There is a problem in the massage industry: Less and less of the body is being included in many full-body massage sessions.
The anterior torso, including the chest and abdomen; hips; buttocks; and medial thigh are avoided or only given cursory attention during many massage sessions.
My awareness about this developed after reading many posts on social media about “full-body massage.” Discussions with massage colleagues, educators and therapists indicate this problem is real.
“There is an apparent decline in the number of massage therapists that are willing to perform massage therapy on gluteal, pectoral and abdominal areas,” said Brent F. Jackson, academic program manager, massage therapy, at Central Carolina Technical College, headquartered in Sumter, South Carolina. He said he believes there are three factors contributing to this situation.
First, he said, massage therapy businesses and schools alike are wary of being involved in litigious situations, because of criminal acts by some massage therapists have made the news and are therefore overly conservative when it comes to creating curriculum.
Second, he said, “In academia, we are also encountering a broad spectrum of skill, and therefore a possible lack of qualified and confident massage therapy educators. That lack of training may be inhibiting the student’s professional growth.”
Third, said Jackson, there is simply a growing trend of the therapist not wanting to put in the effort required of a true full-body massage. Instead, he said, therapists are cutting corners.
“As a profession,” Jackson said, “it is necessary to be open to treating these areas when warranted, as would any other health care professional.”
Educator Nancy Dail, of Downeast School of Massage in Waldoboro, Maine, has also witnessed this trend. “I have long been aware that massage therapists have been cutting corners around the human body, basing massage on a rote recipe and repetitive sequence versus a treatment based on the individual’s medical history, posture, repetitive actions or injuries,” she said.
“Since society has a vulnerable perception of the abdomen, it has been the most logical area to skip,” Dail continued. As to other areas, she said, state regulations on breast massage, draping and professional conduct have led to restrictions on how the client’s body is addressed.”
However, student ignorance and state regulations cannot fully explain the diminishment of the full-body session. In my research and conversations, I have come to realize there are three pieces to this situation: incomplete massage education; apprehension on the part of clients; and insufficient informed consent across the profession.
“Attempting to avoid excessive intimacy, my students’ hands often tense up around buttocks, chest, belly and inner thighs. I teach them instead to deliberately connect with these tissues using safe touch,” said Barbara Helynn Heard, a continuing education provider and practicing massage therapist in Seattle, Washington.
Although many massage schools provide a comprehensive education that prepares students to offer complete, full-body massage sessions, Heard’s approach isn’t how all massage students are being taught to touch clients’ bodies.
I, and many other massage educators, believe some schools’ entry-level education falls short in developing skills in positioning, draping, time management, communication and consent about the process of massage. Massage education sometimes creates fear related to boundaries and sexual misconduct litigation instead of developing professionalism. Instead of assessment and critical thinking skills imbedded into the massage session, a massage sequence is sometimes drilled into students.
Massage therapy education must include training in massage for the gluteals, abdomen, chest and thighs, while instilling professionalism in students. The concept of professional boundaries needs to be discussed, since there is obvious confusion about appropriateness of massage for certain areas of the body. Students need to be trained to ask direct questions and make direct statements during informed consent procedures.
For example, the common statement, “Disrobe to your level of comfort,” only creates confusion. Instead, direct instruction needs to be given. Such an instruction might sound like one of these two examples:
“If lubricant is used during the session or if outcomes involve access to superficial skin and superficial fascia, massage needs to be applied to the skin. Massage application through clothing or draping material will limit massage application to compression and movement methods”; or
“Clients typically feel most comfortable removing clothing, but it is fine to leave on undergarments that cover the buttocks and genitals. When it is time to massage the buttock and hip area, I will ask you to move the garment or move it with your permission.”
Massage education must provide massage skills that include appropriate massage for the head; face; neck; shoulders; arms; forearms; hands; anterior and chest, although not breast tissue unless specifically indicated and with additional informed consent; abdomen; back; low back; hips; thighs, including anterior, medial, lateral and posterior areas; legs; and feet.
“I regard the anterior torso as crucial, yet it is avoided in 90 percent of the massages I receive,” said Eric Stephenson, who was interviewed for this article when he was director of education at imassage continuing education and consulting company and who is now chief wellness officer for Elements Massage. “This is one of the great paradoxes of massage therapy.”
Certainly, client attitudes play a major role in the development of this problem. Elizabeth Edgar, who was a massage therapist in of Elizabethtown, Kentucky, when this article was written, was asked about her experience of trying to include potentially misunderstood regions in a full-body massage. She said, “When clients ask what a full-body massage entails, I name off all the areas—and most of my clients cringe when I mention abdominal, glutes or pec work.
“Before I can even explain the benefits, they cut me off and tell me to skip it,” Edgar continued. “When I do have the chance to explain the benefits and how they will be properly draped or that I can also work over the sheet, they still hesitate.”
Edgar said comments she has heard from clients include not wanting her to see their imperfections, such as scars and stretch marks. Some clients don’t want abdominal or glute work for fear of passing gas during the session, she said. And when it comes to pec work, “Men are usually up for it, while women give you the look of fear, thinking you’re going to remove their entire breast out of the sheets.”
One caveat regarding full-body massage is that some clients who are survivors of sexual or domestic abuse may never be comfortable with particular areas of their body being massaged, and their boundaries must be respected, as any clients’ boundaries must be. But for the vast majority of clients, surviving abuse is not an issue.
Part of the problem, in my opinion, is that the two national massage organizations do not accurately educate the public. One association’s website states, “A typical full body session will include work on your back, arms, legs, feet, hands, head, neck, and shoulders. You will not be touched on or near your genitals (male or female) or breasts (female).” This statement essentially omits the chest, abdomen, hips, buttocks, thighs and face. With these areas unmentioned, what type of expectation does this create in the consumer and employer?
Another association’s website states, “Depending on your needs, the massage therapist will massage either the full body (except private areas) or only specific areas that need attention, such as especially tight muscles.” This statement is so ambiguous that the information is confusing. What are private areas?
Despite professional strides in the massage industry, confusion between massage therapy and illegal sexual solicitation continues to occur. Something must be done so that the massage therapy profession as a whole can move beyond this degrading situation. I challenge our professional organizations and major employers of massage therapists to collaborate and directly address this issue.
Additionally, there is gender bias pertaining to male massage therapists. Unfortunately, male massage therapists do need to be especially concerned about allegations of sexual misconduct, which can then make them overly cautious during massage.
“As a male therapist, I have to maintain trusted professional relationships with clients, [which includes] education about various body areas included in the massage session, to achieve client goals,” said massage therapist (and my son) Luke Fritz, an instructor at my school, Health Enrichment Center in Lapeer, Michigan.
I believe the massage field should launch a public awareness campaign that clearly discusses sexual inappropriateness by both the client and the massage therapist, and that describes body areas included in general massage coupled with an example of informed consent. There should be ethical guidance by our professional associations and employers that frames clear statements to the public and massage therapists about appropriate behavior.
Such a statement might read: “Massage therapy is a nonsexual health service. Sexual behavior by the therapist toward the client or by the client toward the therapist is always unethical, inappropriate and illegal. It is always the responsibility of the massage therapist and business management to ensure that sexual misconduct does not occur and to report sexual solicitation by clients to law enforcement. Clients who feel that the massage therapist engaged in sexual misconduct should immediately report to the business management and to law enforcement.”
Lack of Informed Consent
The problem of the diminished full-body massage begins during entry-level education, but certainly does not end there. In response to a lack of skills developed during entry-level education, it is possible that major employers are accepting substandard massage as the norm.
One reason for this may be that the confusion between massage and sexual interaction will just not go away, so employers might limit massage application to particular body areas because of the fear of sexual misconduct lawsuits. It is possible that massage therapists in general—employee and self-employed—are avoiding body areas because of these same issues.
Appropriate informed consent clearly discusses the massage process. This is especially important for the new client intake. Our professional organizations, massage therapy employers and the entire massage community need to support a standardized set of policies related to the informed consent process, including concise explanation of massage for the chest; abdomen; inner thigh near the groin; and gluteal regions.
Part of the intake process should be a form that indicates all of the body areas included in a general massage: head; face; neck; shoulders; arms; forearms; hands; anterior and chest, although not breast tissue unless specifically indicated and with additional informed consent; abdomen; back; low back; hips; thighs, including anterior, medial, lateral and posterior areas; legs; and feet.
This intake form can show a generic outline of a body with the gluteal cleft, perineum and genitals indicated as always avoided and breast tissue area indicated with additional written consent only. Clients can indicate areas they want and do not want worked, as well as areas to avoid for safety.
Assurance is Needed
It is very concerning to me if we have come to believe that the major body areas cannot be massaged in the typical 50- to 60- minute session. Massage employers and clients need to be assured that all massage therapists are providing quality massage services and can provide massage to all appropriate areas of the body.
About the Author:
Sandy Fritz is a founding member of the Alliance for Massage Therapy Education, and the author of massage textbooks including Mosby’s Fundamentals of Therapeutic Massage; Mosby’s Essential Sciences for Therapeutic Massage: Anatomy, Physiology, Biomechanics, and Pathology; and Sports & Exercise Massage: Comprehensive Care for Athletics, Fitness, & Rehabilitation. She owns and directs Health Enrichment Center massage school in Lapeer, Michigan.