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The answer to this question depends on who you ask and where in the world you live. The practice of massage is extremely popular all over the world, but what exactly defines it as a profession is varied and open to much discussion and debate.

In Canada, every province has its own association and practice definition. Only 4 of the 10 provinces have legislation under a health care act. In the US, the profession differs among states. What about Australia and New Zealand? They have massage therapists and something called a myotherapist? Their scope appears to be wider than that in Canada. However, a wider scope does not mean better. According to the Australian Association of Massage Therapists (AAMT), some of the approved modalities are, applied kinesiology, orthobionomy, ear candling, emotional freedom techniques and Looyen work. It seems that the pseudoscience and focus on modalities over science based reasoning and clinical decision making is prevalent everywhere people practice massage. Why is this? I believe an inconsistent scope of practice plays a role in confusing the profession. We don’t really know who we are. I think a simple answer is because being told what to do and mirroring techniques is much easier than learning how to think.

One of the principal issues with the profession is its name, massage therapy.

Massage indicates something that is being done, not a health care profession. It implies that we rub skin for therapeutic purposes. Which isn’t far from the truth. However, the name overly simplifies the true scope of our potential knowledge and skills in the rehabilitation world.
Registered Massage Therapy (RMT) is a health care profession in Canada. It is the most widely utilized non-physician health service in BC. Next to pharmaceuticals and dentists, RMT’s are the largest expense to 3rd party insurance companies. Is this a good thing? It’s good for the standard of living for the average RMT and it indicates how much the public values the service we provide. However, with a lack of good research to support the mechanisms of massage and manual therapies, combined with a poor educational curriculum that is based on outdated biomedical beliefs (read my prior blog here) the profession of massage therapy still needs to mature.

The public perception of massage therapy and its usefulness in the health care world is hampered by the fact massage is often viewed as something of a ‘feel-good’ luxury and not as a valid health care profession. I have no personal problem with therapists who work in a spa or resort, but how massage is marketed at these places distorts the public image of our profession. If we want to become more of an evidence informed medical profession we need to start portraying ourselves as one.

The context of massage is loaded with powerful psychosocial effects which we should be embracing and using to their fullest potential.

The belief that massage alone is a significant intervention to relieve complex pain problems appears to be held by many therapists and the general massage seeking population. For massage therapists to evolve and develop into the profession that we desire, we need to expand our comfort level to include more exercise, movement strategies and pain education. This would provide us with the knowledge necessary to provide optimum management strategies to the patients’ who already entrust us with their care, and make our work more defensible in the evidence based health care environment.

Our old scope of practice in BC was defined for decades as rubbers and kneaders of the skin.

It even included something regarding the use of steam or vapour baths?! Thanks to the RMTBC we recently had an updated scope of practice definition which is much more fitting:

“massage therapy” means the health profession in which a person provides, for the purposes of developing, maintaining, rehabilitating or augmenting physical function, or relieving pain or promoting health, the services of
(a) assessment of soft tissue and joints of the body, and
(b) treatment and prevention of physical dysfunction, injury, pain and disorders of soft tissue and joints of the body by manipulation, mobilization and other manual methods.

While this definition does not expressly include, for example, formulating a treatment plan and designing a home care program, neither does it exclude those activities, which are important parts of massage therapy practice (and are expressly referenced in the College’s Standards of Practice).

A health profession is defined, under section 1 of the Health Professions Act, as meaning a profession in which a person exercises skill or judgement or provides a service related to:

  1. the preservation or improvement of the health of individuals, or
  2. the treatment or care of individuals who are injured, sick, disabled or infirm. (emphasis added)

Now we are finally considered professionals who can treat people in pain and dysfunction.

A big problem for massage therapy?

Nothing is unique to us as a profession. Kinesiologists, Physical Therapist’s and Athletic Therapist’s have more standardized and recognized education (a university degree) and DC’s have a scope that defines who they are and what they do. As much as RMT’s like to think they are special and have distinctive skills and knowledge, we don’t. We are no better trained than any of these professions, except we know how to give a good massage. Is that enough to justify us being part of the healthcare environment and demanding the high fees and insurance reimbursements? How do we move into a professional landscape where we can define ourselves and maintain relevancy? I propose the profession will need to change its name, increase its educational standards and rewrite from scratch the Interjurisdictional Competency document and the associated Guidelines for Foundational Knowledge.

I strongly believe that we can become true leaders in the rehabilitation world by embracing an accurate understanding of pain science, manual therapy, and learning how to maximize our skills to influence the contextual effects of our clinical interactions. Let’s adopt a defensible conceptual framework, and focus on understanding that pain is a multifactorial biopsychosocial experience. To treat pain and its related dysfunction we need to incorporate an approach which addresses the multitude of factors associated with the pain experience.
A treatment scope that is focused on manual skills but nothing that addresses or appreciates psychosocial factors is negligent. If our scope allows us to treat people in pain than we should be given the tools that enable us to do this as effectively as possible. A few of us are trying this using continuing education, but a system wide change is necessary for large scale reform.

Because of solid efforts from groups such as the RMTBC, we continue to develop and progress as a profession in Canada. More work still needs to be done as we have further to go and much more to achieve.

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