Ancient and religious origins
Ancient India, China, Egypt, Greece, and Rome
Forms of massage and therapeutic touch were used in ancient medical, religious, bathing, athletic, and domestic settings.
These practices are part of the longer history of hands-on care, but they should not be described as hospital-based massage in the modern sense. Ancient temples, healing halls, baths, and military facilities were different from present-day hospitals.
Fourth century: Christian houses of refuge
Early Christian communities established houses that cared for people who were sick, poor, dying, or traveling.
Hands-on comfort may have been part of this care, although the surviving evidence does not support a continuous line between these institutions and modern professional massage therapy.
Middle Ages: Touch in religious care
Touch appeared in Christian healing traditions through nursing care, anointing, comforting the sick, and the “laying on of hands.”
Religious touch and prayer should be distinguished from massage as a defined clinical treatment.
Massage enters organized medical and hospital care
Eighteenth century: Massage used in European medical institutions
Manipulation, rubbing, friction, exercise, and related physical treatments were used in some European hospitals, military facilities, spas, and medical institutions.
The terminology and professional roles varied. Massage had not yet developed into the standardized occupation recognized today.
1882: Anna Maxwell introduces massage into American nurse training
Anna Caroline Maxwell, later called the “American Florence Nightingale,” began teaching nursing students at Massachusetts General Hospital.
Historical accounts report that she instructed students in massage. Head nurses reportedly requested additional instruction at their own expense, and physicians began prescribing massage for patients.
Massage subsequently appeared in nursing textbooks and hospital training programs as an important nursing skill. By the early twentieth century, massage location, frequency, and purpose could be included in a patient’s nursing care plan.
1883: John Harvey Kellogg and Battle Creek Sanitarium
John Harvey Kellogg incorporated massage, exercise, hydrotherapy, diet, and other physical methods into patient care at the Battle Creek Sanitarium in Michigan.
Nurses and attendants were trained to provide massage as part of the sanitarium’s treatment system. Kellogg later published extensively about massage, including The Art of Massage in 1895.
The frequently repeated 1883 date appears to relate to Kellogg’s developing sanitarium system. It should not be used as the publication date of The Art of Massage.
1901: Massage instruction in hospital training schools
Helen Conkling Bartlett published “The Teaching of Massage to Pupils in Hospital Training-Schools” in the American Journal of Nursing.
Bartlett discussed the qualifications needed to teach massage and the importance of proper instruction for nursing students. The article shows that concerns about competence and educational standards existed more than a century ago.
1907: “Notes on Massage”
Helene Biermann published “Notes on Massage” in the American Journal of Nursing.
Massage remained part of nursing education and hospital care during this period.
1915: Physiological effects of massage
Anna Quincy Churchill published “Massage, Its Physiological Effects” in the American Journal of Nursing.
Hospital literature was connecting massage methods with physiology, clinical purposes, and safe application.
1918: Gertrude Beard joins the Army reconstruction program
During World War I, nurse Gertrude Beard was recruited into an Army orthopedic unit preparing to staff a reconstruction hospital in France.
The Army sought nurses with training in massage and therapeutic exercise. Beard later became an important figure in the development of physical therapy education at Northwestern University.
This period was important because massage, exercise, rehabilitation, and physical therapy were still closely connected.
1923: Massage used in military medical barracks
Photographs and historical accounts show soldiers receiving massage and rehabilitation treatments in military medical facilities.
Massage was used alongside therapeutic exercise and other physical reconstruction methods for injured service members.
1927: Massage taught through physical therapy education
Massage was taught through the Physical Therapy Department at Wesley Hospital, while other technical instruction and clinical practice were provided through Northwestern University.
This illustrates a major professional shift. Massage that had previously been taught largely within nursing was increasingly incorporated into physical therapy and rehabilitation education.
1920s–1940s: Massage remains part of nursing curricula
Massage continued to appear in nursing textbooks and school curricula. It was taught as part of bedside care, comfort, circulation, rehabilitation, and the management of selected medical conditions.
Paula Thomas Ruffin’s 2011 study, “A History of Massage in Nurse Training School Curricula, 1860–1945,” documents this period.
Decline of routine nursing massage
Mid-twentieth century
Massage and routine back rubs remained part of nursing care in many hospitals, but their use gradually declined.
Several factors probably contributed:
- Increasing nursing responsibilities
- Shorter hospital stays
- Greater use of medical technology
- Changes in staffing
- Development of physical therapy
- Changing professional boundaries
- Growing dependence on medications and procedures
- Less time for extended bedside care
Hospital massage did not disappear completely, but it no longer had a consistent place in mainstream nursing education and practice.
Rebuilding hospital massage
1980s: Massage develops in hospice, HIV/AIDS care, geriatrics, and integrative medicine
A number of practitioners began developing adapted forms of massage and compassionate touch for people with serious illness, frailty, cancer, HIV/AIDS, and end-of-life needs.
This work helped establish the modern field of hospital-based and medically adapted massage.
1980s: Irene Smith, Dawn Nelson, and Helen Campbell
Irene Smith, Dawn Nelson, and Helen Campbell were among the practitioners who developed and taught touch-based care for people with HIV/AIDS, serious illness, frailty, and dying.
Their work challenged fear of touching people with serious or stigmatized illnesses.
Exact dates for individual courses and programs should be verified before assigning all of this work to 1980 specifically. Much of the documented activity appears to have developed across the 1980s and early 1990s.
1980s: Dawn Nelson and massage for older adults
Dawn Nelson helped develop adapted massage and touch for older adults and medically fragile people.
This work contributed to later approaches involving geriatric massage, compassionate touch, and reduced-pressure treatment.
1980s: Helen Campbell and hospice massage
Helen Campbell helped develop massage and touch practices for hospice and hospital patients.
Her work contributed to the recognition that massage for seriously ill or dying patients required different goals, techniques, pacing, and expectations from conventional massage practice.
1980s: Boulder Hospice and Colorado programs
Practitioners including Barbara Carnahan and Mary Kathleen Rose were associated with early hospice and compassionate-touch work in Colorado.
Colorado became an important center for the development of hospital, hospice, and medically adapted massage education.
Mid-1980s: California Pacific Medical Center program develops
Social worker Tedi Dunn and nurse Marian Williams helped develop massage and touch services at what became California Pacific Medical Center in San Francisco.
The program became an important example of massage integrated into hospital care through nursing, integrative medicine, and volunteer services.
The exact institutional names and dates should be checked carefully because California Pacific Medical Center was formed through mergers of predecessor hospitals.
1980s–1990s: Karen Gibson advances hospital massage
Karen Gibson, a nurse and massage therapist, helped develop hospital massage programs in Colorado.
She worked with the Boulder School of Massage Therapy to develop hospital internship opportunities. Her work included hospital administration, clinical procedures, therapist preparation, program design, and patient safety.
1992: National Association of Nurse Massage Therapists
The National Association of Nurse Massage Therapists was founded by Andy Bernay-Roman, who was a registered nurse, massage therapist, and psychologist.
The organization represented nurses who incorporated massage into nursing practice and supported the relationship between the nursing and massage professions.
1992: Early modern hospital programs
Some programs later documented by the Hospital-Based Massage Network traced their origins to the early 1990s.
Summit Medical Center in California, for example, reportedly had a massage therapist volunteering in the hospital by 1992.
These early programs used many arrangements:
- Hospital employees
- Independent contractors
- Nurses who were also massage therapists
- Volunteers
- Massage students
- Outpatient providers
1995: Hospital-Based Massage Network is created
Laura Koch founded the Hospital-Based Massage Network in Colorado.
HBMN collected information about:
- Existing hospital programs
- Program proposals
- Hospital administrative approval
- Safety protocols
- Universal precautions
- Documentation
- Training
- Internships
- Research
- Insurance
- Funding
- Consultants
- Population-specific practice
HBMN became an important organizing and information-sharing project before field-wide hospital massage competencies existed.
1995–2000: Hospital massage knowledge is collected
The Hospital-Based Massage Network published articles addressing:
- Definitions of hospital-based massage
- Program development
- Administrative approval
- Proposal writing
- Infection prevention
- Documentation
- Nursing relationships
- Staff and patient surveys
- Funding
- Insurance reimbursement
- Volunteer programs
- Internships
- Research
- Oncology
- Hospice
- HIV/AIDS
- Pregnancy
- Infants
- Geriatric care
1998: First Hospital-Based Massage Programs List
HBMN published its first directory of hospital-based massage programs.
The directory allowed programs to learn from one another and gave therapists examples they could include in proposals to hospital administrators.
1998: Hospital use of complementary care remains limited
One frequently cited estimate reported that 7.7 percent of United States hospitals offered one or more complementary or alternative services in 1998.
This statistic concerns the broad category of complementary and alternative services. It does not mean that 7.7 percent of hospitals offered massage specifically.
1999: St. John’s Rehabilitation Hospital establishes a massage clinic
St. John’s Rehabilitation Hospital in Toronto established a massage therapy clinic.
The clinic was later formally integrated into the hospital’s Back on Track outpatient rehabilitation program. Massage therapists worked with patients experiencing:
- Burns
- Amputations
- Neurological conditions
- Organ transplants
- Complex trauma
Therapists participated in assessments, progress reports, treatment planning, outcome measurement, clinical rounds, family meetings, and hospital committees.
2001: Exploring Hospital-Based Massage is published
HBMN published Exploring Hospital-Based Massage: Selected Articles from the Hospital-Based Massage Network Quarterly, 1995–2000.
The book warned that reading about hospital massage was not enough to prepare a therapist to work safely with hospitalized patients. Specialized education and supervised experience were still necessary.
2001: Investigation of hospital massage programs
Teri K. Polley Michea completed “An Investigation of the Value and Function of Hospital Based Massage Therapy Programs in the United States.”
Questionnaires were sent to 50 hospitals thought to have massage programs. Twenty-nine completed surveys were returned.
Among those responding programs:
- 41 percent had existed for more than five years.
- 28 percent had existed for three to five years.
- Physicians referred patients in 25 programs.
- Nurses referred patients in 21 programs.
- 72 percent were fee-for-service programs.
- 24 percent reported some insurance reimbursement.
- 21 percent reported tracking patient outcomes.
Because this was a small survey of known programs, the findings should not be treated as representative of every American hospital.
2002: More than 100 hospital programs documented
An updated HBMN directory contained more than 100 hospital-based massage programs and more than 150 practitioners or interested colleagues across more than 40 states and other countries.
A later summary described 116 voluntarily reported programs:
- 36 provided massage in obstetrics or gynecology.
- 34 provided massage in oncology.
- 31 worked through wellness programs.
- 22 worked with infants.
- 21 worked in physical therapy.
- 19 worked in geriatrics.
- 16 worked in surgery.
- 78 provided massage to hospital employees.
- 52 offered educational classes.
- 11 reported conducting research.
Programs also reported serving intensive care, critical care, emergency, psychiatric, cardiac, orthopedic, rehabilitation, HIV/AIDS, traumatic brain injury, spinal cord injury, and stroke populations.
These voluntary listings document the range of programs, but they were not a national census.
2004–2005: Clinical textbook for medically fragile patients
Gayle MacDonald published Massage for the Hospital Patient and Medically Frail Client.
The book became an important resource for adapting massage for hospitalized and medically fragile patients.
It addressed the reality that hospital massage requires different goals, positioning, pressure, treatment duration, communication, and safety decisions from ordinary massage practice.
2007: Five factors for a successful hospital practice
Anna Kania published “Building a Hospital-Based MT Practice: 5 Key Factors.”
Based on her experience at St. John’s Rehabilitation Hospital, she identified five central requirements:
- Define the massage therapist’s role.
- Educate hospital staff and patients.
- Develop strong clinical skills.
- Participate in hospital activities.
- Use sound business and administrative practices.
She emphasized that massage therapists needed to show what they contributed without duplicating nursing, physical therapy, occupational therapy, or other services.
2007: Society for Oncology Massage is founded
The Society for Oncology Massage was established to support safe, adapted massage for people affected by cancer.
Oncology massage became one of the most important specialty areas connected with hospital and medical massage.
2007: HBMN publishes an extensive resource directory
The third edition of 1001 Sources to Build Your Hospital Massage Program was published.
It included resources related to:
- Hospital program development
- Professional organizations
- Credentials
- Consultants
- Internships
- Hospice
- Oncology
- Geriatrics
- HIV/AIDS
- Manual lymph drainage
- Pregnancy
- Infant massage
- Infection control
- Insurance
- Research
- Clinical trials
- Medical literature databases
2007–2008: Growth in hospital complementary services
A 2007 American Hospital Association survey found that 37 percent of responding hospitals offered one or more complementary or alternative services.
Massage was reported as a leading outpatient integrative service and one of the most common inpatient services.
This does not mean that 37 percent of all hospitals offered massage. The percentage concerned hospitals reporting at least one complementary service.
2008: Massage Therapy Foundation addresses clinical guidelines
The Massage Therapy Foundation’s Best Practices Committee published “Steps toward Massage Therapy Guidelines: A First Report to the Profession.”
The project was broader than hospital massage. It helped establish a more formal professional discussion about:
- Clinical competence
- Evidence
- Guidelines
- Credentialing
- Transparency
- Professional accountability
2009: Cardiovascular surgery massage program begins
A large Midwestern academic medical center, identified in the course-development literature as Mayo Clinic, hired two part-time massage therapists for cardiovascular surgery patients.
The program followed a quality-improvement project and research examining massage for postoperative pain, anxiety, and tension.
The therapists had more than 1,000 hours of massage education and relevant healthcare experience, but neither had initially received comprehensive hospital-massage training.
About 2010: Massage expands into colorectal surgery
The same medical center added a massage therapist to work with patients undergoing colorectal surgery.
As massage expanded to more complex patients, therapists identified important gaps in their original education:
- Hospital safety
- Charting
- Medical terminology
- Infection control
- Hospital navigation
- Communication with healthcare professionals
- Tubes, lines, and incisions
- Hospital-bed positioning
- Pressure modification
- End-of-life care
- Emotional self-care
2011: Nursing curriculum history is documented
Paula Thomas Ruffin published “A History of Massage in Nurse Training School Curricula, 1860–1945.”
Her research documented the historical role of massage in nursing education and hospital care.
The study provided scholarly support for the argument that massage had once been an established part of American nursing knowledge.
2012: Hospital-Based Massage Therapy Task Force is formed
The Academic Collaborative for Integrative Health formed the Hospital-Based Massage Therapy Task Force.
The task force was created because hospitals were using massage but lacked consistent standards for:
- Education
- Hiring
- Credentialing
- Orientation
- Clinical supervision
- Competency evaluation
2013: Survey of hospital programs
The task force sent a survey to 37 known hospital massage programs. Thirty-two hospitals responded.
The survey found considerable variation.
Among the responding hospitals:
- 81 percent required graduation from a massage program.
- 75 percent required training specified by state or local regulation.
- 75 percent required massage licensure.
- 44 percent required additional training.
- 38 percent required national certification.
- 66 percent provided internal training or orientation.
- 39 percent used massage-specific clinical supervisors.
- 18 percent reported no clinical supervision beyond administrative oversight.
- 94 percent offered massage to inpatients.
- 75 percent offered outpatient massage.
- 58 percent reported some type of paid status.
- 18 percent used volunteers.
- Nearly half participated in research.
Training ranged from approximately 20 hours of shadowing to 500 hours of internship-style education.
Because the researchers surveyed a small convenience sample of known programs, these percentages cannot be generalized to all hospitals.
2014: Educational gaps are identified
The survey identified recurring gaps in massage therapists’ preparation:
- Documentation
- Charting
- Assessment
- Treatment planning
- Medical terminology
- Electronic health records
- Hospital culture
- Communication
- Infection control
- Medical devices
- Precautions
- Contraindications
- Oncology massage
- Therapeutic relationships
- Hospital experience
- Interprofessional teamwork
2015: More than 125 programs reportedly listed
The Society for Oncology Massage reportedly listed more than 125 hospital-based massage programs on its website.
This is useful evidence of continuing program growth, but the underlying list and its inclusion criteria should be located before the number is presented as a verified national count.
2015: Hospital massage course is published
Liza Dion and colleagues published “Development of a Hospital-based Massage Therapy Course at an Academic Medical Center.”
The Mayo Clinic course included:
- Eight to ten hours of online education
- A 40-hour classroom and simulation program
- A 25-hour supervised hospital internship
Students practiced working with hospital beds, patient positioning, pressure modification, safety procedures, and simulated clinical situations.
The program was an educational model, not a national requirement.
2016: “Many Benefits, Little Risk”
Kathryn Westman and Cathy Blaisdell published “Many Benefits, Little Risk: The Use of Massage in Nursing Practice” in the American Journal of Nursing.
The article revisited massage as a nursing-related intervention and reviewed its potential use for pain, anxiety, stress, and patient comfort.
It also drew attention to the historical relationship between nursing and massage.
2016: Call for hospital massage competencies
The Hospital-Based Massage Therapy Task Force released “Hospital Based Massage Therapy: A Call for Competencies.”
It recommended:
- A baseline hospital massage curriculum
- Supervised shadowing
- Direct hospital experience
- Competency sign-off before independent work
- Massage-specific clinical supervision
- Condition-specific protocols
- Training in documentation, infection control, medical devices, precautions, teamwork, terminology, and electronic records
The DOI 10.1097/01.NAJ.0000476164.97929.f2 belongs to the Westman and Blaisdell nursing article. It does not belong to the Massage Magazine “Call for Competencies” article.
2016–2018: Competencies are refined
The task force collected feedback from hospital practitioners and other experts.
A Delphi-style process was used to revise the proposed competencies and build agreement about what therapists should know and be able to demonstrate.
2017–2018: Hospital-based massage competencies are completed
The Academic Collaborative for Integrative Health released its Hospital Based Massage Therapy Competencies for Optimal Practice in Integrated Environments.
The document is marked “Rev 2017_0322,” although the distributed PDF has commonly been identified as the 2018 competency document.
The framework contained three major areas.
Hospital Environment
Therapists should demonstrate competence in:
- Ethics
- Patient dignity and privacy
- Cultural differences
- Interprofessional respect
- Chart review
- Documentation
- Electronic records
- Medical terminology
- Communication through proper channels
- Reporting suspected abuse
- Medical devices
- Evidence-informed decisions
- Professional roles
- Infection-control precautions
- Personal protective equipment
- Required credentials
- Informed consent
Massage Protocols
Therapists should demonstrate competence in:
- Medical conditions and symptoms
- Patient assessment
- Treatment planning
- Pressure modification
- Positioning
- Treatment location
- Pacing
- Duration
- Treatment dose
- Indications
- Contraindications
- Precautions
- Practitioner safety
- Hospital equipment
- Professional limitations
- Hospital-appropriate body mechanics
Therapeutic Presence
Therapists should demonstrate competence in:
- Clear communication
- Interprofessional relationships
- Healthcare hierarchy
- Conflict resolution
- Recognizing pain, anxiety, grief, stress, and trauma
- Remaining present without attempting to cure or fix the patient
- Scope-of-practice boundaries
- Patient and staff boundaries
- Therapist self-care
- Maintaining a professional demeanor in difficult circumstances
2017–2020: Blessing Hospital develops an employed program
Blessing Hospital in Quincy, Illinois began an integrative-care initiative in 2017 and subsequently developed an employed massage therapy program.
A cardiologist helped introduce the idea, the chief executive supported it, and massage therapy was placed under rehabilitation services.
The program initially focused on one-day surgery and obstetrics. It expanded within approximately three months to rehabilitation, medical-surgical care, oncology, skilled nursing, and most other inpatient units.
Its operational structure included:
- Nurse- or physician-entered orders
- Electronic health record integration
- A massage therapist work list
- Full-time, part-time, and per-diem staffing
- Massage therapists participating in peer interviews
- Therapist involvement in policy development
- Monday-through-Saturday coverage
- No direct charge to patients
- Discharge-call feedback
- Coordination with nursing and physical therapy
2019: Competencies enter the peer-reviewed literature
MK Brennan, Dale Healey, Carolyn Tague, and Beth Rosenthal published “Hospital based massage therapy specific competencies” in the Journal of Bodywork and Movement Therapies.
The article presented the survey, consultation process, and resulting competency framework in a peer-reviewed journal.
The authors proposed that the competencies could be used by:
- Hospitals hiring and evaluating massage therapists
- Massage schools
- Continuing education providers
- Practicing massage therapists
- Organizations developing specialty credentials
Reported reasons for offering massage in hospitals
Historical hospital-program materials have reported massage being used for:
- 66 percent: pain management
- 57 percent: care of patients with cancer
- 55 percent: pregnancy-related massage
- 53 percent: physical therapy or rehabilitation support
- 45 percent: mobility training
- 41 percent: palliative care
These percentages need to be tied to their original survey, sample size, date, and question wording before being published as national statistics. They should not be presented as percentages of all American hospitals without that documentation.
Present situation
Hospital-based massage now has a published competency framework and several documented program models. It still lacks:
- A universally required national credential
- One accepted minimum number of training hours
- A single employment model
- Consistent clinical supervision
- A standard financing system
- Uniform hospital credentialing procedures
- A widely adopted specialty certification
State massage licensure remains the legal starting point. Licensure alone does not establish competence to work safely with medically complex hospitalized patients.