Medical Massage Therapy: The Search for Definition By Gregory T. Lawton, DN, DC Massage Today January, 2002, Vol. 02, Issue 01
Summary: Gregory T. Lawton’s article, Medical Massage Therapy: The Search for Definition, delves into the concept of medical massage therapy and the challenges surrounding its definition and validation as a medical practice. Historically, medical massage was widely practiced by medical professionals in the 19th century. However, with the rise of the “drug era,” traditional practices like medical massage, midwifery, and herbal medicine became marginalized, resulting in regulatory restrictions that relegated massage therapy to a lay practice. The article argues that back in 2002, there was a growing movement to re-establish massage’s therapeutic role in the medical field, particularly as massage therapy schools generally emphasize Swedish or therapeutic massage techniques rather than medical protocols.
The article critiques Swedish massage for its broad, generalized techniques and points out the lack of scientific evidence specific to medical massage, emphasizing that research has primarily focused on general massage methods, leaving gaps in understanding its therapeutic impact on specific medical conditions. While scientific validation of medical massage remains scarce, Lawton highlights a need for targeted studies on particular techniques and modalities within medical massage to distinguish its effects. He points out that other manual therapy disciplines, like physical therapy and chiropractic, offer some research insights that could guide the development of a more defined medical massage framework.
Medical massage therapy is emerging as a manual medicine system of treatment that does address the needs of a rehabilitation therapy environment. Medical massage therapy achieves this clinical criteria because:
1. Medical massage is not a general massage treatment; it is manual therapy applied to the specific area and the primary pathology of the patient’s chief complaint.
2. Medical massage is delivered to an anatomical region based on soft tissue and joint findings and after diagnostic palpation.
3. Medical massage protocol involves several progessive steps or stages of treatment that attempt to correct abnormal conditions affecting the joint complex.
4. Medical massage therapy is not limited to myofascial tissues; it includes highly specialized joint complex and joint mobilization techniques.
5. Medical massage adopts the medical techniques and protocols of other systems of manual therapy, including medical acupuncture and naprapathy.
Lawton proposes that medical massage therapy should be seen as a specialized manual therapy designed for rehabilitation settings. He outlines several distinguishing features of medical massage, including its specific focus on anatomical areas tied to a patient’s main complaint, a protocol based on soft tissue and joint findings from diagnostic palpation, and progressive treatment stages that target joint abnormalities. Lawton also discusses the inclusion of joint mobilization and deep tissue techniques, drawing from osteopathic and naprapathic principles to address chronic pain and connective tissue dysfunction. Medical massage thus integrates soft tissue techniques and joint mobilization, aiming to rehabilitate connective tissue through methods such as therapeutic exercise, patient education, and physiotherapeutic modalities.
In essence, Lawton argues that medical massage should be regarded as a modern renewal of historical manual medicine, rooted in connective tissue rehabilitation rather than general relaxation. This form of massage therapy demands a synthesis of training, intuition, and hands-on technique. Its goal is not merely to alleviate symptoms but to address the root causes of dysfunction for a long-term therapeutic impact.
Sept 2002 Massage Today. AMMA Releases Guidelines for Medical Massage Curriculum
https://web.archive.org/web/20021013025438/http://www.massagetoday.com/archives/2002/09/01.html
Summary: In the article AMMA Releases Guidelines for Medical Massage Curriculum, the American Medical Massage Association (AMMA) outlines a structured, evidence-based curriculum designed to elevate medical massage training to the standards of clinical care. According to the AMMA, medical massage differs from general massage practices by emphasizing physiological, biochemical, and neurological principles to treat specific pathologies, such as musculoskeletal and neurological conditions. This curriculum advocates for a “patient-centered education” approach, focusing on actual treatment scenarios to develop competencies aligned with health care standards, thereby distinguishing medical massage from relaxation or spa-based massage modalities.
The AMMA’s curriculum structure for medical massage therapists revolves around comprehensive anatomical and pathological knowledge, practical treatment skills, and clinical competency, starting with detailed anatomy and progressing through condition-specific protocols. Training follows a body-part and condition-based approach, where students learn region-specific anatomy, common pathologies, and targeted therapeutic techniques. Key clinical goals include reducing inflammation, restoring normal tissue conditions, ensuring range of motion, and addressing both objective findings and subjective symptoms. A minimum of half of the training should occur in supervised clinical settings, such as internships at medical clinics, to allow students to work directly with patients and develop critical clinical skills.
The medical massage approach uses technique to achieve four important clinical objectives:
1. reduction of the inflammatory process;
2. restoration of a normal soft tissue environment;
3. establishment of normal range of motion and
4. improvement in objective findings and the patient’s subjective complaints.
In addition to hands-on massage techniques, the curriculum incorporates therapeutic adjuncts such as hot/cold packs, infrared lamps, electrotherapy, and topical herbal treatments to enhance therapeutic outcomes and reduce therapist burnout. Furthermore, students are trained in essential administrative skills like SOAP note-taking, coding, and medical record-keeping, which are necessary for operating within health care environments. The AMMA underscores that medical massage is rooted in a natural, holistic model rather than an allopathic one, with the primary goal of supporting the body’s own healing mechanisms through manual therapy grounded in scientific and clinical understanding.
This curriculum contrasts sharply with traditional massage training, which often centers on a set number of hours without specific, measurable outcomes. The AMMA asserts that successful medical massage training requires a well-defined curriculum, qualified instructors with clinical experience, and practical training environments to prepare students for a range of health care settings. By adopting these standards, medical massage therapists can gain the competencies needed to treat clinical conditions effectively, contributing to the field’s credibility and expanding career opportunities within the health care sector.
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Nov./Dec. 2002, Issue 100 Massage Magazine. Roundtable by Charlotte Michael Versagi
https://web.archive.org/web/20021201171602/http://www.massagemag.com/current_issue.htm
Summary: In Roundtable by Charlotte Michael Versagi, published in Massage Magazine, the article addresses the growing presence of massage therapy in medical settings and the debate surrounding the term “medical massage.” Since the 1990’s (and maybe earlier) massage has found a home in diverse medical environments such as oncology units, delivery rooms, and outpatient clinics, where it’s valued for its ability to promote relaxation and recovery. This rise has been accompanied by an increasing use of the term “medical massage,” leading to a divergence of opinions within the profession regarding its meaning and application.
The term “medical massage” currently lacks a standardized definition, prompting discussions on what sets it apart from general massage practice. While some massage professionals argue that standard relaxation massage suffices for treating any client, others believe medical massage requires a higher level of expertise, specialized training, and an understanding of medical conditions to ensure safe and effective practice. Proponents see medical massage as a specialized modality, where advanced techniques and clinical insight are necessary to work effectively with patients facing specific health challenges.
This article kicks off a two-issue roundtable discussion that promises to delve into the complexities of defining medical massage, including terminology, training requirements, and the potential future of this evolving area within massage therapy. The roundtable aims to clarify whether medical massage should be recognized as a distinct practice requiring specialized skills and education.
Introduction, With a Response to AMMA By James H. Clay, MMH, LMBT Massage Today January, 2003, Volume 03, Issue 01 .
https://web.archive.org/web/20060521153838/http://www.massagetoday.com/archives/2003/01/12.html
O body swayed to music, O brightening glance, How can we know the dancer from the dance? – W.B. Yeats
Summary: In Introduction, With a Response to AMMA, James H. Clay offers a critical perspective on the American Medical Massage Association’s (AMMA) proposed curriculum guidelines for medical massage. He begins by contextualizing clinical massage therapy as a synthesis of various bodywork traditions, including techniques from myofascial release, structural alignment, and pain treatment, which have been informed by pioneers such as Ida Rolf and Janet Travell. However, Clay highlights a prevailing issue: both the public and medical community tend to perceive massage primarily as a relaxation therapy, limiting acceptance and understanding of clinical massage’s therapeutic benefits for pain and dysfunction.
Clay expresses agreement with AMMA’s recommendations for more robust anatomy, physiology, and pathology training, as well as for clinical exposure and internships. However, he raises several critiques about AMMA’s approach. First, he questions the use of the term “medical massage,” suggesting that “clinical massage” more accurately reflects the distinct, non-medical diagnostic approach massage therapists bring to treatment. For example, a physician diagnosing tendinitis might prescribe anti-inflammatory medication, while a clinical massage therapist would approach it with deep tissue therapy based on trigger point activity. Clay argues that adopting the term “medical” may suggest an eagerness to gain medical prestige, which he warns could stifle the massage profession’s independence and creativity, much like what happened to physical therapy when it became tightly integrated into managed care.
Clay also critiques AMMA’s proposed curriculum for its reductionist, body-part-focused approach, noting that pain in one area is often connected to muscles or postural factors from other body regions. He believes this model fails to embrace the holistic principles often valued in massage therapy. Additionally, he challenges AMMA’s focus on rigid “current and correct applications of medical massage,” warning that this could institutionalize the profession and limit continued exploration and growth. Instead, Clay advocates for flexibility and open-mindedness in technique development to prevent the profession from becoming overly prescriptive.
3) The article says that, “Currently, massage education is fixated on ‘hours in training,'” and later that “Time in training is not the central factor in developing good medical massage therapists; it is simply one factor.” I certainly agree with that concept. However, a quick trip to AMMA’s Web site (www.americanmedicalmassage.com), reveals that graduation from a 600-hour program is a requirement for membership in AMMA. Why 600 hours? Most programs I have come across span 500 to 600 hours, and I’m quite certain that most therapists practicing clinically are essentially self-taught, having gained the necessary knowledge and experience after massage school by attending workshops, reading books, watching videos, and working with clients. Among them are probably outstanding clinicians, but they would be ineligible for membership in AMMA.
Lastly, Clay points out minor yet significant errors in AMMA’s statements, such as their misuse of anatomical terminology (e.g., “bicep” instead of “biceps”). His emphasis on such details underscores the importance of precision, especially in a field focused on technical knowledge. Clay closes by encouraging an ongoing dialogue within the massage community to shape clinical massage therapy’s future collectively rather than leaving it to a single organization’s directives. His response emphasizes the need for a balanced, open-minded approach to clinical massage education that respects tradition while fostering innovation.
The “Medical Massage” Controversy Massage Today April, 2003, Volume 03, Issue 04 By Vivian Madison-Mahoney, LMT
https://web.archive.org/web/20060521152640/http://www.massagetoday.com/archives/2003/04/07.html
Summary: In The “Medical Massage” Controversy, Vivian Madison-Mahoney explores the ongoing debate over whether “medical massage” should be considered a distinct practice within massage therapy and the value of additional training and certification for this specialization. Madison-Mahoney clarifies that these are her personal opinions, acknowledging that her perspective comes from over 15 years of experience working with physician-referred medical cases. She questions the necessity of labeling massage as “medical” when it is provided in response to a physician’s diagnosis and prescription, arguing that this inherently qualifies it as medically necessary without the need for specialized nomenclature.
Madison-Mahoney points out that the term “medical massage” may be used by some for commercial or prestige reasons, but for others, it reflects a sincere commitment to improving patient outcomes, safety, and treatment efficacy. She contends that, while basic massage school training is a solid foundation, it is insufficient for addressing all clinical needs. Instead, she recommends a continuous pursuit of diverse hands-on training over the course of a career, which she believes benefits both practitioners and patients. This approach allows massage therapists to refine their skills across various medical cases, as new techniques and knowledge are often acquired gradually and applied as experience and patient needs evolve.
For some, medical massage simply means more money-making opportunities gained from teaching; for others, it is possibly nothing more than an ego trip; and for others still, it is truly about care, safety and success in treating patients. This last motivation is the only reason I feel any specific medical massage training or education should be considered. Does it really need to be defined as “medical massage”? I don’t think so.
Madison-Mahoney further argues that all massage therapists should receive at least basic instruction in medically oriented massage during their initial training, as it prepares them for potential referrals from medical professionals. Those interested in more medically focused work can pursue additional training in specific areas, such as geriatric care, cancer treatment, or injury rehabilitation. For her, the key to successful patient outcomes lies not in standardized certification but in ongoing education that adapts to the changing landscape of patient care and medical knowledge. This foundational medical understanding would enable therapists to provide effective care within their scope, whether or not they specialize in medical cases.
Drawing on her own career experience, Madison-Mahoney concludes that the ability to work with medically complex cases is built over time through diverse education and practical experience, rather than any single certification or training course. In her view, maintaining an open mind toward continuous learning is essential to sustaining patient trust and advancing the massage profession.
Massage Today February, 2004, Vol. 04, Issue 02 Orthopedic Massage vs. Medical Massage: Are We Using the Correct Terminology? By James Waslaski
https://web.archive.org/web/20120618050026/http://www.massagetoday.com/archives/2004/02/03.html
Summary: In Orthopedic Massage vs. Medical Massage: Are We Using the Correct Terminology?, James Waslaski discusses the importance of distinguishing between orthopedic and medical massage to prevent potential risks and enhance professional credibility. Waslaski recounts a personal experience where his mother’s serious medical condition, a dissecting aortic aneurysm, manifested symptoms similar to musculoskeletal pain. He notes that had an inexperienced practitioner attempted to treat her with massage, it could have resulted in a fatal outcome. In contrast, her orthopedic condition, iliotibial band friction syndrome, was effectively treated with orthopedic massage techniques, avoiding the need for surgery.
I am concerned about organizations that claim to “certify” massage therapists in medical massage in as few as three days. Doctors – especially chiropractors – frequently ask me how a massage therapist with as little as 300-500 hours of training can become certified in assessing and treating medical conditions in one weekend. I tell them that many educators and therapists in our industry misuse the term “medical massage” because it is the current “buzz word.” In other words, it sells seminars and sounds very clinical when used in practice and on business cards.
Waslaski defines orthopedic massage as the therapeutic assessment and treatment of soft tissues to restore structural balance, reduce pain, and prevent or rehabilitate musculoskeletal dysfunctions. He argues that the term “medical massage” is frequently misused, primarily because it is a trendy term that seems to convey clinical authority, which in turn, can create unrealistic expectations among patients and healthcare providers. According to Waslaski, using “medical massage” loosely builds a barrier between massage therapists and medical professionals who invest years in studying complex medical conditions. Instead, he asserts that orthopedic massage is a more accurate term for addressing pain, musculoskeletal issues, and conditions related to soft tissue and joint imbalances, such as thoracic outlet syndrome, carpal tunnel syndrome, and Achilles tendonitis.
Waslaski expresses concern about certification programs that claim to “certify” massage therapists in medical massage after only a few days of training, often without rigorous exams. This practice undermines the credibility of massage therapists and leads to skepticism from the broader medical community, particularly when therapists have minimal foundational training. Waslaski advocates for longer, more comprehensive training and calls for a distinction between medical and orthopedic conditions in massage education. He also highlights the need for multidisciplinary approaches, as combining techniques like CranioSacral Therapy, neuromuscular therapy, and myofascial release can yield better outcomes for patients with complex needs.
In his view, distinguishing medical conditions from orthopedic issues would benefit the profession by aligning massage therapists with other orthopedic practitioners, such as physical therapists and chiropractors. He supports the idea that the National Certification Board for Therapeutic Massage and Bodywork should establish a clear, advanced level of certification that involves rigorous assessment, ensuring that massage therapists possess the necessary expertise to safely and effectively treat complex cases.
April 22, 2005 | Ron Precht Profession Has Yet to Define Medical Massage Says
AMTA
https://web.archive.org/web/20050426104604/http://www.amtamassage.org/news/042205defined.html
Summary: In the article Profession Has Yet to Define Medical Massage, Ron Precht reports on the American Massage Therapy Association’s (AMTA) stance that the term “medical massage” remains undefined and lacks a consensus across the massage profession. The AMTA Board of Directors has written to state massage therapy regulatory boards, advising caution against establishing separate credentials or certifications for “medical massage” until the profession achieves a unified definition. They argue that without a clear definition, regulatory decisions or credentialing related to medical massage would be premature and could lead to inconsistencies in practice standards and expectations among massage therapists, healthcare facilities, and the public.
AMTA President Mary Beth Braun emphasized the importance of gathering input from diverse stakeholders, including the massage and medical professions, credentialing bodies, and regulators. She noted that while many practitioners refer to their work as medical massage, the legal meaning of “medical” in some states complicates its use without a shared understanding. Braun argues that defining “medical massage” would require collaboration across the profession and related fields to ensure that any definition reflects an informed consensus rather than fragmented interpretations.
It is AMTA’s point of view that the massage therapy profession needs to expand its body of knowledge to include core terminology, scope of practice and baseline competencies and generally agreed-upon baseline education standards. However, neither baseline educational standards nor a scope of practice could be determined without agreed upon definitions for key terms such as ‘medical massage’.
The AMTA believes that before setting standards or scopes of practice for terms like “medical massage,” the massage therapy profession must first establish baseline terminology, core competencies, and agreed-upon educational standards. This inclusive discussion would help the profession expand its body of knowledge while providing clarity and consistency for educators, therapists, employers, and consumers. The AMTA continues to gather feedback and promotes the ongoing discourse within the profession as an essential step toward any formal definition or regulation of medical massage.
Massage Today, July 2005, Vol 5. Issue 7. Using Medical Massage by Cliff Korn, BS, LMT, NCBTMB
Summary: In Using Medical Massage, Cliff Korn critiques the competition and confusion surrounding the term “medical massage,” especially in light of two organizations — the United States Medical Massage Association (USMMA) and the American Medical Massage Association (AMMA) — vying to define and control it within the massage therapy field. Korn observes that both organizations promote themselves as leaders in medical massage, asserting they represent the interests of all massage therapists. However, he suggests that much of their rhetoric is marketing-driven, or “puffery,” aimed at enhancing their influence and profitability rather than genuinely advancing the profession.
A cynic’s hat may sit comfortably on my head but I think that the rhetoric from both of these organizations sounds more like marketing than anything else. I believe the sales term is “puffery,” which means greatly exaggerating the benefits of a product with the intent of capturing a prospective buyer’s interest. Puffery is frequently entertaining but consists of promotional claims that no one out of diapers takes literally.
The article highlights the problematic aspects of the USMMA’s involvement in a class-action lawsuit against State Farm Insurance over down-coding of a medical massage billing code. The USMMA reportedly suggested to the court that only therapists certified by their organization or its affiliated certification body, the Medical Massage National Certification Board (MMNCB), should be eligible for insurance reimbursement, creating what Korn and others see as a conflict of interest. This stance was controversial because the MMNCB, TMMO (The Medical Massage Office), and USMMA are closely interlinked, all founded or controlled by David W. Luther, leading to questions about the credibility and objectivity of their certification processes.
Korn also includes a letter from Whitney Lowe, director of the Orthopedic Massage Education & Research Institute, who criticizes the MMNCB for its vague definition of medical massage. According to Lowe, the MMNCB’s definition focuses on insurance and physician referral requirements rather than specifying clinical skills or competencies that define medical massage. Lowe suggests that without transparency and rigorous validation, such certifications could undermine the profession by prioritizing insurance reimbursement over professional standards.
The article references the American Massage Therapy Association (AMTA)’s April 2005 statement, which advises regulatory bodies that no consensus on “medical massage” exists within the profession and recommends against creating special credentials until a unified definition is reached. Korn applauds the AMTA’s call for an inclusive discussion to develop a clear and meaningful definition of medical massage. He emphasizes the need for the profession to agree on core terminology and standards to prevent regulatory confusion and ensure credible certification pathways for therapists.
In closing, Korn suggests that the term “medical massage” already has a straightforward dictionary definition as a therapeutic practice aimed at treating or preventing health conditions through massage. He expresses hope that ongoing discussions will lead to a balanced and practical resolution without further division or misrepresentation within the field.
Massage Today, August 2005. Vol 5. Issue 08 Medical Massage: Facts, Fiction and Frustration By Rebecca J. Razo
Summary: In Medical Massage: Facts, Fiction and Frustration, Rebecca J. Razo explores the escalating controversy over defining “medical massage” in the massage therapy profession. The issue has gained prominence due to a Pennsylvania class-action lawsuit filed by Tracey Roberts, a massage therapist and United States Medical Massage Association (USMMA) state chapter president. The lawsuit against State Farm Insurance challenged the denial of reimbursement for massage therapy billed under a specific procedural code, alleging that these denials were based solely on Roberts being a massage therapist rather than a licensed physical therapist. The settlement eventually stipulated that State Farm could not deny payment solely on this basis, but the case triggered broader questions about defining “medical massage.”
The questions surrounding medical massage have plagued the profession for years, and yet clear-cut answers remain elusive: What exactly is medical massage? Who can practice it? What constitutes a medical massage therapist? The list goes on and on.
The USMMA’s founder, David Luther, stirred additional controversy by suggesting to the court that “medical massage therapist” should be limited to those certified through the Medical Massage National Certification Board (MMNCB), an organization he founded and controls. This prompted concerns of monopolization, with the Business League for Massage Therapy and Bodywork (BLMTB) warning that Luther’s influence could lead to a restrictive definition of medical massage, disadvantaging those who do not meet his criteria. BLMTB’s efforts to address these concerns led to a letter to the court urging a broader, less restrictive term. Luther, however, defended the MMNCE certification as a means to ensure qualified practitioners, arguing that only therapists with in-depth training should be allowed to bill insurance for medical massage services.
The article highlights multiple perspectives from within the profession. Vivian Madison-Mahoney, a longstanding advocate of insurance reimbursement for massage therapy, disagrees with limiting medical massage billing to specific certifications, emphasizing that all massage prescribed by a physician for a diagnosed condition should qualify for insurance coverage. Similarly, Patricia Cadolino, a medical massage therapist, warns that requiring MMNCE certification could negatively impact therapists in hospital settings by narrowing the scope of practice and limiting access to insurance reimbursement.
The American Massage Therapy Association (AMTA) added its voice, emphasizing that the massage profession has not reached a consensus on the definition of “medical massage.” They advised regulatory bodies to avoid creating separate credentials for medical massage until a unified definition is established. This ongoing lack of consensus is evident in the varied definitions offered by organizations like the Medical Massage Practitioners of America (MMPA) and the American Medical Massage Association (AMMA), each proposing unique, sometimes conflicting views on what constitutes medical massage.
The article concludes by underscoring the need for unity and a clear, agreed-upon definition within the profession to ensure consistent standards. Until such consensus is reached, Razo suggests the debate over medical massage will remain a contentious issue, posing challenges not only for practitioners but also for patients seeking specialized massage therapy care.
Massage Today October, 2005, Vol. 05, Issue 10 Searching for Medical Massage By Keith Eric Grant, PhD, NCTMB
Summary: In Searching for Medical Massage, Keith Eric Grant addresses the ongoing debate about defining “medical massage” by examining its potential roles within healthcare. Grant suggests that if massage is to be termed “medical,” it must align with medical objectives, specifically in treating dysfunction, achieving measurable outcomes, and possibly supporting preventative care. To further explore the relationship between massage and medical applications, he conducted a PubMed search covering January 1997 to August 2005, identifying 172 articles focused on massage treatments for various patient populations and medical goals.
If we are to call an area of massage “medical,” then it seems it should have connection to those who practice medicine and the treatments they provide. To be both relevant and comprehensive, medical massage should both fall within medical interest in massage and be broad enough to span the scope of such interest. Because medicine directs its efforts toward the treatment of dysfunction, medical massage also would be expected to produce measurable outcomes within the context of such treatment. Where integrated with medical efforts aimed at preventative intervention, preventative use of massage also would be medical massage. Outcomes might be directly observable based on patient reports, or on third-party diagnostics such as laboratory blood analysis.
The data Grant compiled showcases the wide range of conditions where massage is applied, from palliative care to chronic pain management, with goals such as pain reduction, stress management, and orthopedic rehabilitation. For example, massage has been used in treating infants, cancer patients, the elderly, and even caregivers, addressing both physical and psychological outcomes. Grant presents tables summarizing the populations and treatment goals, underscoring the diverse needs that medical massage can support, including improved psychological well-being, reduction of pain, and enhancement of immune function.
Grant draws several conclusions from his research. First, he argues that the terms “medical massage” and “clinical-orthopedic massage” address different focuses within massage therapy. While orthopedic techniques may target specific tissues, medical massage spans broader therapeutic goals, depending on the patient’s health needs. Second, he stresses that medical massage practitioners must understand and communicate effectively within medical settings, including familiarity with protocols, record-keeping, privacy, and the specific requirements of different patient populations. For instance, working with cancer patients requires knowledge of their diagnosis and treatments to ensure safe, tailored care.
Finally, Grant observes that clear norms and guidelines for medical massage training and practice are still needed, emphasizing the importance of collaboration with healthcare professionals to establish these standards. To him, “medical massage” is best defined by its integration within a medical context and its outcome-focused approach, and he encourages massage therapists to recognize the substantial opportunities to support patients across diverse healthcare settings by developing the necessary expertise and maintaining an outcome-oriented focus in their practice.