Massage Therapy Career and Training Information
With an origin that traces back thousands of years, massage therapy is an ancient practice that is not only still relevant, but has also been increasingly gaining in popularity over the last two decades.
More and more people are turning to holistic health practices, and studies have shown the positive effect massage therapy can have on relieving stress and pain and improving overall well-being. All of these factors have combined to make it an in-demand career field.
In simple terms, it is the act of using your hands (elbows, forearms, and feet are sometimes used also) to apply a variety of "rubbing" techniques (as Hippocrates is said to have called them) such as stroking and kneading in order to manipulate the soft tissue and joints in various areas of the body. (Skin, muscles, tendons, ligaments, and joint capsules all fall under the category of "soft tissue.")
The primary components used in virtually all techniques include:
- Effleurage—Strokes that use long, gliding movements and various amounts of pressure
- Petrissage—Kneading movements that are typically conducted in a circular motion
- Tapotement—Tapping motions performed with the fingers, palm, or side of the hand
- Vibration—Rapid, pulse-like hand movements
- Friction—Circular hand movements using strong pressure in order to create heat
Importance of Massage
Massage therapy might sound like an enjoyable way to relax and de-stress (and it is), but the positive effects go far deeper. It helps release muscle tension and improves blood flow to joints and muscles. However, it has also been proven to have a positive effect on various body systems, including:
- Central nervous system—triggers a relaxation response, causing the body to release endorphins that act as natural painkillers and calming aids.
- Circulatory system—helps stimulate the circulatory system, increasing circulation, which in turn increases the amount of oxygen and nutrients reaching body tissues.
- Digestive system—helps stimulate organ activity, improving waste removal, enzyme production, and more.
- Respiratory system—deepens, stabilizes, and normalizes breathing patterns, and can help clear congestion in the lungs.
- Skeletal system—decreases inflammation in joints, helps restore range of motion, and can help improve posture.
Additional benefits include:
- Reduction of pain and stiffness in muscles and joints through removal of lactic acid and other waste
- Lowering of stress hormone levels, helping to reverse the damaging symptoms of stress, such as raised blood pressure, accelerated heart rate, and respiration
- Increased cranial vagus nerve activity, which helps with food absorption, heart rate, and respiration
- Heightened levels of dopamine and serotonin, which reduce feelings of anxiety and depression
- Decreased stress, which often leads to better sleep, improved concentration, and more
Some of the conditions for which massage therapy can be utilized as part of a treatment or prevention plan include:
- Arthritis, tendonitis, and other inflammatory conditions
- Headaches and migraines
- Repetitive strain injuries, including carpal tunnel syndrome
- Back pain, including sciatic nerve conditions
- Muscle strains, sprains, and spasms
- Rehabilitation from surgery or injury
This depends on a few factors, including the type of massage therapist and the environment he or she works in. For example, a registered massage therapist (RMT) working in a sports medicine facility can be quite different from a spa massage therapist working at a resort. However, there do tend to be common duties.
The administrative portion of the career usually involves:
- Scheduling appointments
- Consulting with new clients to review symptoms, record medical histories, and learn about lifestyle factors
- Billing and insurance processing
Aside from specific techniques and types of massage therapy (which will be outlined next), most jobs consist of a common set of general hands-on tasks. The typical process begins by setting up the massage table in a private area and organizing any needed supplies (massage oils, aromatherapy candles, etc.). Once the patient has arrived, he or she is taken to the private area and left alone to disrobe and lie face down on the massage table, under a sheet. (In North America, clients must be covered by a sheet at all times, with the massage therapist only exposing the part of the body being massaged.)
Once the therapist returns, he or she ensures that the client is comfortable and begins the massage. Most massage sessions last between 30 and 90 minutes. Unless a specific injury or illness is being treated, massage therapists begin with the back and neck, followed by the legs. The client is then asked to turn onto his or her back, and the massage resumes with the neck, arms, abdomen, and legs. At the completion of the massage, the therapist will give the client time to redress, often asking for feedback afterward in order to add notes to the client's file and plan future sessions. He or she will then complete the billing process, and if applicable, schedule the client's next appointment.
Now that the general similarities between massage therapy careers have been covered, it is important to understand that there is a significant difference between spa and registered massage therapy:
Registered Massage Therapy
- Tends to involve advanced techniques plus additional therapies, including hydrotherapy
- Generally requires more education and has stricter certification requirements
- Focuses on therapeutic treatments for general or orthopedic pathologies, including chronic back pain, tendonitis, chronic headaches, and muscle strains
- Career choices for RMTs are more likely to include health care settings, such as chiropractic offices, sports medicine clinics, or nursing homes
Spa Massage Therapy
- Tends to focus on relaxation and stress management rather than therapeutic treatments
- Is generally performed within spas, salons, resorts, or cruise ships
- Aside from massage, it can include additional services, such as aromatherapy, reflexology, body wraps, and hot stone treatments
- Generally attracts clients who are looking to treat themselves with enjoyable pampering rather than seeking treatment for an injury or illness
Differences Between Massage Techniques
Both generally utilize multiple massage techniques. Because of the huge variety, it is important to understand the differences between techniques. Here are some of the most common massage techniques found in the industry today:
- Thought to be the western world's most widely-used technique
- Invented by a Swedish physician who combined Chinese gymnastic and medical techniques with 19th-century sports medicine
- Typically used to relieve sore muscles, increase flexibility, and promote general well-being
- A Japanese massage technique that mainly involves using thumb pressure along the body's energy meridians
- Typically performed on a floor mat rather than a massage table, with the client remaining fully dressed
- Used to help athletes prevent injuries and enhance their performance abilities
- Created using advanced knowledge of the structure and biomechanics of the musculoskeletal system
- Typically involves soft tissue manipulation as well as gentle stretching and mobilization techniques
- Uses intense pressure to manipulate the connective tissue found deep within muscle or fascia structures
- Often used to relieve chronic muscle tension or knots
- May cause uncomfortable sensations during muscle manipulation, but the end results can outweigh the discomfort
- Also known as corporate massage
- An acupressure-based therapy that is performed on the back and neck
- Typically 10-15 minutes in length and performed with the client sitting in a special chair with his or her face resting in a cradle and arms resting on supports
- Typically offered in high-stress locations such as airports and convention centers
- Hands-on therapy using light strokes to help soothe infants and treat various ailments, such as colic
- Often used as part of treatment for premature infants
- Massage therapists can perform infant massage personally, or teach parents the necessary techniques to handle it themselves
- A combination of acupressure and reflexology mixed with energy work, meditation, and yoga
- Performed on a floor mat or a firm mattress
- Can involve the massage therapist walking on the client's back, performing rhythmic pressing and stretching and gentle pulling of ears, fingers, and toes
- Trigger points are areas of soft tissue that experience tenderness, pain, numbness, itching, tingling, or burning sensations
- The focus is on these trigger points, applying pressure in order to flush blood and toxins out of the area and promote healing
- Typically involves the use of smooth basalt or marble stones
- Depending on the intended usage, the stones are either heated or cooled and used as a tool to massage deep into muscles without causing the discomfort typically associated with traditional deep tissue massage
- Involves manipulation of the fascia (connective tissue layer surrounding muscles, joints, and bones) in order to free fascial restrictions and help muscles move more efficiently
- Primarily used to eliminate pain and increase range of motion
- Traditional Chinese massage technique
- Involves applying pressure to specific points in the hands, feet, and ears that are thought to correspond to various organs and tissues throughout the body
How to Become a Massage Therapist
You will need to first decide whether you want to become a spa massage therapist or a registered massage therapist since the educational and licensing requirements differ depending on the type of career you intend to pursue.
Becoming a spa therapist (also called spa practitioner) usually requires completing a certificate or diploma course that is typically 300 to 1,000 hours in length. The focus of these programs tends to be on using massage as a tool for relaxation and self-pampering. The curriculum can include:
- Swedish techniques
- Hot stone therapy
- Mud and seaweed wraps
- Salt glows
- Body scrubs
In addition to massage, relaxation, and beauty techniques, many spa therapist programs include business training related to spa management or entrepreneurship. Some of the general topics that get covered can include marketing, customer service, sales, and basic accounting.
If you wish to become a registered massage therapist (RMT), you will likely have to complete a more in-depth program that provides up to 3,000 hours of training. While you will most likely learn about relaxation-based massage techniques, the primary focus of registered massage therapy programs is on the treatment of injuries and illnesses. Therefore, the majority of RMT courses tend to highlight therapeutic techniques, such as:
- Deep tissue massage
- Sports massage
- Chair massage
- Thai bodywork
- Myofascial release
- Lymphatic drainage
- Neuromuscular techniques
- Joint mobilization
RMT programs also usually provide an extensive background in health care-related topics, including anatomy, physiology, kinesiology, and pathology. And, since RMTs are required to obtain national certification, programs generally need to be accredited by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) so that they can prepare students for national certification examinations.
Massage Therapy Certification Requirements
For those in 38 states and the District of Columbia, National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) certification is required by law in order to work as a massage therapist. However, even if you don't live in a state that requires certification, there are various reasons why you should still consider becoming certified:
- It shows that you are dedicated to your profession and committed to maintaining the highest industry standard in terms of skills and knowledge.
- It proves that you have obtained a minimum of 500 hours of instruction.
- It ensures that you have a strong understanding of safety and ethical considerations.
The NCBTMB offers two different exams:
- National Certification Examination for Therapeutic Massage and Bodywork (NCETMB)
- National Certification Examination for Therapeutic Massage (NCETM)
The eligibility criteria is the same for both exams and requires that you:
- Obtain the minimum hours of instruction: 125 hours of body systems, 200 hours of massage and bodywork assessment, theory, and hands-on application, 40 hours of pathology, 10 hours of business and ethics, and 125 hours of further theoretical instruction in massage therapy or another related field
- Graduate from a program at an NCBTMB-accredited school
Both exams are multiple choice and share most of the same content, including general knowledge of body systems, detailed knowledge of anatomy, physiology, and kinesiology, therapeutic assessment and application, and professional standards, ethics, and legal practices. The only critical difference between the two is that the NCETMB also includes questions regarding bodywork assessment and application whereas the NCETM focuses solely on massage.
Length of School
This depends entirely on the type of program you choose and the type of school offering the program.
Vocational schools, trade schools, and colleges usually offer short-term, career-focused programs. These programs are typically one year or less in length (and very rarely longer than two years) and focus solely on providing the hands-on skills and practical knowledge required to work in the industry—often omitting the general education and loosely-related theoretical material. Graduates generally receive a certificate or diploma.
Many public and private colleges and universities also offer certificate and diploma programs, and they often provide degree options as well. Degree programs are usually two to four years in length and, in addition to practical and theoretical massage therapy courses, also tend to include general education courses related to business, professional development, and more. This can be of benefit if your future goals involve taking on advanced or managerial positions in the industry or becoming an entrepreneur and opening your own massage therapy business.
No matter which type of massage therapy program or school you choose, it is important to keep in mind that if you want to live and work in a state that requires NCBTMB certification, the program you choose must meet the minimum requirements for training hours, and the school must be accredited by the NCBTMB.
Cost of Training
Just like with program length, program cost is entirely dependent on the type of program you choose to pursue.
However, for a typical certificate or diploma program, the average tuition can be as little as a few thousand dollars on the lower end of the scale, to $15,000 or more. The average tuition for a degree program can range from $20,000 to $40,000 and higher.
It is important to note that regardless of which program option you choose, most will require that you purchase books and equipment (such as a massage table), which are added expenses on top of the price of tuition. These prices can vary quite a bit, but the overall average tends to be around $1,000.
You might be pleased to know that there are a wide range of working environments for both RMTs and spa therapists. Some examples include:
- Private practices
- Health clubs and fitness centers
- Spas and salons (including ones at resorts and on cruise ships)
- Chiropractic offices
- Physicians' offices
- Rehabilitation centers
- Nursing homes
- Sports medicine clinics
In addition, some massage therapists opt to work in more than one environment. They buy portable massage tables and make house calls, spending their days traveling from house to house.
Salaries in this field tend to vary depending on experience, work environment, geographic location, and other factors. However, according to nationwide salary estimates from May 2017, massage therapy pay looked like this:*
- The median yearly pay for massage therapists was $39,990.
- The top 10 percent of earners made more than $77,470.
When it comes to salaries for licensed massage therapists, it is important to keep in mind that they tend to earn a combination of wages and tips. It is also notable that roughly half of them work part-time.*
The alternative health sector is becoming more and more popular, and one of the main areas people are embracing is massage therapy. National projections indicate that, between 2016 and 2026, the number of massage therapy jobs could rise by 26 percent. That is more than three times as fast as the national average for all career fields, which is seven percent.*
Benefits of the Career
- You can become part of a growing career field thanks to the alternative health sector's rising popularity.
- There are many different opportunities in the field. From entrepreneurship to health care, you can explore many different routes. Plus, if you choose to pursue a position on a cruise ship, you could even have the opportunity to travel as part of your job.
- Depending on what area of the field you choose to enter, you could enjoy extreme flexibility when it comes to your work schedule. Many independent massage therapists are able to set their own hours.
- If you are truly passionate about the work, you will likely never tire of it. Many massage therapists feel physically, mentally, and spiritually fulfilled by healing others through touch.
- Since you will be working one-on-one with clients, you have the opportunity to meet a variety of people and build close and lasting professional relationships.
* Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, web site last accessed on October 4, 2018.
National Certification Board for Therapeutic Massage & Bodywork (NCBTMB), web site last accessed on November 8, 2017.
American Massage Therapy Association (AMTA), web site last accessed on November 8, 2017.
Registered Massage Therapists' Association of Ontario (RMTAO), web site last accessed on November 8, 2017.
Federation of State Massage Therapy Boards (FSMTB), web site last accessed on November 8, 2017.