The unique and non-descriptive language used in massage therapy creates confusion among massage therapists, other health and medical professionals, and the general public.

The unique and non-descriptive language used in massage therapy creates confusion among massage therapists, other health and medical professionals, and the general public.

As a textbook author for massage therapy education, I have struggled for years with massage-related terminology. Even a discussion of terminology has terminology issues:

Terminology: the system of terms belonging or peculiar to a specialized subject; nomenclature.

Nomenclature: a system of names used in the classification of an art or science or other field or subject.

Taxonomy: the science or technique of classification.

The best word to use for this discussion is nomenclature. The absence of an agreed-upon massage therapy nomenclature makes it difficult to ensure solid entry-level education and for graduates to be prepared to succeed on licensing exams.

Often, massage styles with different names are essentially the same. The unique and nondescriptive language use in massage therapy creates confusion among massage therapists, other health and medical professionals and the general public.

This issue plagues manual therapy overall, including osteopathy, chiropractic and physical therapy as well as massage therapy. Each discipline has created its own language.

To add to the confusion, groups within an individual discipline use unique terms. This is especially prevalent in the massage therapy continuing education market, where numerous styles of massage have been developed and taught by individuals who use specialized language to describe their approach.

Also, a variety of manual therapy methods from other disciplines, primarily osteopathy and a variety of cultural healing systems, have been appropriated, renamed and incorporated into massage therapy. This practice makes meaningful discussion of massage methodology nearly impossible and complicates interdisciplinary communication.

Attempts at Definitions

Two profession-based attempts have been made to describe massage therapy:

• Massage Therapy Body of Knowledge (MTBOK) in 2010

• Entry level Analysis project (ELAP) in 2012

Both projects resulted a recommendations for a unified definition of massage therapy and a suggested nomenclature. But neither have been endorsed by the massage community, even though massage therapy organizations funded each project.

Also problematic is the massage therapy community lacks a unifying definition of massage. I recommend the following, based on the article, “Clarifying Definitions for the Massage Therapy Profession: the Results of the Best Practices Symposium,” by Ann B. Kennedy, et. al., publishing in the International Journal of Therapeutic Massage & Bodywork:

Massage: Massage is a patterned and purposeful soft tissue manipulation accomplished by use of digits, hands, forearms, elbows, knees, and/or feet, with or without the use of emollients, liniments, heat and cold, hand-held tools or other external apparatus, for the intent of therapeutic change.

Massage therapy: Massage therapy consists of the application of massage and non–hands-on components, including health promotion and education messages, for self-care and health maintenance; therapy, as well as outcomes, can be influenced by: therapeutic relationships and communication; the therapist’s education, skill level, and experience; and the therapeutic setting.

Massage therapy practice: Massage therapy practice is a client-centered framework for providing massage therapy through a process of assessment and evaluation, plan of care, treatment, reassessment and re-evaluation, health messages, documentation, and closure in an effort to improve health and/or well-being. Massage therapy practice is influenced by scope of practice and professional standards and ethics.

No One Knows What We’re Talking About

For years the massage therapy community has talked about being part of interdisciplinary health and medical care. The Massage Therapy Foundation’s research agenda and research funding has supported progress in scientific support for massage therapy.

One of the challenges in conducting research in the field of massage, as well as all manual therapy professions, is the lack of consistent terminology. I have had multiple researchers tell me they have little or no idea of what massage therapists are talking about when those massage therapists describe their work.

Unifying terminology must be easily understood by professionals from multiple backgrounds and should not reflect a particular history or legacy. The ability to communicate clearly and accurately, is essential if the variety of practitioners of manual therapy are to incorporate shared research in practice and work successfully together.

A New Approach: The ICMT

There are some encouraging developments. The International Consortium on Manual Therapies (ICMT) is tackling this issue. Over two years ago, when I was recruited to be part of this group, I felt that this was the chance to make something positive happen.

We do not need to prove that massage therapy has benefit, nor do we need to prove ourselves to other professions. The research that exists has done that. Collaborative research will increase the information base. That is a huge focus of the ICMT—shared language so scientists can expand on research that benefits us all.

This cannot occur without collaboration. Massage therapists are equals at this table. Opportunities for a shift in paradigm rarely occur, but I strongly believe the International Consortium on Manual Therapies is an important development. We must not miss this opportunity.

It is important that the massage community participates in the ICMT initiatives and does not ignore the impact of this interdisciplinary global collaboration among those who use manual therapy in professional practice. Brian Degenhardt, DO, Paul Standley, PhD, and Francesco Cerritelli, PhD, DO(Europe) founded the ICMT after collaborating at several osteopathic manipulative medicine conferences.

Standley specifically made a huge impact on me as he presented at the 2007 Fascial Research Congress at Harvard University when he described the problems related to ambiguous terminology used in massage therapy and other forms of manual therapy.

Standley is one of a select group of people around the world studying how manual therapy affects gene expression. His research at the College of Medicine-Phoenix focuses on the biomechanical regulation of gene regulation and cell growth in bioengineered tendons, bioengineered fascia and skeletal muscle cells.

Degenhardt, Standley and Cerritelli understand that to truly advance the manual therapy field both scientifically and clinically, the 20th-century silos between professions need to be removed and communication and collaboration needs to be established. To begin this process, they decided that fundamental yet critical issues need to be overcome, such as variation in nomenclature systems within and across professions, and to build a platform to improve communication between clinicians and basic scientists. It is from this perspective that ICMT’s first conference program was developed.

The ICMT Massage Therapy Working Group, in collaboration with the other ICMT working groups including structural integration, physical therapy, osteopathy and chiropractic, has prepared documents as a starting point for an interdisciplinary conversation. The intention is to foster understanding among professions practicing manual therapy and to move toward a language that scientists can use in research to benefit all involved in the practice of manual therapy.

For massage therapy, the foundational language that can be used to describe how massage methods are applied and described is taken from the Entry Level Analysis Project (ELAP). This document can be found at elapmassage.org. Only the recommended language has been used in creating the ICMT documents.

Other factors related to curriculum recommendations were not relevant for the ICMT project. The scope-of-practice document is derived from multiple sources to reflect the most commonly described scope in state licenses and the Model Practice Act from the Federation of State Massage Therapy Boards.

The goal is to collapse massage therapy terminology to fundamental objective, observable and reproducible descriptors and avoid specific terms related to the various forms and styles of massage therapy named using cultural/historical terms, eponyms, as well as brand- based terms or abbreviated names. The other involved occupations are working toward the same goal. The vision is to identify a nomenclature that researchers can use across disciplines. The massage therapy community is invited to view and comment on these documents using this link.

Get Engaged

The ICMT conference will be interactive. In most conferences, participants just watch and listen to lectures—but at ICMT, participants will actively engage in the entire program. You will be working with respected colleagues and peers from across many manual therapy disciplines to collaboratively discuss the latest insights into manual therapies and to help shape future collaboration and research. Importantly, the scientific community will be involved by supporting evidence-informed practice and identifying gaps for future research design.

[Click here to visit the ICMT Discussion Forum video presentation.]

Articulating what we do as massage therapists can come with some challenges, but it is my belief that we can do it in a way that will promote growth and development of the profession and build a cohesive message of our nature and value that we offer. I strongly encourage you to become part of the conversation by registering for the virtual conference that will be uniquely presented over a 30 day period. Learn more and register for the conference here.

Sandy Fritz

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.” Her articles for MASSAGE Magazine include “Old Myths Die Hard: The Truth About Toxins,” and “The Massage Profession Needs to Face the Future—United.”