Massage benefits are more than skin deep

Reprinted from the New York Times (www.nytimes.com). (link to original article at bottom of page)

By RONI CARYN RABIN
Published: September 20, 2010

Does a good massage do more than just relax your muscles? To find out, researchers at Cedars-Sinai Medical Center in Los Angeles recruited 53 healthy adults and randomly assigned 29 of them to a 45-minute session of deep-tissue Swedish massage and the other 24 to a session of light massage.

All of the subjects were fitted with intravenous catheters so blood samples could be taken immediately before the massage and up to an hour afterward.

To their surprise, the researchers, sponsored by the National Center for Complementary and Alternative Medicine , a division of the National Institutes of Health, found that a single session of massage caused biological changes.

Volunteers who received Swedish massage experienced significant decreases in levels of the stress hormone cortisol in blood and saliva, and in arginine vasopressin, a hormone that can lead to increases in cortisol. They also had increases in the number of lymphocytes, white blood cells that are part of the immune system.

Volunteers who had the light massage experienced greater increases in oxytocin, a hormone associated with contentment, than the Swedish massage group, and bigger decreases in adrenal corticotropin hormone, which stimulates the adrenal glands to release cortisol.

The study was published online in The Journal of Alternative and Complementary Medicine.
The lead author, Dr. Mark Hyman Rapaport, chairman of psychiatry and behavioral neurosciences at Cedars-Sinai, said the findings were “very, very intriguing and very, very exciting — and I’m a skeptic.”

A version of this article appeared in print on September 21, 2010, on page D6 of the New York edition.

Online edition link to article: http://www.nytimes.com/2010/09/21/health/research/21regimens.html?_r=1

Massage Therapy Anatomy Review – Systems of the Body

There are 10 systems in the body.
1. integumentary system – skin and structures within it
2. skeletal – bones and cartilage
3. articular – joints and associated ligaments
4. muscular –
5. nervous – central nervous system (brain and spinal cord), and peripheral nervous system (cranial and spinal nerves)
6. circulatory – cardiovascular (heart and blood vessels) and lymphatic systems (lymphatic vessels and lymph nodes)
7. digestive or alimentary (organs associated with ingestion, digestion, absorption of food and elimination of its associated waste)
8. respiratory – air passages and lungs that supply oxygen to the body and eliminate carbon dioxide
9. urinary – kidneys, ureters, urinary bladder, urethra – which filter the blood and excrete waste (as urine)
10. reproductive – genitals and organs that are involved in reproduction
11. endocrine – glands and specialized cells that secrete horomones

Often the urinary and the reproductive systems are lumped together and are collectively known as the genitourinary system

Massage Therapy and Insurance Fraud

An unfortunate trend seems to be rearing its ugly head in the massage therapy profession in Nova Scotia, Canada. Could fraudulent billing by businesses and massage therapists be the beginning of the end of insurance coverage for massage therapy services?

In most areas of North America, and Canada in particular, the massage therapy profession has long been promoting itself as a viable and legitimate health care modality. For several years massage therapists belonging to professional colleges and associations in Canada have been privileged to have our services covered by private and motor vehicle insurance, allowing us to build our practices upon an expanding base of savvy health care consumers.

In the recent months, however, it has come to the our attention as a profession that BlueCross insurance is rightfully investigating allegations of insurance fraud, and has gone so far to revoke direct billing rights of some businesses found to process fraudulent claims. BlueCross has also gone so far as to re-establish the direct billing Terms of Use agreement by massage therapists – but the general fear is that if this privilege continues to be abused it will eventually be revoked, leaving many of us out in the cold with a client base who will no longer be able to afford, or be willing to pay for, our services.

What is insurance fraud?

For our purposes, a simple definition of insurance fraud (please see my source FraudEducation.com) would be “criminal act requiring a material and intentional misrepresentation in order to obtain a benefit.”

This intentional misrepresentation regarding massage therapy services could possibly encompass:

1) Billing an insurance company for a therapeutic massage treatment that never happened (for example, a therapist or clinic bills insurance for a missed appointment)

As I have mentioned in my previous article Massage Therapy and Preventing Missed Appointment by Clients , I prefer to let one missed appointment go without penalty to the client, but in the event that it happens a second time, you need to be prepared to stand strong in case your client refuses to pay. Under no circumstance should the therapist allow these missed appointments to go by without bringing it to the client’s attention. Clients must understand that a therapist or clinic is unable to “just bill insurance” and you will not commit insurance fraud to let them off the hook. If a client won’t pay the fee, then it is better to discharge the patient from your care and document the events leading up to the dismissal.

In the case of a patient undergoing treatment in a motor vehicle insurance claim, it is necessary to document not only subjective and objective findings, but their compliance to your treatment plan and home care. If you find that a client is always late, misses appointments and doesn’t do suggested home care, you can discharge a patient for “non-compliance”. Clients should be informed up front that being discharged for non-compliance will not work in their favour, and that any further requests for treatment will not likely be granted, as the insurance company will not take the request seriously. After all, if a client is unable or unwilling to follow a previous treatment plan, then he or she is unlikely to be compliant in the future.

2) Performing treatments which are excessive and unnecessary.

There is a difference between what we think is necessary and what is considered excessive treatment – this is difficult, as a massage therapist working on MVA clients may identify a need for more treatments than the insurance tables deem appropriate. However, very few people need treatment more than a couple of times a week, unless you have specialized in a therapy such as Manual Lymph Drainage (aka MLD or Lymphatic Drainage), which is most effective initially in several treatments in a shorter time frame. I would have to say that if you can’t document objective findings which demonstrate an improvement in your client’s condition, or you can’t propose a reasonable treatment plan, you will probably find that your client will get limited treatments approved by insurance.

As massage therapists are not considered primary health care providers, our clinical impression is often trumped by a diagnosis of physician, chiropractor or physiotherapist. There’s not a lot we can do about that, but the reality is that in the past there have been therapists who have treated insurance coverage like a cash cow, instead of a tool to help their clients get needed treatment. (Not only is this fraudulent, but it is also unethical on the part of the therapist.).This quite rightfully has led insurance companies to view the profession with a bit of trepidation and suspicion, which is why a primary health care provider’s opinion will be taken over a massage therapist’s.

3) Billing an insurance company for a “massage therapy treatment” but performing another service (for example, a body treatment, such as a mud wrap. This has been alleged to be happening in Nova Scotia in spa settings.)

4) Using the billing number of a registered or licensed massage therapist by another party to perform services.

In the case of billing spa or esthetic treatments as “massage therapy”, or an unqualified practitioner using a therapists billing number, this is absolutely inexcusable. This practice has resulted in several spas being investigated. To my knowledge, there is at least one spa in Halifax that has had BlueCross direct billing privileges revoked, with several more under investigation.

Unfortunately for some of the therapists involved, this fraudulent billing has happened without their knowledge, and while I know this may seem little suspect, I really believe that a lot of therapists have been put in a no-win situation. In most spas and some clinics, therapists do not have access to the system which allows them to process the charges, so they sign a waiver allowing the business to do this admin work on their behalf. If a greedy business owner wants his or her cut of the action, they may instruct admin staff to bill a mud wrap or pedicure as massage therapy. If a client is aware that this is happening, then the client is every bit at fault as the therapist. I would also like to point out that a therapist signing a waiver does not imply that they are in agreement with fraudulent billing practices, and many are not offered a choice of refusing to sign.

Does Fraudulent Billing = Professional Misconduct?

Any one of the above mentioned situations is not only considered fraudulent, but may also be considered professional misconduct by a professional college or association. Part of required client records according to the CMTO is a financial record – this includes not only the date and time of the treatment, but also of the treating therapist, duration, the fee, and how it was paid. Any falsification of client records is considered professional misconduct.

If a therapist’s billing number is fraudulently used, should the therapist have to reimburse the insurance company? Or should it be the spa or business’s responsibility? Who is culpable of fraud?

I have discussed this at length with several friends and colleagues of mine. While I do agree that it is a therapist’s responsibility to oversee his or her account with the insurance company, I do not necessarily agree that a therapist should be held responsible for reimbursing the insurance company if the spa or clinic fraudulently billed it on his or her behalf and the therapist did not receive the money. This places many therapists in a very difficult situation as they often don’t have access to the company system to review the billing. It will be interesting to see how this all unfolds and if it results in criminal charges of fraud for spas and businesses, and professional misconduct of therapists.

For further reading, please go to the post “Massage Therapists – Prevent Insurance Fraud”.

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How Often Should I Get a Massage – Frequency Guideline

Following my initial blog post on this subject How Often Should I Get a Massage, here is my treatment frequency guideline, for massage therapists and their clients.

Remember, this is just a very generic guide, and will have to be adapted for individual situations.

Here are my general guidelines for treatment frequency:

Relaxation – once a month for an hour, unless you want to come more often.

Acute injury – more frequent treatments of shorter duration should help – for example, 2 times a week for 30 – 45 minutes. This should help relieve pain and congestion in the area, then after a few weeks, switch to deeper, muscular work for longer periods of time. At this point your injury may have moved into a subacute or chronic stage of healing, depending on the severity of the injury, 1-2 times a week for an hour, over a period of 3-4 weeks should get you on the road to recovery.

Treatment for chronic conditions (i.e. headaches or back pain) – one hour twice a week for 4 treatments, then try once a week for 3 or 4 weeks, and try to decrease to 1x in 14 days for 2 treatments. You will then go into maintenance mode. Once again, very individual, and the longer the condition has been an issue for the client, the more treatments will usually be needed to make consistent gains.

Some more general guidelines:

Follow remedial exercise and homecare advice – passive treatments such as massage therapy can only take you so far, it is YOUR responsibility to be proactive in your own health care. This means follow exercise, stress management, nutrition and lifestyle advice. Record what you do and how you feel, try to make a correlation between various factors. If you have a team of health care providers who are willing to work together, use them!

Don’t go too long between treatments! Progress made during a treatment is building on the progress made in a prior treatment. This means that if I’ve treated a client for chronic back pain for a month and we’re seeing some results, if he stretches out the length of time between appointments to 8 weeks instead of my recommended 2 – 4 weeks, it may be like starting all over again. What a waste of money for the client!

Remember, though, that if you start to feel consistently better (and consistent is key), you have the right to say “I’d like to stretch out the time between treatments a few more days, can we try that?” Your therapist can only give you advice and guidance, you have to figure things out what works for your situation.

If the treatment is not helping – find another therapist! Sometimes people feel awkward about ditching their therapist, especially if you have a good relationship with him or her. BUT, it’s your time and money, and you should see results. Sometimes massage therapy is not the be-all-end-all of treatments, I personally find a combination of therapies to be the most effective.

Knowing your rights as a client will prevent you from getting expensive, unnecessary or ineffective treatments, and will enable you to receive treatment that suits your needs.

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How Do I Choose the Best Massage Therapy Education or School?

If you are considering a career in massage therapy, you need to make sure that you are going to purse the best education possible. This choice will set the stage for years to come, so choose your school wisely. After all, the best massage therapy education won’t be cheap or easy, but it will set you up for future success as a massage professional if you decide to go for it.

Here are some quick tips on how to choose the best education possible:

1. Get to know the massage therapy regulations in your state or province concerning the practice of massage therapy. Does the school in which you are interested comply with the standards? Is the college or education program recognized by these regulatory bodies?

2. How successful are previous graduates? Do they own their own businesses, or are they working in the type of field in which you’re interested? For example, sports, rehabilitation, spa etc. Keep in mind that someone’s ambition is not dependent on the school where they went, but a good educational foundation will help set a therapist up for success.

3. How interested are potential employers in the school’s graduates? For example, how many students have jobs before graduation, and where are the jobs located? (hint: graduates who are going to well-established and reputable clinics are an indication of the quality of the massage training program.)

4. Is there a job board at the school? What types of employers are actively seeking the graduates?

5. Are the students and graduates generally happy with the program?

6. Do students have the opportunity to treat members of the public at a student clinic, and do they have opportunities to network with professionals in the industry?

7. What do current massage therapists think of the program you want to pursue? No school is perfect, but if you get an overall thumbs up for the program then it will in all likelihood be worth your while.

There are several great options for massage therapy education, so sometimes it may just come down to how a college “feels” to you. If you get good feedback from students and professionals alike, and the school “feels” right to you, you can be quite confident that you are pursuing the best massage therapy education for your needs.

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How often should I get a massage?

Without fail this is one of the most common questions I receive as a massage therapist. The truth is, though, how often you should get a massage treatment is very individual and doesn’t follow a set formula.

As a massage therapist, I am asked this question by every 9 clients out of 10.  There are several factors that I take into consideration, and these factors include, but aren’t limited to, the following:

1. Why are you coming for treatment?  For example, is this for a specific issue, or is it for relaxation?

-       treatments which focus on specific issues are usually more frequent, though I rarely have treated a client more than 2 times a week for more than 3 or 4 weeks.

-         for relaxation and general health purposes, more than once a month is not necessary unless you have the time and financial resources to get treated.

2. What is the tissue presentation?

-         if you have a chronic, long-standing issue, and the tissue is very “dense” or “hard”, then you may need several treatments over a few weeks to make progress. Once your tissue has loosened up a bit, you should start feeling better. After a few weeks, your therapist should see how you are progressing, and you should be given the option of reducing treatment frequency.

-         tissue that is inflamed from injury cannot be treated directly with massage therapy, however, surrounding and compensating structures can and should be addressed to prevent pain and muscle imbalance.

-         tissue that is inflamed from injury can be treated with Manual Lymph Drainage (also known as lymphatic drainage or mld). Frequent treatments of this nature are recommended as this therapy facilitates the removal of metabolic waste from the injury and relieves pain and congestion.

3. Keeping in mind that everyone is individual and responds differently to treatment, you may notice that the effects of the treatment last only a day or so after the first treatment, with longer periods of feeling better as you progress – this is when your therapist should reduce treatment frequency.  After all, how are you going to know that you’re feeling better if you are still getting treatments twice a week? Exactly …

4. After 3 treatments, how are you feeling?

-         Personally, even with chronic issues such as upper back pain and tension, I feel that a client should notice an improvement by the end of the 3^rd treatment. This is my guideline which tells me I am on the right track, and it keeps me focused on what the client needs. I’m not saying there should be a huge or remarkable improvement, but some progress should have been made.

-         And just a side note for clients – if you aren’t seeing some improvement such as decreased pain, increased mobility etc by the end of the 3^rd treatment, then your issues aren’t being addressed. At this point your therapist should go over the treatment plan again (sometimes we miss things), and perhaps revamp it a bit.

-         If no progress has been made by treatment #5, ask to be referred to another therapist.  Beware the therapist who insists that you continue to book, and don’t be shy to say that you’re not feeling any different, after all, massage therapy is your investment in health.

If you are unable to come for the recommended frequency due to financial concerns, talk to your therapist. If he or she is aware of your financial limitations, she might be able to adjust the treatment plan so that you can maximum benefit for your restricted budget, or recommend things you can try at home to enhance and prolong the effect of the treatment.

For more information on Massage Therapy Treatment Frequency Guideline …

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A Massage Therapy Career – What’s Your Motivation?

I remember the days before I began my massage therapy career. After getting a treatment, I used to float out of the clinic, eternally grateful to my therapist for holding my migraine headaches at bay for another two weeks. Yes, even before I began massage school, I wore rose colored glasses and thought that when I became a therapist, I would save the world, one treatment and one client at a time.

Then school began, and the reality of what I was undertaking hit me. Since I had left a great career in high tech with equally great benefits, gone was the hefty paycheck, and the “love and fluff” of only ever being on the receiving end of a massage. It was really hard, being in class for 7 hours a day and then going home to study some more. And the detail, my God, the detail – how many nights did I dream of that darn Kreb’s cycle, and of muscle origins and insertions (and not of Brad Pitt, either!). Then came the task of learning the hands-on aspect of the profession, the subtle nuances of giving a great treatment (the subtlety and greatness of which didn’t even happen for me until after I graduated. I had the treatment part down quite well, however.) I lived and breathed massage therapy as most of us do, and loved every minute of it.

In hindsight I realize that while I had the most altruistic motivation when I started my massage therapy education, eventually the reality hit home that this was actually (gulp) a career. I would have to pay rent and bills with the earnings of this endeavor, and with that reality came a little less altruism. After all, not only did I have to pay my living expenses, I would also have to pay student loans and eventually a car payment once my vehicle had finally had it. Wow. I hadn’t really thought of that.

So, what’s your motivation for a career in massage therapy? Are you in it purely for financial gain, or is it altruistic? If it’s for financial gain, you might want to consider another career path, for several reasons, not the least of which is the human cost of looking at clients like a cash machine. If it’s about helping others, can you see beyond the client to see the business side of the profession? Do you really think that you can save the world, one client at a time, or do you have a bit more realistic vision of how the profession will play out in your life. Let me just say that to be altruistic is great, but it will in all likelihood change during the course of massage therapy college, when you realize that there are limitations to what massage therapy can do for others. In fact, I noticed this decrease in idealism not only in myself, but also former students, and it is well explained and quantified in an article published in the International Journal of Therapeutic Massage & Bodywork.

During my second year of college, my chiropractor told me something that sticks with me to this day. She said “You will help about 80% of your clients to some degree. There will be 10% who are completely better from your treatments, and 10% whom you won’t help at all. Don’t let that last 10% discourage you from your work. You will still make a positive difference in so many lives.” What a brilliant woman she is! (and she was so right).

Before you take the plunge into a massage therapy career, take the time to examine your motivation and learn as much as you can. And, if you decide to go for it, don’t let the fact that your motivation might change upset or discourage you, you will still be true to your inner saint and help countless people with your skills.

If you are ready to start your Massage Therapy career, click HERE to Find a School, or look on the menu bar at the top of the page. Good luck!!!!

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Can Massage Therapy Treat Fracture Injuries?

Massage therapy treatment can help maintain and improve tissue health in a fracture injury, enabling a person to regain his or her full function sooner.

Massage therapy is a treatment option which can reduce pain and discomfort in the soft tissue surrounding a fracture injury, and it can also assist in reducing edema and muscle tension of both the affected and compensating structures. When a massage therapy treatment plan is carried out correctly, once the cast is removed, a client can regain full function sooner as the health and mobility of compensating muscles has been addressed.

Initially, your massage therapist will only work above the cast, and will take care to not disturb the healing bone. Eventually, when the cast is removed, massage therapy will continue to restore the health of the tissue by increasing circulation, restoring function and strength, and reducing any scar tissue.

Considerations for treatment

It is highly recommended that your physician provide a written recommendation for massage, and your therapist probably won’t agree to treat you until your doctor has given the green light.

In all likelihood, you will also be seeing a physical (physio) therapist. It’s a good idea to provide written permission for your massage therapist to collaborate with your other health care professionals to ensure the best possible care and treatment outcome.

Before your massage therapist begins to treat you, he or she will want to verify the following information:

• your physician has approved massage therapy
• are you on any type of medication? (anti-inflammatory, analgesic, anti-coagulant, antibiotics).
• what is your general health – for example, consider age, fitness prior to injury, nutrition (your MT may refer you to a nutritionist, as proper nutrition impacts the healing process), lifestyle (i.e. do you smoke?)
• are there any open wounds which must be addressed? (i.e. with a compound fracture)
• Will treating the affected limb with massage therapy stress and disrupt the healing of bone, muscle, skin or nerve tissue?
• is there any neurological or vascular impairment in the area which prevents the use of certain massage techniques or modalities?
• do you have any plates, wires or pins? If so, hydrotherapy over the site will be contraindicated.
• the most important consideration is to avoid stressing and interfering with healing tissue. Any pressure or traction applied to the affected bone is contraindicated.
• have other types of injuries been sustained, such as sprains or contusions? (in all likelihood, there will be other injuries)
• muscle atrophy from disuse will be present when the cast is removed. Provided that the injury is not an avulsion fracture, the development of atrophy can be reduced by the use of isometric contractions at the appropriate time with cast on. If an avulsion fracture is present, avoid isometric contractions, as this may disrupt the healing bone.
• tissue under the cast will be fragile when the cast is removed, so extra care must be taken when massaging this tissue

As treatment progresses and the injury heals, issues such as tissue atrophy, altered biomechanics and altered proprioception must be taken into account. For this reason, there are different considerations for treatment with cast on and cast off.

Types of fractures

There are several basic types of fractures:

1. Simple – there is no broken skin, and the break is clean. Also known as a “closed” fracture.
2. Compound – the broken bone damages surrounding tissue and skin by piercing it. There is a greater risk of infection in this type of break due to breaking of the skin and protrusion of the injured bone.
3. Comminuted – a fracture that is in several pieces – common among a population with more brittle bones (i.e. elderly)
4. Compression – a fracture where the bone is crushed
5. Depression – a fracture where the bone is crushed and pressed inward
6. Impacted – bony surfaces are forced into each other (impacted)
7. Spiral – an break with ragged edges that result from twisting
8. Greenstick – an incomplete break that is common in children, as bones are more flexible
9. Stress fracture – a.k.a. hairline fracture, is a tiny crack in the bone and may not be visible with an x-ray
10. Avulsion – this occurs when a ligament or tendon pulls away a chunk of bone to which it is attached.

Fractures and breaks are repaired by “reduction” – when the bony ends are placed back together. A closed reduction is done manually by a physician, whereas an open reduction involves surgery, and possibly the placement of pins or wires to hold the bony surfaces together.

Finding the best massage therapist for you

It goes without saying that an injury as serious as a fracture or break will require treatment from a therapist who really knows his or her stuff and understands the healing process. Personally, I would ask my physical therapist if he or she could refer me to a qualified and experienced massage therapist, and then ensure that I give them both permission to communicate with each other so that my treatment plan would address all of my needs and concerns.

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What is muscular atrophy, and what causes denervation and disuse atrophy?

What does atrophy mean, and what causes atrophy of a muscle?

The definition of Atrophy, according to Human Anatomy and Physiology (8th Edition) is “reduction in size or wasting away of an organ or cell resulting from disease or lack of use”. Atrophy is also referred to as “muscle wasting”.

Atrophy of a muscle can occur in 2 ways – from disuse or denervation.

Disuse atrophy will occur when a person is unable to use a muscle for any number of reasons. It is very common when a limb has been cast from a break or fracture, or a person has been on bed rest for a extended length of time. Once a person is mobile again, or a cast has been removed, the client should undergo a rehabilitation process designed to challenge and strengthen the involved structures. Assuming that the atrophy was only caused by lack of use, the patient will eventually regain strength and normal size of the muscle.

Denervation atrophy occurs when the nerve supply to a muscle is interrupted and the muscle no longer receives signals or stimulus from the nervous system. This type of atrophy can occur from injury to the central nervous system, as in a spinal cord injury, or in the peripheral nervous system, such as a broken bone which damages surrounding nerve. Damage doesn’t necessarily mean a complete severing of the nerve, in which case nerve tissue is not known to regenerate. Damage will occur in varying degrees of severity, and may be a result of compression (impingement), crushing or partial tearing. If this is the case, with proper care and rehabilitation the injury will heal and muscle strength can be regained.

Why is this important to a Massage Therapist?

Massage therapists are specialists in treating the dysfunctions of the musculoskeletal system, and understanding the anatomy of the involved structures is key to providing a successful treatment. Odds are that you will see quite a few conditions throughout your career that will either cause, or have the potential to cause, muscle atrophy. Conditions such as chronic Thoracic Outlet Syndrome or Carpal Tunnel Syndrome may cause denervation atrophy due to impingement or compression of the ulnar nerve root and median nerve respectively, and can be successfully resolved once the underlying cause of the compression has been addressed.

Atrophied tissue is very fragile, and deep techniques are contraindicated until the condition of the tissue improves. Initially, the primary goal of treatment for atrophied tissue is to increase circulation and to stimulate the nerves – this can be accomplished by gentle dry brushing, followed up by light stimulating techniques such as stroking, effleurage or c-scooping. Great care must be taken if there has been crushing or tearing of the nerve, as any local techniques which apply pressure or traction can disrupt the healing of the injury.

It is highly recommended that you consult with the client’s physician, physiotherapist or chiropractor to verify the cause of atrophy, and that you work under his or her supervision and guidance if the atrophy is caused by denervation.

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Where can I find a great Massage Therapy job?

Knowing your job options BEFORE you embark on a massage therapy career can help you better decide if this is the profession for you.

Start your own practice – this is a great option for those who are entrepreneurial minded. It means you can call all of the shots, but be forewarned, if you don’t already have entrepreneurial experience, you have quite a learning curve. You’ll have to know when to take off your therapist’s hat and put on your business one, and keep it separate. It can be done, many therapists successfully own their own clinic.

Join a clinic that hosts a variety of treatment modalities. This could be anything from physiotherapy, chiropractic and massage therapy to a naturopathic or holistic clinic or doctor’s office. It’s a wonderful thing to be surrounded by people who are passionate about integrated health care. You will have the benefit of working with other professionals who are highly trained, and you will participate in the care of patients with a variety of conditions, from common injuries to extensive rehabilitation.

Start a mobile massage service – if you don’t like the idea of being stuck in a small room all day, and like to get out and about, this could be great for you. The key is to be organized – time management is really important in this business, and it is even more so when you are mobile.

Go corporate! Many large companies provide employee benefits that include massage therapy, and the coverage is usually great. Corporations provide these benefits because they realize that employees who use stress management tools such as massage therapy miss less time and are more productive. Even better if the therapist is on site, then employees miss less time going to and from appointments.

Health or Fitness facility – massage therapy is a great adjunct to fitness, so many club owners are wising up to having a massage therapist available. They realize that having qualified therapists on hand enhances their professional image by providing an additional service to clients seeking optimal fitness performance.

Sports teams or facilities – this is a little more intense than your average health club. This is where you will find budding stars with huge performance goals – as a result, you, too, will have to be at the top of your game whenever you are needed. Unless you have a sports medicine background or contacts in the business already, you probably won’t get into this right out of school, but that’s not saying it’s not a possibility. Work hard, get your sports massage certification (there are different programs available in Canada and the United States), volunteer, and it could just happen. What a great way to combine a love of sports with a passion for health.

Spa – not all spas employ licensed, certified or registered massage therapists, but many do, and the number is growing. If esthetics and hydrotherapy interest you, a spa could be a great place to start learning in that capacity. Medical spas are also growing in number, with treatments being a little more therapeutic in nature – let’s think lymphatic drainage after cosmetic procedures. Either way, a bonus is that you may get discounted or even free esthetic services, which is really great. Pedicure, anyone?

A resort or cruise ship – Depending on the location of the resort or cruise line, either one may give you the opportunity to rub elbows with a high end clientele. Your accommodation may be provided, and will definitely be part of the plan when you are on a ship. In the case of working for a cruise ship, while the hours are long and the pay is not so great, tips can be fantastic, everything is provided for you, and if you have a bit of wanderlust, working for a cruise ship could be your ticket to the world.

Hospitals or palliative care. It takes a special type of person to work in these environments, but if you have “the stuff” to do it, then it can be a very rewarding career path. Whether the service you provide is in a rehabilitative capacity with a physiotherapist or bed side with palliative care patients, you will be providing human contact to people who may be touch deprived. You may not be able to make a living per se, but you can improve the quality of life for someone, even if (in the case of palliative care) it is only for a brief period of time.

Senior’s centres – with a growing aging population, the need for extended health care grows as well. Your clients can range from a vibrant “80 years young” to a senior with a few more health concerns. Once again, a lot of times it’s about providing company and human contact to the elderly more so than the massage itself, which is a very compassionate way to enhance the quality of life for someone.

Any way you look at it, there is a ton of potential with a massage therapy career. It is Ok to change course as well, and you may find that you like to try your hands in different capacities until you find the perfect one for you.

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