The Massage Profession
People generally seek massage in environments where they feel comfortable, and thus therapists choose to work in environments that attract their preferred types of clients. The job market for massage therapists is expanding as the public increasingly understands massage and values its benefits. Massage is now offered in a variety of locations ranging from private offices to chiropractic offices, gyms, hospital wards, spas, cruise ships, and many other locations.
Private Practice
Many massage therapists want to own their own businesses and run their practices in leased commercial spaces or separate areas of their homes. The attractions of having your own business include flexible working hours, being able to make business decisions yourself, the satisfaction of overcoming obstacles, the opportunity for creative problem solving, and a sense of personal achievement. Drawbacks include the lack of a financial safety net, potentially longer working hours, and the duties of marketing and managing the business.
Private massage practices generally attract a specific type of client based on the type of massage offered, the facility, its visual appearance, and service prices. The therapist-owner makes these decisions. A therapist might dedicate the practice completely to relaxation services and offer Swedish massage, reflexology, aromatherapy, and certain spa body treatments. The business may focus specifically on Eastern approaches to bodywork and offer Amma, shiatsu, Thai massage, and ayurvedic bodywork. Alternatively, a therapist might form close ties with chiropractors and physical therapists in the area and offer healthcare massage for patients with soft-tissue injuries. Anything and everything is possible in a private practice, although not everyone is well suited to self-employment. Self-employment requires good business skills as well as good massage skills. Self-employment demands excellent time-management, organizational, and communication skills. Self-employed people must also be good planners and have a positive attitude and strong determination.
Massage Clinics
In a massage clinic a number of massage therapists often work together cooperatively, sharing a receptionist and possibly employing a manager and bookkeeper. In some cases one person owns the business and either pays or subcontracts to the other massage therapists. When several therapists join forces to share resources, each contributes to the setup costs of the business (e.g., furniture for the reception area, massage tables, linens, washer and dryer, etc.) and splits the cost of the lease, receptionist, phones, advertising, and other running costs. Services vary from clinic to clinic. Some clinics focus on a particular client group like pregnant woman, athletes, or people with a recent soft-tissue injury. Others might specialize in a specific modality like reflexology, neuromuscular therapy, or psychological body-mind approaches.
One of the benefits of working in a massage clinic is the opportunity to interact with other therapists and gain from their experience and knowledge. This can also help the business be more successful, because one therapist might be very good at marketing while another understands insurance billing and a third retail sales. Also, therapists working in clinic often help each other by covering shifts for their colleagues when they are sick or on vacation.
Wellness Centers
Wellness centers employ many different types of healthcare providers. In addition to a massage therapist, the center may also employ a chiropractor, nutritionist, naturopathic doctor, physical therapist, meditation leader, counselor, fitness trainer, yoga instructor, hypnotherapist, esthetician, and life-coach among others. Wellness centers often focus on promoting health for body, mind, and spirit. Wellness centers are now found on college campuses, in community centers, in large corporations as part of a medical clinic, in gyms, in retirement homes, and in stand-alone businesses similar to spas. As in a massage clinic, a wellness center owner may employ each therapist, or a group of different healthcare providers might join forces to form a partnership or association. The services offered are determined by the focus of the wellness center. For example, the center may take a broad approach to wellness and offer a variety of services, or the center might specialize in supporting clients with particular conditions such as anxiety disorders, weight management needs, or insomnia.
Spas
Like wellness centers, spas may employ a wide variety of healthcare professionals to offer services that address body, mind, and spirit. Some spas focus on skin care and beauty and may offer medical cosmetic procedures such as liposuction, botox injections, laser skin treatments, and plastic surgery as well as facials and waxing. Other spas may focus on promoting healthy life choices, diet, nutrition, and exercise. Each spa is unique, but because massage is currently the most requested spa service, it is not surprising that spas are the number one employer of massage therapists.53
Spa work can be varied and creative, allowing therapists to offer a number of different services during the day. The day might begin with a full body massage, followed by a herbal body wrap, and then a hot stone massage, a seaweed treatment, and a foot treatment to finish. Working conditions at spas vary widely. Some spas require their staff to work long hours with little flexibility, but others try hard to work out a good schedule with therapists. Spas usually pay a flat fee to therapists for each treatment performed, regardless of the price that the client pays. Established spas tend to emphasize a structure promoting harmony and tranquility. Dress and appearance are important, as are retail sales. While many therapists resist selling products to clients, the sale of retail products is an important means of ensuring the financial success of the business. Most spas therefore require sales of retail items as part of their employment package. Some talented therapists work their way up in the spa industry to become spa consultants, spa department managers, and even spa directors. Others train in esthetics (skin care) to diversify their skills and practice. Many therapists now offer selected spa services such as salt-glows, body wraps, and foot treatments in their private practice without using expensive hydrotherapy equipment. These services are relaxing and provide clients with new ways to experience health and wellness.
Medical Settings
According to the American Pain Foundation, 83 million adults experience pain that is significant enough to limit their participation in daily activities. An additional 75 million people live with chronic debilitating pain.54 When conventional medicine (drugs and/or surgery) fails, many patients seek alternative treatments for soft-tissue pain and dysfunction, such as acupuncture, physical therapy, chiropractic treatments, massage, and bodywork.
Medical environments in which massage is offered include chiropractors’ offices, hospitals, hospices, naturopathic practices, sports medicine clinics, clinical massage practices, physical therapy offices, and rehabilitation centers. The type of massage offered in medical settings varies a great deal, as do the clients. In one chiropractic office, for example, a massage therapist might provide 15-minute warm-up massages to clients. Chiropractors find it easier to adjust a client when certain muscles are soft and relaxed. A therapist providing massage in such as office is likely to find that basic Swedish and deep tissue skills are adequate. A different chiropractor may expect the massage therapist to understand advanced massage assessment techniques and treatment massage protocols and to participate in treatment planning for clients. This requires knowledge beyond Swedish and deep tissue.
In another example, some therapists provide massage to patients and their families in hospital oncology wards. These therapists need to understand the indications and contraindications of massage in relationship to cancer, how to work around medical equipment, how to keep accurate chart notes, and how to work effectively with physicians and nurses. The techniques used may include holding strokes, guided deep breathing, gentle Swedish strokes, and some energetic approaches to calm the patient and ease pain. These basic massage techniques are not difficult to master, but the knowledge of cancer, cancer medications, and critical reasoning to make good massage-related choices for cancer patients requires deep sensitivity and understanding.
Many therapists focus on healthcare massage to address soft-tissue injuries and dysfunctions for such conditions as whiplash, carpal tunnel syndrome, thoracic outlet syndrome, and many others. To undertake this level of work the therapist must have an in-depth understanding of anatomy and physiology, kinesiology, soft-tissue pathology, assessment methods, and clinical massage techniques. This type of massage might be offered in a physical therapy office, a wellness center, a sports medicine clinic, a treatment-oriented massage clinic, or a private practice. In a small number of states, health insurance plans recognize complementary medicine, and massage therapists can bill insurance companies for massage when they have a doctor’s diagnosis and referral.
Cruise Ships
Some therapists like the idea of cruise ship work because it affords them the opportunity to travel and meet new people. The benefits of this type of work include free room and board and medical insurance, which are required by maritime law. Some cruise lines also offer discounts on cruise vacations to the friends and family members of employees. Cruise ship spas most often offer wellness massage enhanced with luxurious touches that make the client feel pampered (paraffin dip for the hands, aromatherapy accents, etc.). The therapist might deal with minor sports injuries, but usually general Swedish skills suffice. One of the main difficulties for therapists working on a cruise ship is the time pressure. Often therapists move directly from one massage to the next, and the importance of a thorough health intake process is de-emphasized. Healthcare concerns are further complicated because a wide variety of clients with a various health issues often take cruise vacations, many of whom increase their alcohol consumption during the trip. Therapists with a good understanding of contraindications for massage and critical reasoning skills are better prepared to make good decisions in this fast-paced environment. These therapists should also be in good shape and have good body mechanics. While good health and good body mechanics are always important, massage work shifts on a cruise ship are particularly demanding, lasting as long as twelve hours with back-to-back appointments. One should always research the working conditions on cruise ships carefully and compare pay rates and work hours before signing a contact.
On-Site Massage
Seated, on-site massage is currently popular in shopping malls, airports, corporate workplaces, and events like fairs and sporting events. Seated massage is often provided as a marketing tool at events to raise awareness of a massage practice at another location. Seated massage is given through the client’s clothing without lubricants in 10-30 minute sessions. Seated massage in offices and events is a good way for new therapists to gain experience. Massage chairs can be transported almost anywhere, allowing therapists to work in a variety of locations. Clients drawn to seated massage include office workers and other busy people who want quick work on target areas. Massage students usually learn basic seated massage skills as part of their training or can take continuing education classes.
Work with Special Populations
Some massage therapists are drawn to work with a particular type of client and focus their career on those clients’ special needs. Pregnancy massage, sports massage, and animal massage are some of these special populations.
Pregnancy and Infant Massage
Massage can provide relief from aches and pains related to pregnancy as long as the therapist knows how to position the client properly and use appropriate techniques. Many therapists are drawn to massage clinics where they can work with a mother before, during, and after pregnancy. The massage therapist may even become part of the labor and delivery team at a hospital or birthing center, providing massage between contractions to help with relaxation or using specific techniques to reduce pain and pressure during contractions.
After the birth, massage often plays a role in the mother’s rehabilitative process and supports the health of the infant. Research has found that the massage of low-birth-weight infants increases their weight and decreases the length of their hospitable stay.55 Another study showed that massage supports neurological development in infants.4 Massage also helps to ease the discomforts of teething, colic, and emotional distress in children. A therapist might also seek additional training to become a certified doula, a person who acts as a knowledgeable companion during pregnancy, birth, labor, and the transition of the new child into the family.
Sports Massage
Athletes recognize that massage increases flexibility, supports the body’s recovery process after events or training sessions, and improves performance. Some therapists, often with specialized massage training, work with professional athletes as part of the training team. Competition for such positions is often fierce, and it may be easier to find work with amateur or semiprofessional athletes in high school or college or with athletic individuals who have made physical activity a primary focus in their lives. Sports massage is mobile. Sometimes it is offered in an office setting, but it might also be offered on-site before or after an event. A recent trend is the inclusion of massage practices in gyms. In this setting therapists work with a variety of clients, ranging from people trying to get into shape to professional athletes in peak condition. Some sports massage therapists also become trained and certified in fitness training so that they can offer a more diversified range of services.
Animal Massage
Dogs, cats, horses, and other animals respond to the calming and relaxing effects of animal massage. Performance animals like racehorses and show jumping horses benefit from massage in the same way as human athletes (e.g., better flexibility, faster recovery time, etc.). Effective animal massage requires training in animal anatomy, movement, and animal observation. Smaller animals can be massaged while they are resting on a treatment table, but larger animals such as horses usually remain standing. Some animal massage practitioners work on-site with the animal, while others have an office to which owners bring their pets.
Exploration of a Massage Career
The work environments and client types discussed above represent just some of the opportunities for massage therapists. Massage is a diverse field, and many graduates pursue unique occupations, defined through their own hard work, research, and interests. At the time of this writing, the 1,566 massage programs in the US graduate approximately 70,000 massage therapists each year, and about 241,000 therapists are now working in the U.S.56 On average, therapists stay in the massage profession 7.8 years and often work in complementary occupations as massage instructors, fitness trainers, estheticians, and clinical hypnotherapists or in other forms of related bodywork. As mentioned previously, there are 250 known types of massage and bodywork, allowing therapists to continue to develop new skills throughout their careers.
AMTA and ABMP conclude that 83% of massage therapists are female, and that massage is often a second career. Therapists work an average of 15 hours a week providing massage and earn half of their income from their massage career. The AMTA points out that according to the U.S. Department of Labor Statistics, massage therapists earn a annual income comparable to other healthcare support workers.
Some massage students at the start of their training program have strong ideas about where they want to work, while others have little or no idea. Massage instructors sometimes hear students say things like, “I don’t really need to know about posture and gait assessment because I’m just going to do relaxation massage,” or “I’m not going to bother to learn aromatherapy because I am going into clinical massage and I won’t use it.” Nonetheless, the best massage therapists are always open to learning new skills and applying new knowledge in a session. For example, many clinical massage therapists do not use aromatherapy because they do not fully understand its benefits. In fact, it is very useful for helping clients relax and cope with the emotional trauma of injury. Because some essential oils have natural anti-inflammatory and pain-relieving effects when applied topically, learning aromatherapy provides new options for a therapist working with soft-tissue dysfunction. In all cases, exploration of all options is advised. As you progress through your training program, you will learn and grow. You will be exposed to a variety of techniques, models, clients, and ideas. Students often develop an interest in a previously unknown area of massage. Some students end up doing the opposite of what they originally thought they liked. For example, a student who is determined to work with athletes and practice sports massage might be surprised to discover that he or she loves spa work. Similarly, a student planning to offer relaxation massage may discover a strength in clinical massage. At this point it is probably best to stay flexible and enjoy learning. Planning your career ahead of graduation is a good idea, but do not let your career plan limit your learning opportunities. As we saw earlier, some of the biggest advances in the massage profession have come when people integrated existing ideas and techniques into new systems and approaches.