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Reassurance for Massage Therapists

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

Paul Ingraham • 10m read
Although this is addressed primarily to massage therapists, and massage has some unique advantages, much of it is also relevant for physical therapists, chiropractors, and osteopaths.

There are some major issues with massage and most other manual (hands-on) therapies that many professionals remain unaware of. shines a bright light on these. That reality check crushes the spirits of some massage therapists when they first come across it.

That is not the intended outcome! I sincerely love massage and always have, despite my reputation for debunking it, and 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 this sooner in my career.

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

I can’t offer (positive) reassurance without explaining the (negative) reasons for why reassurance is needed in the first place. Here is a summary of all the bad news about massage therapy. All of these issues are explored in great detail around this website, and there’s a complete reading list at the bottom of the article:

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, there’s a lot of this: 🙈🙉🙊 or 🤬. Many pros encounter these opinions and ideas for the first time here, and they reject them reflexively: it’s just too much of an existential threat to process. They dismiss me as “negative” and get on with their lives and careers without missing a beat.

But some new readers more or less accept the disappointing reality, and some of those suffer a crisis of faith in the value of their work. A surge in uncertainty about the nature of health problems and what to do about them can be highly corrosive to professional satisfaction.1 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?

Such declarations even crop up on social media, massage therapists publicly announcing that they’re not sure how they can go on after discovering (or kindred sources), asking their colleagues for help. It’s nice that they aren’t disagreeing with me, but it really tugs at my heart strings that they are 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. Although some claims are made here, I don’t do my usual thorough referencing.2

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 — so very long ago now — I often thought saw seemingly impressive clinical results. As I studied the science of massage other hands-on therapies, I eventually realized that I couldn’t take much credit for that. After subtracting all the confounding factors, delusions and illusions, plus all the genuine perks of a strong “therapeutic alliance,” what was left? What genuine treatment effects, what biological benefits unique to massage?

Those fell well short of “miraculous” and were probably more like, um, “occasionally slightly helpful.” 😕

But here's the thing: that’s not nothing! It really isn’t. And neither are the non-specific effects of any kind of compassionate healthcare. And there are probably some specific effects of massage. And so I found it easy to enjoy my work 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 — but something else probably was occasionally slightly helpful. To the extent that I engaged in obviously experimental therapies (trigger point therapy), I made a point of acknowledging 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 I still would have written articles about stupid massage myths, of course.

Massage is still a good thing, I pinkie swear.

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., or subscribe:

Related Reading

What’s new in this article?

Six updates have been logged for this article since publication (2020). All updates are logged to show a long term commitment to quality, accuracy, and currency. more Like good footnotes, update logging sets apart from most other health websites and blogs. It’s fine print, but important fine print, in the same spirit of transparency as the editing history available for Wikipedia pages.

I log any change to articles that might be of interest to a keen reader. Complete update logging started in 2016. Prior to that, I only logged major updates for the most popular and controversial articles.

See the What’s New? page for updates to all recent site updates.

Jun 3, 2023 — Filled out the extro a little. Just a bit more detail and context.

2022 — Science update. Added a citation about tolerance of medical uncertainty (Begin).

2021 — Adjusted to be more inclusive of other kinds of professionals, not just massage therapists, plus some other polishing, especially rejiggered main list of reassurances to make it much more readable, less of a “wall of text.”

2021 — Added minor references to counterstimulation and autonomous sensory meridian response.

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. Begin AS, Hidrue M, Lehrhoff S, et al. Factors Associated with Physician Tolerance of Uncertainty: an Observational Study. J Gen Intern Med. 2022 May;37(6):1415–1421. PubMed 33904030 ❐ PainSci Bibliography 51391 ❐

    This survey of doctors found that a low tolerance of medical uncertainty was linked to much more burnout, low job satisfaction, and lower “engagement” at work.

    No doubt it’s the same for many other kinds of healthcare professionals as well. But many alt-med practitioners are likely happier in their work due to the illusion of certainty provided by ideologically-driven overconfidence in simplistic and fanciful ideas about health: they really do think that they know what’s wrong with people and how to fix it. Which must feel great!

    The only real solutions for medical uncertainty are probably emotional and philosophical. Education can help, but it certainly can’t cure it! “The more you learn, the less you know.” Any serious attempt to learn leads to an inevitable confrontation with the abyssal depths of our own ignorance! 🕳 (That’s a “hole” emoji there: it may not render clearly or consistently on all devices.)

  2. The point here is not to build a scientific case for massage, but to provide a high-level overview of reasons for optimism in spite of how hard it is to do that. But I do make that case as rigorously as I can in my main article about massage therapy: Does Massage Therapy Work? A review of the science of massage therapy … such as it is.
  3. “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.
  4. Basically sensation-enhanced descending modulation of pain. I explore this hypothesis in Counterstimulation, Counterirritation, and Gate Control: Minor but reliable, counterstimulation is the most basic pain-killing mechanisms in biology… and maybe there’s a fancier version that’s more useful.
  5. Silvernail J. Manual therapy: process or product? J Man Manip Ther. 2012 May;20(2):109–10. PubMed 23633891 ❐ PainSci Bibliography 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.”


linking guide

3,250 words

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