Licensed Massage Therapy
Massage has been shown to alleviate pain and to aid in the healing process, which is one reason why it is being used as a complement in the recovery from physically difficult conventional procedure like surgery and childbirth.
Licensed Massage Therapists, or LMTs, are highly trained professionals. They may operate independently, as a member of a group of integrative therapists, including as part of a team within a center for integrative medicine that are available in hospitals and many US medical schools.
Professionals working in the US: 300,000 States with LMTs: 50
|Examples of Use||Education & Certification||Massage in US|
Examples of Use:
Illness, Disease and Injury
Massage therapy has been shown to provide therapeutic value for patients in a wide set of circumstances. This is reflected by recent research that shows consumer use of massage for treating ill health conditions or to aid in healing after medical procedures has been increasing. [FN ]
The following chart lists the most common medical complaints and conditions for which massage has been prescribed and for which patients have reported benefits:
Practitioners are trained to evaluate the possibility that a therapeutic measure may worsen a patient’s health, in the same way that physical therapists do. As always patients should make a point of telling therapists everything about their health before any therapy is applied.
Education, Training, Certification and Licensure
The educational and credentialing requirements for massage therapists who deliver care to patients have matured markedly in the last decade. Schools specializing in massage therapy education have gained accreditation from the US Department of Education, and the profession has established its own rigorous baselines of competencies through training and testing organizations. (The federal government recognized massage therapy accrediting organizations in 2002.)
Most states require a minimum of 500 hours of instruction and clinical experience from board-approved massage schools. New York and Nebraska require 1,000 hours; Ohio, 750; Arizona and Mississippi, 700. The massage therapy curriculum will include the following:
- Massage Assessment, Theory & Technique
- Professional Ethics and Business
- Allied Modalities
- Statutes and Rules of Massage Practice
The discipline’s scope of practice is determined by the state board where the licensed therapist is in practice. Requirements for licensure vary from state to state; six states do not impose statewide requirements, but leave licensure to local authorities. Some states have created independent boards of massage with legal authorities, others have boards whose role is advisory only, and in a handful of states massage practice is overseen by the state’s full medical board. (See specific state licensure status in our States section.)
Massage Therapy in US Health and Wellness
By a wide margin, therapeutic massage is provided mostly in the US by those 300,000 professional licensed practitioners working in all parts of the country, as has been the case for several decades and will remain so for the foreseeable future. But this historic track record of consumer preference plus provisions of the Affordable Care Act mean that conventional care institutions are likely to increase use massage as they adjust to new models of care.
Consumers and MDs: Trending to More Massage
A major report on consumer use of massage therapy published in 2013 by the American Massage Therapy Association (AMTA) highlights these trends:
- 14% of respondents were referred to an LMT by their doctor
- 48% said they were encouraged by their doctor to get a massage
- 13% were told by their doctors that massage might be beneficial
- Referrals FROM hospitals to LMTs rose 7% between 2011 and 2013
- 56% of people (a 12% increase over 2011) chose massage for specific conditions, such as:
- soreness, stiffness or muscle spasms
- stress relief and management
- aid in injury recovery and rehabilitation
- controlling headaches and migraines
- Respondents also reported using massage to remain fit and to maintain their basic good health.
Such high levels of sustained acceptance illustrate why the Affordable Care Act directs insurers to give massage and other licensed integrative health services a position of parity in the remuneration system.
Massage in the New Models of Care
Not only will the Affordable Care Act – properly implemented — expand access to licensed massage therapists, this wider access can also address the most important goal (after access to insurance) of the ACA – to improve care and patient satisfaction and to reduce the overall costs of care. This is the “Triple Aim” objective of the legislation.
You may have read about the models of health care delivery that were written into the ACA to achieve those goals: the Patient-Centered Medical Homes (PCMH) and Accountable Care Organization (ACO). Healthcare organizations who participate in these programs — whether hospital systems, clinics, insurers or physician groups — will be motivated to achieve financial benefits largely for keeping patients healthy.
One way to do that will be to conduct care in team-based groups and through collaboration among the different disciplines. Particularly as the health care system confronts a large population of aging patients with multiple and chronic conditions, such team-based approach will prove beneficial, if not essential. For massage therapists and other integrative care providers, team-based care has almost always been the norm; whether when called in to provide adjunctive care in a hospital or physician group practice, or as part of a group of integrative medicine specialists.
2706 note: Massage therapists can play a significant role ion re-defining the therapeutic order of care that eventually begins with the patient requesting a least invasive approach first. Research shows that “least-invasive first” can lead to less total treatment costs. That potential however, is unlikely to be achieved unless licensed therapists are as available to patients under the same financial conditions that are enjoyed by other licensed practitioners.
Massage is increasingly being included in health insurance plans, but this coverage is often inconsistent. For example, some plans may cover massage when it is provided by a chiropractor, for instance, but not when provided by an LMT: even when treating an identical condition. This is often the result of stipulations in the plans that massage treatment is only available through referral.
Although chiropractors share the same interest that massage therapists do in ending provider discrimination, this is an example of how insurers can exclude an entire class of provider (LMTs), a marketplace condition that Section 2706 of the ACA was written to prohibit. (See a practitioner’s real experience with this in our Story Album.) [ to Natalie’s story ]
Clinical research on massage therapy has increased in recent years, as patients and practitioners have applied new applications and as new technologies have started to illustrate the effects of treatments.
When it comes to pain, massage has been shown to be effective in two basic circumstances:
- Reducing pain that can be a side effect of physically difficult on intense procedures such as needed surgery or trauma
- Pain inherent in chronic conditions, including low-back pain, osteoarthritis, rheumatoid arthritis, fibromyalgia, and migraine headaches
As massage has been shown to be effective reducing pain in these circumstances it has also lessened the anxiety, depression, fatigue and erratic sleep often accompany the healing process. These are not “secondary” effects, but rather inherent outcomes of the treatment that may be felt differently by each patient.
Significantly massage can lead to measurable reductions in the need for pain medication. The American College of Physicians and the American Pain Society issued joint clinical practice guidelines in 2007 that includes massage therapy as: “one of the non-pharmacologic treatment options that should be considered for patients with low-back pain who do not improve on their own.” With opioid use at epidemic levels in the US, pain-reducing options like massage and other integrative techniques offer proven and tangible options (now favored in US military and veterans health).
Notable Research Examples
- Research into breast cancer shows that massage can effectively complement traditional care for women undergoing lumpectomy, mastectomy or breast reconstruction. In a study at the University of Miami School of Medicine patients who received massage three times a week reported lower levels of depression, anxiety and anger. Massage after breast cancer treatment has also been shown to boost the immune system.
- Patients recovering from heart bypass surgery at Cedars-Sinai Medical Center in Los Angeles reported reduced pain and fewer muscle spasms and even expressed a willingness to pay for massage therapy out-of-pocket.
- Reviews of studies on depression and anxiety at the University of Miami School of Medicine concluded that massage therapy can lower the stress hormone cortisol by as much as 53%, while increasing serotonin and dopamine, neurotransmitters that help reduce depression.
- Published studies have reported that adult patients treated with massage experience fewer migraines, headaches, sleep disturbances and other distress symptoms
- Patients suffering from carpal tunnel received massage in a 2004 study of at the University of Miami School of Medicine; they experienced less pain, reduced symptoms and better grip strength than patients that did not receive massage.
- Hypertensive patients who received three 10-minute back massages a week had a reduction in blood pressure, compared to patients who tried to increase relaxation without massage.
For more on the sources for the research and data used here, see the Reference section at the end of the article.
The Costs Benefits
In cases where massage is included in a therapeutic program in conjunction with a more costly alternative – for example, in a pain management program along with prescribed painkillers – the reduction in total cost (i.e.: fewer painkillers are needed) of such treatments is starting to become clear through research efforts. The savings in cases like these may be modest individually. But when massage becomes more widely available, and covered by insurance, the potential cost savings from hundreds of thousands of treatments could be quite substantial, for states and for national healthcare costs.
This is the essence of an extensive economic analysis of Medicare and Medicaid payments associated with selected outpatients services that was conducted by the American Massage Therapy Association (AMTA) in 2013 and published in its 2014 report, “The Value and Efficacy of Massage Therapy in Integrated Heath Care” (see the References section for the link).
The potential cost-of-care savings suggested in this report are compelling: more than $4.5 billion when massage is fully available and covered. As of today, however, such prospective savings paint an unavoidable picture of “What could be, if…”
- If massage is insured… the market will deliver more massage therapists to meet a now suppressed demand.
- If massage is more widely available… and applied, chronic conditions will cost less over time.
The potential implicit in this What If scenario, however, is precisely why Section 2706 was written into the law in the first place: to correct a marketplace imbalance that has prevented patient-preferred access to licensed providers of their choice on financial parity with other providers.
References for Massage Therapy
American Massage Therapy Association Resources
The Value and Efficacy of Massage Therapy in Integrated Heath Care (PDF), AMTA, 2014
Research Roundup: Massage for Mental Health and Wellness
Research Roundup: Massage for Pain Management
Massage therapist online locator
Massage Industry Research
The Triple Aim
Berwick DM, Nolan TW, Whittington J (2008) The triple aim: care, health, and cost. Health Affairs 27: 759-769.
US Dept. of Energy: Massage for High Risk Workers:
Labor Department report citing; “reducing pain and muscle tension, increasing flexibility.”
Department of Labor (2013). EEOIPCA Bulletin 13-01, issued Jan 2, 2013.
Mayo Clinic, post-surgical use:
Mayo post-surgical use: x – Bauer BA, Cutshall SM, Wentworth LJ, Engen D, Messner PK, Wood CM, Brekke KM, Kelly RF, Sundt TM 3rd. (2010) Effect of massage therapy on pain, anxiety and tension after cardiac surgery: a randomized study. Complement Ther Clin Pract 16: 70-75.
Moffitt Cancer Center, Tampa
Myers CD, Walton T, Small BJ (2008) the value of massage therapy in cancer care. Hematol Oncol Clin North Am 22:649-660
Anxiety and Depression in Heart Disease
Watkins L, Koch GG, Sherwood A, Blumental JA, Davidson JRT, O’Connor C, Sketch MH Jr. (2013) Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease. J Amer Heart Assoc PMID: 23537805
Lin C-W C, Haas M, Maher CG, Machado LAC, van Tulder MW (2011) Cost-effectiveness of guideline-endorsed treatments for low back pain. Eur Spine J 20:1024-1038