This isn’t incompetence. It’s structural and until we understand the structure, we can’t fix it.

Let me explain the two legal systems that are supposed to be protecting the massage therapy profession — and why they keep failing us.

Two systems. Two completely different jobs.

Civil law — sometimes called administrative law — is where licensing lives. Your massage license is a civil instrument. Your state board is a civil agency. When the board fines someone, suspends a license, or denies an application, that’s civil law doing its job. Civil law is about regulation, compliance, and professional standards.

Criminal law is where trafficking, prostitution, and organized crime live. When law enforcement makes an arrest, charges someone with a crime, and sends a case to the district attorney, that’s criminal law doing its job. Criminal law is about punishing conduct that harms people and society.

Here’s the problem: these are two separate systems, with two separate agencies, two separate courts, two separate standards of proof, and almost no coordination between them. We keep trying to solve a criminal problem with civil tools.

What a licensing board can and cannot do

Your state board can inspect premises. It can review license applications. It can fine licensees, suspend licenses, and revoke them. It can deny renewal. In some states it can assess civil penalties.

What it cannot do: make an arrest. Kick down a door. Charge someone with a crime. Subpoena records from a criminal enterprise. Freeze assets. Compel testimony under oath in a criminal proceeding.

So when a board inspector walks into a business and finds unlicensed workers, they can write a civil fine. That fine goes to the owner of record — who may be a shell company, a fake name, or someone who has already moved on to open another location two miles away. The business keeps operating. The fine is a cost of doing business. The workers, many of whom are trafficking victims with no control over what happens to them, face the consequences.

You cannot regulate a criminal problem with an administrative solution. It has to go through the criminal justice system.

That is not a criticism of state boards. It is a description of reality. Boards were built to regulate professionals. They were not built to investigate criminal enterprises.

Four Things That Would Actually Change This — And How to Make Each One Happen

We have been having the same conversation for decades. How do we get rid of the sexually oriented businesses disguised as massage that are destroying our profession’s reputation, trapping women in exploitation, and making it impossible for licensed therapists to be taken seriously?

We keep getting the same answers: more ordinances, more establishment licensing, more paperwork, more compliance burdens on the people who already followed all the rules.

None of it is working. The number of these businesses has nearly doubled since 2018.

I want to talk about what would actually work. Not more laws layered on top of broken enforcement. Not more requirements for licensed therapists to prove they’re not criminals. What would actually change this.

There are four things and for each one I have some ideas on exactly how to push for it.

The Fix Is Simpler Than You Think

We keep making this complicated. It isn’t.

Four things would change this situation. Here they are, plain and direct.

1. Give law enforcement the authority to act.

Right now a police officer can walk into a massage business, find workers without licenses, and do almost nothing about it — because in most states, licensing violations go to the board, not to law enforcement. The board can write fines. It can’t make arrests.

We need law enforcement to be able to write a citation on the spot, the same way a cop writes a traffic ticket. No board referral. No complaint form. No waiting. An unlicensed worker in your business? The officer cites the owner. That day.

To make this happen, ask your state legislators one question: does a police officer in this state have the authority to cite a massage business owner for employing unlicensed workers? In most states, the answer is no. That is your opening.

2. Stop treating our profession as the problem.

Every law that piles new requirements specifically onto massage businesses — requirements that don’t apply to physical therapists, chiropractors, or acupuncturists — treats massage therapy as inherently suspect. We are not the problem. We are a healthcare profession that criminals are using as a cover. Those are not the same thing.

We regulate doctors. We prosecute drug dealers. We do not make every physician’s office prove it isn’t a pharmacy front. We should be demanding the same standard for ourselves.

When a new licensing bill comes up in your state, ask this: does this apply to physical therapy offices? If the answer is no, push back. Ask why massage is being treated differently. Put that question on the record every single time.

3. Make it a crime to OWN/ RUN an unlicensed operation — and aim at the owner.

A civil fine doesn’t stop an organized criminal operation. It’s a business expense. What stops it is a misdemeanor charge on the first offense and a felony on the second — aimed at the owner who is running the business, not the workers who may have no say in what happens inside it.

Add one more thing: a prohibition on reopening. An operator who has been convicted cannot open another massage business in this state (or any state - not sure how to make that happen). Period. That closes the revolving door where someone gets caught, closes the location, and reopens two blocks away under a different name three weeks later.

Talk to your state legislators about criminal penalties aimed at owners. Tell them the owner bears the responsibility, the owner faces the charge.

4. Stop trying to build the perfect case. Just make it uncomfortable to operate.

Human trafficking prosecutions are hard. They require enormous resources, terrified witnesses who may not be able to testify, and months or years of investigation. Most districts cannot build them. While everyone waits for the case that never comes, the business keeps running. Just make it harder to do business with stricter fines like felonies and high monetary penalties.

The Missouri Attorney General’s Hope Initiative produced a 45% statewide reduction in these businesses in nine months. Not through trafficking convictions. Through letters to landlords.

That is the model. Make it expensive. Make it visible. Make it a problem every single day. Ongoing unannounced inspections. License verification every time. Landlord letters. Business license denial for operators with a history of violations. Bad actor registries. None of these require a trafficking case. All of them make the business model harder to sustain.

The people running these operations are counting on us to stay confused, stay fragmented, and keep trying to solve a criminal problem through licensing paperwork while they operate in plain sight.

We can do better.

Subscribe now

That’s not an opinion. That’s the gap this work is trying to close.

Today I’m releasing a resource I’ve been building for the Massage Therapy Nexus HUB: a state-by-state analysis of every establishment licensing law currently on the books in the United States. Twenty-three states. Five questions answered for each one and a clear-eyed look at what we actually know — and what we urgently need to find out. ( I did this all myself - yes with the help of AI but I am checking everything so let me know of any errors or misinformation.)

Why this matters

The only published academic research on this question — a peer-reviewed study comparing Texas and Oklahoma1 during the period when Texas implemented licensing — found no evidence that massage therapist licensing reduced crime rates. That study had real limitations, and the authors acknowledged them. But its core finding was damning: we passed these laws, we told the profession it would help, and we never measured whether it did.

The FSMTB’s establishment licensing toolkit argues these laws are valuable tools. The profession’s two largest associations, ABMP and AMTA, have pushed back, arguing that establishment licensing treats massage therapy differently from every other healthcare profession and puts the burden of a criminal problem on civil licensing2. They’re both right about something. They’re both missing data.

The argument that has never been settled — because nobody has done the work to settle it — is this:

Does establishment licensing actually reduce the presence and operation of sexually oriented businesses disguised as massage, or does it simply create a compliance burden for licensed therapists while bad actors adapt and reopen somewhere else?

The scoping document in my research files puts it plainly: “Legislative whack-a-mole. Traffickers adapt and more and tougher establishment licensing laws are not the answer.” That might be true. But it also might not be. We don’t know.

The full guide — all 23 states, all five questions, every verify flag and research gap — is available as a downloadable PDF through the link. This is the foundation document for the research that needs to happen next.

The survey. No one has asked licensed massage therapists in establishment licensing states how the law has affected their practices. I built one.

Take the survey today.

Now I need more help.

I am asking for help in submitting public records requests to state boards for establishment license counts, denial rates, and enforcement actions. I am asking for your help first - ask your state board for the information. I have the full instructions here.

Twenty-three states have some form of establishment licensing. Every single one of them passed that law without a benchmark, without a measurement plan, and without asking the people most affected — licensed massage therapists — whether it helped.

That’s not good enough. The profession deserves to know whether the laws being passed in its name are actually working. The victims in these businesses deserve better policy, not more paperwork. And the licensed therapists who carry the compliance burden every single day deserve someone asking whether it was worth it.

Here’s where I need your help.

I need people who are willing to help me request public records from state boards. Enforcement data, establishment license counts, denial rates — this information is public record. It just takes someone willing to submit the requests and wait for the responses. Sign up here to let me know you are working on your state.

Download the form letter to request public records. https://docs.google.com/document/d/1vEAdFykthdY9r6VJcqMNzz4OR_btf_OFtLC6OC_ihdU/edit?usp=sharing

I need LMTs in states that are currently debating establishment licensing to let me know what’s happening in your legislature. These debates are happening right now, with the same recycled arguments on both sides and no new data. We can change that.

For 128 years this profession has been fighting to separate itself from businesses that have nothing to do with massage therapy. We’ve tried associations, certifications, individual licensing, and now establishment licensing. Each tool has been adopted with confidence and evaluated with almost no rigor.

It’s time to actually look.

If you’re in state with establishment licensing, sign up to investigate your state! Let’s find out together what’s working, what isn’t, and what we should be asking for instead.

— Julie Onofrio, LMT
www.lookbeforeyoubookamassage.com
www.massagetherapynexus.com
Tired of waiting for our associations to do something. I am not even sure if this will work or provide us with the information we need to help create better laws. I won’t be stopping until we figure it out!

2

https://www.abmp.com/updates/news/abmp-and-amta-joint-response-fsmtb-human-trafficking-report

Local governments are writing — or rewriting — ordinances that regulate massage businesses. Some of these ordinances are good. Some are well-intentioned but flawed. Some of them treat you, a licensed healthcare professional, like a suspect. It is clear that the leaders in our communities are not informed about what happens in a massage business which leads them to create ordinances that add burdens to massage therapists while ignoring the real problem in our communities - the fact that the men who frequent these places are doing so for various reasons.

The stakes are real. The wrong ordinance can require you to submit to a second criminal background check your state already required. It can let inspectors walk into your treatment room unannounced while a client is on your table. It can mandate unlocked doors putting you and your business at risk. It can force you to keep your hours to a schedule that makes no sense for your clients’ lives.

The right ordinance, on the other hand, can do something genuinely important: make it harder for sexually oriented businesses (SOBs) disguised as massage to operate in your community — and easier for clients to find you, a real massage therapist.

We need to understand the difference. Because if we’re not at the table when these rules get written, we become the target instead of the protected.

I will actually take it a step further and say if only our laws were able to make unlicensed massage a felony with stricter penalties and law enforcement would do their job of going after these ‘bad actors’, we would not need ordinances.

Why Ordinances Exist at All

Let’s be direct about what’s happening. SOBs disguised as massage businesses are operating in every state in the country. They use the cover of massage therapy — the signage, the terminology, the storefronts — to sell commercial sex. Many of the people working in these operations are trafficking victims, controlled through debt bondage, document confiscation, and physical coercion. The victims often don’t even understand that they are victims.

This is not a massage therapy problem. It is a crime problem that is using our profession as a disguise.

Because these operations look like massage businesses on the outside, local governments have tried to regulate them through massage ordinances. When the ordinance isn’t written carefully, the burden falls on licensed massage therapists rather than on the operators of illicit sex businesses.

We can fix that. But first we need to understand what’s actually in these ordinances and what the research says works.

What the Research Shows Actually Works

The Network Team, an anti-trafficking research organization, analyzed massage ordinances from cities across the country and interviewed law enforcement, city councils, and code enforcement officials in places that had measurably reduced the presence of SOBs disguised as massage. Successful Massage Ordinance Factors September 2021 provides insights into various ordinances and provides suggestions for successful ordinances.

The cities that succeeded didn’t just write a list of rules. They focused on two things simultaneously: preventing illicit businesses from opening in the first place, and having real teeth when violations occurred.

Aurora, Colorado implemented an ordinance in 2018 that required a thorough application process and gave the city authority to close businesses immediately for certain violations. Within a year, Aurora had closed 18 illicit businesses. By 2021, its closure rate was at least 93%.

Cedar Rapids, Iowa saw a nearly 60% drop in illicit businesses within a year of passing its ordinance in November 2018.

Johnston, Iowa implemented an ordinance requiring detailed credential verification for all employees — not just the owner of record — plus an in-person interview as part of the application process. The Network could find no illicit businesses listed on sex buyer review sites in Johnston since 2016.

What made the difference? Not unlocked doors or health certificates. The things that actually worked were:

• Unannounced inspection authority. Pre-scheduling inspections lets operators hide evidence and rotate workers. Unannounced inspections — the same standard we apply to restaurant health codes — don’t.

• Rigorous application processes that verify credentials for all employees and check criminal backgrounds, not just for the owner.

• Authority to close businesses immediately when unlicensed workers are caught giving massages, when sexual activity is found, or when evidence shows women are living on the premises.

• Prompt notification of personnel changes, because trafficking operations rotate victims frequently. Requiring a business to notify the city whenever a new worker starts — with that worker’s license information — closes a major loophole.

• Regional coordination. When Aurora drove illicit businesses out, they simply moved to Denver and neighboring suburbs. When those cities passed similar ordinances the following year, the regional net became much harder to escape.

What Burdens Legitimate Massage Therapists — And Doesn’t Work

Here’s where we have to be honest about the friction between two legitimate concerns: protecting trafficking victims and protecting licensed massage therapists.

Some ordinance provisions that get proposed — sometimes with good intentions — fall harder on licensed therapists than on the illicit businesses they’re trying to address.

Unlocked door requirements are a clear example. The idea is that inspectors can verify what’s happening inside a treatment room. But a client receiving a massage has a reasonable expectation that no one will walk in unannounced mid-session. The American Massage Therapy Association explicitly opposes this provision, and they’re right to. A legitimate massage therapist shouldn’t have to choose between client privacy and legal compliance. Alternatives — like door viewing panels or mandatory response to a knock — can serve the same purpose without stripping away professional standards.

Duplicate criminal background checks add cost and delay for licensed therapists when the state practice act already required one. If your state board ran a background check before issuing your license, a second local check provides no additional public protection.

Doctor’s examinations and health certificates have no parallel in any other healthcare profession. Requiring them implies that massage therapists are presumptively a public health risk. No other licensed health professional is treated this way.

Hour restrictions so narrow they don’t match other healthcare settings penalize the many legitimate therapists who see clients in the evenings and on weekends. Reasonable late-night restrictions — say, no operation after 10 p.m. — have real enforcement value, because that’s when illicit businesses do most of their business. Restrictions tighter than that hurt legitimate therapists without added benefit. (Most massage therapists have already limited their hours because of the high risk of getting those bad actors as clients at that hour. This is problematic for many workers like airline pilots/stewardesses, doctors, factory shift workers and others.)

Ordinance provisions that apply equally to solo practitioners miss the mark entirely. A solo massage therapist working out of a single room does not present the same risk profile as a multi-practitioner establishment with rotating staff. Exemptions for sole practitioners aren’t a loophole — they’re recognition of reality.

State Establishment Licensing vs. Local Ordinances: Which Is Better?

This is the question I get asked most. The honest answer: state establishment licensing is the stronger, more durable solution — but local ordinances fill critical gaps.

As of June 2026, 24 states have some form of state-level massage establishment regulation. If your state isn’t one of them, a local ordinance may be the only tool available.

But here’s why state-level licensing is generally superior:

It creates a uniform floor. A business can’t hop from city to city to escape stricter rules when the state standard applies everywhere. This is the Aurora problem made structural — when Aurora drove illicit businesses out, they moved. A state framework eliminates that game.

It puts oversight with people who understand massage. Your state massage board knows the difference between a legitimate therapeutic business and an illicit sex operation. Local code enforcement officials often don’t. The Federation of State Massage Therapy Boards (FSMTB) has developed a full model establishment licensing framework — complete with a model application, inspection checklist, and citation form — specifically designed to be adopted by states and adapted to local needs.

Fsmtbestablishmentlicensing

1.06MB ∙ PDF file

Download

Download

It protects sole practitioners by design. The FSMTB model explicitly exempts sole practitioners, out-call therapists, and healthcare facilities from establishment licensing requirements. That’s not an oversight — it’s intentional recognition that a single therapist working independently is a different category than a multi-practitioner business.

It bars illicit businesses from the start. The FSMTB model includes explicit language prohibiting sexually oriented businesses from obtaining a massage establishment license. They can’t even apply.

It ties violations to the disciplinary system that licensed therapists already live within. An establishment that violates standards can lose its license through the same board that licenses individual therapists — with the same due process protections.

Local ordinances still matter, though, for one crucial reason: they can move faster than state legislation, and they have an enforcement tool state boards typically lack. A city inspector can post a “closed for violations” sign the same day a violation is found. State board disciplinary processes take months.

The ideal arrangement — and what the FSMTB model explicitly builds in — is state establishment licensing that sets the floor, with local authority to enforce and add location-specific requirements that don’t conflict with state law.

What a Good Ordinance Actually Looks Like

Based on everything the research shows, here’s what we should be pushing for — and what we should be pushing back on.

Every ordinance should require:

• Verification of valid state massage therapy licenses for all practitioners — employees and independent contractors, not just the owner on record

• Criminal background checks on owners and responsible managers (not individual therapists when the state already required one)

• Explicit prohibition on SOBs disguised as massage obtaining any establishment license or permit

• Public display of all licenses

• No living on premises

• No sexual conduct on premises

• Inspection authority

• Non-transferable permits — when ownership changes, the new owner must apply from scratch

Strong ordinances also include:

• In-person application interviews

• Pre-licensing inspections before a business can open

• Hours restrictions (no operation after 10 p.m.)

• Human trafficking awareness poster requirements in multiple languages

• License numbers required in all advertisements

• Landlord notification when illicit activity is found on the property

Ordinances should never include:

• Doctor’s examinations or health certificates

• Therapist dress or hygiene language beyond what state rules already require

• Unlocked door requirements (consider alternatives instead)

• Duplicate background checks when the state already requires them

• Requirements that apply equally to solo practitioners without exemption

What You Can Do Right Now

Your city council may be writing these rules right now. Your state legislature may be considering establishment licensing. You may not know about it until it’s already law.

Here’s how to get ahead of it.

Find out what’s already on the books in your city and state. Look up your local business ordinances and your state massage practice act. What do they say about establishment licensing? Inspections? Hours?

Get connected with your state massage therapy association. They track legislative activity and often need voices like yours when ordinances are being drafted. (AMTA has already said that they are not able to help with local ordinances so consider creating a coalition in your state that will work to address the problem locally)

Learn the FSMTB model. The Federation of State Massage Therapy Boards has published a full Massage Establishment Regulatory Toolkit — including model law, a model application, inspection checklist, and citation form. It’s publicly available at fsmtb.org. If your state or city is working on establishment regulation, this is the framework you want them to start from.

Show up. City council meetings are public. Public comment periods exist. When an ordinance is being drafted that affects your profession, you have a right to be in that room. Bring your perspective. Bring the research. Bring colleagues.

Correct the language. When your local news outlet calls an illicit sex business a “massage parlor,” write to the editor. When a council member talks about “cracking down on massages,” gently redirect: this is about sexually oriented businesses disguised as massage, not about massage therapy. Words matter, and the wrong language shapes the wrong policy.

The Bottom Line

The communities that have successfully reduced the presence of SOBs disguised as massage didn’t do it by treating massage therapists as suspects. They did it by making it very hard for illicit businesses to open, and by making it fast and decisive to close them down when they did.

That’s a framework we can support. That’s a framework that protects victims, protects our profession, and protects the public.

But we have to be in the room when it’s written.

I watched it happen again last week.

A city council, four hours into a the second meeting on this topic, voted to advance an ordinance that bans massage therapists from locking their front doors. The police chief said it would help him fight trafficking. The mayor said it would send a strong message. One massage therapist after another stood up and explained, calmly, that being forced to leave her door unlocked while alone with a client in a closed room doesn’t make her safer. It makes her a target. Dozens of emails were sent with the same supporting comments.

One of them had already been robbed when her door was unlocked. One was a survivor of assault inside her own practice. One described watching a stranger walk into a spa, grab something off the counter, and run — while the therapist was in the back, alone with a client, unaware.

The council passed it anyway. The last time they did add an amendment that said licensed massage therapists could ask for a voluntary inspection of their premises to get an exemption from the things in the ordinance that were asking us to break the law.

The ordinance also said that a massage business could not accept cash. Apparently the illicit businesses are mainly cash businesses and have tons of cash on hand and are part of larger money laundering schemes…so the council thinks by making all massage therapists stop taking cash that it would help them to investigate and prosecute.

They also want to regulate the hours a massage business can stay open. We all know that most licensed massage therapists don’t stay open that late because it often does attract that other crowd looking for happy endings. That also leaves a gap in care for people who work swing shifts and late hours. (Airline Pilots and attendants are a good example.)

They also wanted to ban warning systems and were not clear on the definition of what a warning system was or wasn’t.

So they were saying that they would use discretion and not go after licensed massage therapist but in essence they were saying we would be OK in breaking the law. This also would compromise our liability insurance plans and some code of ethics of the professional associations we belong to.

Who shows up.

One of the most interesting observations on the meetings were who is showing up to support massage therapists in these cases. It was clear that AMTA was NOT there even though they have a statement on their website with recommended language for ordinances. (I have asked the AMTA-WA Chapter to get involved and their hands are tied as AMTA National won’t help them with ordinances.)

I ran the ordinance and their statement through Claude.ai to provide this scorecard on the language.

Amta Standard Scorecard

109KB ∙ PDF file

Download

Download

This is happening everywhere, and it’s going to keep happening, because the people writing these ordinances — police departments and city attorneys, usually with good intentions — don’t understand what massage actually is or how these businesses actually work. The people who do understand, the licensed therapists, mostly aren’t in the room.

I want to change that. So l am researching ordinances and establishment licensing to see what if anything helps the most to help create a best practices document or more specific guidelines for stopping these places.

The businesses they’re worried about are real

Let me be the first to say it: the illicit sex businesses operating under the cover of massage are a genuine problem. They’re in nearly every community. Many are tied to organized crime. The women working inside are frequently trafficking victims — coerced, controlled, sometimes living in the building, often unable to leave. They also don’t even know they are being trafficked as they willingly sign contracts with these bad actors thinking they are coming to work in the US to send money back to their families in China, Korea and other countries.

Those businesses should be shut down. The victims should be helped. No argument.

These are not massage businesses. They are illicit sex businesses that have stolen the name of my profession to operate. That distinction is the whole game — and it’s exactly the distinction these ordinances keep getting wrong.

Why the obvious approach backfires

When a council first confronts this, the instinct is to make operating as painful as possible. Ban locked doors so police can walk in. Ban cash to disrupt money laundering. Ban “warning systems” that tip off lookouts. Restrict hours.

It sounds tough. Here’s why it fails.

Traffickers adapt. Licensed therapists don’t. An organized criminal operation responds to a cash ban with prepaid cards and shell companies. It responds to a locked-door rule with lookouts. What it does not do is comply in good faith. Meanwhile the licensed therapist down the street — who follows the rules, because her license is her livelihood — loses her locked door, her cash-paying seniors, and her security alarm. The rule sorts people by their willingness to follow rules. Only the law-abiding get caught in it.

“They’re already operating illegally” is the tell. Practicing massage without a license is already a crime everywhere. If a city isn’t enforcing the laws it already has against businesses it has already identified, why would those same businesses suddenly comply with new rules about doors and payment methods? They won’t. The new rules only bind the people who were already following the law.

“We’ll just use discretion” isn’t a safeguard. Police reassure councils: don’t worry, we won’t enforce this against legitimate businesses. But that means writing a law and promising not to apply it as written — and leaving every therapist’s safety to depend on which officer shows up. A law that only works if it’s selectively unenforced is a law aimed at the wrong people.

This is why showing up matters

These ordinances are spreading fast, and right now they’re being written without us. That’s the whole problem. An informed therapist in the room — one who says “I want these businesses gone as much as you do, and here’s how to do it right” — changes the outcome. An empty chair changes nothing.

So I am building the tools to put you in that room.

For paid subscribers: the complete toolkit (Coming July 1, 2026 (hopefully)!

Below are the documents I’ve spent weeks building — everything a massage therapist needs to walk into a city council meeting and shape an ordinance instead of just reacting to one. They’re free to use, adapt, and bring to your own community.

• How to Use This With Your Council — read this first. A one-page strategy guide so you bring the right approach to your community, and don’t accidentally trigger a bad ordinance in a town that wasn’t even thinking about it yet.

• The Massage Ordinance Decision Guide (2 pages) — the pull-out summary to hand a council member who won’t read more than two pages.

• The Massage Ordinance Toolkit (full) — the complete reference. Plain-language sections for council members, technical sections for the staff and attorneys who draft, real-ordinance comparisons, a model-provision checklist, and the voluntary-inspection exemption written out as model language.

• How to Actually Stop Them — the prevention-and-closure plan: what actually shuts these businesses down, before they open and after.

• The rebuttal set — the side-by-side comparisons and point-by-point answers I built for a live ordinance fight, ready to adapt for yours.

Bring them. Share them. Put them in front of your council before the next ordinance is written about you instead of with you.

It’s the summer of 1894. London.

The British Medical Journal just dropped an exposé calling out so-called “massage shops” as fronts for prostitution. The article is titled — and I’m not making this up — *”Astounding Revelations Concerning Supposed Massage Houses or Pandemoniums of Vice.”*

Sound familiar?

A legitimate profession. Criminal operators hiding behind the name of massage. A confused public and licensed practitioners left holding the bag.

Four nurse-midwives in London read that BMJ article and made a decision. They were done being lumped in with sex businesses. Done having their profession defined by people who had nothing to do with legitimate massage. They founded the Society of Trained Masseuses within six months of that exposé — and they built it specifically to draw a line between real massage and what was happening in those backrooms.

That Society eventually became the Chartered Society of Physiotherapy — one of the largest and most respected healthcare professions in the world.

They got out.

Which means the question we have to sit with right now, in 2024, is this: **Can we do it again?**

We Have Been Here Before. Many Times.

Let’s be honest about the history, because it matters.

This is not a new problem. It’s not a post-pandemic problem. It’s not something the internet created. The massage profession has been confused with sexually oriented businesses for well over a century — and we have been fighting it the entire time.

In 1979, the president of AMTA was quoted in the *New York Times* saying that “massage parlors” are “usually a front for prostitution or other illicit sexual activity.” That was 45 years ago. The profession was already exhausted by the association then.

In 1987, AMTA made the news again pushing back on the word “masseuse” because of what it had come to mean.

We have tried licensing. We have tried national certification. We have tried professional associations and codes of ethics and continuing education requirements. And yet here we are. The problem hasn’t gone away — it’s gotten bigger, more organized, and more deeply embedded in the public imagination of what massage is.

Over 350,000 licensed massage therapists in the United States are still waking up every day and explaining to clients, to legislators, to their own families, that they are not *that kind of place*.

That has to stop. And to understand how to stop it, we need to understand what actually worked in 1894 — and why we’re in a harder position today.

What the 1894 Founders Did Right

Those four Victorian women didn’t just complain about the problem. They executed a strategy. And it was remarkably sophisticated.

**First, they separated identity through credentials.** They created rigorous examinations, a formal curriculum, and a code of conduct. The message was simple and aggressive: *we are not them, and here is the documentation to prove it.* Licensing became a visible, verifiable line in the sand — not a burden, but a badge.

**Second, they reframed what massage meant.** This is the move that changed everything. They aligned with the medical model. They positioned massage as a clinical intervention — something done to a spine, a joint, a nervous system. Not to a person as a sensual being. They didn’t just change their practices. They changed the *mental picture* the public had when they heard the word massage. Clinical rooms. Plain dress. Daytime-only practice. Medical referrals. Every detail said: *this is healthcare, not entertainment.*

**Third, they controlled the language from day one.** They named themselves deliberately. They refused to let anyone else define what their profession was. The word “trained” in “Society of Trained Masseuses” did enormous work. It said: there is a difference. We are it.

**Fourth, they found powerful allies.** They didn’t go it alone. Within the first years, 79 physicians publicly endorsed the Society. That medical patronage gave them credibility they could not have manufactured on their own.

**Fifth, they built institutional infrastructure.** The Society became the gatekeeper — vetting referrals, setting rates, policing its own members, establishing a monopoly on what legitimate massage looked like. They created the machinery that enforced the separation.

The result was a complete transformation of how the public understood massage. Not overnight. But durably.

Why It’s Harder Today — Let’s Be Honest

We are more entangled than the 1894 founders were. Here’s why.

**The scale is incomparable.** In 1894, the problem was a handful of London establishments. Today, sexually oriented businesses (SOBs) disguised as massage are operating in strip malls in every American city. We are talking about tens of thousands of locations, organized crime networks, and an industry generating hundreds of millions of dollars in criminal revenue. This is not a local scandal. This is a national crisis.

**The internet collapsed the distinction.** In 1894, you couldn’t Google “massage near me” and end up on an escort review site. Today the same search terms, the same storefronts, the same generic signage serve completely different markets. The confusion isn’t just social anymore. It’s algorithmic. It’s structural.

We lost the language battle in 2017

This is the one that haunts me. When the Polaris Project published their report on human trafficking and coined the term “illicit massage business,” they handed every reporter, every legislator, and every law enforcement officer in America a phrase that permanently embeds the word *massage* in the vocabulary of trafficking. Every headline that uses that term is an advertisement for the idea that massage and sex work are the same thing.

The 1894 founders never let that happen. They refused to be defined by the scandal. They named the problem themselves, in their own terms. We did not do that. And we are paying for it.

Establishment licensing is making things worse, not better.

It is almost like it is a last ditch effort to get the problem under control because it has gone on for so long. More than 20 states now have establishment licensing laws requiring licensed massage therapists to obtain additional permits, submit to inspections, and prove they are law-abiding. Here’s the problem: the 1894 founders used licensing to create distance from sex work.

Today’s establishment licensing does the opposite.

It treats every licensed massage therapist as a potential suspect. It embeds the massage profession inside the regulatory framework designed for SOBs, rather than separating us from it. There is no research — none — showing it reduces trafficking or closes these businesses.

If licensing a physical therapist’s office doesn’t require them to prove they’re not running a sex business, why does ours?

**We are fragmented.** AMTA, ABMP, the Federation of State Massage Boards — they are not pulling in the same direction. There is no unified strategy. No “Reclaim Our Name” campaign with muscle behind it. No coordinated legislative response. The 1894 founders acted together, fast, and with a shared vision. We are still debating terminology in committee meetings while legislators write laws that define us by our worst impersonators.

So. Can We Do It Again?

Yes. I believe we can. But not by doing more of what hasn’t worked.

Not by more licensing that treats us as the problem.

Not by staying quiet and hoping it goes away.

Not by letting Polaris or law enforcement or the nightly news define who we are.

The 1894 playbook still works. The principles haven’t changed. What changed is the scale, the technology, and the urgency. We need to execute that same strategy — a separation of identity, a reclaiming of language, a medical alignment, powerful allies, and institutional infrastructure — at a scale those four Victorian women couldn’t have imagined.

That is what this series is about.

Over the next several articles, we are going to map the problem honestly. We are going to look at what’s working and what isn’t. We are going to look at language, legislation, law enforcement, landlords, and the media — all the places where the entanglement lives and where the separation has to happen.

And we are going to end with a concrete plan.

Not a wish list. A plan.

Because we have been fighting this fight for 130 years and we deserve a strategy that actually works. The Victorian women who built physiotherapy from the wreckage of a scandal proved it can be done.

Now it’s our turn.

*This is Article 1 of the Hands Off Our Name Series— an ongoing exploration of the entanglement between the massage therapy profession and sexually oriented businesses (SOBs), leading to a concrete action plan for separation. New articles drop regularly at lookbeforeyoubookamassage.com.*

Julie Onofrio, LMT, has been a licensed massage therapist for 39 and is the creator of lookbeforeyoubookamassage.com, a resource for clients, therapists, and communities working to understand and address this issue.

**Coming in Article 2:** The Language War — How the words we use (and allow others to use) either protect our profession or bury it. And what we can do about it right now.

A city council member said it’s a law enforcement problem.

A police chief said it’s a board of massage problem.

The board of massage says it’s a law enforcement thing.

A state legislator said it’s a a federal government problem.

A county official said it’s massage therapists problem so lets put more regulation sanctions on them.

AMTA and ABMP say:

“Human trafficking is an indefensible act and, globally, very prevalent, but it isn’t a massage therapy fight. It’s a distraction from our mission to promote massage therapy as a means for health.”"

Meanwhile….The problem is we have illicit businesses disguised as massage businesses all over our cities, towns and states and we have many human trafficking task forces in states and cities but no one is talking to each other.

What These Ordinances Are Actually Doing

When a city faces political pressure to “do something” about suspected sex businesses hiding behind the word massage, they have two choices.

They can go after the criminal operators directly — which requires law enforcement resources, prosecutorial will, interagency coordination, and political courage to pursue organized crime. It isn’t just sex work or unlicensed massage. These places are usually involved in money laundering, racketeering and human trafficking. That is hard, expensive, and slow.

Or they can regulate massage businesses — which requires a city ordinance, a council vote, and a press release. That is easy, cheap, and fast. Often they do not even know the difference between a licensed massage therapist who are often healthcare providers and these illicit businesses hiding in plain sight. One council member asked how long has this been going on and the prosecutor answered since the 1990’s.

So they regulate massage businesses. Every time.

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The result is that they are attempting to control what happens inside suspected sex businesses by adding rules to licensed massage therapists. The businesses actually selling sex are not complying with the old rules or the new ones. The legitimate massage businesses — the ones that were never the problem — are now buried under more paperwork, more inspection risk, more regulatory burden. The city councils and law enforcement are not enforcing the laws we have now for licensed massage therapists—how will they be able to enforce even stricter regulations?

Here is the clearest way I know to say this:

**Establishment licensing laws and city ordinances put the responsibility on the massage therapy profession, not on the bad actors and the Johns who make these places profitable. Responsibility needs to be returned to real cause of the problem and stop these places from opening in the first place rather than going after them after they are open and established.

As I have studied this, I have gone through many stages of what really needs to be done and have a list of things that are being tried and could be tried, but today after hours of research into ordinances I think these ordinances need to stop. State establishment licensing is the next best option but once again it puts the burden on licensed massage therapists. City business licensing requiring owners of massage businesses to show they have hired only licensed massage therapists is another option…but do you think the illicit businesses would even apply for a license?

And here is the critical piece nobody says in public:

**You cannot regulate a criminal problem with an administrative solution. A board’s job is to control licensees. It cannot control those who are not licensed without law enforcement and the criminal justice system.**

Think about how we handle other licensed professions. We know doctors should not be drug dealers — but the laws regulating doctors do not explicitly prohibit drug dealing. Why? Because drug dealing is a crime. It is handled by law enforcement, not by medical boards. The medical board handles unprofessional conduct by licensed physicians. The criminal justice system handles the drug dealing.

We have spent decades trying to get the massage board to solve a problem that belongs to the criminal justice system. That is backwards. And it has not worked.

We Are Regulating Sex Workers Through Massage Therapists

Here is the observation that should change this entire conversation.

When these ordinances add new requirements — license display, ID verification, hours restrictions, cash prohibitions — they are aimed at businesses using the word massage. Some of those businesses are legitimate healthcare practices. Some are suspected SOBs. The legitimate businesses comply. The suspected SOBs do not.

So the practical effect of every new ordinance is to add regulatory burden to legitimate massage therapists while doing nothing to the criminal operators who were not complying anyway.

We are regulating the suspected sex workers by regulating the licensed massage therapists. We are controlling behavior in suspected criminal operations by adding paperwork to the people who had nothing to do with the crime.

This is not hypothetical. It is exactly what is happening.

The Right Frame — And the Right Fix

Your own state’s research on this problem contains the answer. Let me make it explicit.

**The right frame is not massage regulation. It is sexually oriented business regulation.**

Define sexually oriented businesses to include any enterprise that meets the definition — whether it holds a massage license or not. Prohibit any sexually oriented business from providing massage, bodywork, or touching of any kind. Put the violation in the sexually oriented business code, not the massage therapy code.

This matters enormously. You should not arrest someone for violating massage therapy codes because they were engaging in prostitution. You should arrest them for violating sexually oriented business codes, for prostitution, for human trafficking. Keep the massage therapy code clean. Keep the violations where they belong — in the criminal code, not the professional licensing code.

**The second piece is a state-level Human Trafficking Task Force with real authority and real funding.** Housed in the Attorney General’s office. With a mandate to coordinate between state, local, and federal authorities. With investigators who can cross jurisdictional lines. With prosecutors assigned to build financial cases — money laundering, tax evasion, RICO — that do not depend on victim testimony. With the authority to act across counties so that shutting down in Kent does not just move the problem to Federal Way.

**The third piece is returning enforcement responsibility to law enforcement** — with the funding to match. That means the legislature has to appropriate it. Which means massage therapists, anti-trafficking organizations, city councils, and community members have to make enough noise that legislators feel more pressure to fund enforcement than to ignore it.

Local jurisdictions do not have the resources to conduct major investigations. That is one of the main reasons they are passing establishment licensing ordinances — because they are trying to solve a problem that requires state-level resources using city-level tools. The state needs to step up and give them those resources.

They need to do full investigations on each place (over 17,000 in the US) and get them on human trafficking and the main problem is finding support for the women who often don’t even know they are being trafficked. They sign contracts willingly with these traffickers looking for a better life and money for their families back in China and Korea and wherever they come from.

What We Are Demanding

We are licensed massage therapists. We are healthcare providers. We completed state-approved education, passed licensing examinations, and submitted to background checks. We work in clinics, hospitals, rehabilitation centers, and private practices. We help people recover from injury and manage chronic conditions.

We are not the problem.

We have watched criminal networks hide behind our profession’s name for over a hundred years. We have watched ordinance after ordinance add burden to our practices while doing nothing to dismantle the organizations exploiting our name. We have watched agencies point at each other while thousands of suspected sex businesses operate openly in our communities.

We are done waiting for someone to figure out whose problem this is.

**It is a crime problem. It belongs to law enforcement, prosecutors, and the criminal justice system — properly funded, properly coordinated, and properly focused on the operators and traffickers, not on the workers and not on the therapists.**

Regulate sex businesses as sex businesses.

Fund the task forces.

Return responsibility to law enforcement.

Enforce what already exists before creating more.

And leave licensed massage therapists — who did everything right — out of it.

The city’s response? New rules for massage therapists.

I want to be fair. Some of what Federal Way passed is genuinely good — prohibiting internal warning systems designed to alert operators when law enforcement is nearby, banning late-night operations, requiring card-only payments to create a financial paper trail. These provisions target real operational signatures of criminal businesses.

The other requirements - not so much.

But here is what I can’t stop thinking about.

Licensed massage therapists in Washington State are already required by law to display their license and carry valid ID. That law exists right now. Any investigator could walk into any business claiming to offer massage and verify licensure on the Washington Department of Health website in under sixty seconds.

That tool is already in hand.

It is not being used.

So before we talk about what Federal Way got wrong — and before we talk about what actually works — we need to talk about the question nobody in that council chamber asked out loud:

Why aren’t we enforcing what we already have?

The Problem Nobody Owns

The answer is a coordination failure so complete it’s almost architectural.

Unlicensed massage practice is a civil matter — it belongs to the Washington Department of Health. Prostitution belongs to law enforcement. Business licensing belongs to the city. Human trafficking belongs to a task force that may or may not exist, may or may not be funded, and may or may not include any of the above.

Everyone has a piece of this problem. Nobody owns it.

The Department of Health is complaint-driven. They don’t have investigators walking into businesses. They respond when someone files a complaint. Trafficking victims can’t file complaints. Buyers won’t. Neighbors don’t know what they’re looking at. So the complaints don’t come, and the businesses keep operating.

Law enforcement is focused on prostitution charges — which require proving a sex act occurred, often dependent on victim testimony from women who are traumatized, linguistically isolated, and afraid of deportation. Those cases are hard. So they don’t get made.

The city can revoke a business license — but only if someone tells them to and so these businesses thrive. Not because the laws don’t exist. Because the laws exist in separate silos, each silo waiting for someone else to act first.

Federal Way’s ordinance is a local workaround for a state enforcement failure. That’s what it is. Until we name that clearly, we’ll keep passing ordinances that burden the compliant and ignore the criminal.

What Doesn’t Work

More regulations on licensed massage therapists will not close a single SOB disguised as massage.

Not. One.

These criminal networks are sophisticated, well-funded, and highly adaptive. They comply with nothing. They move when pressured. They reopen under new names. When Kent, Washington cracked down and shut down 18 suspected businesses, authorities immediately noted that operators simply moved to neighboring cities.

This is called the whack-a-mole effect and it’s the predictable result of every single-jurisdiction crackdown that doesn’t coordinate with its neighbors.

The businesses that comply with new display requirements, new ID requirements, new hours restrictions — those are the legitimate massage therapy businesses. The ones that were never the problem. They now carry more paperwork, more inspection risk, more regulatory burden and the criminal operations continue operating until law enforcement decides to act.

We are regulating the compliant and ignoring the criminal.

Establishment licensing — requiring the business itself, not just individual therapists, to obtain a special license — is frequently proposed as a solution. There are arguments for it, the evidence that it actually reduces trafficking or shuts down SOBs is thin. The ABMP and AMTA have both opposed it for years, for a simple reason: it treats massage therapy differently from every other licensed healthcare profession and implies that licensed therapists are part of the problem rather than victims of it. (AMTA now apparently is for it as seen in many states proposing establishment licensing.)

We are not the problem. We have never been the problem.

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What Actually Works

The cities that have actually moved the needle — not just passed ordinances, but sustained real reductions in SOBs disguised as massage — did five things that most cities, including Federal Way, are not doing.

1. Prosecute operators as criminal enterprises, not businesses.

These are not massage businesses that went bad. They are organized crime operations using the word “massage” as a cover. Treat them accordingly.

The charges that actually dismantle these networks are not prostitution charges. They are RICO charges. Money laundering. Tax evasion. Labor law violations — failing to file I-9s, misclassifying employees, not carrying workers’ compensation insurance. Consumer fraud. Unlicensed practice of a health profession.

These charges are built on financial and paper trails, not victim testimony. They don’t require a traumatized trafficking survivor to relive her abuse in open court. Denver’s “Bad Apple” RICO case. Ohio prosecutions using corruption and money laundering charges. Multi-state federal cases involving the IRS and DOJ. These are what actually take networks down.

The cash is there. Seizures in the tens and hundreds of thousands of dollars have been reported in successful operations. Asset forfeiture funds the investigation and cripples the network simultaneously.

2. Assign someone to own the problem across every agency.

This is the simplest and most important structural fix. A designated cross-agency coordinator — someone whose actual job is to connect the DOH civil violation to the law enforcement investigation to the city license revocation — changes everything. Where this coordination exists, results follow. Where it doesn’t, the problem persists regardless of how many ordinances get passed.

No new laws required. Just someone whose job it is to make the existing systems talk to each other.

3. Use nuisance abatement.

This is the most underused and most effective tool cities have right now, and almost none of them are using it.

Nuisance abatement uses building codes, fire codes, zoning ordinances, and health codes to shut down a property — without ever proving prostitution or trafficking. A coordinated inspection by health inspectors, fire inspectors, code enforcement officers, and police, all entering simultaneously and looking for code violations, sanitation failures, zoning violations, and signs of people living on premises — can shut a building down legally, quickly, and without a single victim having to testify.

Bellevue WA used this approach awhile ago.

4. Go after the demand.

Surveillance near suspected locations. Traffic stops. Buyer arrests and public identification. Every buyer who faces consequences reduces the flow of money into these operations. These businesses run on demand. Interrupt the demand and the business model collapses.

This is politically uncomfortable. It is resource-intensive. It requires cooperation from prosecutors who may not prioritize it. But it works. And it is the only intervention that attacks the criminal network at its revenue source.

5. Hold landlords accountable.

The landlord knows.

In most cases, the landlord is collecting cash rent, seeing the late-night traffic, noticing the covered windows and the buzzer system, and looking the other way. Some landlords are profiting directly. Some are simply afraid. All of them are enablers.

Washington State’s Attorney General has attended convenings by the Network Team who promote a Landlord Engagement Program specifically designed for this. ( I actually spoke with someone in the AG office back in 2023 who was working on this…of course it never came to fruition and the person has left. When I most recently contacted the AG office, they would not speak to me on the issue.) Some jurisdictions now allow landlords to break leases and evict tenants when human trafficking or prostitution is suspected — and are exploring penalties for landlords who refuse to act when presented with evidence.

When the building is unavailable, the business cannot operate. Target the real estate and you target the infrastructure.

Stop with the Ordinances. Demanding

We are licensed massage therapists. We are healthcare providers. We have completed state-approved education, passed licensing examinations, and submitted to background checks. We work in pain clinics, rehabilitation facilities, hospitals, and hospice. We help people recover from injury, manage chronic conditions, and reduce the stress that underlies so much disease. In WA State we are providers with health insurance companies providing relief from pain and injuries.

We are not the problem.

We have watched our profession be hijacked by criminal networks for over a hundred years. We have watched media call them “massage parlors.” We have watched ordinance after ordinance add burden to our practices while doing nothing to dismantle the organizations exploiting our name.

Here is what we are demanding — from every city council, every law enforcement agency, every state legislator who wants to address this problem:

Enforce what exists before you create more. Washington State law already gives you the tools to walk into any business using the word massage and verify licensure in sixty seconds. Use it.

Coordinate your agencies. Assign someone to own this problem across DOH, law enforcement, and city licensing. Right now nobody does.

Prosecute operators as criminals. RICO. Money laundering. Tax evasion. Labor violations. Build financial cases that don’t depend on victim testimony.

Use nuisance abatement. You don’t need to prove trafficking to close a building that’s failing health codes and housing workers against their will.

Engage the landlords. Make harboring these operations legally and financially costly.

Stop adding regulatory burden to licensed massage therapists who were never the problem, who are already complying with every existing law, and who are absorbing the stigma and cost of criminal enterprises they have nothing to do with.

The whack-a-mole stops when the entire environment becomes inhospitable — through coordinated multi-agency enforcement, financial prosecution, landlord accountability, and demand suppression, all happening simultaneously across jurisdictions.

That takes political will. It takes resources. It takes agencies working together instead of protecting their turf.

What it does not take is more paperwork for licensed massage therapists.

Julie Onofrio, LMT, is the author of The Massage Therapists Toolkit and the creator of www.lookbeforeyoubookamassage.com*, a national resource for the public, law enforcement, and legislators. She has been a licensed massage therapist for [X] years and has spent [X] years documenting the impact of sexually oriented businesses disguised as massage on the profession.*

If you are a massage therapist, share this article with your local network, your city council member, and your state representative. If you are a legislator or law enforcement officer, reach out. We are ready to work with you.

Meanwhile, down the street, a business with no licensed massage therapist in sight put the word “massage” on their sign, opened their doors, and started operating. In most states, nothing happened to them.

That’s title protection in action — or rather, title protection failing in action. If we want to change what’s happening to this profession, we have to start here: understanding what title protection is, what it was designed to do, and why the gap between the law on paper and the law in practice is costing us everything.

Also looking at the history of our licensing laws is needed to see how we got into this entanglement. AMTA has been the force behind licensing laws since the early 1950s and continue to have their head in the sand on this issue. (I have written AOD proposals on the topic that were rejected and one AOD proposal that got passed a few years ago on the issue has no report on the progress. I also volunteered with my local chapter in WA State as GR for a few years asking AMTA for help on these city ordinances that were popping up all over and no response.)

What Title Protection Is Supposed to Do

Title protection laws exist to do one simple thing: reserve the use of professional titles for the people who have earned them. When a state passes a massage therapy licensing law, it is saying that only a licensed massage therapist — someone who has met specific education, examination, and background requirements — can call themselves a massage therapist or advertise massage therapy services.

Think of it like medicine or law. You can’t hang a shingle that says “Dr.” or “Attorney at Law” unless you’ve gone through the required training and passed the required tests. Title protection for massage therapy is the same concept. The word “massage” belongs to us — the licensed professionals who earned it.

Most states now have these laws. In most states, a licensed massage therapist is the only person legally authorized to use the term massage or massage therapy to advertise or perform services. The laws typically require that your license number appear on your advertising, that your license hang on the wall of your office, and that you carry photo ID that matches that license.

What the Laws Actually Look Like

The strength and specificity of title protection laws varies enormously from state to state. Some are strong. Some are full of holes and a few states still don’t have licensing at all — which means title protection there is essentially nonexistent.

In the states that do have licensing, most also have laws against unlicensed practice. The penalties for practicing massage without a license are supposed to create a deterrent. But here’s what those penalties often look like in practice: civil fines. Misdemeanors. Minimal consequences for operators who are often running profitable businesses and simply write the fines off as a cost of doing business.

A small number of states have elevated unlicensed massage to a felony or made it a felony to knowingly aid and abet unlicensed practice. NY and OR are two that I know of that make it so unlicensed massage is a felony. Yet NY has one of the highest numbers of illicit massage. So is making it a felony the answer?

The Loopholes That Swallow the Law

Even in states with strong title protection laws, there are gaps and sexually oriented businesses disguised as massage (SOBs) are very, very good at finding them.

The reflexology exemption. Some states exempt reflexology — foot and hand massage — from massage licensing requirements. That sounds reasonable on the surface. In practice, it means that an Sexually Oriented Business (SOB) can open a “foot massage” business, avoid the licensing requirement entirely, and use that loophole to operate without background checks, without a licensed therapist in sight, and with near-total impunity.

The “relaxation massage” loophole. Some states (OH) allow something called “relaxation massage” to be performed without a license. The same problem applies. The loophole becomes the front door.

The “Asian massage” problem. There are often no specific laws against using the term “Asian Massage” even though it carries no licensing requirement and is routinely used as a cover by illicit sex businesses. Legitimate Asian bodywork practitioners use specific titles for their work — acupressure, shiatsu, tuina, and others — not the vague marketing term “Asian massage.” The loophole is being exploited at our expense and at the expense of Asian communities.

Diploma mills and fake credentials. This one is particularly painful. Some SOBs don’t avoid the licensing system — they game it. Fake massage schools have issued fraudulent credentials. Some businesses obtained one legitimate license and displayed it on the wall while every worker in the building claimed it was theirs, because no one was required to carry photo ID. It took years for states to add the photo ID requirement specifically because of this tactic.

The Enforcement Gap: Where the System Really Breaks Down

Even where the laws are good, enforcement is inconsistent at best and nearly nonexistent at worst. Law enforcement does not understand that it is a crime and when it is only a civil offense or misdemeanor it is not high on their list of priorities.

State massage boards primarily exist to regulate licensed massage therapists. They handle complaints about licensed practitioners — discipline, license suspension, revocation. When an unlicensed business shows up on their radar, they typically refer the case to law enforcement. Then what happens? Often, very little.

Law enforcement agencies are stretched thin. They are dealing with violent crime, property crime, drug offenses — and then there’s this referral about a business using the word “massage” without a license. The business may simply close and reopen somewhere else. Traffickers are highly adaptive. They move, reopen, and adjust faster than enforcement systems can follow.

The result is a significant enforcement gap — the law says these businesses are illegal, but the law isn’t being applied consistently enough to stop them. This isn’t just a missed opportunity. It’s an open door that criminal networks walk right through.

When “Protecting the Public” Ends Up Targeting Us

Because state and local governments struggle to enforce title protection and unlicensed practice laws against SOBs, many have turned to a different approach: regulating massage businesses harder. Establishment licensing laws — now on the books in states including Alabama, Alaska, Colorado, Florida, Texas, Oregon, and many others — impose additional licensing requirements on massage businesses. Inspections. Operating hour restrictions. More paperwork. (State Establishment licensing is being worked on now across the US mainly because the individual cities are creating a mish-mash of ordinances to try to deal with the problem and they usually start out with unfair rules like a massage business must be a cash business only or be open only certain hours of the day restricting business.)

There is no conclusive research showing these establishment licensing requirements actually separate legitimate massage from SOBs. Traffickers adapt. They find new loopholes. Meanwhile, legitimate massage therapists bear the cost and burden of complying with yet another layer of regulation designed to fix a problem we didn’t create.

Cities and counties are passing ordinances that restrict massage businesses in ways that make it sound like we are the problem. We are not the problem. We never were. We are licensed healthcare providers who are being regulated as if we are the criminal element — while the actual criminal element continues to operate with minimal consequences.

The responsibility for this problem has been placed squarely on our shoulders. That is wrong, and we need to say so loudly.

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What Good Enforcement Actually Looks Like

Title protection only works when it is enforced. That means:

We need Laws with real penalties — not just civil fines and misdemeanors, but felony-level consequences for operators who knowingly run unlicensed businesses and for those who aid and abet unlicensed practice.

We need enforcement agencies that are trained and empowered to act on unlicensed practice referrals — not just licensed-therapist complaints need training on how to handle the women who work at these places as they are usually the victims of human trafficking or indentured servitude.

We need to close the loopholes. Reflexology exemptions need to be tightened or eliminated. Relaxation massage carve-outs need to go. Laws still using the terms “massage parlor” or “masseuse” need to be updated — those words now signal sexually oriented businesses, not legitimate massage therapy. We need to do away with them and explain it or fight for them like we do the words massage with “Hands Off Our Name”

Photo ID requirements enforced. License verification systems made publicly accessible and promoted to the public.

More critically: law enforcement, city councils, and legislators need to understand the difference between the massage therapy profession and sexually oriented businesses disguised as massage. Right now, many do not.

That education gap is part of our work. (Because no one else is doing it. Our professional associations could be doing this but they won’t.)

Why This Matters to You Right Now

You might be thinking — I follow the law. I have my license. I’m doing everything right. Why is this my problem to solve?

Because when title protection fails, it’s your reputation that suffers. Your clients who don’t know the difference. Your community that sees “massage” and thinks of something shameful. Your profession that gets lumped in with criminal operations. Your income that gets undercut by businesses charging $30 for “massage” because they have no overhead — no school, no exam, no license, no legitimate employees.

This is your problem because it is our profession and the only way to fix the laws is for us — the licensed professionals, the people who know this issue from the inside — to show up and demand it. (Got a better idea? Let me know.)

Action Box

• Know your state’s laws. Look up your state’s title protection and unlicensed practice laws. (Check on www.lookbeforeyoubookamassage.com or your state board website.) Know exactly what the penalties are in your state and whether unlicensed practice is a civil matter, misdemeanor, or felony.

• Report unlicensed businesses. When you see a business using the term “massage” without visible licensing, report it to your state massage board. Document everything. Also use www.simplyreport.com to report suspicious businesses.

• Contact your state legislators. Push for stronger unlicensed practice penalties, closure of loopholes like reflexology exemptions, and removal of outdated language (”massage parlor,” “masseuse”) from your state statutes or officially reclaim them.

• Educate your clients. Tell them how to verify a massage therapist’s license. Direct them to your state’s license verification system. An informed public is one of our strongest tools.

• Connect with your professional associations. Push them to take a unified, vocal stance on this issue. They work for us.

• Work with your City Council to educate them in your communities about the issue and work with law enforcement and fire departments to help shut these places down. Have them contact the Network Team to get a list of suspected businesses to look at. Make sure law enforcement is trained in how to handle these cases. Make sure there is a community support system for the women who are victims of these places.

• Federal trafficking prosecutions

• National Human Trafficking Hotline reports

• State anti-trafficking policies

• Online commercial sex advertisements

• Illicit Massage Business (IMB) locations. I will be referring to them as IB’s. We need to change the narrative and take the word massage out! These are not massage businesses.

This multi-dataset approach helps reveal how trafficking operates across different venues and where exploitation is most likely occurring.

1. Illicit Businesses Are a Major Trafficking Venue

The report identifies illicit businesses (IBs) as storefront businesses that appear to be legitimate massage establishments but are actually used to facilitate commercial sexual services, often connected to human trafficking.

These businesses are important indicators because they provide a physical venue for trafficking networks, unlike online advertisements which are purely digital.

2. Thousands of Illicit Businesses Operate in the U.S.

The report compiles data from an organization called The Network, which tracks IMBs through online ads, business listings, and buyer review sites.

Some of the highest numbers of illicit massage businesses by state include:

• California — 4,284 IMBs

• Texas — 1,777 IMBs

• Florida — 1,213 IMBs

• New York — 1,145 IMBs

• Washington — 762 IMBs

• Illinois — 658 IMBs

These numbers correlate strongly with population size but also reveal trafficking patterns.

For example:

• Washington State has 762 illicit massage businesses despite not being one of the largest states.

3. Some Cities Have Very High Concentrations

Large metropolitan areas dominate the list of cities with the most IMBs.

Examples include:

• New York City — 725

• Los Angeles — 405

• Houston — 402

• San Diego — 244

• Chicago — 223

But when adjusted for population, some mid-sized cities actually have higher rates, including:

• Albuquerque

• Seattle

• San Diego

• San Jose

This suggests trafficking networks adapt to local demand rather than simply population size.

4. IBs Are One of the Top Sex-Trafficking Venues

Across many states, the report identifies the most common venues where trafficking occurs.

Illicit businesses repeatedly appear among the top three venues for sex trafficking, along with:

• Hotel/motel based trafficking

• Residence-based commercial sex

• Online advertising venues

This confirms that IMBs are not a marginal issue—they are a central venue for commercial sexual exploitation in the U.S.

5. Online Commercial Sex Ads Are Massive

The report also tracked 19.3 million online commercial sex advertisements in 2024, averaging about 1.95 million ads per month.

These ads help drive demand for commercial sexual services, which in turn fuels trafficking networks.

6. The Data Likely Underestimates the Real Problem

Researchers emphasize that the IMB numbers are almost certainly undercounts because:

• Some businesses operate without online footprints

• Businesses frequently change names or locations

• Some operate in hidden networks or private advertising channels

  2026 State Human Trafficking Re…

In other words, the real number of illicit massage businesses is likely higher than reported.

The Cost to a Profession

This issue is not just about trafficking.

It has three major consequences for legitimate massage therapists:

1. Reputation damage

The public often cannot distinguish between:

• healthcare massage

• sexual services marketed as “massage”

2. Regulatory overreaction

Many cities pass ordinances that regulate legitimate therapists instead of targeting traffickers.

3. Economic harm

Legitimate therapists compete with businesses that:

• operate illegally

• evade taxes

• exploit workers

For legitimate massage therapists, this issue creates a unique and painful reality.

An entire healthcare profession—one built on therapeutic touch, rehabilitation, and wellness—has had its identity hijacked by criminal networks.

Massage therapy did not create this problem.

But it has been forced to live with the consequences.

The Question We Must Ask

The data raises an uncomfortable question:

If illicit massage businesses are such a clear indicator of trafficking…

Why has the problem continued to grow for decades?

Is it a failure of law enforcement?

A failure of regulation?

Or a failure to separate legitimate healthcare massage from sexually oriented businesses?

Those are the questions the massage profession—and policymakers—must finally confront.

Because as the data makes clear:

The problem isn’t hidden.

It’s sitting in plain sight. Here is my first edition of the Massage Therapists Toolkit to learn about the problem and possible solutions. New edition coming soon.

Yet thousands of licensed massage therapists work in clinics, hospitals, and rehabilitation settings where their work is clearly part of health care.

How did these two realities become tangled together?

The answer lies in a long and complicated history of language, public perception, and vice enforcement. Understanding that history is the first step toward changing it.

When Massage Was Part of Medicine

In the late nineteenth century, massage was widely practiced as part of medical treatment. Physicians used manual therapy for circulation problems, muscle injuries, and rehabilitation. Early physical therapy programs often included massage as a central skill.

Hospitals trained practitioners in “medical massage,” and the work was considered respectable and therapeutic.

But at the same time another development was quietly taking shape.

Some brothels began advertising “massage” services as a way to disguise prostitution. The word allowed establishments to operate in a legal gray area while hinting to customers what was really being offered.

Newspapers of the era often put the word massage in quotation marks when describing police investigations, which signaled that reporters understood the term was being used as a cover.

This is the beginning of the linguistic problem that continues today.

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The Rise of the “Massage Parlor”

By the early twentieth century the phrase “massage parlor” began appearing regularly in police and vice reporting. Cities used the term when describing establishments suspected of prostitution.

Headlines from the 1920s and 1930s frequently included phrases such as:

Police raid massage parlor

Massage parlor closed in vice sweep

Officials crack down on massage parlors

Over time the phrase became a kind of shorthand. It no longer referred simply to a place where massage occurred. It became a code word for prostitution businesses.

That shift had consequences for legitimate practitioners.

Massage therapists working in medical or therapeutic settings suddenly found their profession linked to something entirely different.

The Stereotype Becomes Entrenched

After World War II the phrase spread even further through newspapers, television, and crime reporting. By the 1950s and 1960s most Americans had absorbed a cultural association between massage and sexual services.

At the same time, the profession itself was trying to professionalize. Massage schools were expanding. Professional associations were forming. Therapists were pushing for education standards and licensing laws.

But the public stereotype was already well established.

By the 1970s the problem had become serious enough that professional organizations were publicly addressing it. A 1979 article in the New York Times described how therapy associations were working to combat the negative connotations attached to massage.

That effort has continued for decades.

A Quiet Change in Government Language

One small but significant shift occurred within the federal industry classification system used by economists and government agencies.

The phrase “massage parlor” was removed from the North American Industry Classification System because it was associated with illegal activity rather than legitimate businesses. (NYS Society of Medical Massage Therapists)

The official category now used for legitimate practices is Massage Therapy Services.

Businesses that provide massage therapy services are under NAICS 621399, Offices of All Other Miscellaneous Health Practitioners. Massage Parlor was previously under NAICS 81299 and has been removed from the codes.

This change reflects an important distinction.

Massage therapy is a licensed profession with education requirements, exams, and regulation in most states. Businesses that use the word massage as a cover for prostitution are something entirely different.

Yet media language has not fully caught up with this distinction.

Why the Language Still Matters

Some people argue that the words themselves are not important. But language shapes how society understands a profession.

When journalists repeatedly use the phrase “massage parlor,” several things happen.

First, the public associates massage with crime stories rather than healthcare.

Second, policymakers may design regulations based on the assumption that massage businesses are primarily a vice problem rather than a healthcare profession.

Third, young people considering the profession may hesitate because of the stigma.

In other words, the words influence the future of the profession.

What Can Actually Change This

Changing a cultural stereotype is difficult, but it is not impossible. Several practical steps can make a difference.

1. Encourage Better Media Language

Journalists often use the phrase “massage parlor” simply because it has appeared in news coverage for decades.

Therapists and professional organizations can ask reporters to use more accurate language such as:

• massage therapy clinic

• massage therapy business

• illicit business posing as massage

• Providing reporters with accurate terminology often improves coverage.

2. Correct the Record When You See It

When inaccurate language appears in news stories or online discussions, polite corrections can help shift the conversation.

Many reporters and editors are willing to update terminology when the issue is explained clearly.

Over time these small corrections accumulate.

3. Emphasize Healthcare Connections

Massage therapy increasingly operates in healthcare settings including hospitals, rehabilitation centers, and pain management clinics.

Highlighting this work helps move public perception away from outdated stereotypes.

The more people see massage therapy connected to healthcare, the less persuasive the old stereotypes become.

4. Educate the Public About the History

One reason the stereotype persists is that most people do not know how it developed.

When therapists explain that the phrase “massage parlor” emerged from vice reporting more than a century ago, people often understand immediately why the language is misleading.

History can be a powerful teaching tool.

5. Support Clear Professional Identity

Education standards, licensing laws, and professional frameworks all contribute to public understanding of a profession.

The clearer the profession defines itself, the harder it becomes for outdated stereotypes to survive.

A Long Battle Over Words

The struggle to separate massage therapy from prostitution has been going on for more than a century. It did not begin with modern trafficking discussions, and it will not end overnight.

But there has been progress.

Licensing laws now exist in most states. Massage therapy is practiced in hospitals and medical clinics. Government classification systems recognize it as a legitimate health service.

The language is slowly changing as well.

The phrase “massage parlor” belongs to an older era of vice reporting. The profession that exists today looks very different.

The question now is whether the public conversation will finally catch up with that reality.

Hands Off Our Name!

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It’s data-driven.
It triangulates multiple datasets.
It attempts to move beyond assumptions and toward measurable patterns.

For the first time, it combines:

• State anti-trafficking policies

• Federal prosecutions

• National Human Trafficking Hotline data

• Online commercial sex advertisements

• And estimated numbers of “illicit massage businesses”

That last category is where this article begins.

Because when data gets more sophisticated, language matters more — not less.

The Shift Toward Evidence-Based Enforcement

The report integrates five datasets to create what it calls a “multi-dimensional view” of trafficking. That’s a meaningful advancement.

It analyzes:

• Where prosecutions are happening

• Where hotline reports are increasing

• Where labor trafficking identification is rising

• Where online commercial sex demand appears concentrated

• And where “illicit massage businesses” are estimated to operate

The goal is alignment.
Do laws translate into enforcement?
Do policy environments correlate with case activity?
Are there gaps between demand and prosecution?

Those are legitimate questions.

But embedded in this framework is a structural assumption that deserves examination.

The Category Problem

The report includes “Illicit Massage Businesses (IMBs)” as a trafficking marketplace indicator.

Pause there.

The word “massage” is embedded inside a trafficking data category.

Licensed massage therapists are healthcare professionals.
We attend approved schools.
We pass state exams.
We undergo background checks.
We operate under health and licensing statutes.

Yet in national trafficking analytics, “massage” is treated as a commercial sex infrastructure marker.

That matters.

Because classification shapes policy.
And policy shapes regulation.
And regulation shapes the daily experience of licensed professionals.

What Happens When Language Blurs Boundaries

When the term “illicit massage business” becomes standard in federal and state reporting, it reinforces a perception:

Massage is a potential trafficking venue.

Even if that is not the intention.

Even if the dataset is careful.

Even if the analysis is rigorous.

Once embedded in enforcement frameworks, the word “massage” becomes tethered to commercial sex demand modeling.

The result?

• Municipal crackdowns on licensed therapists

• Establishment licensing burdens

• Zoning restrictions

• Increased inspections

• Suspicion toward legitimate providers

• Harassment from buyers who believe massage equals sex

This pattern has existed for over a century.

We are not dealing with a new problem.

We are dealing with a persistent language architecture problem.

Enforcement Is Evolving. Professional Clarity Is Not.

The 2026 report expands to 25 policy indicators and adds datasets tracking:

• Commercial sex advertisements

• IMBs

• Hotline disclosures

• Federal prosecutions

It moves enforcement analysis forward.

But it does not address:

• State licensing board enforcement of protected terms

• Misuse of the word “massage” in commercial advertising

• Regulatory confusion between healthcare massage and sexually oriented businesses

• The collateral damage to licensed therapists

The trafficking system is being analyzed.

The regulatory confusion system is not.

That gap is where the massage profession continues to suffer.

Precision Is the Whole Point of Data

The report emphasizes precision.
It stresses that no single dataset captures trafficking prevalence.
It cautions against over-interpretation.
It calls for alignment between policy and enforcement.

Good.

Then let’s apply the same precision to language.

If a business is engaged in commercial sex, it is a sexually oriented business.

If a business is fraudulently using the word “massage” to mask commercial sex, that is a consumer protection and licensing violation.

But calling it an “illicit massage business” keeps massage embedded inside the trafficking category.

And that has consequences.

This Is Not Anti-Trafficking

Let’s be clear.

Nothing in this article minimizes trafficking.

Trafficking is real.
Exploitation is real.
Labor trafficking is rising in identification.
Federal prosecutions show real victims and real harm.

This is not about weakening enforcement.

This is about strengthening clarity.

When language is imprecise, enforcement spills over.

And the people who feel that spillover are licensed professionals trying to provide legitimate healthcare.

A Better Framework

If national reports want to maintain analytical integrity, the category could evolve to something like:

• Sexually Oriented Businesses Using Massage as a front for illicit activites

• Fraudulent Commercial Sex Venues

• Commercial Sex Establishments Disguised as Massage

Those terms separate:

Healthcare profession
from
Commercial sex marketplace

That separation protects data integrity and professional identity at the same time.

The Deeper Structural Issue

Here is what I believe is happening :

As anti-trafficking analytics become more sophisticated — incorporating predictive modeling, advertisement scraping, and real-time dashboards — the word “massage” becomes increasingly embedded in enforcement technology.

Once embedded, it becomes normalized.

Once normalized, it shapes zoning boards, city councils, and law enforcement training.

And once that happens, it becomes very difficult to untangle.

We are at an inflection point.

If the profession does not advocate for classification reform now, the entanglement becomes permanent.

What We Should Be Doing

1. Engage anti-trafficking organizations in conversation about terminology.

2. Work in each state to make unlicensed massage a felony with extensive penalties.

3. Work in each state to pass establishment licensing laws. Look at using OR as an example. When they get their license, it is an establishment license so they don’t have to jump through any other hoops (Correct me if I am wrong). Then just people who own a massage business but are not licensed massage therapists are the only ones who have to apply and pay for an establishment license. Learn more on establishment licensing on my website. We don’t actually have any evidence that this will work or not but it is the only thing we have right now.

4. Work with state boards to strengthen enforcement of protected professional language and go after unlicensed massage.

5. Document the real-world impact of terminology confusion on licensed therapists. The studies out of Canada show what we already know. RMTAO Sexual Assault and Harassment Survey Summary

6. Look at the Network Team’s Landlord Engagement Program. I have been following that for a few years and it seems to work when implemented. Getting the AG to do that is another story. I talked with the AG here in Seattle back in 2023 and they said they were working on it…but nothing so far.

This is not defensive.

It is structural reform.

The Bigger Picture

The 2026 report is trying to answer:

Where are systems working?
Where are they misaligned?
Where is targeted action needed?

Here is one answer:

There is misalignment between trafficking analytics and professional licensing clarity.

And that misalignment has gone largely unexamined.

Until now.

If we want massage therapy to be recognized as healthcare — in insurance systems, in policy frameworks, in public perception — then we cannot remain embedded inside commercial sex classification systems.

Language is infrastructure.

And infrastructure determines the future of a profession.

If this conversation matters to you, consider becoming a paid subscriber to support deeper policy analysis, advocacy strategy, and professional framework development inside Massage Therapy Nexus.

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The future of the profession will not be shaped accidentally.

It will be shaped intentionally.

Hands Off Our Name.

To understand why massage therapy still struggles for legitimacy in the eyes of lawmakers, insurers, and the public, we have to go back to basics: what licensing is, why it matters, and how the profession got stuck where it is today.

What Is a License, Really?

A professional license is not a certificate of completion. It’s not a membership card. It’s not just a piece of paper you hang on a wall. A license is a legal credential issued by a state that grants someone the authority to practice a specific profession. Without it, doing the job—or even calling yourself by that title—can be illegal.

Licensing laws are created by a state legislature. They spell out who is allowed to practice, what qualifications are required, and what the boundaries of the profession are. They also create a regulatory board to oversee the profession. That board then writes rules—the administrative code that governs things like continuing education requirements, complaint investigations, and disciplinary actions. The law sets the destination; the rules pave the road.

Most importantly, licensing laws usually include title protection. This means that only someone who holds a valid state license can legally use a specific professional title—like Licensed Massage Therapist or Physical Therapist. Without title protection, anyone can use the title, regardless of their training or background. That’s how we end up with sex workers calling themselves massage therapists and casting a long shadow over legitimate practice except for we have a big problem of the laws not being enforced in the US.

How Other Professions Did It Right

The American Physical Therapy Association (APTA) and the American Occupational Therapy Association (AOTA) understood early on that professional legitimacy would require consistent laws, high standards, and a unified message. Physical therapists got their first state licensing law in 1957. Occupational therapists followed in the 1970s. Over time, both professions achieved licensure in all 50 states and created one national exam accepted everywhere.

They didn’t stop there. They pushed for interstate compacts—agreements that allow professionals licensed in one state to practice in others without reapplying. These compacts promote workforce mobility and ensure that providers can follow patients, job opportunities, or family obligations across state lines.

In short, PTs and OTs built systems that said: We are healthcare providers. We are educated, regulated, and accountable. We protect the public and deserve to be treated like professionals.

Massage Therapy’s Broken Ladder

Massage therapy’s history started strong. Ohio passed the first law licensing massage as a “limited branch of medicine” in 1916. The American Association of Masseuses and Masseurs—now AMTA—was founded in 1943. But while other professions coordinated, standardized, and progressed, massage fractured.

AMTA moved ahead promoting state licensing through the years without having a Model Practice Act in place for states to follow. This has led to a lack of consistency in the language used in licensing laws as well as things like the number of hours of required education, CE requirements for renewal and penalties for unlicensed practice.

Today, 45 states license massage therapists. But five states—California, Minnesota, Kansas, Vermont, and Wyoming—do not. In these states, local city and county ordinances fill the gap. Some are fair. Most are not. Many assume that every massage therapist is a potential criminal and treat legitimate professionals like they’re the problem. These same gaps make it easy for illicit businesses to hide in plain sight while harming the public and tarnishing the name “massage therapist” in the process.

The basic licensing exam is the MBLEx created by the Federation of State Massage Boards. The profession lacks a true advanced certification. The National Certification Board of Massage and Bodywork offers an exam that requires 500 hours of education which is what most states require for basic massage licensing so it doesn’t really provide an advanced level of massage therapists.

And what about the interstate compact? A version exists. It’s called the IMpact. It was developed with public input and guidance from compact experts. But AMTA—the very organization that says it represents massage therapists—refused to endorse it. Despite growing support from state boards and working therapists who want portability and simplicity, AMTA’s national office said the compact wasn’t “ready,” effectively stalling progress and protecting its own centralized control over government relations. Our other main massage association Associated Massage and Bodywork Professionals whole heartedly supports it. AMTA (the supposed member driven association has not informed their members of the details of the IMpact (www.massagecompact.org) and have not polled their members to find out what they want. They have assumed that their members do not want it based on the idea that some of their members live in states that will not meet the qualifications to join the compact. The qualifications outlined in the compact are based on the 625 hour education recommendations in the Entry Level Analysis Project (ELAP - www.elapmassage.org) created in 2012 which should also be the basis of all education requirements in state laws yet it remains to be implemented.

Why This Matters

Licensing is not just about paperwork. It’s about whether society sees your profession as credible, competent, and necessary. It determines whether you can bill insurance, work across state lines, and collaborate with other healthcare providers. It determines whether a city can make you jump through hoops that no nurse or PT would ever face.

The massage therapy profession has spent over a century inching toward legitimacy. But we’re not there yet—not because of the public, or the science, or the workforce. We’re not there because we have not demanded it. Because we have let our associations drift away from their member base. Some say it is because we have two major associations which has split the profession. ABMP came on the scene in about 1987 and was created by people who were fed up with AMTA moving toward becoming more integrated into healthcare.

Because we have allowed confusion to persist about what it means to be licensed, certified, or simply “trained.”

What Comes Next

We can change this. We must.

• We need licensing laws in all 50 states.

• We need a single, valid qualifying exam recognized by every jurisdiction and an advanced certification and specialty certifications

• We need title protection that is enforced—and laws that punish those who misuse the title "massage therapist."

• We need to support the IMpact and stop allowing national organizations to stall it.

• We need to reevaluate whether NCBTMB serves today’s profession—or whether it's time for something new.

• And we need AMTA to either recommit to its roots as a membership-driven organization or make way for one that will.

Sign up for my free newsletter to learn more about the history of massage licensing and other issues that we are faced with in the massage therapy profession.

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Licensing isn't glamorous. It's not inspiring. But it is the foundation of everything else we want—respect, recognition, reimbursement, and protection. If we don’t fight for it, we are handing that fight over to people who don’t speak for us.

And that’s not something we can afford to keep doing.

See also: Getting Your Elbows Out: Why Licensing Matters to Massage Therapy. Healwell’s Substack