiration works, noticing how it feels to breathe “as usual” compared to breathing with a few gentle cues. It looks like noticing how our bodies feel and learning to trust the signals they send us when we are not ok with something, and talking about boundaries. It also sometimes looks like discussing access to counselling and psychotherapeutic services, or referrals to the family doctor for further help with pharmaceutical care or further specialist referrals. Massage Therapy is certainly a lot more than the memes and jokes would have us believe and those memes, however humourous they may be, don't help the public, nor the medical community, understand what massage therapy actually is and what it can do for the public. With the conversation begun at the Best Practices Symposium, we can continue to pursue clarity on the subject of massage and massage therapy so the decision to use the service can be made with greater confidence and RMTs in Ontario can develop a deeper understanding of their own roles in their chosen areas of focus, within the health care profession.
References Kennedy, A. B., Cambron, J. A., Sharpe, P. A., Travillian, R. S., & Saunders, R. P. (2016). Clarifying Definitions for the Massage Therapy Profession: the Results of the Best Practices Symposium. International Journal of Therapeutic Massage & Bodywork, 9(3), 15–26.