35 Years Of Massage Therapy Progress And Change

The past ten years have been a time of change for the Massage Therapy profession.

New schools, changes in education, changes in regulatory bodies, regulatory rules, a new pain science model challenging our assumptions and much more.

As times change, it can be interesting to take a look at where we’ve been.

In 35 years in the profession, I’ve seen change before. Lots of it.

When I graduated in 1981, there were only about 125 RMTs in British Columbia, now there are 3800.

At the time, there were only 2 schools turning out RMTs in all of Canada, both in Ontario. Now there are seven massage schools in BC alone.

So I trekked across the country to Ontario to go to massage school.

I had 1500 hours of training over twelve months. Along with anatomy and physiology, we were taught Swedish Massage, Hydrotherapy, a little Lymphatic Drainage and very basic remedial exercise. That’s about it.

So I was certainly not as thoroughly educated as RMTs are now. But here’s the upside: I studied every night, there were no projects, no case histories, no overload of homework, not much student clinic time, and no excess stress.

I enjoyed massage school! I wasn’t half insane or exhausted by the end of it!

After I wrote the Board exams in 1981, my brand new certificate named me a Registered Masseuse. Ouch!

Not long after that, we insisted on new certificates calling us Registered Massage Practitioners, our official name at the time.

New Massage Therapy Models And Principles

I was trained in a very simple version of what you might call an inflammatory model of pain.

The treatment principle was that pain was caused by inflammation, and our job was to move the inflammatory fluid out of the tissues with massage. At the same time, tight muscles were to be massaged, well, just because everyone knew a tight muscle hurt!

It wasn’t really a very detailed model.

No research had been done on massage, so there wasn’t really much to go on except for traditional thinking and clinical experience.

The biomechanical dysfunction model came along a couple of years after I graduated, borrowed from physical therapists and osteopaths.

This was helped by the opening of the West Coast College of Massage Therapy, in the mid-1980s.

It was the first massage college in BC and was started by a BC Massage Therapist who wanted massage therapy education to expand beyond Swedish massage.

The Board of the licensing organization enthusiastically agreed with the plan, and we were able to add techniques such as joint mobilizations and Muscle Energy Technique to the massage curriculum and the Board exams.

Now, in response to federal government requirements, all the regulated provinces share a common required curriculum and soon will share a board exam.

Those changes that were made so easily before?, now to do that would mean three other regulated provinces would have to agree first!

Our world is far more complicated than it was.

When I started up my practice, I didn’t expect to be busy right away. No one was.

Massage therapy wasn’t well known at all, although the worst of the sexual associations were behind us.

After I joined a clinic, I took as many part time jobs as I could find elsewhere. The rest of the time, I sent out letters to doctors and sat in my clinic waiting for the phone to ring until my practice started to fill up.

At the time, the Medical Services Plan covered a limited number of massage therapy treatments if referred by a doctor. Most of our patients were doctor referrals.

We’d see two patients an hour for twenty minute treatments, and got paid $10 each by MSP. $20 an hour wasn’t such a bad wage in the early 1980s.

Some people even saw three patients an hour, which was considered slightly scandalous. You had to have a receptionist to make that work, and many of us didn’t.

Clinics were small and informal. We only occasionally worked with chiropractors and never with physical therapists.

The limited number of Medical Services Plan treatments could be used by the patient for either massage or physiotherapy, so it put us in direct competition with the physiotherapists for those MSP dollars. That was a definite recipe for conflict.

Improvement In Massage Therapy Education And Culture

Shortly after I graduated, I got on the Board of the licensing organization, in those days it wasn’t called the CMT, it was the Association of Physiotherapists and Massage Practitioners.

We were linked with physiotherapists then, although mostly we ran our own affairs.

Currently, the Board must have public members appointed by the government with expertise useful to Board deliberation. But at that time, we ran things all on our own, with only occasional input from the Ministry of Health or the physical therapists.

We were amateurs, but we Massage Therapists mostly had to figure things out for ourselves.

Now both the CMT and the RMTBC are far more influenced by non-RMTs on staff or on the CMT Board.

In the 1980s, massage therapy and physical therapy attracted very different people. PTs were conservatively dressed.

We were casual in the extreme, with a slight post-hippie flavour. When we had joint meetings with them, the PTs wore suits and dresses, and the Massage Therapists wore old baggy pants.

On top of the cultural disconnect, PT’s had dropped massage as an outdated technique years before, and didn’t have much respect for it. It was a very uncomfortable pairing!

We get along well with physical therapists now that we are legally completely separate, our education has improved, our cultures are more similar, and the value of massage has been rediscovered.

I fit in well with massage therapy culture at the time, except for one thing: hugging. We hugged each other to say hello, we hugged to say goodbye.

But, but, I said, if I don’t like someone, do I have to hug them anyway? I was a stiff and reluctant hugger.

Finally in exasperation, one of my friends took me aside and told me I was going to have to practice hugging with her until I learned to relax and do it right. So I did. Now I’m a fairly competent hugger, but it seems to have disappeared from massage therapy culture now.

Can’t say I’m really sorry.

Massage Therapy Associations And Turf Wars

At first, the Board of the licensing organization handled all the business of running the profession.

But soon the Massage Therapists Association was formed to promote the profession, something that the licensing organization is not allowed to do.

The first meeting of the MTA (now called the RMTBC) was held in a half-built building (available for free!) out in the country. About 30 of us sat around in a circle and had a meeting. Then we went out into the yard of the construction site, set up a massage table and showed each other our favourite massage techniques. Good times!

For a long time, the Annual General Meetings of both the licensing organization and the MTA were held together on one weekend.

It was the massage therapy social event of the year.

The meetings were often held someplace fun outside of Vancouver — the Okanagan, the Island, Whistler, Harrison Hot Springs.

There was free and often heated debate about the issues at the meetings, time to laugh with friends you only saw once a year, and the antics of a few eccentric characters to enjoy. In the evening, there’d be a hired band and dancing for entertainment.

Those meetings are the one thing from back in the day that I miss. Our profession is too big and complex now for that sense of a tight community.

The College of Massage Therapists was formed in the early 1990s when the government changed our legislation and held a scope of practice review. The College of Massage Therapists and the College of Physical Therapists replaced the earlier Association of Physiotherapists and Massage Practitioners, much to the relief of both professions.

At last we became completely independent.

Plus we got the new official title we’d been wanting: Registered Massage Therapist. Finally!

The scope of practice review held at that time was hugely important, partly because of what DIDN’T happen because of it. It doesn’t usually make news when something doesn’t happen, of course.

Under the old scope of practice system, turf battles over techniques were ongoing. The chiropractors were threatening the physical therapists for doing high velocity manipulation. The physical therapists were threatening to take massage therapists to court for doing techniques like joint mobilizations, Muscle Energy Technique, and basically anything other than Swedish massage.

The government stopped those turf battles by deregulating all techniques except for the few that have a signifiant risk of harm. So one profession couldn’t claim to own a technique any more. Fortunately!

Destructive court battles were avoided, and everyone could get on with the business of working with patients.

Photo by: geralt

Photo by: geralt

Getting Massage Therapy Communities Back And More Progress

Of course the internet has made a big difference in the massage therapy world, just as it has everywhere.

We have way more access to information, but also to misinformation.

At its best, the internet has allowed us to start building the sense of community that we lost when the number of schools and RMTs started to multiply quickly.

This time, we can have many communities — our own here in BC and also with manual therapists from around the world.

Big news in our profession recently is a shift of basic models of why we think people have pain, and how to best treat it.

The new model coming down the track is the biopsychosocial model, based on pain science research, that also considers patient’s psychological and life context inputs into pain. It’s a much more brain and nervous system-centred model, and rejects a lot of explanations for pain used by the biomechanical dysfunction model.

It takes time to get used to, but it’s fascinating and important. It’s also a good way to get into on line arguments.

But I’ve seen model changes before too, and that’s also made me a little skeptical of how new ideas can turn into fads.

When the biomechanical dysfunction model came along, it was the shiny new thing.

Now the biopsychosocial model and pain science are the latest shiny thing. The problem with shiny is that what starts as useful information can start to be considered the only possible truth. Complexity gets simplified, and the messy uncertainty of patients and their pain gets forgotten.

For example, people can try to create certainty by spending a lot of time sorting techniques into “good” and “bad” based on pain science. But really, the pain science model doesn’t make any techniques bad.

It just means they may not be as effective as we thought, or effective for the reasons we thought.

So here’s my advice. Look for the well-informed pain science people who are humble about what we know and truly comfortable with uncertainty, and pay attention to them. Here’s an example of uncertainty, the worst of the “bad” techniques in the 1980s and early 1990s was massage! No research to back it up, no reason to think it worked at all, said its detractors. Now, in the pain science model, it’s considered good, very good! In the next model, which will eventually appear, who knows? No matter, we’ll still be here, doing what we do. Massage therapy has been around for centuries, and it’ll probably last a few more..