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Reassurance for Massage Therapists

How ethical, progressive, science-respecting massage therapists can thrive in a profession badly polluted with nonsense

SHOW SUMMARY updated  by Paul Ingraham


There are some major issues with massage therapy that many massage therapists are unaware of: extensive pseudoscientific nonsense and amateurism in the profession. shines a bright light on those issues, and that has crushed the spirits of some massage therapists — even the most progressive and science-respecting ones. What really tugs at my heart strings is that they aren’t necessarily even disagreeing about the problems in the profession, but just feeling awful about agreeing with me. Ouch!

This article tries to do some damage control, and lift those spirits back up. Here are some of the key points of reassurance for massage therapists:

  • Massage is pleasurable and relaxing regardless of whether it has any other specific therapeutic effects, and pleasure and relaxation are inherently valuable. Some massage therapists feel let down by the idea that massage is “just” luxurious, but they shouldn’t.
  • Touch is profound for primates, and massage can probably inspire and facilitate personal growth and awareness in ways that are extremely difficult or impossible to deconstruct, test, and/or even define.
  • Evidence-based medicine isn’t paralyzed by imperfect or incomplete evidence, and massage therapy doesn’t have to be either; uncertainty is normal in healthcare, and there are good and bad ways of coping with it. The good ways can be learned.
  • Skeptics are generally bright and mostly correct about the major myths of massage therapy… but they are not remotely right every time they pipe up, and I have seen some seriously embarrassing, amateurish skepticism about massage.
  • Good health care is a process that is greater than the sum of its parts, rather than just a “service” or “product.” There is a bottomless pit of opportunity to make massage just one part of a process that is probably greater than the sum of it parts.

Word count: 2,500
Reading time: 10 minutes

There are some major issues with massage therapy that many massage therapists are unaware of. shines a bright light on these, and that reality check crushes the spirits of some massage therapists when they first come across it.

That is not the intended outcome! I am not in the business of spirit-crushing. So I’d like to do some damage control (and I’m sorry I didn’t do it sooner in my career).

What are these massage “issues” of which you speak?

I can’t really offer (positive) reassurance without explaining the (negative) reasons for why reassurance is needed. Here is the all the bad news about massage therapy:

Ew. That’s rather a lot for the profession of massage therapy to be ashamed of.

Graphical quote: “The only true disability is a crushed spirit.”

How massage therapists cope when the problems are pointed out

Massage therapy is not just a job for most practitioners. It’s usually more of an identity and a calling. Many call themselves “healers.” When that identity is challenged, in any way, there’s a lot of this: 🙈🙉🙊 or 🤬. Most of them are encountering these opinions and ideas for the first time and quickly throw up walls and reject them reflexively: it’s just too much of an existential threat. They dismiss me as “negative” and get on with their lives and careers without missing a beat.

But some more or less accept the disappointing reality, and some of those suffer a crisis of faith in the value of their work. Countless times over the years I have gotten poignant notes from therapists like this:

I don’t know what to do! I’ve read everything you have written about massage therapy. I didn’t want to accept any of it at first, but I couldn’t actually argue with much of it. Now I’m questioning everything, feeling embarrassed by my profession, and wondering what the point is. How can I even continue selling massage therapy in good conscience?

It’s even become common for such declarations to crop up in on social media, massage therapists publicly announcing that they’re not sure how they can go on after discovering, asking their colleagues for help. What really tugs at my heart strings is that they aren’t disagreeing with me, but just feeling awful about agreeing with me. Ouch.

I need to do some work to protect those massage therapists from that feeling, if I possibly can. Because I didn’t get into this business to crush spirits. Especially the spirits of the more admirable therapists who can acknowledge the problems.

Please do not despair, rational/ethical massage therapists!

Here are several important comforting points for a therapist enduring this crisis:

Coping with a love/hate relationship

Let me ask my wife how she does it… •sad trombone•

I truly love massage. I also hate all the bad ideas that pollute the profession. But these things are both allowed to live in my brain. They co-exist peacefully, like good roommates.

When I was a massage therapist myself, I found it easy to enjoy despite my cynicism about the profession. I just stayed focused on creating an interesting, safe, pleasant sensory experience, because I knew that was inherently valuable even if nothing else was. To the extent that I engaged in obviously experimental therapies (like trigger point therapy), I acknowledged the uncertainties and my own ignorance. I asked a lot of people, point blank, if they wanted to pay for experimental therapy… and that didn’t ruin my career. It just led to a lot of useful and interesting conversations about the pros and cons. I built a busy and satisfying practice on those principles, and I think any massage therapist can.

“But Paul,” protests any reader who knows my story, “didn’t you actually leave the profession because you were disheartened by it?”

Yes, that’s the awkward truth! But I can explain, I swear. I was also being seriously harassed by my licensing agency, which is not an ordinary problem to have. And, of course, I was actually a writer at heart and keen to get on with my true calling. Most massage therapists don’t have sticks or carrots that big pushing and pulling them out of the profession; without those mighty incentives lubricating my path, I would have just fought to stay.

And still written articles about stupid massage myths, of course. And what are those? I promised links…

All the massage myths

The major myths about massage therapy are:

The complete list of dubious ideas in massage therapy is much larger. See my general massage science article. Or you can listen to me talk about it for an hour (interview).

About Paul Ingraham

Headshot of Paul Ingraham, short hair, neat beard, suit jacket.

I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of 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.

Related Reading

What’s new in this article?

May 12, 2020 — Added article summary.

2020 — Added the point that good healthcare is a process not a product/service, and that this represents a significant opportunity for massage therapists (but massage is also a great product/service).

2020 — Publication.


  1. “Proof” is an exceptionally high bar, rarely cleared, because the evidence is routinely incomplete/conflicting, and there are both good and bad ways to bridge the gap between the inevitable scientific uncertainties and clinical decision making. The bad ways of coping are appeals to authority, tradition (“we’ve always done it that way”), fanciful mechanisms, etc. But massage therapists should follow the example of good doctors who, faced with imperfect evidence, also assess the plausibility and relevance of treatment claims, explore the potential risks and benefits with the patient, and so on. Many treatments that are less than “proven” can be ethically prescribed if approached in this way.
  2. Silvernail J. Manual therapy: process or product? J Man Manip Ther. 2012 May;20(2):109–10. PubMed #23633891 ❐ PainSci #54128 ❐ “Published trials of an impairment-based manual therapy approach where the treatment is provided by highly-trained clinicians using manual therapy in the context of a systematic, hypothesis-based clinical reasoning process have consistently shown large effect sizes in validated outcome measures relative to other interventions.”