This is a guide for people who are trying to find a massage therapist who can help with chronic pain. I explain why it’s hard, and share some sad/weird tales of bad massage (all too common, I’m afraid). My recommendations are based on a lot of expertise and direct experience.1 I’ll tell you how to shop around for a good massage therapist, and especially a massage therapist who knows at least a little bit about trigger point therapy2 — enough to understand that it’s an experimental treatment.
Here’s how to find a good massage therapist, basically:
- You must shop around! Expect to go through several massage therapists before you find the one for you.
- Dare to be “high-maintenance” — politely express your preferences, and quickly move on from therapists who don’t respond respectfully. “Train” your therapist to do what you need. I will explain how below.
- Above all, please never tolerate “brutal” massage therapy. If your therapist seems to think there’s no gain without pain, move along.3 You want an intensity that is “satisfying” for you: neither too little, nor too much.
- Look for therapists with at least some kind of credentials. It doesn’t guarantee anything, but it improves the odds.
- “Medical massage” on the sign is usually a good sign. “Sports massage” is also usually a better bet. Not as good as credentials, but it means they are at least aspiring to a higher standard.
- If you are focused on a specific therapeutic goal (e.g. “relief from back pain”) continue therapy only if you see some signs of progress within 3-5 appointments in most cases. I will give some tips on how to tell.
- Beware of massage therapists who trash talk mainstream medicine or push classic quackery like homeopathy, detoxification, or anti-vaccination ideology. I give several examples.
- If you’re seeking trigger point therapy in particular: any good quality massage is better than bad trigger point therapy, so ultimately your most important goal is just to find a massage therapist whose style you enjoy.
Different priorities! Do you want a GOOD massage therapist? Or a good-LOOKING one? If you’re just looking for good-looking, leave this page now, kthxbye.
Sorry, I probably can’t recommend a therapist in your area
I constantly hear from readers who have been dissatisfied with therapeutic massage, and the most common question I get (by far) is:
Can you recommend a therapist in [insert any place on Earth]?
I have been asked a thousand times if I can recommend a therapist in Europe, Asia, India, Africa, Australia … whole continents where I know only a few people, and those few only thanks to email and Facebook and Twitter. And so, unfortunately, the question is mostly impossible to answer. I really need to know a therapist well before I’m prepared to recommend his or her services … and I don’t know them if I haven’t been on their table a few times. Even right here in Vancouver I barely know any therapists that well. And even if I did, they’d soon be too busy to take new patients (or they move, or they retire).
The problem: good massage therapy actually is amazingly hard to find
Massage therapy is like pizza: even when it’s bad, it’s pretty good. But when you’re in pain and you really need competent help, your standards go up, and you start to notice that a lot of so-called therapeutic massage is a bit sketchy.
From 2001 to 2010, I systematically asked patients why they left previous massage therapists. The experiment continues in correspondence with readers today. I have heard it all. Excessive pressure is the most common problem, and massage that is only “skin deep” and unsatisfying is a close second. (See The Pressure Question in Massage Therapy for more about that.)
But I have also heard a litany of basic problems with customer service. You’ve heard of “best practices” — a bit of a buzzword for the last few years. Well, these are some worst practices in massage therapy. For example:
- “He spent the entire time talking, mostly telling stories with lots of hand gestures. I’ll bet, in the entire hour, he spent less than 50% of the time with his hands actually on my body. Furthermore, he was a middle-aged man, and his topic-of-the-day was how he was feeling frustrated because he was still attracted to young women. Good grief!”
- “I had been three times already, and every time she ignored what I asked her to work on. The fourth time I went, I told her that I was feeling frustrated by this, and that I really did not want to work on my lower back, but wanted to work on my shoulders instead. I was that clear. Shoulders. Not back. No lower back, please. Then she started the massage with 15 minutes of work on my lower back. I was so flabbergasted I didn’t even say anything. What do you say to someone like that?”
- “The pain was ridiculous. I told her I was sensitive. I told her I didn’t want a no-pain-no-gain treatment. I stopped her at least a half dozen times and asked her to back off, and she would at first, and then it would creep right back up to agonizing again. I was a wreck for days!”
Such reports were routine during my career as a Registered Massage Therapist in the 2000s, and nothing much has changed since. And these were Registered Massage Therapists in Vancouver, Canada, with our unusually high standards (which have gone down since, not up).
What’s a patient to do in a sleepy midwestern town in the US, in a state where “medical” massage is simply an unheard of specialization? Where the only massage to be had comes from an old hippy bodyworker who speaks passionately about reflexology and wants to know what colour the pressure makes you think of?
My own worst massage ever
I knew I was in trouble the moment I walked into her office: the place reeked of essential oils, enough to give me a headache, her shelves were festooned with crystals, and her walls were covered with Scientology posters. If I’d been just a bit older and wiser at the time, I would have walked out immediately. Unfortunately, I stayed — perhaps out of morbid curiosity.
Cheesy, loud new age music, of course. Violently strong pressures, and total disregard for my requests to ease up. Rapid, erratic changes in technique, intensity and location — one moment she was wrenching my neck, the next slapping my back, and a few seconds later she was driving her elbow into my kidneys. And so on and on. It felt more like an assault than a massage. She actually shoved the heel of her hand into my eye socket, apparently by accident — I wonder what she actually intended to do? For what purpose, exactly, would you shove so hard and suddenly on any part of a person’s face that you might accidentally miss?!
At the very end, she drenched her hands in some floral scent that made me want to throw up, covered my nose and mouth, and commanded, “Breathe! Deeper! Deeper!”
At the end, great insult was added to injury: not only was it the worst massage I’d ever received, it was also the most expensive at $110/hour.
Why it’s so hard to find a good massage therapist
There are a lot of reasons, but here’s some of the main ones:
- Training and certification standards vary dramatically around the world, and are literally zilch in many states and provinces in North America.4 There are no large directories of well-trained, certified therapists.
- The profession attracts people with beliefs that are not consistent with medical science. Some such beliefs are quite outlandish.5 Bluntly put, a lot of massage therapists are flakes. For instance, a huge percentage of therapists practice “energy” massage — massaging your aura. I have a collection of the bizarre opinions of massage therapists, and it’s pretty horrifying.
- Many more therapists are preoccupied with “advanced” techniques of dubious value.
- Industry turnover is high. Many therapists burn out early with arm and hand injuries, long before they have the chance to get more seasoned, confident, and skilful.
- Both public and private insurance for massage is sketchy, which is a catch-22: the profession has difficulty standardizing and upgrading without insurance industry support, but insurers often won’t offer funds for massage therapy until it’s more medically credible.6
“No one has ever pressed on that spot before”? Really?!
There’s all kinds of bad massage, even dangerous massage,78 but this story from my own practice, many years ago, has long been one of my favourite eye-rollers. I still can’t quite believe it …
A young woman with a long history of completely unreasonable chronic headaches sought treatment from three of my colleagues at the time — three unusually well-trained Registered Massage Therapists.9 These people were my colleagues, people that would usually be called “medical” massage therapists in most other places, and, in theory, the créme de la créme of massage therapy. Any BC-RMT could walk into virtually any jurisdiction in America and be — by far — the best-trained massage therapist available to that population.
My client had seen three of these elite therapists before coming to visit me, but had not gotten any relief whatsoever. She enjoyed the massages, but unfortunately did not find them therapeutically useful.
I soon found out why.
An inexplicable oversight of one of the most common trigger points in the body
Not long after I started her first treatment, I checked for unusual sensitivity in her suboccipital muscle group (a “trigger point,” a common source of pain for tension headaches). This is an assessement procedure I consider to be as automatic as breathing for a client with her symptoms — I can’t imagine not doing it. And I immediately found what I was looking for: a highly relevant trigger point, which is exactly what you’d expect to find in about 60% of cases.
What happened next is what makes it a good story. My client said in amazement (emphasis definitely hers):
That’s it! That’s where my headache is coming from! You’ve got it! And no one has ever pressed on that spot before.
Really? Could this possibly be? I asked her to confirm this in detail, because I found it so strange. Looking for and treating suboccipital trigger points is one of the most elementary things I can imagine a massage therapist doing for a client with chronic tension headaches. Not only is it a classic spot for massage therapy for headaches specifically, it’s one of the most useful and pleasant targets for good massage anywhere in the body — “Perfect Spot #1”! And yet three other fancy RMTs had not only missed it, but apparently had not even looked for it — an inexplicable oversight.
Actually, failing to massage suboccipitally in a headache patient is worse than an “inexplicable oversight”: it seems almost impossible to believe that well-trained massage therapists could make this mistake. But, unfortunately, such failures may be typical of the state of trigger point therapy in the world today — even from “elite” therapists.
I’ll return to the special case of trigger point therapy at the end of this article.
The massage therapy shopping tips
You must shop around! Expect to go through several massage therapists before you find the one for you
For every therapist I’ve found that I’m happy to work with for a while, I’ve abandoned a half dozen that annoyed me with various kinds of incompetence:
- fluffy pressure or brutal pressure
- kooky theories, conspicuous ignorance10
- cookie cutter massages (the exact same thing, every time)
- ignoring treatment requests (a strangely common problem)
- unprofessional communication, or just jarringly at odds with relaxation
And much, much more. I’ve seen it all. Basically, it’s hard to find good help. Finding a good therapist can be an expensive multi-month project, with hundreds of dollars spent on relationships that go nowhere. But the consolation prize is great: a massage therapist you like and trust is extremely valuable.
The high-maintenance test
When you start with a new therapist, ask for what you want, and watch what happens. Be politely demanding. Dare to be “high maintenance.” In particular, be picky about pressure. Ask for more or less as needed throughout the treatment. Be nice about it, but say things like, “That’s a bit too strong for me right there, could I get a little less?” If you get a no-pain-no-gain response, counter with this: “Sure, okay, but I’d still like a little break from the intensity for a couple minutes — I need to catch my breath and relax a bit.” Or, if it’s too fluffy a treatment for your tastes, ask for more pressure.
If your therapist doesn’t seem to hear you, or is dismissive, never go back. This is the single most efficient (and likely) way of eliminating therapists who aren’t worth paying.
The letters-behind-the-name test
Find out what the certification standards are in your state or province. Do some Googling. Does your government regulate massage therapy? How much? What does it take for the massage therapists in your region to become massage therapists? Now that you know what the standards are, use them, and favour the therapists who are well-trained and certified.
Credentials really do not guarantee anything, but they are better than nothing. Look for someone with letters behind their name, preferably a “BSc” (although that’s a long shot in most places), but at least “LMT” or “RMT” (licensed or registered massage therapist). I am not saying that unlicensed bodyworkers can’t be good therapists — some of them are truly excellent — but just that your odds are better with someone credentialed.
“Medical massage” on the sign is usually a good sign
There’s not really any such thing as “medical massage,” and the claim can be a symptom of serious overconfidence. Nevertheless, consumers should probably favour therapists who advertise “medical” massage therapy, especially in jurisdictions with low certification standards. It could be a false front, but it usually indicates a therapist who has promising aspirations to professionalism. For instance, it strongly suggests that they are more interested in working with physicians than against them. And so the odds of finding good trigger point therapy are somewhat better in such offices.
An advertisement of “sports massage” is much less of a gaurantee, but it’s better than nothing: therapists interested in sports massage are a little more likely to be focused on sensible goals and techniques.
The big-red-books test
The Big Red Books
Must-have textbooks for all massage therapists … for historical interest if nothing else.
Practically everyone needs a therapist who is familiar with the concept of trigger points (muscle knots).
You can check on this before you even book an appointment: call therapists and just ask them if they know the work of Drs. Janet Travell and David Simons. Tell them you are looking for a therapist with specific skills. Be an assertive consumer, and just politely ask, as easy as asking for their rate: “Do you know the big red textbooks by Travell and Simons?” If they don’t immediately say, “Of course,” then thank them for their time and hang up the phone.
On the other hand, it’s another kind of good sign if they express any kind of skepticism or concern about trigger point therapy … because knowing that there is a controversy is probably more important than which side of it they are on. A therapist who doesn’t think the big red books are any kind of bible is likely a well-read and a creative and independent thinker — and more valuable to you than a therapist who has no clear opinion about it one way or the other.
More about trigger points below.
Let the results speak for themselves
Try it out! If you haven’t seen some sign of progress after your first 3-6 hours of therapy, stop going: you need a compelling reason to wait any longer than that for results. There is some “wiggle room” for things getting worse before they get better, but not that much, and definitely beware of excessively poor results, like feeling too sore and sick after a strong massage.
Or just “train” your therapist
You don’t need to teach a therapist trigger point therapy theory from scratch — if you’re knowledgeable enough you can guide them towards the kind of massage that you know is most likely to help you.
Ultimately, I think it’s important for every patient who has struggled with chronic aches and pains to learn about trigger point therapy for themselves. Everyone can benefit from reducing dependence on health care professionals. And if you know your stuff — and if a therapist is compassionate, open-minded, and has an ounce of common sense — there should be no problem with “training” him or her to apply the kind of pressure you would apply yourself if you could.
Of course it would be preferable if your therapist could be your guide, but it’s not a perfect world.
So, study trigger point therapy yourself, learn what works for you — a good idea in any case — and then find a therapist who is happy to take direction and learn with you. This subject — finding and training good help for muscle pain — is covered in much more detail in my trigger points tutorial.
Beware of “shit massage therapists say”: five common red flags
Here are a few things to watch out for, and more specific than standard caveat emptor stuff like “beware of big promises.” Each of these ideas is something I consider to be particularly a problem in massage therapy. If you catch your massage therapist pushing any of these ideas, watch out!
- complicated biomechanical theories about what’s wrong with you, and too much emphasis on alignment (this is known as “structuralism,” and it’s getting really old11)
- excessive zeal about “fascia” (it’s really not all that interesting12)
- justifying negative reactions to treatment by citing “healing crisis,” the idea that you must get worse before you get better (there is very little truth in this)
- the claim that massage detoxifies, or overemphasis of “flushing” your body after massage with water13
- enthusiasm for blatant quackery (the most common, obvious examples are homeopathy, anti-vaccination, “energy” work, craniosacral therapy, spinal subluxations, and fear-mongering about mainstream medicine, and more14)
The trouble with trigger point therapy specifically
On the one hand, sensitive spots in soft tissue — “trigger points” — are closely linked to chronic pain problems of all kinds. Their clinical significance is substantial. It’s amazing how often just a little of the right kind of massage, on just the right spot, is all that many people seem to need to resolve an otherwise stubborn pain problem. It’s even surprisingly easy for folks to treat many of their own trigger points.
So you’d think it would be easy enough to get some pro help for these trigger point thingies … right? Alas, no.
Although the idea of trigger points has spread far and wide in the last twenty years, it has spread more like religion than science, and mostly among massage therapists. They are still relatively obscure and controversial. Many doctors and physical therapists have scarcely even heard of them. The one kind of therapist that seems most likely to be able to help — massage therapists, professionals who work directly with muscle tissue every day — are often unprepared for challenging cases, or even basic ones, as with the headache story I told earlier in the article.
Massage therapists have many common failings when it comes to trigger points, above and beyond the more general problems with their profession:
- More training and certification issues: there are few widely known certification programs for methods of trigger point therapy. Travell & Simons never got into the business of certifying therapists … which is actually a good thing. I have serious concerns about the certification systems that do exist.15
- Many know almost nothing about trigger points at all. They simply don’t have the education.16
- Most of those that do know a little about them know too little and are overconfident: they “believe” in trigger points, rather than understanding the history, science, and controversies.17
- Difficult cases involve many factors that massage therapists are largely unaware of, and unqualified and legally unable to advise patients on.18 Meanwhile, the importance of some factors (like posture and ergonomics) gets way too much air time.
And so, myths and bogus treatment concepts have always been rampant in the world of trigger point therapy.19 It’s a mess.
Trigger point therapy does not come standard in massage therapy offices — it is a specialization without standards or regulation. It is not reasonable to expect all massage therapists to understand how to treat serious trigger points properly. Most massage therapists are unprepared to treat anything worse than mild-to-moderate cases of isolated trigger point pain.
And this is why readers from around the world so often tell me that they have “already tried massage therapy,” but got no relief. It’s pretty clear that they didn’t get good massage therapy. Specifically, they probably didn’t get good trigger point therapy. So, if you’ve already tried something branded as trigger point therapy, and failed to get good results, do not give up yet!
That all said, when in doubt, it is much better to just have a great massage than bad trigger point therapy. There is plenty of overlap between decent trigger point therapy and an ordinary pleasant massage.
Now that you understand the problem a little better, here’s one more eye-roller of an example of bad trigger point therapy, and a good example of why you need to shop around …
Missing the point: failed trigger point therapy for a simple shoulder case
In another common and disappointing scenario, massage therapy is focused … but focused on the wrong tissue. This story is about a determined and experienced patient, a middle-aged woman with severe, chronic shoulder pain on the “end” of her shoulder — where an officer’s epaulets would be — and radiating downwards on the side of her arm and through her biceps almost to the elbow. It was a nagging, sickening pain, like a toothache in her deltoid muscle.
She had been diagnosed with a whole bunch of common shoulder conditions — basically all of them. Impingement syndrome. Rotator cuff tears. Arthritis and bursitis. And frozen shoulder, of course.
What made her case a bit unusual was that she really had given physical therapy and massage therapy a good chance to work. She had seen a massage therapist and a physiotherapist concurrently and frequently for 12 weeks. But she had gotten exactly no relief. And, if two therapists working with a cooperative, diligent client continuously for many weeks hadn’t helped her … what chance did I stand of making a difference?
I cautiously quizzed her about exactly what kind of therapy she had received. “Oh, trigger point therapy,” she said. “She did detailed trigger point therapy on my shoulder muscles.” That sounded good. She almost certainly had shoulder trigger points! Why hadn’t she gotten relief?
“Did your massage therapist ever work here, on the back of your shoulder blade, several centimetres away from the location of your symptoms?”
“Oh, no,” she replied. “No, she only worked here,” she said, pointing clearly at her deltoid and biceps — the exact location of the symptoms.
Uh oh. Well, there’s your problem, I thought.
“Twelve weeks of that?” I asked. “Only there?”
She nodded. “Why? Is that bad?”
Yes, that is bad.
The most interesting characteristic of trigger point pain — the main thing that makes treatment tricky — is a phenomenon called “referred pain.” The body, somewhat inept at precisely locating internal pain, experiences muscle pain in a broad area around or near a trigger point … exactly like heart attacks are often felt in the arm, shoulder, neck, and even the face. The pattern for each muscle is distinctive, almost a fingerprint.
Her therapists had never checked a likely cause of this particular pattern of symptoms — which happens to be the infraspinatus muscle on the back of the shoulder blade, several centimetres away from the symptoms. Infraspinatus trigger points have a highly predictable pattern of referred pain — knots in that muscle cause pain on the end of the shoulder, and the side and front of the upper arm, exactly like this patient’s symptoms.
Every massage therapist should know this. A massage therapist who doesn’t know it is flying blind, doing massage that is about as therapeutic as a manicure.
This is what patients face, trying to get help for countless frustrating pain problems — pain problems that don’t make it onto the medical radar, but are quite capable of reducing quality of life drastically.
So what happened? Her shoulder problem, after almost a year of misery and misdiagnosis, was 100% relieved by a single dose of infraspinatus treatment. Just one properly directed massage. She sure was happy!
It doesn’t always go quite that smoothly, of course. A therapist may have to spend a fair bit of time looking for sensory relationships like this, and it can be tricky even if just one trigger point really is the only problem. But the point is that any good therapist will be trying to do that. Without knowledgeable exploration, it can’t be good trigger point therapy. And there should be pleasant, satisfying massage along the way — that’s the valuable consolation prize, if hunting for and prodding trigger points should fail to produce therapeutic results, which is of course all too possible.
About Paul Ingraham
I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter., or subscribe:
- Basic Self-Massage Tips for Myofascial Trigger Points — Learn how to massage your own trigger points (muscle knots)
- Does Massage Therapy Work? — A review of the science of massage therapy … such as it is
- The Pressure Question in Massage Therapy — What’s the right amount of pressure to apply to muscles in massage therapy and self-massage?
- Alternative Medicine’s Choice — What should alternative medicine be the alternative to? The alternative to cold and impersonal medicine? Or the alternative to science and reason?
Appendix: More massage awfulness! Patient tales of massage therapy gone awry
Do you have a hair-raising story to tell about massage therapy? Send it along, and let me know if you’re willing to have your name attached to it.
Ugly massage severely re-aggravates an old shoulder injury
This gentleman asked to stay anonymous, but he was very eager for me to share his story. “If my note will help just one other person, it’s worth my time and yours!”
And some follow-up a few months later:
There’s a guy at my gym who is trained in deep massage therapy. I asked he could try to help a stubborn old shoulder injury that was always paining me. The session was 15 minutes and he knew my medical history. He used deep pressure working on the “knots.” It was excruciating! He knew it because I almost left the session. I had the sense that he was fixated on no pain, no gain.
I stuck it out. I almost puked after the session and felt a malaise that lasted for 24 hours. I hurt. I hurt badly. For 3 nights I could not sleep. My shoulder was wicked sore … just like when it was injured prior to the assessments for surgery and the cortisone and physio treatments.
I took pain relievers that had no effect. Ice too. I was a walking sore zombie on drugs with an ice pack.
I had impingement and serious inflammation. From my prior experience, this happens when I am rough on the shoulder and do things I can’t do. But this was much worse and much deeper in the shoulder joint. I had worked for 18 months, 3 times per week in a gym — shoulders, back, core, chest, biceps and triceps — I was careful and made huge gains in strength and in well being. I was healthy and content.
Now, 7 days after I felt my arm being almost pulled out of the socket, I am still stiff and in pain.
Your article hits the key points on the role of the therapist and the care they need to apply. I had “ugly” therapy and it should not have occurred.
I am pissed off and demoralized. I assume that I will have to start over, as if I had just strained my rotator and it was a new injury.
Following my note to you, I met with the therapist/trainer. He listened and was truly sorry. He knew that I had problems following our session because I was not back in the gym for a month, and following that, I was pretty timid. After 6 months, I felt better. But I have a chronic shoulder problem which is worse than prior to this treatment. I understand that his massage therapy has changed, and he is far less aggressive.
- My own decade of experience as a massage therapist, 20 years publishing this website, and relationships with many influential people in the profession today, and of course a buttload of experience as a therapeutic massage customer. My qualifications for this article are actually much better than most topics I write about. I am just a writer, mostly, and I have to lean heavily on science and the opinions of experts when writing about something like ultrasound or low back pain. But in this case, I really am a proper massage therapy expert.
- “Trigger points” are controversial, although published expert opinions criticizing the concept remain relatively scarce. This article does not get into the controversy, but it’s important to acknowledge it. The bottom line is that people do suffer from a painful phenomenon (very sensitive spots), and no one disputes that — they just dispute what to call it, how it works, and how to treat it! The main problem with trigger point therapy is that its practitioners are often overconfident, overzealous, and under-educated about it. It doesn’t have to be snake oily, but it often is. If you want to learn more about the controversies, see: Trigger Point Doubts: Do muscle knots exist? Exploring controversies about the existence and nature of so-called “trigger points” and myofascial pain syndrome
- Massage therapy is safe, but nothing’s perfect. “Deep tissue” massage causes the most trouble. It may aggravate problems, instead of helping. Some chronic pain patients may be disastrously traumatized by it. Occasionally it causes new physical injuries, usually just minor bruises and nerve lesions, but sometimes worse (any neck manipulation has a small risk of stroke or spinal cord injury, and blood clots can be dislodged causing lung damage). Patients often feel sore and a bit “oogy” after massage, a phenomenon known as post-massage soreness and malaise, which may be caused by a form of injury (rhabdomyolysis), not “detoxification.” See Massage Therapy Side Effects: What could possibly go wrong with massage? The risks and side effects of massage therapy are usually mild, but “deep tissue” massage can cause trouble.
- Depending on where you live, your massage therapist may have had as much as 3000 hours (3 years full-time) of somewhat scientific training (as we do here in my part of Canada), or as little as none at all — there are places where no training whatsoever is necessary to hang out a shingle and call yourself a massage therapist! Even in places where the profession is heavily regulated, there may be a thriving industry of less-trained therapists practicing every conceivable variation on massage therapy (which is quite a lot). Unfortunately, they don’t wear signs around their necks saying, “I charge people outrageous fees for a weird mix of treatments that sound good but mostly don’t work.”
- QuackWatch.org [Internet]. Barrett S. Massage Therapy: Riddled with quackery; 2006 [cited 13 Apr 5]. PainSci Bibliography 56500 ❐
Scientifically unsupportable ideas are common among massage therapists, according to Dr. Stephen Barrett. He avoids a blanket condemnation of the profession, conceding that “ordinary massage and the legitimate practice of massage therapy should not be categorized as quackery.” However, “many therapists make claims that go far beyond what massage can accomplish. And even worse, massage therapy schools, publications, and professional groups are an integral part of the deception.” He provides many references to support this view.
I agree with almost every detail of the article and wrote a letter of support to Dr. Barrett, which is published as an addendum to it. That said, the article does neglect some nice things that can be said about massage therapy, and it contains a few minor errors. But I applaud the intent and embrace and welcome most of the criticism. I wish it weren’t mostly true, but I believe that it is.
- Insurance coverage is not remotely evidence-based, but insurers are somewhat sensitive to medical credibility. See Insurance Is Not Evidence: Debunking the idea that “it must be good if insurance companies pay for it”.
- Ingraham. What Happened To My Barber? Either atlantoaxial instability or vertebrobasilar insufficiency causes severe dizziness and vomiting after massage therapy, with lessons for health care consumers. PainScience.com. 4200 words.
- Ingraham. Poisoned by Massage: Rather than being DE-toxifying, deep tissue massage may actually cause a toxic situation. PainScience.com. 9549 words. Sometimes we feel cruddy after a massage, like it was a big workout. Post-massage soreness and malaise (PMSM) is embraced as a minor side effect and hand-waved away by almost everyone as some kind of no-pain-no-gain thing. But it needs explaining. Massage is not “detoxifying” in any way (that’s pseudoscientific nonsense). Ironically, it may be the opposite: some PMSM is probably caused by mild rhabdomyolysis, a type of poisoning that can occur even with heavy exercise (a medical reality), and possibly strong massage (a plausible hypothesis). If so, it’s a big deal, a serious side effect. There are also some non-rhabdo explanations for milder PMSM.
- A “Registered Massage Therapist” (RMT) is a Canadian professional certification (in the province of British Columbia specifically) — one of the most demanding training programs for massage therapy in the world, in fact.
- Great example: over the years, I’ve caught several massage therapists making really serious, embarrassing anatomy errors. This isn’t the kind of thing the average person is going to be able to notice, unfortunately. Once again, I refer you to: 💩 Massage Therapists Say.
- “Structuralism” is the excessive focus on causes of pain like crookedness and biomechanical problems. It’s an old and inadequate view of how pain works, but it persists because it offers comforting, marketable simplicity that is the mainstay of entire styles of therapy. For more information, see Your Back Is Not Out of Alignment: Debunking the obsession with alignment, posture, and other biomechanical bogeymen as major causes of pain.
- Sheets and wrappings of connective tissue called fascia are considered an exciting frontier in massage therapy. Supposedly fascia can get tight and needs to be “released.” However, key examples of research either fail to support fascial therapy or actually undermine it — for instance, fascia is too tough to actually change. Fascia enthusiasm seems to be a fad. For more information, see Does Fascia Matter? A detailed critical analysis of the clinical relevance of fascia science and fascia properties.
- It’s just polite to offer patients a glass of water after a treatment. But therapists who make a production of it as a necessary part of the therapy are just proving their ignorance. For more information, see Why Drink Water After Massage? No reason! Massage therapy does not flush toxins into the bloodstream, and water wouldn’t help if it did.
- Acupuncture should be on this list, but being sympathetic to acupuncture is extremely common and more forgivable. See Does Acupuncture Work for Pain?
- For example, I have many criticisms of the best-known trigger point therapy “system” from Paul St. John. And there are popular certifications for dry needling, which also concerns me.
- Funny story about that: the first time I ever published that opinion, the next day I got an email from a massage therapist confirming her ignorance. “I guess I’ve heard of them, but I thought it had something to do with acupuncture.” It’s not surprising when you consider how many “massage therapists” have literally almost no education at all.
- Ignorance of the controversies is nearly universal. All of the books available on the topic — except mine — completely ignore the controversy.
- Nutritional deficiencies, smoking cessation, drug side effects, sleep deprivation, anxiety disorder … and so on and on.
- For instance: being too aggressive with treatment due to the belief that trigger points get “adhered” and must be “broken up.” That’s almost certainly bogus. At best it’s pure speculation — not a good basis for an aggressive treatment.