Massage Therapists

• Employment is expected to grow faster than average over the 2004-2014 period as more people learn about the benefits of massage therapy.
• Many States require formal training and a national certification in order to practice massage therapy.
• This occupation contains a large number of part-time and self-employed workers.

Many physicians have been recommending massage therapy for years. Nearly 2,400 years. The medical benefits of “friction” were first documented in Western culture by the Greek physician Hippocrates around 400 BC. Today, massage therapy is being used as a means of treating painful ailments, decompressing tired and overworked muscles, reducing stress, rehabilitating sports injuries, and promoting general health. This is accomplished by manipulating a client’s soft tissues in order to improve the body’s circulation and remove waste products from the muscles.

While massage therapy is done for medical benefit, a massage can be given to simply relax or rejuvenate the person being massaged. It is important to note that this type of massage is not intended for a medical purpose, and provides medical value only through general stress reduction and increased energy levels. Massage therapy, on the other hand, is practiced by thoroughly trained individuals who provide specialized care with their client’s medical health in mind.

Massage therapists can specialize in over 80 different types of massage, called modalities. Swedish massage, deep tissue massage, reflexology, acupressure, sports massage, and neuromuscular massage are just a few of the many approaches to massage therapy. Most massage therapists specialize in several modalities, which require different techniques. Some use exaggerated strokes ranging the length of a body part, while others use quick, percussion-like strokes with a cupped or closed hand. A massage can be as long as two hours or as short as five or ten minutes. Usually, the type of massage therapists give depends on the client’s needs and the client’s physical condition. For example, they use special techniques for elderly clients that they would not use for athletes, and they would use approaches for clients with injuries that would not be appropriate for clients seeking relaxation. There are also some forms of massage that are given solely to one type of client, for example prenatal massage and infant massage.

Massage therapists work by appointment. Before beginning a massage therapy session, therapists conduct an informal interview with the client to find out about the person’s medical history and desired results from the massage. This gives therapists a chance to discuss which techniques could be beneficial to the client and which could be harmful. Because massage therapists tend to specialize in only a few areas of massage, customers will often be referred or seek a therapist with a certain type of massage in mind. Based on the person’s goals, ailments, medical history, and stress- or pain-related problem areas, a massage therapist will conclude whether a massage would be harmful, and if not, move forward with the session while concentrating on any areas of particular discomfort to the client. While giving the massage, therapists alter their approach or concentrate on a particular area as necessary.

Many modalities of massage therapy use massage oils, lotions, or creams to massage and rub the client’s muscles. Most massage therapists, particularly those who are self-employed, supply their own table or chair, sheets, pillows, and body lotions or oils. Most modalities of massage require clients to be covered in a sheet or blanket, and require clients to be undressed or to wear loose-fitting clothing. The therapist only exposes the body part on which he or she is currently massaging. Some types of massage are done without oils or lotions and are performed with the client fully-clothed.

Massage can be a delicate issue for some clients, and those clients may indicate that they are comfortable with contact only in specified areas. For this reason—and also for general purpose business risks—about half of all massage therapists have liability insurance, either through a professional association membership or through other insurance carriers.

Massage therapists must develop a rapport with their clients if repeat customers are to be secured. Because those who seek a therapist tend to make regular visits, developing a loyal clientele is an important part of becoming successful.

Massage therapists work in an array of settings both private and public: private offices, studios, hospitals, nursing homes, fitness centers, sports medicine facilities, airports, and shopping malls, for example. Some massage therapists also travel to clients’ homes or offices to provide a massage. It is not uncommon for full-time massage therapists to divide their time among several different settings, depending on the clients and locations scheduled.

Most massage therapists give massages in dimly lit settings. Using candles and/or incense is not uncommon. Ambient or other calm, soothing music is often played. The dim lighting, smells, and background noise are meant to put clients at ease. On the other hand, when visiting a client’s office, a massage therapist may not have those amenities. The working conditions depend heavily on a therapist’s location and what the client wants.

Because massage is physically demanding, massage therapists can succumb to injury if the proper technique is not used. Repetitive motion problems and fatigue from standing for extended periods of time are most common. This risk can be limited by use of good technique, proper spacing between sessions, exercise, and in many cases by the therapists themselves receiving a massage on a regular basis.

Because of the physical nature of the work and time needed in between sessions, massage therapists typically give massages less than 40 hours per week. Therapists who give massages anywhere from 15 to 30 hours per week usually consider themselves to be full-time workers.

Training standards and requirements for massage therapists vary greatly by State and locality. In 2004, 33 States and the District of Columbia had passed laws regulating massage therapy in some way. Most of the boards governing massage therapy in these States require practicing massage therapists to complete a formal education program and pass the national certification examination or a State exam. Some State regulations require that therapists keep up on their knowledge and technique through continuing education. It is best to check information on licensing, certification, and accreditation on a State-by-State basis.

There are roughly 1,300 massage therapy postsecondary schools, college programs, and training programs throughout the country. Massage therapy programs generally cover subjects such as anatomy; physiology, the study of organs and tissues; kinesiology, the study of motion and body mechanics; business; ethics; as well as hands-on practice of massage techniques. Most formal training programs require an application and some require an in-person interview. Training programs may concentrate on certain modalities of massage. Several programs also provide alumni services such as post-graduate job placement and continuing educational services. Both full- and part-time programs are available.

These programs vary in accreditation. Massage therapy training programs are generally accredited by a State board or other accrediting agency. Of the many massage therapy programs in the country, about 300 are accredited by a State board or department of education-certified accrediting agency. In States that regulate massage therapy, graduation from an approved school or training program is usually required in order to practice massage therapy.

After completion of a training program, many massage therapists opt to take the national certification examination for therapeutic massage and bodywork. This exam is administered by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB), which has eligibility requirements of its own. Several States require that a massage therapist pass this test in order to practice massage therapy. In States that require massage therapy program accreditation, an exam candidate must graduate from a State-licensed training institute with at least 500 hours of training or submit a portfolio of training experience for NCBTMB review; in locations that do not require accredited training programs, this is unnecessary. After the applicant is approved for testing, the applicant may schedule a test time at a local testing center. Tests are available six or seven days a week, depending on the test site, and are entirely computer based with multiple choice questions. The exam covers six areas of content: general knowledge of the body systems; detailed knowledge of anatomy, physiology and kinesiology; pathology; therapeutic massage assessment; therapeutic massage application; and professional standards, ethics, business and legal practices.

When a therapist passes the national certification exam for therapeutic massage and bodywork, he or she can use the recognized national credential: Nationally Certified in Therapeutic Massage and Bodywork (NCTMB). The credential must be renewed every four years. In order to remain certified, a therapist must perform at least 200 hours of therapeutic massage during the four year period, and complete a minimum of 48 credit hours of continuing education. In 2005, the NCBTMB introduced a new national certification test and corresponding professional credential. These are the national certification exam for therapeutic massage and the Nationally Certified in Therapeutic Massage (NCTM) credential. The new test covers the same topics as the traditional national certification exam, but covers fewer modalities of massage therapy. Recognition of this new national certification varies by State.

Many of the national, State, and local requirements coincide. States that require the national credential also require accredited training programs to comply with NCBTMB standards of training. Professional associations require that a professional member graduate from a training program that meets NCBTMB standards, have a State license, and/or have a national certification from the NCBTMB. Actual requirements differ on a State-by-State basis.

Because of the nature of massage therapy, opportunities for advancement are limited. However, with increased experience and an expanding client base, there are opportunities for therapists to increase client fees, and therefore income. Both strong communication skills and a friendly, empathetic personality are extremely helpful qualities for fostering a trusting relationship with clients and in turn, expanding one’s client base. In addition, those who are well organized and have an entrepreneurial spirit may even go into business for themselves. Self-employed massage therapists with a large client base have the highest earnings.

Massage therapists held about 97,000 jobs in 2004. About two-thirds were self-employed. Of those self-employed, most owned their own business, and the rest worked as independent contractors. Others found employment in salons and spas; the offices of physicians and chiropractors; fitness and recreational sports centers; and hotels. About three-quarters of all massage therapists worked part-time or had variable schedules, although as mentioned earlier many massage therapists who work 15 to 30 hours per week consider themselves to be full-time workers.

Employment for massage therapists is expected to increase faster than average over the period from 2004 to 2014 as more people learn about the benefits of massage therapy. In States that regulate massage therapy, therapists who complete formal training programs and pass the national certification exam are likely to have very good job opportunities. Because referrals are a very important source of work for massage therapists, networking will increase the number of job opportunities. Joining a State or local chapter of a professional association can also help build strong contacts and further increase the likelihood of steady work.

Massage is an increasingly popular technique for relaxation and reduction of stress. As workplaces try to distinguish themselves as employee-friendly, providing professional in-office, seated massages for employees is becoming a popular on-the-job benefit.

Increased interest in alternative medicine and holistic healing will mean increased opportunities for those skilled in massage therapy. Healthcare providers and medical insurance companies are beginning to recognize massage therapy as a legitimate treatment and preventative measure for several types of injuries and illnesses. The health care industry is using massage therapy more often as a supplement to conventional medical techniques for ailments such as muscle problems, some sicknesses and diseases, and stress-related health problems. Massage therapy’s growing acceptance as a medical tool, particularly by the medical provider and insurance industries, will greatly increase employment opportunities.

Older citizens who are in nursing homes or assisted living homes are also finding benefits from massage, such as increased energy levels and reduced health problems. Demand for massage therapy should grow among older age groups because they increasingly enjoy longer, more active lives and persons age 55 and older are projected to be the most rapidly growing segment of the U.S. population over the next decade. However, demand for massage therapy is presently greatest among young adults, and they are likely to continue to enjoy the benefits of massage therapy as they age.

Median hourly earnings of massage therapists, including gratuities earned, were $15.36 in May 2004. The middle 50 percent earned between $9.78 and $23.82. The lowest 10 percent earned less than $7.16, and the highest 10 percent earned more than $32.21. Generally, massage therapists earn 15 to 20 percent of their income as gratuities. For those who work in a hospital or other clinical setting, however, tipping is not common.

Other workers in the healthcare industry who provide therapy to clients include physical therapists, physical therapists’ assistants and aides, chiropractors, and workers in other occupations that use touch to aid healing or relieve stress.

General information on becoming a massage therapist is available from State regulatory boards.

For more information on becoming a massage therapist, contact:

• Associated Bodywork & Massage Professionals, 1271 Sugarbush Dr., Evergreen, CO 80439.
• American Massage Therapy Association, 500 Davis St., Suite 900, Evanston, IL 60201. Internet: http://www.amtamassage.org/

For a directory of schools providing accredited massage therapy training programs, contact:

• Commission on Massage Therapy Accreditation, 1007 Church St., Suite 302, Evanston, IL 60201. Internet: http://www.comta.org/
• Accrediting Commission of Career Schools and Colleges of Technology, 2101 Wilson Blvd., Suite 302, Arlington, VA 22201. Internet: http://www.accsct.org/

Information on national testing and national certification is available from:

• National Certification Board for Therapeutic Massage and Bodywork, 1901 S. Meyers Rd., Suite 240, Oakbrook Terrace, IL 60181.

• Source: Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2006-07 Edition