Dr. Zang has unbelievably gifted hands. What he is doing looks to you and me like massage, but he’s worked on my body for months, and his hands are like radar. They can find spots you didn’t know were sore. The first time he taught me, he brought in a bag of millet and threw it on the floor and said, “When you can use your hand to crush this to dust, then you have the beginning movements. But until you learn to crush it with your finger, you are not ready.” It takes a lot of energy and skill to use your hand to crush millet into dust. That’s the amount of force he can use, if he wants, on a single spot. He has to know many different manipulations — but more important, he has to know when and where to use them.
David Eisenberg, MD1
In China, massage therapy is usually practised only by medical doctors — and the profession probably commands more respect there than anywhere else in the world, with good reason. It is wise to respect someone who can crush millet into dust with their bare hands.
This is a trick I have not yet learned.2
Nevertheless, in British Columbia, a registered massage therapist (RMT) is a health care professional. For about four decades, RMTs were regulated by the same legislation that applied to physiotherapists, and we were a part of the health care system. In 1995, the Government of British Columbia designated massage therapy as an independently regulated profession3 with increased standards for training and certification.
Indeed, outside of China, RMTs in BC are probably the best-trained massage therapists in the world,4 with 3000 hours of education required for certification at that time (it has been dropped back down to 2000 hours in the years since). The curriculum includes:
- Medical sciences — primarily the highlights of general physiology, musculoskeletal anatomy in excruciating detail, and pathology relevant to our profession.
- Orthopedic assessment: trying to determine the cause of problems with your muscles, bones and joints, ligaments and tendons.
- Manual therapies ranging from classic Swedish massage to technical modalities like manual lymphatic drainage and proprioceptive neuromuscular facilitation, just to name a couple of the more impressive-sounding ones.
Basically, massage therapists in BC learn everything but millet crushing. When school is complete, to enter the profession, students must pass gruelling certification examinations: nearly half of my class failed on their first attempt. I passed, and entered the profession with pride. I had learned a great deal — and proved it.
However, there are reasons not to be so proud.
Problems with massage therapy in BC
In the years since my graduation — a great many of those now — I have encountered far more questions than answers about the human body and manual therapy. Musculoskeletal health care is surprisingly primitive, with many gaps in our knowledge of what works, what doesn’t, and why. Three years of training is not really all that impressive — any doctor has far more training and generally much higher scientific literacy5 than the vast majority of massage therapists, chiropractors and physiotherapists.
And “hours” of training shouldn’t be a basis for bragging rights in any case. As the director of my alma mater, Doug Fairweather, has written, “hours are not the contemporary way in which standards are described. They are not used by other health professions as a defensible standard of education.”
Instead, education standards should probably described in terms of “competencies” — what are we actually good at? What can we do and what do we know? And here’s where we see the problem with only counting the hours: because a lot of those hours were spent on pseudoscientific curricula,6 topics of study that seem at odds with the profession’s desire to be taken seriously. What’s the point in having only the appearance of high educational standards, but padding the curriculum with stuff that makes doctors roll their eyes?
Like all of “alternative” heath care, it turns out that my profession is dominated by people who believe that we should provide services that are an alternative to science.7 This unfortunate attitude is so pervasive that, over the years, my pride in being a massage therapist slowly evaporated away, to the point where I retired from the profession at the end of 2009.
Plus, I still can’t crush millet without a couple of big rocks.
About Paul Ingraham
I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.
- Healing and the mind, a book by Bill Moyers. BACK TO TEXT
- Possibly because it’s bullshit and isn’t actually possible? Worth considering. BACK TO TEXT
- “Legislation and Professional Regulation: Massage Therapy.” Government of British Columbia: Ministry of Health Planning. June 29, 2004. BACK TO TEXT
- So far as I know. When I started school in 1996, we were told by our teachers that we were entering the longest, best training program for massage therapy anywhere. This may or may not have been true. There might have been a few other places in the world with comparable training, and certainly some North American and European jurisdictions have caught up with us since. But the claim that we were “the best” is not without substance: 3000-hour training programs are definitely rare. If anyone can validate or refute this opinion with evidence, please contact me. BACK TO TEXT
- This is discussed in more detail in Therapy Babble: Hyperbolic, messy, pseudoscientific theories about therapy are all too common. BACK TO TEXT
- For instance, craniosacral therapy is in the curriculum — but craniosacral therapy has no basis in scientific evidence, and has been denounced by prominent members of the profession (osteopathy) that spawned it. See Does Craniosacral Therapy Work? Craniosacral therapists make big promises, but their methods have failed to pass every fair scientific test of efficacy or plausibility. BACK TO TEXT
- PS Ingraham. Alternative Medicine’s Choice: Alternative to What? Alternative to what? To cold and impersonal medicine? Or to science and reason? ❐ PainScience.com. 4279 words. BACK TO TEXT