"We hold these truths to be
"There is no standard for what constitutes a 'good' massage.... Each client will have his own opinion on the subject, depending on his own tastes and physical condition.... Massage is an art. There is no one right way of doing it." It is a "misconception" to assume "that there is one definition of what constitutes a 'good' massage and a 'bad' massage.... Students and new graduates often ... think the way they were taught to massage in school is the 'right' way to do massage, and that massaging any other way is 'wrong'.... What you learn in school is a good basis from which to develop your own style."1
"The core issue that most therapists do not want to acknowledge is that massage as an art can be, and is, practiced by anyone without training."2
A letter of inquiry
To: Rhonda L. Whitener
Secretary, North Carolina` Chapter, AMTA
In your Letter to the Editor (on page 15 in the Fall l999, issue of Massage Therapy Journal), you say, "Most people don't know the difference between a good or bad massage."
We would appreciate your providing us with the information we request about that and other comments in your letter. Also, please give us permission to publish your reply in the Massage Law Newsletter. In return, we will answer questions you ask us, and give you permission to publish our reply.
What is a "good massage"?
Your Letter raises serious questions. How do you define a "good massage" and a "bad massage"? What well-documented evidence do you have which validates your allegation that "most people don't know the difference between a good or bad massage"? What criteria do "most people" use to decide whether a massage is "good" or "bad"? Who is more qualified to decide whether a massage is good" or "bad" than the individual who has received that massage?
What well-documented research correlates hours of training, test scores on the national certification examlnatlon and graduation from a COMTA-accredited school with "good" massages?
Afraid of what"
Why do you say you are frightened by "people out there calling themselves massage therapists who have not had one hour of training" and who "reflect on us as a whole."? How many massage therapists "have not had one hour of training," and how do you know they "have not had one hour of training"? In what ways and to what extent (for each for each of those ways) do those "people out there" ... ''reflect on us as a whole"?
If you are concerned that "those people out there" are incompetent, how do you define and how do you objectively measure hands-on competence? If you are unable to objectively measure hands-on competence, how do you differentiate allegedly competent from allegedly incompetent massage therapists? If you are unable to differentiate allegedly competent from allegedly incompetent massage therapists, how do you know which massage therapists are competent and which are incompetent? If you do not know which massage therapists are competent and which are incompetent, how do you know there are incompetent massage therapists. If you do not know there are incompetent massage therapists, why would you be concerned about incompetent massage therapists?
Who's inadequately trained?
If you are concerned about allegedly inadequately trained massage therapists' harming people with contraindications, what well-documented evidence do you have that allegedly inadequately trained massage therapists have actually harmed people with contraindications in North Carolina? How many allegedly inadequately trained massage therapists have injured how many people (with contraindications) in North Carolina during the past five years? What was the nature of those injuries, and how serious were they? What contraindications did the injured people have? What training and how many years of experience did the allegedly inadequately trained massage therapists, who injured people, have? If you don't have well-documented information to answer these questions, why would you be concerned about allegedly inadequately trained massage therapists' harming people with contraindication?
There's no harm in Georgia
In 1997, the Georgia Senate rejected the undocumented evidence of harm submitted by the Georgia AMTA Chapter to support a bill to regulate massage therapists. A Senate committee did its own research and concluded: "There is no documented danger of actual harm to the public... The potential for harm to the public appears to be remote and would not be alleviated by licensing." The Georgia legislators decided there was no reason to regulate massage therapists since they caused no harm, regardless of their training.3
There's no harm in the Canadian
Province of Quebec.
A governmental agency in Quebec conducted a comprehensive two-year research project which revealed that no harm was caused by massage therapists, regardless of their training. For this reason, Quebec has not regulated massage therapists.3
The College of Massage Therapists
of British Columbia (CMTBC) tells us there is no significant risk of harm by massage
therapists in the U.S.
CMTBC provided the following information in its July 6, 2000, submission to the Health Professions Council.4
"Massage therapy is unusual as compared to most therapies in that its effectiveness is greatly out of proportion to its potential harm."
"Reports in the medical literature of injury from massage have been rare in the past. This can be readily understood in terms of the practice and training norms that prevail throughout most of North America... Relaxation massage and general rather than specific therapeutic effects are emphasized. Also, although there has been a great increase in public interest in massage therapy and other forms of complementary health care in recent years, information presented at a recent meeting of the National Certification Board for Therapeutic Massage and Bodywork (May 19-20, 1999) indicated that a majority of U.S. practitioners do not provide treatment in a medical context and receive few if any medical referrals. It was estimated that fewer than 25% of all practitioners in the U.S. currently do any medically oriented massage that involves treating clinically diagnosed conditions. The three most often cited reasons for receiving massage therapy by U.S. consumers are relaxation (27%), relief of muscle soreness, stiffness or spasm (13%), and stress reduction (10%). Outside of BC [British Columbia], both physicians and the public have tended to approach massage therapy treatment with caution, and primarily for relaxation and other general therapeutic benefits. Patients with musculoskeletal injuries and disorders typically receive treatment from MDs or other health care professionals rather that massage therapists. This is not a pattern of massage therapy associated with a significant risk of harm."
Adverse effects of massage
are rare in the U.S.
According to Ron Precht at the AMTA, adverse reactions to massage "are really rare" and the claims against massage therapists annually in the U.S. are "miniscule."5 The term "in the U.S." includes states with and without regulation.
What harm has occurred
in North Carolina?
Since there's no harm in Georgia and Quebec, why would anyone assume there would be harm in North Carolina? Since Georgia and Quebec do not need to regulate its massage therapists to protect the public from harm, why would anyone assume that North Carolina needs to regulate massage therapists to protect the public from harm?
In the absence of well-documented evidence to the contrary, it is logical to assume that the incidence of contraindications is the same in the populations of Georgia and Quebec as it is in the population of North Carolina. Since unregulated massage therapists have not harmed people with contraindications in Georgia and Quebec, why would anyone assume that unregulated massage therapists would harm people with contraindications in North Carolina?
Who wants state regulation in
North Carolina, and why?
How can state regulation protect the public from harm in North Carolina if there's no well-documented evidence that serious harm has actually occurred.?
What well-documented evidence have those, who want state regulation, provided to show that state regulation is needed to protect the public safety, health, and welfare in North Carolina? If they have not provided this well-documented evidence, why do they want state regulation in North Carolina?
What well-documented evidence have those, who want state regulation in North Carolina, provided to show that there's less harm in states which regulate massage therapists than in states which do not?
What Consumer Protection Agencies have lobbied North Carolina state legislators to enact legislation which would regulate all massage therapists to protect the public from harm by allegedly incompetent massage therapists?
There is no well-documented evidence that the incidence of harm is less in states which regulate massage therapists than in states which do not. There is no well-documented evidence that the incidence of harm is less in states which now regulate massage therapists than it was before regulation was enacted. By incidence, we mean the number of cases of well-documented harm per 10,000, 100,000, 1,000,000 or more massages in a given period of time such as, for example, five years.
"The validity of what we do"
The only legal justification for state regulation is a well-documented need to protect the public health, safety, and welfare. Contrary to what your Letter to the Editor alleges, "Licensure does" NOT "give validity to what we do." What is your definition of "validity"? For us, validity (in states with and without regulation) is the value clients attribute to the quality of service their massage therapists provide.
Detriomental effects of licensure
It seems that proponents of licensing are hopeful that state license would mean more money, status, and power. Jerry A. Greene. Attorney for the California Coalition on Somatic Practices3
I think the move toward licensing is regrettable. I believe licensing creates state-sanctioned monopolies ... with the explicit goal of 'protecting the public, but with the real effect of protecting those who hold the monopolies' respective entitlements, reducing information to the public, and restricting competition. Don Schwartz. Director, Trager Institute3
Gail Frei reported that The Connecticut Center for Massage Therapy (CCMT) ... charges twice the national average for tuition! In effect, Connecticut's restrictive licensure law creates a state-sanctioned monopoly for CCMT, and constitutes restraint of trade.5
Self-regulation in the Canadian Province of Ontario enables massage therapists, who want to be regulated, to get themselves regulated. It permits those, who don't want to be regulated, to do massage without being regulated. This is a democratic live and let live regulation.
In Ontario, which has self-regulation by title protection, anybody - regardless of her training - can do massage and even use the term "massage'' in advertising. But only a practitioner who has met the title protection requirements may call herself a "Massage Therapist." One reason why this kind of self-regulation was established is that it avoids monopoly control.3
We are unaware of any evidence (a) that people with contraindications, have been harmed by unregulated practitioners in Ontario, (b) that Registered Massage Therapists are frightened by unregulated massage practitioners in Ontario, and (c) that unregistered massage practitioners have reflected adversely on registered Massage Therapists in Ontario. The public in that province appears to be well-satisfied with the two categories of registered and unregistered practitioners. What well-documented evidence do you have that the public in North Carolina would not be satisfied with having the same two categories of massage practitioners which Ontario has?
1. Sohnen-Moe, C. A peek at the future evolution of practices. Massage Journal. 38(5):56-66. Millennium issue. 2000.
2, Greene, L. Save Your Hands! Injury Prevention for Massage Therapists. Infinity Press. Seattle, WA. 1995.
3. Schatz, A. Massage should be deregulated because it does not cause harm. Massage Law Newsletter. 5(2)1-18. 1998.
4. Schatz, A., and Brewster, M. The College of Massage Therapists of British Columbia tells us there is no significant risk of harm by massage therapists in the U.S. Massage Law Newsletter 14(3):1. 2000.
5. Marcus, A. Rubbed the wrong way. HealthScout. December 22, 1999.
6. Frei, G. A report of harm caused by state regulation. Massage Law Newsletter. 11(1):10. 1999.