History of the Medical Massage Controversy Part 2.
2006-2024
March 27, 2006 Ron Precht Is AMTA Defining Medical Massage?
https://web.archive.org/web/20060422023507/http://www.amtamassage.org/news/032706release.html
Full Article:
Evanston, IL (March 27, 2006) -- The American Massage Therapy Association (AMTA) would like to clarify for everyone in the massage therapy profession that it has no plans to define the term medical massage. AMTA’s Board of Directors continues to be concerned about the potential for a definition of medical massage to restrict the practices of massage therapists. AMTA believes discussion needs to continue among all stakeholders in the profession to verify definitions for a variety of massage therapy terms.
AMTA believes all massage is therapeutic. Clearly, medical massage may include, but not be limited to intended purpose and outcomes, massage as part of a treatment plan determined by a licensed healthcare professional and/or practice setting. However, it’s important to point out that empirical evidence hasn’t been provided to support or refute the concept of medical massage as a distinct area of specialization within massage therapy practice. This would be a necessary step if the profession tries to define it.
In 2005, an AMTA volunteer workgroup examined how the term medical massage is being used. They examined published definitions of the term used by many of the groups that give certifications in medical massage; surveyed AMTA members on their views of the term (816 members participated); collected input from about 30 other massage therapists (not all AMTA members), who have a strong interest in medical massage issues, through emails, phone calls and letters; and held a hearing at AMTA’s Albuquerque convention to get more member input on the term. The workgroup reported its research to the AMTA Board in December 2005.
AMTA will continue to gather information on use of the term medical massage and has already participated in discussions with some of the stakeholders in the profession regarding the potential for defining it.
With more than 55,000 members, the American Massage Therapy Association works to serve its members and to advance the massage therapy profession through ethics and standards, public education, and promotion of fair and consistent licensing of massage therapists in all 50 states. The association is directed by a volunteer Board of Directors, chosen through a national election and encourages members to participate through its 52 chapters
Massage Today May, 2006, Vol. 06, Issue 05 "Medical Massage" Survey and Results By Vivian Madison-Mahoney, LMT
Summary:
In February 2006, a group called the National Training Institute, led by Damien Berg and Shannon Ring, invited a group of prominent people in the massage industry to join its online Yahoo Chat Group to participate in a "Medical Massage Summit" discussion. The purpose of this two-hour session was to try and obtain opinions, feelings, attitudes and suggestions about training, education, licensing, credentialing and philosophy statements on "medical massage."
In "Medical Massage" Survey and Results, Vivian Madison-Mahoney shares insights from a survey she conducted on the contentious issue of defining and certifying “medical massage” within the massage therapy profession. This survey, sent through her newsletter and yielding 159 responses, sought to gather opinions on whether a distinct designation of “medical massage” is necessary and what regulatory or educational standards should apply.
The survey results reveal a strong majority opposition to defining "medical massage" as a distinct practice. For example, in response to whether any massage should be formally defined as “medical massage,” 129 respondents answered “no,” compared to only 21 who said “yes.” Many respondents argued that all massage has therapeutic, potentially medical benefits, whether or not it is prescribed by a physician. Some compared it to other health professions where practitioners are not labeled as “medical” within their specialty, such as physical or occupational therapists. Others felt that if massage therapy involves treating medically relevant conditions, it inherently qualifies as medical.
When asked if therapists should need specific certification as “medical massage therapists” to accept physician referrals or insurance reimbursement, an even stronger consensus emerged: 128 respondents said “no,” with many expressing emphatic objections. For those few who supported certification, preferred oversight bodies included state boards, the NCBTMB (National Certification Board for Therapeutic Massage & Bodywork), or a national standards group. However, several respondents emphasized that certification should focus on training in medical conditions, patient charting, HIPAA compliance, and insurance billing, rather than a “medical massage” designation.
The survey highlights widespread sentiment that any massage prescribed for a medically diagnosed condition can be considered “medical,” without the need for separate certification. Madison-Mahoney’s summary underscores the ongoing resistance within the profession to formalize or restrict medical massage as a unique credential, with most therapists viewing additional training as optional rather than mandatory. This survey offers a snapshot of the strong opinions surrounding the term “medical massage,” revealing that the profession remains divided and that further discussion and consensus-building may be necessary before any formal designation is widely accepted.
Medical Massage October 4, 2006 Julie Onofrio www.thebodyworker.com
https://web.archive.org/web/20120120184319/http://thebodyworker.com/massage_blog/medical-massage/
In Medical Massage, Julie Onofrio critiques the concept of “medical massage” as a recent trend in the massage profession, noting that it primarily serves as a pathway to bill insurance companies rather than a distinct therapeutic approach.
Onofrio highlights the role of the United States Medical Massage Association (USMMA) and its founder, David Luther, in advocating for increased credentialing and education requirements for medical massage. She notes that Luther has ties to various for-profit entities related to medical massage certification, which could introduce conflicts of interest. This commercialization of “medical massage,” she argues, seems to draw massage closer to fields like physical therapy and osteopathy, creating confusion about the boundaries between massage therapy and other health professions.
Medical Massage A Marriage or a Monster By Deane Juhan. Feb/March 2007 Massage and Bodywork Magazine
Summary: In Medical Massage: A Marriage or a Monster, Deane Juhan explores the growing trend of "medical massage" in the massage therapy profession, examining both its appeal and the potential risks of aligning massage too closely with the medical field. Juhan describes the rise of "medical massage" as a grassroots response to the increasing interest in alternative therapies by a U.S. healthcare system that is costly and often inaccessible. Notably, he points to the popularity and growing acceptance of alternative therapies among educated, middle-class Americans, with many patients turning to these approaches for their perceived benefits in health and recovery.
It is obvious to everyone in the massage profession that our work very successfully addresses a wide spectrum of emotional, physical, and physiological conditions related to trauma, disease, debilitation, and recovery. A growing number of health professionals are recognizing this as well. How best to weave together often sharply divergent ways and means to accomplish mutually agreed upon ends will be a topic that is bound to absorb many minds from all sides of the issue.
Juhan questions the implications of medicalizing massage, cautioning that efforts to present massage as a strictly medical practice could lead to over-regulation, reducing the field’s flexibility and creativity. He highlights that the term "medical" implies rigorous, highly regulated standards typically associated with life-and-death care, which could make the regulatory environment for massage much stricter if medical authorities began to dictate its practice. He cites the example of the American Medical Massage Association (AMMA), whose guidelines dismiss practices such as reiki, craniosacral therapy, and energy healing as “fringe” and scientifically unproven, suggesting they might advocate for eliminating these approaches from legitimate massage training altogether.
Juhan raises concerns about maintaining the essence of massage therapy, which he believes derives strength from diverse practices that may not always fit neatly into a medical model but offer valuable, holistic benefits. He encourages massage professionals to balance collaboration with healthcare providers while protecting the unique attributes of massage therapy. He advocates for massage therapists to work as part of multidisciplinary teams in integrated clinics rather than strictly conforming to the constraints of medical models, arguing this will allow massage to retain its open-ended, exploratory nature that has contributed to its success.
I do fear that an aggressive effort to medicalize massage could be edging us toward a trip switch that could have major unintended consequences. Here is why: as I said earlier, for many in the healthcare establishment therapeutic does not equate with medical. They are willing to concede that many things are indeed therapeutic: lowered stress levels, healthy diet, vitamins, exercise, vacations, pets, supportive relationships, bodywork. But medical is quite another matter. For them, this term connotes a collection of professions whose education is long and exhaustive, that is very tightly regulated, and that commonly treads a fine line between life-saving procedures and life-threatening mistakes. They are not likely to throw open their institutional arms to us regardless of how therapeutic we can demonstrate ourselves to be. And in some quarters, they are already aggressively active in heading off any such possibility.
Juhan’s reflection closes with a call to preserve the "fringe" aspects of massage, suggesting that true integration should allow therapists to bring diverse approaches to patient care without abandoning the flexibility and holistic perspective that define the massage therapy field.
Medical Massage vs Relaxation Massage March 26, 2007 Julie Onofrio
Summary: In Medical Massage vs. Relaxation Massage, Julie Onofrio addresses the confusion surrounding the terms "medical massage" and "relaxation massage," emphasizing that neither is clearly defined by the massage profession. According to Onofrio, "medical massage" is not a specific technique or modality but rather refers to the process of billing insurance for massage therapy services when a therapist can show the treatment is "medically necessary" for a patient's recovery from injury or illness. She explains that to bill for medical massage, therapists primarily need to communicate effectively with insurers through thorough chart notes rather than specialized techniques.
Onofrio criticizes certain organizations and massage schools that promote medical massage as a specialized service or advanced practice, often implying additional qualifications or certifications are necessary. In her experience, however, the essential skills involve writing chart notes, understanding pathology, and managing the practicalities of billing. She highlights that in Washington State, while massage therapists can become contracted providers for HMO and PPO networks, these lists are often closed or require two years of experience—information she says massage schools tend to omit when marketing "medical massage" programs.
She also discusses the financial challenges of medical massage billing in Washington State, where insurance networks are increasingly setting reduced rates for massage therapists, impacting profitability. This arrangement, she warns, forces therapists to compensate by charging higher fees to cash-paying clients, thus creating an unsustainable business model. Onofrio anticipates that similar reimbursement reductions could spread nationally, which would further limit massage therapists' control over their profession and earnings.
Through her reflections, Onofrio encourages massage therapists to carefully consider the practical realities and financial risks associated with billing insurance, rather than relying on the label of "medical massage" as an assurance of advanced practice or increased income potential.
Medical Massage or Not May 7, 2008 Julie Onofrio
Summary: In her article "Medical Massage or Not," Julie Onofrio critiques the trend of positioning medical massage as the future of the massage profession, specifically regarding contracted work with HMOs, PPOs, and auto insurance companies. Based in Washington, a state where massage therapists can be contracted providers with insurance companies, Onofrio outlines several challenges that have emerged over time, painting a cautionary picture for those considering insurance-based work. Her main concerns include:
Decreasing Fees: Onofrio notes that insurers have been consistently lowering the reimbursement rates for contracted providers. While her initial rate in 2000 was about $90 an hour, it dropped to under $70 within a few years, with a minimal increase of only 40 cents since.
Reduced Benefits for Clients: Insurance companies are tightening their policies, decreasing the number of reimbursable massage or physical therapy sessions per year. For example, one company reduced its combined massage and PT coverage from 45 sessions to just 14.
Increased Barriers to Payment: Insurance companies require additional proof of "medical necessity" after only a few sessions, often leading to denial of further treatments.
Mid-Year Rate Changes and Payment Clawbacks: Onofrio highlights reports from chiropractors and acupuncturists of insurers retroactively lowering allowable fees and demanding payback of the difference, creating financial strain for providers.
Out-of-Network Rates Exceed In-Network Rates: In some cases, out-of-network providers receive a higher percentage of the billed rate than in-network providers, diminishing the financial benefit of being a contracted provider.
Auto Insurance Network Rules: Some auto insurers are now using provider networks, which means contracted providers must accept lower rates for services rendered in car accident cases.
Static Fees: Despite inflation and rising costs, many insurers have not increased their allowable rates for massage since 2000, with no cost-of-living adjustments for contracted providers.
Imposed Educational Requirements: Insurers are defining required credentials for massage providers, which can override state licensing requirements and limit which therapists can work with them.
Affinity and Discount Networks: Many therapists unwittingly join discount networks expecting more clients, only to realize they must accept reduced fees for each session.
Onofrio’s analysis underscores her opposition to allowing insurance companies to shape the massage profession through restrictive policies and low compensation. Her article calls for therapists to consider whether joining provider networks and billing insurance is truly beneficial, given these pitfalls.
2008 byregion.net. The Training and Care of a Medical Massage Therapist: Developing Medical Massage Curriculum by Gregory T. Lawton, D.C., D.N.
Summary: In "The Training and Care of a Medical Massage Therapist," Dr. Gregory T. Lawton outlines the educational and practical training necessary to define and equip a “medical massage therapist.” Lawton proposes a structured approach to the medical massage curriculum, based on both clinical and theoretical knowledge, with a focus on understanding the human body, patient pathology, and condition-specific massage techniques.
Medical massage therapy is massage that uses technique that is supported by current knowledge regarding the body's natural physiological, biochemical, and neurological processes. Medical massage is first and foremost massage, and is therefore a natural and non-invasive approach to health care and seeks to support the body's own natural healing capacities. The power that created the body is the power that heals the body. This "power" is identifiable and understandable in scientific terms, to the limits of our ability to observe it, but the frontier of our understanding and knowledge keeps advancing and evolving.
Key Elements of Medical Massage Training:
Foundational Knowledge: Training must include comprehensive anatomy, physiology, and pathology, reflecting the scientific principles behind therapeutic approaches. This knowledge is essential to distinguish medical massage as a non-invasive treatment that aligns with natural healing processes.
Problem-Based and Patient-Centered Education: Following a “problem-based” or “patient-centered” model, students learn to approach patient care through practical, hands-on experience. Lawton recommends that at least half of the training occur in supervised clinical settings, allowing students to treat actual patients and build experience with real-world conditions under professional guidance.
Systematic Body Part Focus: To develop proficiency, students are trained on specific body regions (e.g., wrist, elbow) one by one. This includes learning the anatomy, pathology, and associated treatment techniques for each area, which Lawton believes better prepares therapists for clinical practice.
Clinical Objectives: Medical massage techniques aim to:
Reduce inflammation,
Restore soft tissue health,
Normalize range of motion, and
Address patient complaints effectively.
Incorporation of Therapeutic Modalities: Lawton suggests training in adjunctive therapies such as hot/cold packs, infrared lamps, low-level laser therapy, and herbal liniments. These tools can enhance treatment outcomes, increase patient visit efficiency, and reduce therapist burnout.
Patient Management Skills: Lawton emphasizes patient management skills, including setting clear treatment plans (e.g., six-visit models), maintaining comprehensive patient records (SOAP notes), and employing standard medical billing and diagnostic codes.
Professional Preparedness: By including modules on office administration, billing, and patient documentation, the training ensures therapists can effectively manage a clinical practice, understand medical terminology, and adhere to legal standards of patient record-keeping.
Competency of Instructors: Lawton asserts that schools should have instructors who are not only skilled massage therapists but also allied health professionals (e.g., physical therapists, nurses). This diverse teaching staff brings a well-rounded understanding of “medicalese” and can bridge the gap between massage therapy and conventional healthcare standards.
Differentiation from General Massage:
According to Lawton, medical massage diverges from relaxation or full-body massage by focusing exclusively on treating specific conditions rather than providing general relaxation. Medical massage therapists are trained to conduct more focused, condition-oriented treatments without the use of oils typical in spa settings, instead relying on medicated liniments as needed.
This rigorous, clinical-focused education model, as proposed by Lawton, positions medical massage therapy as an accessible yet specialized career within healthcare. By establishing these standards, he believes the profession can maintain a structured, respected role in a variety of clinical and medical settings.
Medical Massage: Facts, Fiction and Frustration By Rebecca J. Razo
May 29, 2009 Massage Today
https://www.massagetoday.com/articles/13256/Medical-Massage-Facts-Fiction-and-Frustration
In "Medical Massage: Facts, Fiction and Frustration," Rebecca J. Razo delves into the contentious and unresolved debate over what constitutes "medical massage," a term that lacks clear definition and standardization in the massage therapy profession. The article explores various controversies, stakeholder perspectives, and challenges involved in establishing and potentially regulating medical massage as a recognized subset of massage therapy.
The Elusive Definition of Medical Massage
For years, a number of well-known massage therapists have utilized the term medical massage therapy in practice and in continuing education seminars. And some therapists, who may or may not call themselves medical massage therapists, are indeed practicing massage in hospitals and medical offices. Yet, there still has not been an industry-wide consensus on what exactly constitutes medical massage therapy.
Key Issues in Defining Medical Massage
Terminology and Legal Implications: The term "medical massage" lacks a formal definition, which has led to disagreements within the profession. This ambiguity became particularly problematic in a 2004 lawsuit filed by Tracey Roberts against State Farm Insurance, arguing that massage therapists should be reimbursed for services billed under medical codes, specifically CPT Code 97140, typically reserved for physical therapists. This case underscored the legal and regulatory risks surrounding the term, as it could impose limitations on who is authorized to practice medical massage and set reimbursement precedents for insurers.
Conflicts over Certification and Credentialing: David Luther, founder of the United States Medical Massage Association (USMMA), advocated for a certified title of "medical massage therapist" tied to his Medical Massage National Certification Examination (MMNCE). Luther claimed this certification was necessary to ensure therapists were competent in treating medically complex cases. His stance, however, raised concerns about monopolization and self-interest, with critics arguing that allowing a single organization to define "medical massage" posed conflicts of interest and could restrict broader access to insurance billing.
Divergent Views within the Profession: Key voices, including Vivian Madison-Mahoney, Chair of the FSMTA Insurance Committee, argued that all massage, when prescribed for a medically necessary condition, could be considered "medical massage" and should be eligible for insurance reimbursement without additional certification. Patricia Cadolino, another industry leader, also cautioned against certification requirements, warning that such a mandate could limit access to insurance billing and create unnecessary barriers for massage therapists.
Stakeholders' Definitions and Goals: Despite the lack of consensus, various organizations have attempted to define medical massage to reflect specific goals:
Medical Massage Practitioners of America (MMPA) defines medical massage as “result-oriented” and “diagnosis-focused,” relying on physician prescriptions for specific conditions.
American Medical Massage Association (AMMA) emphasizes a “medical model” focused on treating connective tissue issues and achieving measurable clinical responses, seeking to align with medical professionals through evidence-based practices.
AMTA’s Call for Unity and Further Research: The American Massage Therapy Association (AMTA) has taken a cautious stance, refraining from endorsing a definition for medical massage. The AMTA advises further discussions within the profession and has engaged stakeholders to contribute to a more unified approach. Their position reflects concerns that hastily setting a definition could inadvertently restrict practice options and impact the broad therapeutic applications of massage.
Conclusions
Razo's article underscores the profession's lack of unified standards for medical massage, revealing a spectrum of opinions on education, certification, and reimbursement practices. The discourse highlights fears that defining medical massage too narrowly could fragment the field, elevate entry barriers, and create an unintentional hierarchy within massage therapy. With organizations like AMTA pushing for continued dialogue and open-minded exploration, the hope is to establish a comprehensive understanding that serves the profession and respects its diversity of practices.
This ongoing debate reflects broader issues within massage therapy around regulation, access to healthcare funding, and the role of evidence-based practice, illustrating the complex intersection of tradition, medicalization, and professional evolution.
A Comparison of the Somatosensory Effects of Therapeutic and Medical Massage, Part I By Gregory T. Lawton, DN, DC May 29, 2009Massage Today
Summary: Gregory T. Lawton’s article, "A Comparison of the Somatosensory Effects of Therapeutic and Medical Massage, Part I," explores distinctions between medical and therapeutic massage, specifically examining how each interacts with the somatosensory system. This article focuses on the physiological and clinical effects of both modalities on key elements of the sensory system—mechanoreceptors, nociceptors, and joint complexes.
Key Comparisons and Definitions
Medical Massage:
Purpose and Protocols: Lawton describes medical massage as employing a clinical protocol that aims for specific physiological outcomes aligned with medical treatment goals. He emphasizes that these goals often involve managing pain, reducing inflammation, and restoring joint range of motion.
Techniques and Clinical Claims: Medical massage practitioners aim to demonstrate clinical outcomes similar to other medical therapies, drawing on existing research from fields like histology, orthopedics, and biomechanics. This approach contrasts with the general effects attributed to therapeutic massage.
Current Gaps: Lawton notes that despite a rich body of research from allied health disciplines, there is limited direct research on medical massage. Consequently, clinical claims in medical massage often rely on findings "borrowed" from other disciplines, though he suggests that adapting this research to massage is both possible and beneficial.
Therapeutic Massage:
Focus on Relaxation and Stress Reduction: Typically associated with relaxation or stress management, therapeutic massage (also known as Swedish or general massage) is widely used in non-clinical settings, such as spas. While it can contribute to a person’s general well-being, its goals do not necessarily include treating specific medical conditions.
Technique Varieties: Therapeutic massage techniques encompass Swedish massage, trigger point therapy, proprioceptive neuromuscular facilitation (PNF), and muscle energy techniques. While these can offer therapeutic benefits, they are often categorized as adjuncts rather than as primary methods of medical intervention.
Somatosensory Mechanisms:
Mechanoreceptors and Nociceptors: Lawton explains how both therapeutic and medical massage impact mechanoreceptors and nociceptors, though medical massage specifically aims to activate these sensory systems to manage chronic pain and inflammation.
Critique of Proprioceptor Concept: He challenges the use of "proprioceptor" in massage therapy, noting that the term is outdated and scientifically inaccurate in explaining somatosensory functions. Lawton encourages moving toward evidence-based terminology that better reflects the underlying mechanisms of massage.
Medical massage therapy contends that any system of manual therapy that claims a specific clinical effect must demonstrate that its techniques can achieve clinical outcomes identical to those measured in other clinical systems, or techniques that have been scrutinized in research studies and clinical settings. One example would be the ability of a series of techniques or a massage treatment protocol to effectively address chronic pain through stimulation of mechanoreceptors and inhibition of nociceptor activity, while also reducing acute and chronic inflammation and restoring normal joint range of motion. Any system of massage therapy that systematically obtains these clinical objectives is a form of medical massage.
Challenges in Standardization
Lawton attributes the lack of a standardized medical massage curriculum to several factors, including low consensus within the profession, varied educational standards, and a historical hesitancy in the massage community to fully embrace research-based techniques. He argues that embracing scientifically valid terminology and adapting existing research to massage therapy could strengthen the practice’s clinical validity.
Implications for Massage Education and Research
Lawton proposes that medical massage curricula should align more closely with scientific and medical knowledge, integrating comprehensive training in clinical techniques and patient management. He sees this alignment as vital for enhancing massage’s credibility within the healthcare community.
He advocates for future studies that are specifically focused on measuring the outcomes of medical massage techniques, with the goal of developing new evidence-based protocols tailored to massage.
Conclusion
Lawton’s article underscores the need for clear distinctions between therapeutic and medical massage, advocating for a scientifically grounded approach to medical massage that could elevate its status as a recognized, evidence-based healthcare practice. By distinguishing medical massage as a clinical approach with measurable outcomes, Lawton envisions a future where massage is more closely integrated with the medical field and informed by robust research and standardized protocols.
A Definition of Medical Massage By W.D. "Peter" Lane, LMT, CNMT, NCTMB
May 29, 2009
https://www.massagetoday.com/articles/13847/A-Definition-of-Medical-Massage
Summary: In "A Definition of Medical Massage," W.D. "Peter" Lane addresses the ambiguity surrounding the term "medical massage" and proposes a clear definition and educational framework for licensing medical massage therapists (LMMTs). Lane argues that an LMMT designation should require significantly more training than standard massage therapy and should position medical massage as a recognized, specialized field within allied healthcare.
There is a need to define the frequently used term "medical massage." One proposed definition would require a medical massage therapist to have significantly more training to qualify for licensure. The curriculum for medical massage would include cadaver studies, chemistry and nutrition, as well as an internship. The state would provide a separate license for a medical massage therapist, which would allow the practitioner to bill insurance. The insurance component would compensate a therapist for the additional required education. A medical massage therapist would work with a patient's primary care physician to provide optimum health for the patient.
Key Points of Lane's Proposed Definition and Structure for Medical Massage
Enhanced Educational Requirements:
Lane advocates for a curriculum of 2,000 to 2,400 hours, covering extensive anatomy, pathology, patient assessment, musculoskeletal anatomy, and cadaver studies.
Training would include areas often not covered in standard programs, such as chemistry, nutrition, and business management.
Scope of Practice and Clinical Approach:
Medical massage, according to Lane, should be a scientific, hands-on, and results-oriented system of patient care based on a medical model.
Treatments would be derived from specific diagnoses and follow protocols designed to achieve measurable clinical outcomes.
Practitioners would work alongside primary care physicians, supporting treatments for musculoskeletal and other specific health conditions but not prescribing medications.
Insurance and Licensing:
Lane proposes a separate licensure for medical massage therapists, allowing them to bill insurance as part of their standard practice.
The suggested licensure would indicate a higher level of competency than standard massage therapy, qualifying LMMTs to practice in environments like HMOs or private practices.
Curriculum Outline for Medical Massage Therapy:
Lane’s curriculum includes areas such as cellular anatomy, musculoskeletal pathology, nutrition, hydrotherapy, electro-therapies, cadaver dissection, and advanced clinical practice in neuromuscular therapy.
Emphasis is placed on clinical internships and supervised practice to prepare practitioners for hands-on medical treatment.
Goal and Benefits:
A national definition and licensing standard would allow patients to seek services from qualified medical massage therapists who can legally and effectively address their specific health needs.
Such standards could also benefit the insurance industry, as LMMTs would follow consistent treatment protocols and documentation, thus supporting ethical and measurable treatment outcomes.
Avoiding Conflicts of Interest:
Lane stresses that definitions of medical massage should be created with the patient’s benefit as the primary goal, not driven by individual or organizational financial interests. This implies avoiding definitions that favor specific certification boards or organizations without consensus from the broader healthcare community.
Conclusion
Lane’s vision for medical massage centers on creating a standardized, credible, and scientifically-based healthcare field, advocating for both stricter education and a defined role within the healthcare system. He believes that through these steps, medical massage can be distinguished as a specialized and effective component of patient care, one that is fully integrated and recognized within the broader medical community.
An Open Letter to the Massage Profession: David Luther - Fraud or Founder? By David Luther May 29, 2009
My name is David Luther, and I would like to offer my apologies for not being a more prolific writer. I know many of you have been confused about my intentions in regard to the massage profession. Hopefully, I can set the record straight and dispel some of the misinformation. I am an owner of The Medical Massage Office & Associates (TMMO), a for-profit company. I also currently own the Medical Massage National Certification Board (MMNCB), a for-profit company. I do not own the United States Medical Massage Association (USMMA), which is a not-for-profit membership association; however, I am USMMA's founder and current president, and I did provide the initial financial endowment.
Summary: In the article, An Open Letter to the Massage Profession: David Luther - Fraud or Founder? on Massage Today, the controversy surrounding David Luther, founder of the United States Medical Massage Association (USMMA) and the Medical Massage National Certification Board (MMNCB), is explored. The article presents a detailed examination of Luther’s activities and influence within the massage industry, especially his efforts to establish a certification and professional identity for "medical massage."
Background on David Luther’s Role and Actions
David Luther, a longtime figure in the massage profession, has advocated for distinguishing "medical massage" as a specialty. He established both the USMMA and MMNCB, which promote standards and certifications for medical massage therapists. Through the MMNCB, Luther sought to offer a national certification in medical massage, requiring massage therapists to pass the Medical Massage National Certification Examination (MMNCE).
Luther's initiatives have faced backlash within the industry, particularly due to perceived conflicts of interest and accusations of monopolizing the term "medical massage." Critics argue that Luther’s efforts to define medical massage have been primarily self-serving, as he owns the organizations that provide both the certification and associated training programs. Furthermore, some have voiced concerns about the lack of external validation or industry-wide support for Luther's certification standards, given that MMNCB is not accredited by recognized credentialing bodies like the National Commission for Certifying Agencies (NCCA).
Key Issues and Legal Implications
A pivotal issue in this controversy arose in Pennsylvania, where a class-action lawsuit involving a massage therapist and State Farm Insurance was settled with terms that could potentially reshape the practice and payment for medical massage nationwide. In this case, the settlement barred State Farm from denying insurance claims under CPT Code 97140 solely on the grounds that a massage therapist, rather than a physical therapist, provided the service. Luther’s involvement in the settlement, however, raised questions. He suggested to the court that only therapists certified through the MMNCB as "Nationally Certified Medical Massage Therapists" should be recognized as qualified medical massage providers, a move perceived by many as an attempt to establish MMNCB certification as the gold standard for medical massage.
This statement led to an outcry from other massage professionals and advocacy groups, like the Business League for Massage Therapy and Bodywork (BLMTB), who expressed concerns about Luther’s influence on legal definitions and his attempt to control what constitutes a "medical massage therapist." They argued that his approach lacked transparency and industry-wide consensus, suggesting that his motivations were not in the best interest of the profession as a whole.
The Professional Divide
Luther's efforts have highlighted a significant divide within the massage industry regarding the definition and requirements for "medical massage." Many industry professionals are concerned that strict definitions and certification requirements could create barriers for massage therapists seeking to work in medical contexts, especially without broad agreement within the profession on what qualifies as "medical massage." Furthermore, Luther's initiatives could limit access to insurance reimbursement to only those certified by MMNCB, marginalizing a large portion of the profession and centralizing control under his organizations.
Conclusion
The open letter raises a call for transparency, collaboration, and an industry-wide dialogue to establish any definitions and standards for medical massage, urging against unilateral definitions and certifications. Many in the profession advocate for a more inclusive approach that incorporates diverse voices and perspectives to better serve massage therapists and their clients, while ensuring fair and accessible standards for practice and reimbursement.
Massage Magazine Orthopedic Massage Isn’t the Same as Medical Massage — Is It? July 16, 2020 James Waslaski
https://www.massagemag.com/orthopedic-massage-116767/
Summary: In "Orthopedic Massage Isn’t the Same as Medical Massage — Is It?" by James Waslaski, orthopedic massage is presented as a flexible, assessment-driven approach that targets musculoskeletal conditions without relying on a single, defined set of techniques. Waslaski contrasts orthopedic massage with medical massage, noting that while both approaches focus on treating specific conditions, they differ in their foundational definitions and applications within healthcare.
Key Concepts of Orthopedic Massage
Broad Scope and Definition:
Orthopedic massage is characterized by assessment and individualized application of techniques. Rather than a single modality, it encompasses a range of treatment methods chosen based on a client’s unique presentation and assessment.
Techniques in orthopedic massage address specific soft-tissue musculoskeletal disorders, making it especially relevant in treating sports injuries and other musculoskeletal issues.
Assessment-Centered Practice:
Waslaski emphasizes that ongoing assessment throughout treatment—before, during, and after each session—ensures that the chosen techniques are appropriate and effective.
Using specialized tests like the Eden’s, Adson’s, and Wright Abduction Tests, practitioners tailor their interventions to the client’s pathology. For example, thoracic outlet syndrome might involve techniques to elevate the clavicle, stretch the scalenes, or release the pectoralis minor.
Integration of Techniques:
Orthopedic massage draws from various manual therapies such as myoskeletal alignment, posturology, active isolated stretching, and lymphatic balancing.
Waslaski’s seminars, now called Integrated Manual Therapy, underscore the importance of continuously learning and integrating multiple approaches to enhance client outcomes.
Differences Between Orthopedic Massage and Medical Massage
Medical Massage: Defined primarily by insurance parameters, medical massage refers to treatments prescribed by a physician for medically necessary care rather than a specific massage technique or modality. Techniques are based on the therapist's skill set and tailored to the doctor’s prescription, often for insurance reimbursement purposes.
Orthopedic Massage: Distinct from medical massage, orthopedic massage emphasizes clinical reasoning and assessment without necessarily being prescribed or contingent on insurance. The approach is condition-focused and adaptable to both athletes and non-athletes, prioritizing functional recovery and pain relief.
Orthopedic massage, as Waslaski describes, bridges multiple manual therapy techniques with a flexible, outcome-based approach tailored to the musculoskeletal needs of each client. The primary goal is to create specific therapeutic effects through well-assessed, individualized interventions, making orthopedic massage valuable in clinical settings and across varied patient demographics.
Jan 29, 2024 Whitney Lowe Youtube
What is Medical Massage vs. Clinical Massage vs. Orthopedic Massage
Summary: In this video, Whitney Lowe provides insights into the terminology challenges in massage therapy, specifically focusing on medical massage, clinical massage, and orthopedic massage. He breaks down their definitions and how they relate to broader categories within massage therapy.
Main Categories of Massage Therapy
Wellness Massage:
This category, often seen in spas and health clubs, focuses on relaxation and stress reduction without addressing specific health issues.
Sometimes referred to as therapeutic massage, but Lowe suggests "wellness" or "personal care" as more accurate descriptors, distinguishing it from healthcare-focused massage.
Healthcare or Medical Massage:
Encompasses massage for clients with compromised health conditions, such as injuries, cancer, palliative care, and musculoskeletal issues. It includes terms like medical massage, clinical massage, and orthopedic massage, which all address some type of health concern.
Definitions of Key Terms
Medical Massage:
Often used as an umbrella term for massage treating medically relevant health conditions.
Confusion with Medical Massage:
Mayo Clinic’s definition links medical massage to conditions diagnosed by a doctor, implying that a doctor’s referral is necessary. Lowe critiques this as it doesn’t change the treatment approach, only the referral pathway.
Insurance Confusion: Some groups define medical massage as any massage eligible for insurance reimbursement, adding further ambiguity.
Lowe prefers a more outcome-oriented approach for defining medical massage, focusing on treatment goals set through assessment rather than how or why a client was referred.
Clinical Massage:
Can be used interchangeably with medical massage but generally denotes massage used within a healthcare context.
Lowe emphasizes that clinical massage is also outcome-oriented and used to address specific health concerns but is not dependent on the treatment environment (e.g., clinic or spa).
Orthopedic Massage:
A narrower term focused on treating movement-related soft-tissue disorders, such as muscle and joint issues affecting mobility.
Unlike general healthcare-oriented massage, orthopedic massage strictly addresses locomotor dysfunction and musculoskeletal pain, with a structured approach involving assessment, clinical reasoning, and targeted treatment plans.
Lowe advocates for using these terms more as functional categories based on treatment goals and assessment processes rather than specific modalities or techniques. Each approach, whether medical, clinical, or orthopedic massage, involves comprehensive assessment and is outcome-focused, even though terminology and definitions vary widely across the profession.
This nuanced approach helps massage therapists understand how to apply these terms within their practices and communicate effectively about the nature and objectives of their work.
See also:
The Medical Massage Controversy