Saturday, December 27, 2014



Ten years ago.

I am working on textbook revisions.  The reason publishers have textbooks on revision schedules are to assure that content remains current.  My revision schedule for Fundamentals of Therapeutic Massage and Essential Sciences for Therapeutic Massage is at minimum every 5 years. That means every 3 years I begin a revision cycle.   Truth is that I am always revising textbooks because Mosby’s Massage Therapy Review for licensing exam preparations and Sports and Exercise Massage plus other books are also on revision schedules.  I am always looking for what has changed and what is the same in the world of massage.

This commitment to textbook revisions places me in a unique situation.  I have to stay current with all developments that impact massage therapy education and practice and I have to be a visionary able to project into the next 5 years to assure that content remains viable between revision cycles.   I have been writing textbooks for a long time – since 1995.  Wow 20 years!  And I have been a massage therapy school owner and instructor since 1985. Wow 30 years! I have been a massage therapist since 1979. Wow 36 years!  Let me tell you,  a lot has changed!   And I have had to change too.  I am 61 and expect to be active in the massage world another 30 years.   I will have to continue to embrace change.  My next 30 years is devoted to developing the next generation of massage therapist, teachers and leaders. Over the years of professional practice I have a good track record for being accurate with future events and will share a few of major future events I expect.  But first, a reflection on just the events of the past year. 

It has been quite a year.  Major events include:

·        Release of the Entry Level Analysis Project (Dec 2013 technically but close enough to 2014)

·        Release of the Federation of State Massage Board’s Model Practice Act.

·        National Certification Board for Therapeutic Massage and Bodywork moving beyond licensure and putting full support to the advanced credential Board Certification

·        Movement by Commission on Massage Training and Accreditation to provide a programmatic approval outside of institutional accreditation.

It was rough going but all four of these events are necessary for advancement of massage therapy.

Other important events include:

The Joint Commission, the accrediting body for health care released the Clarification of the Pain Management Standard November 5, 2014. The implications are huge for massage becoming part of integrated health care.

Effective January 1, 2015, for Ambulatory Care, Critical Access

Hospital, Home Care, Hospital, Nursing Care Centers,

and Office-Based Surgery Practice Programs

Standard PC.01.02.07: The [organization] assesses and

manages the [patient’s] pain.

Revised Rationale for PC.01.02.07 (New for Ambulatory

Care and Office-Based Surgery Practice)

The identification and management of pain is an important

component of [patient]-centered care. [Patients] can expect

that their health care providers will involve them in their assessment

and management of pain. Both pharmacologic and

nonpharmacologic strategies have a role in the management

of pain. The following examples are not exhaustive, but strategies

may include the following:

l Nonpharmacologic strategies: physical modalities (for

example, acupuncture therapy, chiropractic therapy,

osteopathic manipulative treatment, massage therapy, and

physical therapy), relaxation therapy, and cognitive behavioral


l Pharmacologic strategies: nonopioid, opioid, and adjuvant


C EP 4 : The [organization] either treats the [patient’s] pain or

refers the [patient] for treatment. M

New Note for EP 4 (Additional Note for Nursing Care


Note: Treatment strategies for pain may include pharmacologic

and nonpharmacologic approaches. Strategies

should reflect a [patient]-centered approach and consider the

patient’s current presentation, the health care providers’ clinical

judgment, and the risks and benefits associated with the

strategies, including potential risk of dependency, addiction,

and abuse


Education was shook up with the collapse of the corporate financial aid based school sector and increased regulation and oversight of private post-secondary education accepting financial aid as well as limits on amount of federal aid available based on projected income upon graduation (gainful employment). This development is going to need to be watched closely.

Massage Franchises

The increase in massage therapy and spa focused franchises will continue.  Massage Envy is not the only player.  There are multiple franchise options these days.   Like it or not, the franchise model is successful.  Stomp and spit and get your fascia in a twist, pay rates and yearly income amounts in the franchise structure are reasonable based on a 625 contact hour entry level vocational education and comparable to other health professionals with similar education. Ongoing confusion on income perpetuates because the misunderstanding of what is charged for massage is not what is actually made.  In past blogs I have discussed this topic often.   If a massage therapist works full time and doing 5-6 massage sessions per 8 hour day 5 days per week (which is reasonable) should make between $25000 and $30000 per year and payroll taxes will be deducted from that.  A massage therapist with more education and experience should make more.  This is employment in the real world and massage is a health service. 

Yes this is change from when I first came into the profession or is it?  I charged $20 per hour massage, work all hours of the day and night, did between 20 and 30 massage sessions per week and made about $30,000.  Calculate all the time actually spent and I made about $12 per hour. You would think the economy would be better today but it is not.  The median wage for 2014 in the U.S. per person is $26,695 and median household income is at $50,500( multiple people working).

Today the franchise fee for basic massage ranges from $40-$60.  As an employee you should get ¼ of that fee per massage. You walk in, provide excellent massage, be a great employee and walk out. The business owner takes all the risk, pays the overhead and expects to make a profit.  Overhead is 50% of gross sales. Wages are 25% of gross sales.  It just is and doesn’t matter if you are your own boss and self-employed or an employee where the owner has to pay the overhead and take the risk. And all, heads up.  Pay rates in health care establishments will not be any better.  The business owner needs to make a profit and that should be 25 % of gross sales.  Here is the kick. The owner gets paid last.  Overhead and employees have to be paid first.   

Education has to prepare graduates for success and realistic expectations. I think those that do not achieve success 2 years post-graduation from massage school should not have become a massage therapist in the first place.  Schools need to better inform potential students about income and work expectations and do a much better job screening potential students. This is a service profession. There must be a passion for massage therapy independent of income potential. Not everyone should be a massage therapist.

 Graduates must be able to provide a beneficial therapeutic massage clients are willing to pay $50 (average) for and they have to be able to do 20-30 massage sessions per week. Somebody has to step up and do a for real ergonomics analysis to prevent burnout. Educators at entry level needs to get real and provide a curriculum that does reflects the job market for graduates today and tomorrow.  Massage therapist have opportunity to advance and increase income with continuing education and experience reflected by Board Certification.

Continuing education needs to be practical and actually provide skills instead of fluff.  Too much of the continuing education available does not translate to practical skills in the actual massage practice.

I am excited about the next 5 years. Ongoing research will continue to validate the biologically plausible benefits of massage.  I think by 2020 most of the confusion about massage therapy education and practice will sort itself out.

One of the biggest shifts I think will be employment out pacing self-employment for massage therapists at entry level.  Franchises, spas and healthcare establishments will be the major employers.  I think that major employers for massage will make adjustments to support income and advancement for top performing massage therapists.

Tuitions need to come down to a more realistic level.  Student should pay per classroom hour what is a typical hourly wage for massage practitioners $10-$15. This means entry level tuition at the 625 ELAP recommendations should be between $7000 and $10,000. 

I think massage therapy will sort into a tier system based on licensing at entry level and then Board Certification and Specialty Certification. I do not see massage education routinely becoming an associate’s degree entry point into the job market. I believe entry level education is best provided at a diploma level. I do think more community colleges will begin to provide massage education.

 I hope and believe the small vocational school will become again the major avenue for massage education as corporate schools continue to be under pressure.  I think the financial aid system will be completely revamped and I recommend that massage educators avoid getting into the financial aid trap.  I expect COMTA will provide a programmatic approval process for small schools that do not participate in financial aid.  Truth is COMTA has to do this for it’s own survival.   I do hope that massage educators will be required to achieve specific certification and be encouraged to achieve at least associates degree to bachelor’s degree academic education.   

So change is inevitable.  Fighting to stop change is a waste of time.  Working to guide change for the best outcome is an important commitment. Let’s get over the past, learn from it and move forward.

Now !


  1. Well said Sandy –– an accurate assessment of where things are and where they may be expected to evolve. Thank you for you hard work, passion to help on many levels, and for your diplomatic manner.

  2. Thanks You Sandy! This is an Excellent Overview of the development of the Massage & Bodywork Therapy profession.