5 Things You Need To Know About The Business Of Being A Massage Therapist


It’s not like any of us set out to be a colossal failure in our business adventures, but it happens.

An average of 7000 businesses file for bankruptcy in Canada each year.

30% of small businesses won’t survive two years, and only 50% make it to year five. That’s a high failure rate when you consider that 98% of Canadians work in small businesses.

Many healthcare professionals graduate college only to discover the running of their practice is in fact another full aspect of their career that they are ill prepared for.

When I started college I had envisioned a lot of candle light and Enya music.

Reality hit me like an avalanche; the pace and volume of information I ingested was like inadvertently entering an eating contest every day for three years. It was much the same when I decided to be self employed, a sole proprietor, upon graduation.

The reality of my situation was vastly different from the mental picture I had.

I thought I was ready to take on the role of a sole proprietor, that my education had prepared me for life as a healthcare professional.

It became blindingly obvious that there was a whole other side to being a RMT, a side that I was unprepared for, the part where I actually had to run a business. The first 5 years in business would show me how much I had yet to learn and teach me some tough lessons about running a small business in the healthcare industry.  

The business of being a healthcare professional comes with it’s own set of rules in addition to all the other more traditional rules of running a business.

There are layers of rules, processes, procedures, variations of business plans and models.

Why did I not know about this? Why did no one seem to know about this? Why did we not learn about this in professional development?

I really had no idea how to get started as a business woman, a sole proprietor, how my proprietorship fit into an existing clinic,  or how to open my own clinic based on what I had learned in college.

So, I paid for that education too…eventually.

But first, I jumped into deep waters without a plan or a personal floatation device. I realize retrospectively that there was an easier way, but some people have to experience the shark tank for themselves. And I assure you, my first few years as a clinic owner were akin to swimming in shark infested waters.

I made a plethora of mistakes along the way and witnessed other therapists make their own host of mistakes as well.  There were so many things I was just not prepared for, and an equal amount of things I didn’t know I needed to plan for.

After much floundering, I decided to take some business classes, read Business For Dummies, and hire a consulting company to help me stabilize the business.  

Those years of change were rough.  

I felt like Captain Jack Sparrow, shouting “Stop blowing holes in my ship!”.

The combined efforts of the consulting company I hired, business specific education, a ton of reading, and a collaborative group that I belong to, helped me get my business shipshape and under way.

I just wish that I had been better prepared for the business aspect of my career coming out of college.

I also wish there were more resources and maybe even some continuing education courses about the business for Massage Therapists. As a profession, we quite simply need to learn more about business.

1.The Myth of “Fair Rent”

The question often arises in conversations and on social media around what is “fair rent”.

I honestly think we’re asking the wrong question, and it articulates our collective lack of understanding of the business aspect of our profession. Although, in some situations we might actually be talking about “rent”, such as when a therapist leases/rents a commercial space.

It seems more accurate to describe the fees paid to a clinic as “association fees”.

It’s possible that the relationship between the therapist and the clinic is a straightforward room rental arrangement, but it’s equally possible the relationship is more of an association, like in a law firm or a real estate agency. In which case, there is so much more going on than just simply renting a room.

In order to determine value, we need to distinguish between rent and association, and itemize what services are offered in exchange for the fees. It means we can ask questions that more accurately determine what would be a fair fee based on the services offered.

Consider it this way, what is a fair price for a car?

We would need to consider several things about the car in order to determine it’s value, such as: Make, model, age, features, accessories, mileage, past, maintenance records, tires, etc. It is similar when we inquire about compensation as a sole proprietor/contract worker as well.

The questions could be:

  • What services are included in my association fees with the clinic?
  • What services are not included in my association fees but are necessary for me to conduct business?
  • What services are negotiable, which are not?
  • What fees are negotiable and which are not?

There are a variety of different clinics to choose from, with variations of administrative structure, clinic management services, policies, procedures, and unique business models.

Because there are so many variables and differences between clinics, it means there are a variety of association fees that are fair. So, it seems that the correct answer might be something we, as Massage Therapists, are all too familiar hearing…it depends.

2. Cost Benefit Analysis, Profit & Loss Statements: Putting It Into Perspective (know your numbers)

You’ve attended school for 2 + years, graduated, passed your board exams, and now you’re looking for a place to hang your shingle.

Or maybe you’re a seasoned therapist, and you just want to go to work, treat your patients, and go home.

And possibly, you’re one of those entrepreneurial marvels and you fancy opening or owning and managing your own clinic. Whichever business model you’re interested in, a solid cost benefit analysis (CBA) or Profit & Loss Statement (P&L) is a good place to start.

“It costs money to make money” is one of my least favourite expressions in business, however true it is.

If you’re a new graduate you’re already wracked with debt, and the thought of start up costs can be overwhelming. Let’s be honest, the risk of loss can be overwhelming for all of us, even successful clinic owners.  The object is to plan for success and manage your cash flow.

A CBA will weigh the costs against the benefits in a chart, and should give you a better idea of what you can and can’t afford. The CBA is a technique that is a systematic approach to estimate and compare the benefits and costs of a project or business.

It will help you determine the feasibility of a business decision.  It could prevent you from getting  into a situation where you hemorrhage cash, and the risks outweigh the potential benefits.

A CBA can morph into, but should not be confused with, a profit and loss statement, which is a financial statement designed to summarize and assess the actual revenues, costs, and expenses incurred during a specified time period, usually a fiscal quarter or year.  

This technique may help assess the bottom line by identifying any hemorrhaging of cash or assets in the business, and improving prudent financial planning for the future stability of the business.

3. Massage Therapist Contracts

Contract law is a mirky quagmire to navigate on your own.

It is always a good idea to consult with legal counsel before you sign anything, or if you have any questions or concerns.

Check with your professional association to see if they offer legal advice to their members (The BC association has a legal retainer for members.) I suggest that it is worth the expense if you’re signing a contract in relation to your Massage Therapy practice. This field has a unique language and is too complex for the average Massage Therapist to traverse on their own.

A contract is an agreement between two or more parties, and should be mutually beneficial. It will itemize the exchange of services, goods, or promises.

Contracts are a part of our life in many ways. Everytime you go skiing you sign a contract. When we buy a cell phone plan, lease a car, take out a loan or mortgage, buy insurance for our home or vehicle we are signing a contract. When we go to our physician we sign a contract to agree to receive medical treatment.  

If you don’t like the terms of an agreement, or have concerns about a specific term, negotiate them to be something you can agree to.  But, don’t ever sign an agreement you don’t understand or don’t agree with.

Contracts are a good idea in any business relationship. They clearly detail the services, expectations, rules, boundaries, and consequences.

They protect not only the investment of the clinic, but also the investment of all the therapists that work in association with, or under the umbrella of the clinic.

A well written contract is beneficial for all parties. Contracts are everywhere, they shouldn’t be a scary or threatening thing for Massage Therapists.

Photo by: NobMouse

 4. Sole Proprietorship: The Good, The Bad, And The Ugly Truth

From new graduates to seasoned therapists, I hear the woes of business and ensuing conflicts from poor management practices, poor communication and misinformation running rampant in the Massage Therapy world.

We are taught the value of our service, but not the costs associated with facilities and amenities needed to conduct such service. We are pumped and primed with what we should expect in compensation, how in demand our services are, and what we’re entitled to.

We were even lured into the programs of Massage Therapy with the enticing expectation of making a six figure income with less than 2 years of college education.

The cold hard facts about proprietorship, association with an existing clinic/associates, or contractual work and the risks associated with this business model were briefly touched on, if at all.

Canada Revenue Agency (or other international regulatory bodies for business) have definitions and expectations for those who would define themselves as sole proprietors.

Understanding that the freedom associated with proprietorships comes at a risk of loss is an important shift in paradigm for many healthcare professionals. We want the benefits of proprietorship without the risk of loss, and who can blame us right?

The ugly truth is, there has to be risk of loss if you want to be considered a sole proprietor.

Personal liability is greater in a sole proprietorship also.  

If something should happen in a sole prop. business, if the business should be sued, or if it comes into financial trouble, you’ll be personally on the hook and creditors and lawsuits can come after your personal assets.

If an associate or clinic is audited, and the government determines that the relationship was closer to that of an employee/employer rather than a sole proprietor/contractor, the clinic owner will be at risk of having to back pay the government both the employee and employer portions of CPP, EI, and WCB (taxes and benefits).

The decision is not defined alone by what we say we are, but by how independent the associate is, the autonomy, and the risk of loss. I encourage all sole proprietors to understand how their government distinguishes between proprietorship and employment.

Even an unreasonable client, colleague, or clinic can sue you for breach of contract and you’d be personally liable. It’s important to think about how much risk you’re willing to incur in all your business decisions.

What a proprietorship is not, is a partnership.

Being a sole proprietor working and practicing in a clinic does not entitle the proprietor to a share in the company or make them a business partner. This may seem like a “thank you Captain Obvious” moment, but anecdotal evidence over the last 10 years in business suggests that this is a more common paradigm for registrants than not.  

How does proprietorship of individual therapists fit into the business model of modern clinics?  

The business model for the Massage Therapy profession is closer to that of a law firm or real estate agency than it is to a tenancy agreement.

While some clinics may choose to remain a tenancy styled model, and some may reflect a limited liability partnership, most clinics are like real estate agencies or law firms in their contractual relationship with their associate therapists.  

They offer various associate packages and services in exchange for commision splits or flat fees, but it’s not just based on the splits or fees, there’s a lot more to consider.

For example:

  • What training and education do you need/does the clinic offer?
  • Does the associate require a lot of time and new patient leads provided by the clinic?
  • Is the clinic new/is the associate new?
  • Is there an existing network of referrals and marketing infrastructure to support an additional associate?

To summarize, being a sole proprietor has many benefits, such as flexibility, autonomy, and higher potential revenue. But, it comes at a cost of increased liability, responsibility, and risk of loss.

5. Business Models: Choosing A Clinic Or Practice Model That Meets Your Needs And Plays To Your Strengths.

There’s no single right answer that applies to all circumstances and individuals when it comes to deciding what clinic or practice model is best for you.

You might decide that working alone is what suits you best; A micro business would be your best option if you love the idea of doing it all, the admin, the paperwork, and the practice. Perhaps you are interested in building a huge corporation or franchise with hundreds of therapists and staff members.

Maybe you don’t want to think about the business side of your practice, you just want to go to work, treat your patients, and have administrative staff do all the paperwork for you. Maybe you would like a small local clinic with a solid team and tight knit network of professionals. Or, perhaps you’d prefer a huge integrated health centre with multiple healthcare providers to collaborate with. Maybe your preference is for corporate, sports teams, or mobile services.

From single person micro businesses to huge corporations, there’s really no wrong decision, except to choose a work environment that you don’t enjoy or that doesn’t meet your needs.

It’s critical to be able to analyze the financial viability of your business, project future expenses, plan for success, and understand how to calculate the value of associate fees/packages. Having a well written contract that is clear and fair will give you security and stability. It’s also important to choose a clinic model that meets your individual needs, it will set you up for success and growth. It’s crucial that you appreciate the role, responsibility, liability, and benefits of proprietorship, and how it fits into a clinic environment.  These five things are fundamental to the success of a Massage Therapy business, whether it be a proprietorship, partnership, or corporation. Of course, there’s always the option to jump overboard and take your chances in the shark infested waters of small business. 62% of small businesses in Canada launch without a business plan. In the meantime, I’ve attached a P&L excel spreadsheet from a small Massage Therapy clinic. It itemizes the expenses of a small clinic for 2016 without any of the figures. You can use the list of potential expenses like a draft/template to create a personalized CBA or P&L for your own proprietorship. And, here’s a link to a quick and simple small business startup plan available online through Quickbooks

Back Pain Myths: Posture, Core Strength, Bulging Discs

It is an article of faith among many mainstream experts that poor posture, lack of core strength, and/or structural abnormalities such as bulging discs are major causes of pain, especially back pain. A further assumption is that by working to correct these issues, through stretching or strengthening, or postural retraining, or surgery, pain will decrease. It is probably fair to say that the majority of physical therapy and corrective exercise done in this country is based on exactly these assumptions. Although these ideas have a common sense appeal, there is significant evidence questioning this approach. Here’s a brief review of the conflicting evidence.*


You have probably heard the claim that bad posture causes back pain, or that you should try to improve your posture to get rid of low back pain.

You can find this claim all over the internet – from physical therapists, chiropractors and personal trainers. If you do a Google search for “posture and pain,” you get 4 million hits.

With so many posture police on patrol, it is a near certainty that you will sooner or later be told by some authority that your posture needs work.

For example, if you go to a physical therapist with low back pain and a large curve in your low back, you may be told that you need to correct this by sucking in your gut, squeezing your glutes, tucking your tail, or strengthening your core. If you have upper back pain and a sunken chest, you may be told to pinch back your shoulder blades, strengthen your scapular retractors, stretch the chest, and raise the sternum.

These ideas have intuitive appeal, and are advocated by numerous experts. But are they supported by evidence? And should you spend time trying to analyze your own posture and make corrections? Let’s look at some evidence that might help us answer these questions.

In one study, researchers looked at the posture of teenagers and then tracked who developed back pain in adulthood. Teenagers with postural asymmetry, thoracic kyphosis (chest slumping) and lumbar lordosis (overly arched low lack) were no more likely to develop back pain than others with “better” posture.

Another study looked at increases in low back curve and pelvic angle due to pregnancy. The women with more postural distortion were no more likely to have back pain during the pregnancy. A systematic review of more than fifty four studies found no good evidence of a correlation between posture and pain. Leg length inequality seems to have no effect on back pain unless it is more than 20 mm (the average leg length difference is 5.2 mm). Hamstring and psoas tightness do not predict back pain.

These results are particularly striking given that many studies have quite easily found other factors that correlate well with low back pain, such as exercise, job satisfaction, educational level, stress, and smoking. Although some studies have found a correlation between back pain and posture, it is important to remember that correlation does not equal causation. It may be pain is causing the bad posture and not the other way around. This is a very likely possibility. People will spontaneously adopt different postural strategies when injected with a painful solution. Big surprise!

Based on the above, there is little evidence to support the idea that we can explain pain in reference to posture or that we can cure pain by trying to change posture. For more articles on posture, click here.

Disc Degeneration, Bulging Discs, And Other MRI Abnormalities

Another common idea is that herniated discs or other degenerative changes revealed by MRI are major causes of back pain. Many people who learn of these structural changes will assume it is the cause of their pain and start to consider surgery as a solution. However, numerous studies show that many types of structural abnormalities are poor predictors of pain.

In one famous study, MRIs were performed on subjects who did not have back pain. Fifty two percent of the subjects had at least one bulging disc or other MRI abnormality for which surgery is sometimes recommended. Given these findings, the authors stated that: “the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental.” In a similar study, MRIs on individuals who had never suffered from low back pain revealed that one third had a substantial spinal abnormality and 20% under the age of 60 had a herniated disc.

In a study of pain free hockey players, seventy percent were found to have abnormal pelvis or hip MRIs, and fifty four percent had labral tears. The author stated that “this study shows the limitations of depending too heavily on an MRI. A surgeon may see something in the image, but it isn’t causing a problem.”

In this study, researchers examined forty four volunteers, age 20-68, with no history of knee pain. Sixty percent showed abnormalities in at least three of the four regions of the knee, causing the authors to conclude that “meniscal degeneration or tears…are highly prevalent in asymptomatic individuals.”

Studies of active baseball pitchers or overhead athletes consistently demonstrate very large percentages (over seventy percent) of torn labrums and rotator cuffs.

These are all issues for which surgery is sometimes recommended.

This is not to say that herniated discs, torn labrums or other structural abnormalities cannot cause pain. Of course they can, and you would rather have less damage than more. But if a large percentage of pain free people have bulging discs, then how likely is it that a bulging disc is the cause of your back pain? If you look close enough at almost any joint in the body, you will find something wrong with it. Don’t assume that whatever shows up on the MRI is the source of your pain. For more on the poor correlation between MRI results and pain, click here.

Core Strength And Back Pain

The idea that good core strength is essential for a healthy back is another ubiquitous idea. What is the evidence that poor core strength causes pain or that core strength exercises reduce back pain?

Before reviewing the studies, it is first interesting to note that most of life requires only minimal activation of the core musculature. During walking, the rectus abdominis has an average activity of two percent of maximal voluntary contraction, and the external oblique operates at five percent. During standing, trunk flexors and extensors are estimated to fire at less than one percent. Add more than fifty pounds to the torso and they fire at three percent. During bending and lifting muscular activation is similarly low. Given that daily life seems to require so little core strength, perhaps it is not surprising that research interventions to increase core strength have little effect on pain.

Here’s another quick reality check before moving on to some research: ever noticed a heavily muscled person with massive core strength who has lots of back pain? Or a skinny weak person with none?

Now let’s look at some research. One study showed that core strengthening exercises for pain free persons identified as having a weak core do not reduce the future likelihood of back pain. Numerous studies have been performed to test whether core strength exercises reduce back pain. The thrust of these studies is clear – although core exercise can improve low back outcomes, it is no better than general exercise. The obvious conclusion is that if core strengthening has benefit, it works because of the generally beneficial effects of exercise (or as a placebo), not because lack of core strength or poor firing patterns are a major cause of of back pain. In other words, despite what we are told over and over, the current evidence states that there is nothing magic about core strength as means to prevent or reduce back pain.


The above results are surprising and counterintuitive, and raise many questions such as: why do these approaches seem to work; how can so many people be wrong; and if these aren’t the true sources of pain, then what is?

For more information to answer some of these questions, I recommend clicking on the Posture and Pain links above for relevant articles.

*Most of the studies referenced in this article are from three excellent papers: The Myth of Core Stability by Eyal Lederman; The Fall of the Postural Structural Model in Manual and Physical Therapies by Eyal Lederman; and The Traditional Mechanistic Paradigm in the Teaching and Practice of Manual Therapy: Time for a Reality Check, by Frederic Wellens.

The Importance Of Curriculum Change For Massage Therapy

When I graduated from massage therapy school in 2005 I had already completed my bachelor of science and felt very comfortable in my knowledge and abilities to become a great therapist.  

It became very evident to me over the ensuing years that there was a lot more I needed to know and understand in order to more effectively treat complex problems, particularly those who lived with persistent pain.

It was through the experience of seeing my wife struggle with disabling pain and realizing the treatments she was receiving from medical doctors and allied health care providers were inadequate.

Something was missing in how myself, and other health professionals were educated.  

The conceptual framework and understanding of the human pain experience and how we conduct our treatments appeared incomplete.

This quest for answers led me on a fantastic journey that completely changed how I view the body, the brain, and how I treat my patients.  Last February at the San Diego Pain Summit I was convinced that the path I was going on was the correct one.

Treating people in pain is what we do, and there is a much better way to do it than what we learn in school.  I felt inspired and realized one of the main problems with our profession is that there are not enough of us with advanced degrees to lead the profession towards the changes it needs.

I decided that in order to help advance our profession I couldn’t sit on the sidelines, I would need to be involved and pursued more education.  In September I started my Masters in rehabilitation sciences at the University of BC.

Already, in a short period of time I feel I have gained invaluable tools for critiquing research, finding and utilizing evidence for practice and critical thinking skills.  These skills need to be fundamental to all health-care professionals.

Changes are necessary for us to evolve.

National Standards For Massage Therapists

The profession of massage therapy in Canada (particularly in British Columbia), has a long history of being leaders in its curriculum, standards of education and licensure that can exceed our colleagues in other parts of the world.

There is a strong desire among our membership in BC to increase our education to that of a baccalaureate program.  Our professional association, the RMTBC has completed great work in attempting to make this happen.  Ideally, it would be great if all education for massage therapists was standardized regardless of what province or state you were educated in, much like it is for physical therapists, nurses, pharmacists, opticians, and medical doctors.

Currently in Canada the regulated provinces are working on a national standard of competencies.  

I applaud their attempts in pioneering this endeavour as it could provide a framework that other massage therapy regulatory bodies throughout the world could follow.  However, the lack of quality research used to support the development of the competencies is embarrassingly evident.

As a regulated health-care profession, the educational curriculum and practice standards of massage therapy need to be based on strong scientific principles and good quality relevant research.  In order to make informed practice decisions and incorporate an evidence-based approach to treatment planning the educational standards of RMT’s must be recreated.

As it currently stands, the Interjurisdictional Competency Document and its companion, the Guidelines for Foundational Knowledge in Massage Therapy Educational Programs, which together form the framework of what is taught in the massage therapy colleges and creates the material for what is required to pass board exams, are both regrettably unacceptable as documents around which an entire profession’s competencies are created.

Creating A Greater Understanding Of Massage Therapy

What is wrong with this document and what is a fundamental problem in our profession?

The primary faults I see is the research on the actual mechanisms of manual therapy are ignored and an inadequate understanding of pain and its bio-psycho-social components are missing.

Unfortunately, manual therapy professions base their treatment models and understanding of pain and dysfunction through out-dated biomedical beliefs, structuralism and connective tissues modalities.  There is a better direction to go, we simply need to follow the science.

Manual techniques exhibit the majority of their effects based on mechanoreceptor input from the skin, not the muscles or fascia.  

The words we use, how we interact with our patients and the explanations we give are more important than any miraculous technique that we learn.  This short article provides a great discussion of the need to move beyond our techniques.

All positive or negative changes our patients have in their pain perception or movements are from alterations in their nervous system.  Nervous tissue is the only tissue in the body that can adapt and change quickly within the confines of a treatment session.

Once a therapist realizes that every effect we have is through the nervous system, primarily the brain, massage therapy becomes much more simplified, more powerful as a therapeutic tool and prevents unnecessary and unrealistic treatment plans that do not serve the best interests of the patient.

Research has shown that connective tissue cannot be altered for any length of time through manual techniques, and we shouldn’t want to alter it anyway.  Here are a couple great articles worth the read that refutes fascia’s importance, here and here.  I could post numerous links to all the research, but these two sum it up succinctly.

Trigger points, another sacred doctrine of massage therapy are likely not a problem in muscle tissue, more plausibly it is referred pain from peripheral nerves.  Posture and biomechanics are not always as important as we think they are either, here is a free full text pdf available worth the read.  

These links are not meant to completely invalidate other ways of thinking.  

They are to identify the science and other opinions in the manual therapy field.  As a profession we need to be more open-minded and become science-based clinicians, and not continue to base our curriculum and practices on historical beliefs.  This is still possible while not forgetting the art of what it is we do.

Photo by: BU Interactive News

Three Pillars Of Massage Therapy

The three pillars that guide our profession as outlined by our regulatory Colleges is safe, effective and ethical health care.

By purposely neglecting the wealth of evidence on manual therapy mechanisms we are failing on all three pillars.  This purposeful neglect is unforgivable with the wealth of modern science on pain, fascia, biomechanics and the mechanisms of manual therapy.

By focusing on out-dated beliefs and a biomedical structuralist approach to care, and furthering the pseudoscientific beliefs about fascia, trigger points, cranio-sacral therapy, visceral manipulation, postural asymmetries and adhesions to name a few, we are supporting unsafe, unethical and ineffective practices.  

Our profession needs to move towards an evidence-based model that includes plausible scientific principles of manual therapy.

We do not need to make up stories to explain what we are doing.  Touch is therapeutic, massage and movement is analgesic.  These effects occur because of our interaction with another person’s nervous system.

By adopting a curriculum that includes biopsychosocial approaches to pain management, peripheral and central mechanisms of pain, understanding nonspecific treatment effects, motor control, graded exposure to movement, principles of patient centred care and the pillars of an evidence based practice, we would be much better suited to provide safe, effective and ethical care.  

Those approaches are much more supported by science and encourage a feeling of security, robustness and self-efficacy that can elicit more consistent results and better patient outcomes.

The problem with overcoming this dilemma is the belief systems are so ingrained in the profession.  Too much of what we do is based on faith and not on fact.  Changing the profession will require great force of will and continuous efforts, because it is an entire culture that will need to adapt and change.  

From the top down, national massage therapy organizations, provincial regulatory Colleges’, massage therapy educator’s, current RMT’s, and students will need to adjust.

Changing Massage Therapist Focus

We are so focused on our modalities and learning new techniques to add to our toolbox, that we lose focus on what really matters.

Our profession has made the care we provide more complex than it needs to be.  

If we could focus on having a solid foundation in the core sciences, learn how to interpret research, critically think, and learn advanced skills to more effectively interact and educate patients we would be significantly farther in our progression as a useful component of the health care system.

Patient centred care and evidence-based practices should be the foundation of what we learn in our education.  Assessment and manual skills are important and these skills will always be central to our profession.  RMT’s can still historically do what we have always done, but the time is here for us to adapt and reinvent ourselves.  The regulatory Colleges, professional associations, all the private colleges and most importantly the massage therapists have roles to play in this process and a desire from each organization or individual to implement change is needed for our profession to become leaders in manual therapy education. Change is constant, it is not to be feared, and it needs to be embraced, as change is necessary for the long-term survival and relevancy of our profession.

Visit, Body in Mind at, the NOI Group at,, or go on Facebook and interact with clinicians from Skeptical Massage Therapists, Biopsychosocial therapists, Explaining Pain Science or Dermoneuromodualtion among many others and you will find great debate, discussion and heaps of research to sift through that will quickly get you questioning your current practice and beliefs.

Ethics Violation, or Communication Breakdown?

This year I wrapped up five years of service on the North Carolina Board of Massage & Bodywork Therapy. Anyone who has ever sat on a board will probably agree with me that disciplinary hearings involving massage therapists are one of the most stressful parts of that job. It was for me. I estimate that during my time on the Board, I had to sit through approximately fifty of them. It was very distressing to see my fellow massage therapists trying to defend themselves–and in a few cases, just outright admitting to the violation–whenever they were accused of something.

Nine times out of ten, the accusation was of a sexual nature. 99 times out of 100, it involved a male therapist. I’m dead certain there are female therapists out there performing sexual favors every day, but most men won’t come forward to complain about it. Go figure.

My question to myself at those hearings was always this: “Did this person have an intent to do something evil, or was this a communication breakdown or simple mistake that could have happened to you or me?”

If you’ve been practicing longer than a year or two, the chances are good that in spite of your best efforts, you have accidentally exposed a body part. Or you have said something that the instant it left your mouth, you thought “why did I say that?” The very first massage I ever gave, I accidentally touched the man’s penis. I went to tuck in the drape, and all I can say is there it was. He was supine on the table, his eyes were closed, and when my hand grazed it, I saw his eyebrows shoot up. I said “I’m sorry,” and carried on. If I had made a big deal out of it, I could have just made it worse than what it was.

If your only intent is to give a therapeutic massage, then your major obligation is not just about giving the massage; it is clear and direct client communication. This has come home to me again and again, and most recently when one of my friends was accused of a sexual violation. The case has not been settled yet; it hasn’t even been to court, but he has been crucified in the press and by a number of bloggers–none of whom were present in the room and have no idea what truly happened there, but I’ve been watching what amounts to a feeding frenzy by a bunch of sharks who are determined to hang him from the highest tree. He is apparently guilty until proven innocent. And since no one was in the room except for him and the alleged victim, I am fearful of the outcome. Of course I do not want a sexual predator turned loose on the public. But after a career that has spanned about 30 years with no previous complaints, it’s a shame to see that going down the tubes. He has loyal clients who are still patronizing him (including women), but what do you think the chances are of him getting any new ones while this is going on? Zilch.

You can’t be too careful. Let’s be realistic. Most massage tables are set up so that the table is at about crotch-level. That’s a fact. We lean over people. We use our body weight on people. Some therapists get on the table with people. In my younger, skinnier days, I’ve crawled up on the table when someone was prone. I’ve done pelvic work on people of both sexes. I’ve done pectoral work on people of both sexes. I’ve worked on the gluts of both sexes. If you’re performing medical massage, you’re going to find the need to touch those areas–with the client’s informed consent.

Think for a moment about the muscles that originate on the pelvis. If you want to make the belly of a muscle relax, you need to make the origin and insertion relax. That’s just the way it is. If you’re ignoring the origin and insertion, you might be giving a relaxing massage, but you’re not getting to the root of the problem. However, if you abruptly touch someone’s pelvic bone without discussing that with them beforehand, you’re the next disciplinary hearing waiting to happen.The general public doesn’t know squat about origins, insertions, and actions of muscles. It’s up to you to educate them. And it’s up to you to abide by their comfort level. If they prefer not to have their gluts worked on or you getting near their pubic bone, then you don’t do it, period. I have found it helpful to have a muscle flip chart in the treatment room. That allows me to pick it up while someone is on the table and show them the muscle, where it begins, and where it ends. It’s a professional thing, to me.

There is also no excuse for careless draping. The law in my state says that “the drape may be temporarily moved in order to accommodate treatment.” Yours probably says something similar–or not. Working through the drape may not be ideal, but if that’s the law in a your state, then I suggest you abide by it. Don’t expose more than you need to expose, and don’t leave it exposed. If you have moved the drape in order to work on the gluts, that doesn’t give you license to perform the whole massage with someone’s butt shining. Get it done and cover them up.

Be aware of the comments you make. It’s okay to tell someone they have taut bands or active trigger points in the gluts. It is not okay to tell someone they have a tight ass. You might be thinking it, but keep your mouth shut.

You may think you’re all above-board as a therapist and that you’re never going to be accused of anything. Guess what–all those people who have been accused didn’t expect it to happen to them, either. Two things that did become apparent to me during my years on the Board…one, there are indeed predators out there who decided this profession would be a good place to meet a fresh crop of victims, and two, there are just therapists out there who are guilty–of failure to communicate. Don’t let it be you.

Originally published December 31, 2011

Emergency Action Planning For Sport Massage Therapists

I felt like a deer in the headlights when she asked me.

“Can I get a copy of your Emergency Plan to give to the other team’s trainer?”

My what?

“Your Emergency Plan, you’re supposed to have one ready, or on file before each game to give to the other trainer.”

I had NO idea.

I had volunteered with the team for the previous five years and had never heard of this. However this time I was the head trainer, which came with a whole group of responsibilities I didn’t yet know about.

Part of the league rules were that each team head trainer had to have an Emergency Plan in place in the event that a player was badly injured and needed medical attention beyond what we could provide.

I had yet to do my first road trip and receive one of these documents from another trainer.

All I could do was apologize and promise to have one ready for the next game.

I felt like an idiot.

Massage Therapists As Part Of The Team Within A Team

Even though I felt like an idiot, I was fortunate.

I’ve had to do this kind of thing before and have some experience with it.

There is more to this than just printing up a document. It designates you as a leader, a professional, an expert and a damn good communicator.

When it comes to working in sport, your athletes are your responsibility, but there are times when trainers of opposing teams must work together (actually most of the time it’s important to work together).

I won’t go so far as to speak for other sports (although I’d assume it’s much the same), but in hockey the trainers are almost like their own little team, within the teams. On road trips, it’s not uncommon to forget equipment and have to borrow tools or get help with injuries from the other team’s medical staff. There are constant favors being done back and forth to help each other, whether it’s laundry, equipment trades or holding coaches back from attacking each other (yes it happens).

The same applies when someone is hurt in a game. While your athletes are your responsibility, if they get hurt bad enough that you have to go out on the field, ice or playing surface to help, everyone is on edge.

If the trainer puts their fist up into the air, that’s typically the signal they need more help. At this point, what team you’re on doesn’t matter, it’s all about THAT athletes safety. When it’s done right, it can be seamless, when it’s done wrong it can be a complete cluster…well you know.

There has to be one person in charge and it’s not a time to start second guessing things. When the trainers are working together as a team, in the best interest of the athlete, there can’t be any ego’s. If the athlete is on the other trainers team, they have started first aid protocols before you get there and you may get assigned a somewhat menial task.

If all you are asked to do is call 9-1-1 or go and direct paramedics to the scene, that’s all you need to do.

Why You Need To Develop An EAP

The preparation for these kinds of emergencies starts long before the injury or the game even starts.

Making sure you have a well prepared Emergency Action Plan will give the proper steps to ensure a positive outcome for both trainers and athlete. Also making sure your medical equipment is in good working order and properly stocked prior to game time is crucial.

Like I mentioned before when it’s done properly it can be seamless almost like watching an orchestra of movement. The people who are really good at it, can direct with confidence, which in turn instills confidence in the people they are directing.

I’ve been fortunate to watch several people who excel at it and watch how seamlessly they can direct people to do what they need while still tending to injuries and dealing with a patient.

Being able to direct one person to help deal with injuries, one to lead paramedics in and others to get extra equipment doesn’t come naturally, or easily and it must be practiced.

Part of the reason why it’s important to develop an Emergency Action Plan is because of your knowledge of your environment. When teams come from other towns or cities they don’t have the intricate knowledge of the area like you do. Nor do they have the knowledge of the idiosyncracies of your building or area of play.

Every little thing you know that could possibly delay more advanced medical help arriving is crucial information to be able to share with the other trainer.

For instance:

  • Is there a preferred entrance for paramedics to use?
  • Is there a better entrance/exit to take the athlete away from the playing surface?
  • Are there gates or doors that would have to be unlocked for paramedics to gain access?
  • Where do you keep extra medical equipment stored?
  • Are there more staff/people on hand trained for medical emergencies that can help?
  • Is there an AED stored close by?
  • Where is the closest hospital or medical clinic?
  • Are there any slang names that are used for common areas of the building/sport area?

While these things might seem simple, to someone who isn’t familiar with the area, it can be crucial.

Having a face-to-face with the other trainer before game time to review your Emergency Action Plan is not only beneficial but can be life saving.

Photo by: Jon Candy

Setting Up An Emergency Action Plan For Sport Massage Therapists

I’ll never forget the first time I was in command of an accident scene with the fire department.

I was beyond nervous.

On the way a senior officer was driving and giving me tips on what to do before we got there. But I had never been in command before and was totally unsure of myself.

Midway through the call, one of the chiefs arrived on scene. He calmly came up, grabbed me and pulled me out of the accident. We walked up a hill about 15 feet from the accident and he told me “here is where you need to start”.

His point was to take a deep breath, take a step back and look at the entire scene, not just the middle of it. Look at what things could possibly go wrong, take a broader view to make sure everything is safe.

Undoubtedly, you will be in the middle of the emergency if this is your scene. Before anything ever happens, take a step back. When you’re making up your Emergency Action Plan, try to envision everything that could possibly go wrong when your athlete has to be taken off the playing surface, or is seriously hurt on it. Anticipate as much as possible. While you will never be able to come up with everything, it’s a good start. If an emergency does happen and something you didn’t think of occurs, go back, review and update your EAP.

There are several things that need to be included on your Emergency Action Plan. Remember, this should be shared with the visiting trainer before game time:

  • Level of First Aid that is available during the game (team doctors, first responders, paramedics, and how many of each).
  • Location of any First Aid equipment and supplies (AED, spine board, clamshell).
  • How to get more help if needed (the fist in the air is fairly common).
  • How you will respond if needed.
  • Methods of transport if needed.
  • Any prearranged routes out of the area and to medical treatment (you can just copy and paste in a picture from google maps).
  • The role you want the trainer to follow.
  • The roles other team members will follow (ie: equipment managers, coaches)

If possible, make this a one page plan that can be handed off to anyone. You can make it as detailed or as simple as you want, but the above points should all be included. I’ve heard some trainers say theirs is a 4-5 page document. It’s fine if you want to be that detailed, but in an emergency situation, it’s not practical to have to review something that long.

You can download the one I made up by clicking here, if you want to see a simple example of one.

Whether you’re the head trainer or there strictly as the team Massage Therapist, you should have a working knowledge of the EAP. If you’re not the head trainer, ask if you can review it and ask what role you can play if there is an emergency. More importantly ask if you can be part of a practice to make sure things run smoothly if you are going to be part of the emergency medical team. If you are the main medical person for a team, make sure you conduct a practice every once in a while to make sure all staff members are familiar with their role in the case of an emergency. Go back and review your EAP every once in awhile. Every year, equipment needs, First Responder protocols and athlete medical conditions will change. Make sure the EAP reflects everyone of those changes. Just try to avoid being like me and feeling like an idiot!


Using Your Massage Therapy Skills To Travel In Australia

Has one sentence ever changed your life?

One night, I stumbled across a single woman’s blog on conquering Australia.

She was easy to relate to, her fear and worries were so similar to mine. She calmed my inner fear as her blog resonated with me on a personal level. She was exactly right, “You’re either going to do it or you’re not”.

These little words strung together geared me up and I was moving to the land down under… Australia!


My problem, was I didn’t find any support when I googled BC RMT traveling to Australia.

I knew I wasn’t walking on the moon, someone from Canada had surely already done this. I just couldn’t find them, and I felt alone in my search.

There was too much fear of the unknown! The only option I had was to get as much information as I could to alleviate any negative thoughts about starting my adventure.

There was a place called Magnetic Island and Townsville, Queensland that a friend and I had been conversing about for years. I felt a connection to Magnetic Island even before I even arrived.

My friend and I talked about these places so often that I naturally wanted to see them with my own eyes.

This was my first major overseas experience alone. Thankfully, Australia is a lot like Canada and both countries have a lot of similarities which helped the cultural transition.

The best part, I could chase summer all year round. As I thought about the white sandy beaches and clear turquoise water I knew this was something I really wanted to do.

Prior To Departure

For two years after my board exams, I started taking control of my finances by paying off lingering debt, saving, and also organizing my accounts.

I stopped commission rates at the clinic, paid a set monthly rental and took on my own third party accounts. This gave me control over daily and monthly expenses,  and by having a set rental cost I increased my treatment times without losing a percentage each hour.

I earned approximately $1500.00 more per month in doing this.

I had a vision for change and big goals in mind.

This motivated me to get out of town as fast as I could. With this vision, I sat down and put a plan into place to get all of my ducks in a row and make this happen.

These are some of the things I had to get figured out before I could go to Australia.

  • My Passport.
  • An Australian Working Holiday Visa.
  • Research Massage Therapy regulations.
  • Talk to the one person I knew & find a job.
  • Where to land & start?
  • Accommodations.
  • Banking & Taxes.

Ensure your passport will be valid for the duration of your trip. Get it renewed before you leave if it is going to expire while you’re abroad.

Before entry into Australia you need to have an Australian working holiday Visa.

There are multiple types of Visas and finding the right one can be confusing. Here is a rundown of the different types:

  • Working Visas should not be confused with a Working Holiday Visa. There are two types of Working Holiday Visas: 417 and 462.
  • The Working Holiday Visa is based on your passport. Because I am a resident of Canada I applied for the Working Holiday Visa 417.
  • Working Holiday Visa 462 is for passport holders in countries; Argentina, Bangladesh, Chile, Indonesia, Malaysia, Poland, Portugal, Spain, Thailand, Turkey, USA, Uruguay. Only USA passport holders can apply online for this this visa.

To be eligible for a Working Holiday Visa 417 you:

  • Must be at least 18, but not yet 31 years of age.
  • Do not have a dependent child accompanying you at any time during your stay in Australia.
  • Have a passport from an eligible country.
  • Your partner can accompany you to Australia, but they will need to apply for their own visa.

This Visa allows you to:

  • Stay in Australia for up to 12 months.
  • Work in Australia for up to six months with each employer.
  • Study for up to four months.
  • Leave and re-enter Australia any number of times while the visa is valid.

Approx. Fee : $420.00 AUD

Walk to work in Australia

Massage Therapy In Australia

This PDF file will provide you with the information you need to know about scope of practice, types of massage, education standards, continuing professional development and health fund provider recognition. It is an easy read, but lengthy.

Helpful Translations:

Health FundA benefit plan or extended health plan

Health Fund ProviderA person that is reliable to provide treatment for reimbursement to health fund, this person has “provider status”

RemedialTherapeutic style treatment

RTORegistered Training Organization

RPLRecognition of Prior Learning

There are three nationally recognized Massage Therapy qualifications.

Certificate IV

  • Competent to perform general health maintenance, can be associated with Spa Therapists.

Diploma Remedial

  • Competent to perform treatments involving specific remedial techniques to alleviate common musculoskeletal presentations such as low back pain.

Advanced Diploma Levels

  • Competent to treat complex musculoskeletal presentations with a more extensive range of treatment protocols.

Both Diploma & Advance Diploma:

There are two Massage Therapy Associations, Australian Massage Therapy (AMT) and Australian Association Massage Therapy (AAMT). Both offer classified ads and advertisements for work on their site, so it can also be a good starting point in looking for jobs.

If you’re not sure what your training is like compared to the Massage Therapy training in Australia, there are two schools that I looked at,  Evolve college and NSW School of Massage, they can give you an idea of what Australian tuition and schedules look like.

Tuition range from $7,000 to $11,000 AUS Dollars.

Duration of study is dependent on courses; average 20 weeks – 2 yrs.

Australian Provider Status and Liability Insurance For Massage Therapists

To gain provider status valid for a health fund Australians must have:

  • Certification from RTO.
  • 100 Continuing Education points per year, which roughly equates to around 20 hours or three days per annum.
  • Membership to a professional organization/association such as ATM & AAMT.

Applying for provider status in Australia takes some organizing. This checklist will help you understand what is required, and you can download the word document here to print off if you need it:

? Have your qualification overviewed.

  • This is called Recognition of Prior Learning (RPL). A Registered Training Organization (RTO) does a review of this.

? Provide your transcripts to RTO

  • Include units studied and hours to each unit.

The RTO will compare all the information against the Australian Qualification.

? Provide current resume and include:

? Qualifications

? Work experience

? Letters of endorsement from clients & other professionals to enhance your opportunity.

? Hold Australian First Aid certificate and knowledge of Australia’s Occupational Health & Safety legislation.  

  • Remedial Diploma requires Senior/Level 2 First Aid.
  • HLTFA301B/C – Use this code when searching for the appropriate course information.
  • Check in with your first aid certificate to see if it is internationally recognized. You may have to get your certificate compared to the Australian standards.
  • This is a one or two day course, approx. $110.00-$200.00 AUD.
  • Make sure your First Aid Course is approved by your RTO and is appropriate for the state you chose to live in .

? Set up an interview with the RTO

  • all the evidence you supply must be verifiable.

? Ultimately you will be awarded the current qualification

  • HLT50307 Diploma in Remedial Massage.

There are costs involved and vary from College to College / RTO

There is a list of RTO’s on the AAMT website.

Whether you plan on getting a provider number for Australia or not, you’ll need Liability Insurance. Some companies may provide it, but most require you have it already. This company is commonly used for insurance coverage in Australia,

Finding A Massage Therapy Job In Australia

Before I left Canada I knew one person in Australia.

Luckily my friend on Magnetic Island was neighbours with the owner of Massage on Magnetic. We emailed each other and I had confirmed a Massage Therapy job before I landed in Australia.

I stayed with Massage on Magnetic for five glorious weeks. I had 47 weeks left in Australia and I was on the search for a new job.

Two sites that were helpful in searching for job postings were and

I had not written a resume in over 10 years.  Preparing a couple of resumes before you leave will be helpful, preferably one resume for Massage and one for another skill set if available.

  • Is your email appropriate and professional?
  • Can you get a personalized email? ie:
  • Use and have an Australian phone number that works.
  • Make electronic copies of your college transcript, RMT diploma, continuing education and first aid, these are excellent additions to your resume.
  • Why should they pick you?
  • What makes you unique and stand out?
  • Get a few testimonials together.
  • Prove your experience don’t just state it.
  • Use a comparison profile. List what they require from you and specifically how you do that. This can be in addition to your resume and should change or be modified to suit each employer’s requirements.

Be persistent in applying for a job and do not get discouraged! If you are not responded to right away do not take it personally.

Businesses in Australia are bombarded by hundreds of emails responding to job postings. A lot of those emails are from struggling backpackers and travelers looking for part time work.

Working In A Spa vs A Clinical Setting.

Spas can be more accommodating if you do not have a provider number for Australia. I found numerous postings available for spa practitioners, especially in tourist areas.

If you desire a clinic setting, it will be valuable to gain provider status. Large cities and multidisciplinary clinics are looking health fund providers.

Either way, pick an area you would like to live and work in (search this area on and see what positions are available) and then create a resume at home that will appeal to an Australian Spa or Clinic Owner/Employer and email it to them.

From I found a rocking job out on the Great Barrier Reef as a Massage Therapist.

Massage Therapy On The Great Barrier Reef

While searching I came across a posting by Calm Experience. This was a massage therapy company that was owned by by Intuitive Massage located in Airlie Beach, Queensland.

In conjunction with Cruise Whitsundays, the local ferry system, Calm Experience is contracted to provide Massage treatments on Reefworld.

Reefworld is a permanently located pontoon that sits adjacent to the coral reef walls of Hardy Reef. This pontoon is accessible by Cruise Whitsundays for day and overnight tours. The pontoon itself is home to the Harmony Hut (where Massages are given), the dive centre, snorkelling equipment, underwater semi-submersible sub and underwater viewing chamber.

It was an excellent tour to see nature at its finest. You could spot turtles, humpback whales during migration, reef sharks, hundreds of fish, dolphins and of course Nemo.

Watching this video will help you to understand the Reefworld Tour.

I was persistent in applying for this position.

It took four emails before I received a reply. I called three times and I didn’t stop until we spoke on the phone.  My persistence paid off as I landed this job during my first telephone conversation.

The whole team would arrive by 7:30am to prepare Seaflight; the guests would arrive on board at 8:00am sharp.

Seaflight is a 37m vessel ideally suited for outer reef cruising, each tour started with a short announcement of activities available at Reefworld. Announcing my Massage Therapy skills to a boat full of international strangers was the last thing I thought I would be doing in Australia, so I was a little nervous at first but eventually it was a stress free routine.

My accent seemed to work in my favour.

I was often the only Canadian and my ‘slow’ accent made it easier for people to hear. My approach was:

  • Practice my script each morning on the walk to work
  • Address the audience with a clear and precise message of the Massages I offered.
  • Review, reflect and re-write as needed.
  • Be the first on the microphone.
  • Described my uniform, all black, I was easily found.
  • Speak in an enthusiastic tone.
  • Leave the audience with a call of action and urgency.

“Book your appointment now. I have a limited amount of time and I do not want you to miss out.”

Aside from this small presentation that took only minutes of my day my duties were to:

  • Prepare seated chair massage with fresh towels & face pieces.
  • Book appointments for my day, after my announcement.
  • Provide seated chair massage on Seaflight, to & from Reefworld.
  • Provide Table treatments at Reefworld, 4 hours available.
  • Record daily sales with payment.
  • Return used linens to main office once back at shore.
  • Help provided memorable experience for guest.
  • Work as a team member.

I was paid on commission which relied on my ability to connect with passengers and close a sale. Marketing myself on Seaflight pushed me out of my comfort zone so far I felt like I was going to fall overboard.

I came from a healthy practice where in house referrals fuelled my success.

This job spoke volumes on how much I relied on others for referrals, so this was my time to learn how to market myself and successfully gain clients.

My daily sales ranged from $200-470.00 AUD, minus commission. Averaging $800-1000/week. I made more money in Canada but I was travelling, not making my fortunes; I was just fortunate enough to be there.

I earned a good living, built community support around me, saved money and moved onward to travel the East Coast for nearly three months without working.

This was success for me.

Alicia at the Reef

Reflections Of My Massage Therapy Jobs In Australia

I honestly didn’t need a provider number for the two places I worked at.

I chose to live in tourism based places where having a provider number did not separate me from another, my resume and education stood for itself.

If you choose to not have a provider number, get your insurance and start applying to spas and vacation destination places. You might get paid a little less, but the scenery will most likely make up for it.

If you want a provider number for a health fund it shouldn’t be too difficult, especially now that you are informed.

This would be an excellent advantage if you chose to live in a larger city. If you were planning on staying for a long period of time in cities such as Melbourne, Sydney, Gold Coast, Sunshine Coast and Brisbane you would have a greater chance of finding work with a provider number.

Be mindful when applying for jobs as a Massage Therapist in larger cities, be aware of job postings with bad verbiage, late working hours and low fees. This is not to scare you off, only to inform you.

I went to a job interview in Melbourne that never mentioned it was above a pawnshop (not that there is anything wrong with that, BUT… let’s just say they were surprised I had a resume) the girl working there got her techniques off YouTube and if I was honest, I’m pretty sure it was for prostitution.

I thought, what was I doing?

I knew it was wrong and I left.

I had a little cry with a great friend who helped me overcome the situation and it was onward and upward from there.

I eventually had a really beautiful time in Melbourne, not to mention all the lovely friends I met, but also I worked for a family that owned a small children’s toy shop called, Saraghi.

This was where my other resume came into play.

My child care and reception skills made me the perfect candidate to help people purchase gifts for baby showers and birthday presents, it was cute, fun and I drank a lot of coffee.

Just to touch back on the Massage Therapy side of my life, I resisted the idea of a working at a spa in the beginning, I was a clinic-based practitioner. My patients were recovering from motor vehicle accidents, work related injuries and serious limitation issues. I resisted the idea of a spa and in the end working at them helped me find more love for massage. I was uplifted because people were on holidays and they were happy. Their energy transferred on to me, so I was happy too. There you have it… all the information you need to start your journey as a Massage Therapist in Australia. I am going to say to you now…there are no excuses and “you’re either going to do it or you’re not”. All the best, I believe you can achieve your dream and I am here when you need me. If you would like more information and useful links, click here. Now that you have decided you are going, Yippee!