The Medical Massage Conundrum

Defining critical terms in the massage profession.

The term "medical massage" has become increasingly controversial within the massage therapy field. Critically examining this term reveals several underlying issues, both practical and theoretical, that influence how massage therapy is understood, regulated, and practiced. The misuse of the term by teachers, schools, CE providers, legislators and insurance carriers has caused great confusion in the massage profession. Here’s a closer look at the concerns surrounding the term "medical massage" and its implications for the profession.

The Misnomer of "Medical Massage"

There is not any such thing as Medical Massage. It is not any one method or type of massage. It is nothing more than a marketing term to be used to attract clients in a massage therapy business as that is the term that most people equate with needing extra care for a medical concern like a muscle injury, pain: headaches, back pain, neck pain and other musculoskeletal pain, fibromyalgia, joint replacements, and the long list of other things that massage therapy can help address.

The American Massage Therapy Association (AMTA) has also weighed in, stating:

Medical Massage: "The Term “Medical Massage” is not an accepted term within the healthcare provider community. Chiropractors, Physical Therapists, and Physicians do not recognize the title of “Medical Massage” as it insinuates that Massage is a form of medicine. The words “clinical” or “therapeutic” massage are the correct terminologies." ~AMTA in a personal email to me when I submitted a proposal to the Assembly of Delegates for possible discussion.

Other healthcare professionals, including chiropractors, physical therapists, and physicians, typically do not recognize “medical massage” as a separate entity, partly because it implies that massage alone is a form of medicine, which is not supported by credible or consistent research​(Medical Massage). While some may say they are referring people for medical massage, since there is no clear definition or competencies it further adds to the confusion. There are no specific competencies required to work on medical conditions. What about massage therapy in a wellness environment for stress?

"Clinical" and "Therapeutic" as More Appropriate Terms

Terms like "clinical" and "therapeutic" provide more accurate descriptors for massage practices that involve knowledge of anatomy, physiology, and condition-specific techniques. However, even these terms have their own nuances. The word “therapeutic” can be somewhat ambiguous, as it has two primary definitions. According to the Oxford Dictionary, “therapeutic” can mean “relating to the healing of disease,” which falls outside a massage therapist’s scope of practice, or “having a good effect on the body or mind; contributing to a sense of well-being.” This second definition aligns with the wellness-oriented outcomes that massage typically provides, making it a more suitable term than “medical.”

“Clinical” massage, on the other hand, indicates a more focused approach that requires a thorough understanding of functional mobility, anatomy, and specific health conditions. This level of expertise allows practitioners to work within a structured, outcome-oriented framework without implying that massage is equivalent to a medical treatment. This differentiation avoids the legal and ethical implications of claiming medical status and instead highlights the knowledgeable, skilled application of massage techniques that support overall well-being.

Why "Medical" Poses a Misleading Framework

Comparing massage therapy to fields like chiropractic care and acupuncture reinforces the argument against using “medical massage.” These fields do not label themselves as “medical” despite involving targeted therapeutic interventions and receiving physician referrals. Chiropractors and acupuncturists focus on complementary health practices without implying they are substitutes for medical treatment, and in doing so, they retain credibility within their scope of practice. Similarly, massage therapy does not require a “medical” label to establish its value or legitimacy within the wellness sector.

Labeling massage as “medical” could also lead to misunderstandings among clients. It may suggest that massage therapy can diagnose or cure disease, which not only falls outside the typical massage therapist’s training but could also mislead clients into expecting results similar to those from clinical medical treatments. By avoiding the “medical” label, massage therapists can more accurately communicate their services, emphasizing a holistic, wellness-oriented approach without overstepping professional boundaries.

The Impact on Professional Identity and Client Perception

Using "medical massage" can also affect how the public and healthcare professionals perceive the field. Introducing the term into massage therapy can inadvertently create confusion about what massage therapy is and does. For clients, “medical” may imply a level of treatment efficacy associated with conventional medicine, potentially leading to unrealistic expectations. When clients view massage as inherently therapeutic, they can appreciate the benefits of relaxation and symptom relief without assuming it has curative capabilities.

The term "medical massage" is increasingly being used by schools, educators, and practitioners to market massage therapy as a credible, treatment-oriented approach to patient care. However, without a consistent definition, this label can create confusion, especially when it comes to insurance reimbursement and legislative frameworks. As it stands, both insurance carriers and legislators are stepping in to define "medical massage" independently, often without input from the massage therapy profession itself. This lack of a unified definition can have serious consequences for practitioners, as well as for the future credibility and autonomy of the profession.

Insurance Companies and Legislators: Defining "Medical Massage" for the Profession

When insurance carriers and legislators take the lead in defining "medical massage," they tend to do so from a perspective that may not align with the nuances of massage therapy practice. Insurance companies, for instance, typically frame “medical” interventions as those with clearly defined protocols, evidence-based outcomes, and medical oversight. To be eligible for reimbursement, these companies often require strict documentation, physician referrals, and adherence to protocols that massage therapists may not be trained or legally authorized to fulfill. Without a professional definition of “medical massage,” insurance companies may impose requirements that are difficult for practitioners to meet, complicating the reimbursement process and possibly even disqualifying legitimate massage services from coverage.

This example from Premera Blue Cross Medical Policies(PDF)(an insurance carrier in WA) shows the problem:

Medical massage therapy may be considered medically necessary as the only therapeutic intervention when ALL of the above criteria for physical medicine and rehabilitation— physical therapy (PM&R–PT) are met AND:
• The diagnosis-specific prescription from the attending clinician with prescribing authority, stating the number of medical massage therapy visits, is retained in the member’s massage therapy medical record

∞ Type of Therapy Medical Necessity AND

• The Progress Report documentation describes the following: o The individual has at least one functional limitation (such as sitting, standing, walking, stair climbing, lifting, working, personal care, driving, or sleeping)

o The individual has at least one subjective complaint (such as neck, shoulder, arm, wrist/hand, back, hip, leg, ankle/foot pain)
o Treatment frequency should be commensurate with severity of the chief complaint, natural history of the condition, and expectation for improvement
 When improvements in the individual’s subjective and objective findings are demonstrated, continued treatment with decreased frequency is appropriate
 Progress may be documented by increases in functional capacity and increasingly longer durations of pain relief Physical Medicine and Rehabilitation: Physical Therapy (PM&R-PT) and medical massage therapy are considered not medically necessary when the above criteria are not met

Legislators, meanwhile, face pressure to regulate “medical” services in a way that ensures public safety and aligns with recognized healthcare standards. When legislators encounter an undefined term like "medical massage," they may enact regulations that restrict who can provide it or add credentialing requirements that increase the educational and financial burden on practitioners. In some cases, such regulation could narrow the scope of practice for massage therapists, ultimately placing “medical massage” under the purview of other healthcare providers, such as physical therapists or chiropractors, who may be viewed as more "medically" qualified.

The Problem of Inconsistent Usage in Schools and Marketing

Within the massage profession, the term “medical massage” is used inconsistently, often as a marketing tool by schools and instructors aiming to attract students who seek advanced, clinical-level training. Some massage schools and training programs offer “medical massage” courses without clearly defining what the term means or how it differs from therapeutic or clinical massage. This lack of clarity in education creates a fragmented understanding among students, who may graduate with conflicting ideas of what “medical massage” entails and how it can be practiced legally and ethically. Furthermore, such marketing can lead practitioners to believe they are qualified to provide “medical” services without sufficient education on what this implies in a regulated healthcare setting.

Additionally, when schools and teachers label their courses as “medical massage” without appropriate curricula or clinical standards, they inadvertently contribute to public confusion as well as confusion in the massage profession for those seeking out courses. Clients may be misled into thinking that medical massage offers outcomes equivalent to those provided in a traditional healthcare setting, only to discover that the term does not meet the rigorous standards they might expect from “medical” treatments. This inconsistency erodes public trust and reinforces the need for a formalized definition that can protect both practitioners and the clients they serve.

See also: Certification vs Certificate

The Need for a Standardized Definition of “Medical Massage”

To safeguard the massage therapy profession's autonomy and credibility, there is a pressing need for a clear, standardized definition of “medical massage.” Such a definition should clarify that while massage can be beneficial for managing symptoms and improving well-being, it is not a substitute for medical diagnosis or treatment. An official definition would also protect practitioners from regulatory and financial pressures by clearly delineating the scope of practice associated with “medical massage,” preventing insurance companies and legislators from imposing inappropriate standards on the field.

Developing a standardized definition would involve collaboration among key stakeholders, including massage therapy associations, educators, regulators, and possibly even representatives from the broader healthcare community. This process would ensure that the term “medical massage” reflects both the therapeutic goals of the profession and the legal and clinical boundaries that define safe practice. Establishing clear guidelines for what constitutes medical massage would help practitioners understand how to ethically and effectively communicate their services, particularly when it comes to interfacing with healthcare providers and insurers.

In conclusion, defining "medical massage" is no longer just a semantic issue; it is essential for preserving the integrity of the massage profession and ensuring that practitioners can operate within safe, ethical, and legally sound boundaries. A well-defined framework for medical massage would guide educators and schools in developing appropriate curricula, assist insurance companies in creating fair reimbursement policies, and provide clarity for legislative bodies in regulating massage therapy. Ultimately, this effort would elevate the massage therapy profession by setting a clear standard that enhances both public trust and professional accountability.

Resources:

What is Medical Massage? Massage Practice Builder (my previous article)

History of Massage Therapy in Healthcare on Massage Changes Lives (my other website)