The massage therapy profession sits in an interesting place. It seems to have these two separate identities which share some common ground but also diverge significantly. On the one hand is the practice of massage as what is called a personal care service for lack of a better term. This approach would include massage used in spas, cruise ships, or situations where the primary focus is general relaxation without the intent of addressing a particular health problem. The other approach to massage is when it is used as a health care discipline to address some ailment or pathology.

There has been a tug of war between these two approaches for some time when discussing educational standards and credentialing.  Those who want to make sure there are not unreasonable hurdles for entry into practice (especially for personal care service approaches to massage) don’t want to see rapidly escalating educational requirements. Those who emphasize massage as a health care practice recognize there is no way it will be taken seriously by the health care community unless the educational requirements are increased.

Can we have our cake and eat it too? Yes, I think we can. I do agree that massage is an important skill and there should not be unreasonable barriers to entry for those that want to practice it as a personal care service. I still think it is important for people who practice in this manner to have a solid foundation in the sciences because they are still performing a practice that can have adverse effects on someone’s health and they should understand this thoroughly. For that reason the existing entry level requirements (about 500 hours of eduction in most locales) is a good starting place. Of course it would be better to focus on specific competencies as opposed to hours, but that’s an issue for a different day.

For those that want to practice massage in a health care environment we need to have a credential that designates a higher educational standard—perhaps something like a “massage therapy specialist.” At this level there would be far more attention focused on the necessary knowledge, skills, and abilities that are missing in our current training to prepare people to work as a health care provider. The length of this training program should be constructed by investigating competencies needed by similar health care professionals. It will be hard to predict how that will be converted to hours, but it seems reasonable to suggest this could be at least 750- 1000 hours of additional training above the initial 500 hours that most people currently have.

There will clearly be many obstacles to this process, but other health care professionals are beginning to look at massage as a health care practice. I attended a recent meeting with the Academic Consortium for Complementary and Alternative Health Care. At this meeting it was clear that other licensed health care professions that fall under the CAM umbrella have substantially greater training requirements than massage therapists, yet we face many of the same clinical decisions. We simply can’t continue to be taken seriously as a health care field with only 500 hours of training required. It will take a long time to make this transition so the time is now to get started on this process.

There are a wide variety stretching procedures and it can be confusing to figure out which is the most effective. Some  practitioners advocate a short duration stretch (about 2-3 seconds) as used in the Mattes method of Active Isolated Stretching (AIS). Others advocate a long duration of static stretching (15-20 seconds or more), as in practices such as yoga.

The research literature has studied stretching extensively but there is no conclusive evidence for a best stretching method yet. It appears that certain stretching methods work better in one situation while others work better in another. As I was doing some research on stretching recently it occurred to me that there are some additional factors in stretching that we may want to investigate.

In any stretching procedure there are two primary components that need to be addressed to effectively encourage muscle elongation. The first is a neurological component that governs the muscle’s resistance to stretch. It is here that the proprioceptors play a major role in stretching techniques. Techniques such as PNF or other facilitated stretching methods have been developed to focus on the neurological components of stretching.

Another factor in stretching is the mechanical elasticity of connective tissue (fascia) that surrounds muscles and bundles of muscle fibers. This connective tissue has a resistance to tensile (stretching) forces when those forces are rapidly applied. As you hold tensile force on this connective tissue, its resistance to stretching decreases. The decreasing resistance to stretch tension in connective tissue is a property called creep. Maximizing the effectiveness of connective tissue creep is an argument for a longer held stretch.

Recent research into the physiological properties of fascia have shown that it contains contractile cells. It has also been determined that a prolonged tensile force on connective tissue, such as that used in myofascial release or other fascial techniques, can cause a reduction in contractile activity in these fascial cells.

We now know that connective tissue elongation is enhanced by manual therapy methods of stretching fascia. We also know that connective tissue stretch (resistance to creep) is a limiting factor in stretching methods.  What if we were to combine the two and encourage use of these myofascial techniques on muscles as they were in their fully stretched position? I’m sure some practitioners must be doing this already, so it would be interesting to see some comparative studies performed on this method.

As teachers most of us are interested in how we can get students to come away from our courses with the things we really want them to learn. Yet the emphasis in so many courses is on gathering information that will be needed to achieve a higher score on the exit testing. I’ve watched students in class spend so much time trying to write down everything the instructor says that they miss the opportunity to absorb the overall meaning of the discussion/lecture.

Multimedia presentation is one area where e-learning can offer a significant advantage over the traditional classroom delivery structure. There is no question that you can produce a great live multimedia presentation with lecture and accompanying visual aids- especially if you are a good live presenter. However, one of the great challenges is that once the lecture is over, the students don’t have it to go back to for further study. That’s why so many of them are so frantic to write down everything that is said during the presentation. Many students tape record lectures and this is a great advantage for audio playback, but that misses the important visual aids that are an important part of explaining important concepts.

A well-constructed (and this is crucial) e-learning presentation that includes audio and visuals can be an excellent learning tool because the student can go back to the same original presentation over and over until the concepts have really been absorbed. Research has shown a greater degree of retention and knowledge transfer with high quality multimedia presentations, so I think this learning strategy holds great promise. Our big challenge now is to get people to learn what a high quality multimedia presentation entails and how to produce one.

It has been inspiring to watch the exponential growth of our field over the last 20 or so years. In that time we have seen a host of excellent textbooks published. We have been witness to the emergence of a peer-reviewed science journal devoted to soft-tissue therapy that is now indexed on Medline, the world’s largest medical literature database. There is also an increasing awareness and interest in massage by traditional health care professionals.

I experienced this increased interest first hand several years ago as scores of administrators and educators from the nation’s medical schools gathered at Georgetown Medical School with a group of educators from the complementary and alternative health fields during the National Education Dialogue (NED). One goal of that gathering was to discuss the future of medical education and how it could include greater representation from these CAM perspectives.

Judging from these advances it would be easy to suggest that the massage therapy field is growing, maturing, and the skills and abilities of its practitioners are advancing. There is no question that the number of people in the field has increased dramatically during that time. However, although certain individuals have gone very far, I don’t believe there has been a corresponding growth in the knowledge, skills and abilities (KSAs) of the average practitioner. In fact, I think we have actually been witness to a decline in the quality of KSAs that the average professional displays.

While there is no hard data to back up these perceptions, I have been paying close attention to this for quite some time and talking to many different educators and leaders in the field about this trend. I noticed some years ago that as a continuing education provider, people were coming in to my workshops with less solid knowledge and poorer manual therapy skills. At first I wrote it off as just a widening gap between the advanced work I was studying and what the average practitioner would be likely to know. But then, I started making specific notes about what people seemed to know and be able to demonstrate with quality skills. It was clear that I could no longer rely on people having certain basic knowledge and understanding or being able to perform fundamental technical skills.

It pains me greatly to witness this decline in the quality of our field’s practitioners. But more important is looking at the reason for this decline and what can be done about it. I believe the reason for the decline is very clear. In the last decade and a half we have had a proliferation of schools and training programs to where it is somewhere near 1500 now.

A large number of training programs is not necessarily bad. However, there are nowhere near enough qualified massage therapy instructors to staff these training programs and consequently many programs are being taught by recent graduates or those that do not have seasoned skills, knowledge, or any significant instructor training. This is a massive problem and I don’t know what the immediate solution is, but it seems there is an urgency to look at some form of teacher credentialing or instructor training. What form should that teacher training or credentialing take? This is a discussion we must immediately engage because our future is at stake.

Trends are like ocean waves. The can gently lap up on the shore and recede or they can come inland with a mighty force and dramatically change the landscape. Anyone who has been watching the regulatory landscape in the massage therapy profession in the U.S. in the last several years will clearly recognize that we have been watching a trend that is gathering momentum and increasing in its size. I am of course speaking of the emergence of the Massage & Bodywork Licensing Exam (MBLEx) as an alternative to the National Certification Exam for Therapeutic Massage & Bodywork (NCETMB).

For years the National Certification Board (NCBTMB) has been able to hold their domain as an organization that encouraged the licensing of massage therapists in an increasing number of states. The existence of their exam was a big piece of that puzzle because it meant the states did not have to go to the expense of creating a psychometrically valid exam (an expensive undertaking). But at the same time the NCBTMB was also trying to promote the exam as a certification exam that demonstrated a higher level of knowledge, skill, and ability by practitioners who took this exam. But you can’t have it both ways… The exam can’t be the entry level credential for everyone and also be a more advanced certification exam that is supposed to set you apart from others.

By trying to play both sides of the fence the NCBTMB has lost its focus and in the mean time become a victim of its own success. Out of this turmoil the Federation of State Massage Therapy Boards (FSMTB) has emerged with an exam and a structure that makes very good sense. The initial licensing exam is administered by a group of state licensing boards and they determine its structure, content and handle the logistics of its administration. This exam also helps more with portability of credentials between different states. It just makes sense (as long as it is administered well).

Yesterday the American Massage Therapy Association (AMTA) sent out a press release supporting the use of the MBLEx as the single primary licensing exam for our profession. Because the AMTA gave birth to the the NCBTMB, this is a very significant development. It is another indication that the NCBTMB is losing its hold on the huge revenue stream that is tied to entry level licensure in our profession. With that slipping away, how will the organization re-invent itself? What will become of them? They have reached what Andrew Grove, former chairman of Intel, has called a Strategic Inflection Point– a place that is defined by a major paradigm shift in the way they have to look at their future. They can either re-invent themselves or they may be watching as that huge wave sweeps them back out to sea… My recommendation is that every member of the board and leadership read Grove’s book, Only the Paranoid Survive. Actually the book contains some pretty good messages for all of us in these very challenging economic times.