By Ted Nissen M.A. M.T.

Copyright © May 2021 Ted Nissen





A full Literature review can be found with this link Massage Therapy Literature Review. Pain prevents people from doing what they enjoy. In that way pain negatively affects the quality of a person’s life. For example, if you want to exercise and you can’t because of pain, life is less satisfying. Pain affects sleep, may interfere with work and cause an ordinarily happy person to become grumpy. Interpersonal relationships may suffer. Acute pain may be short lived but lead to chronic pain which has long term unwanted consequences. People are highly motivated to seek relief from pain and often go to MD’s, PTs, Chiropractors, and or Acupuncturists. These aforementioned professions differ in the services they provide but are generally covered by insurance. MD’s tend to provide an assessment to determine the cause of pain before referring to a physical therapist. Due to the opioid addiction epidemic MD’s are less likely to prescribe pain medication. MD’s are less likely to refer to a Chiropractor or Acupuncturist although younger generations of Doctors are being trained to refer to all of the soft tissue modalities (PT’s, Acupuncturists, and Massage Therapists). Currently though most Professionals cross refer in predictable patterns described above. Chiropractors will occasionally hire a Massage Therapist to work on their patients and sometimes refer to a Massage Therapist as will Acupuncturists. Most Massage Therapists in all but a few states cannot bill insurance for their services and therefore many pain patients seek out other professions (MD’s, Chiropractors, and Acupuncturists) that are covered by their insurance plan. 

The fact that many pain patients do not find relief from the more traditional aforementioned professions and seek treatment from Massage Therapists usually at spas speaks to the efficacy of this treatment modality. Pain Patients are willing to pay cash to Massage therapists for Pain relief. I wrote the following referenced paper entitled ;    Professional, Political, and Economic Profiles This paper Details the Massage profession, allied professions and provides a profile of your typical Massage Therapist including salary and typical client. “the typical massage therapist helps people get over their pain 93% of the time. The typical massage client goes to their massage therapist because of a medical condition (46%).” [1] [2] Most people get relief from their massage therapist using techniques (Swedish massage/deep tissue/neuromuscular) (71%)) they learned in a 500-hour massage therapy-training program.” “consumers are getting good results and want their insurance to cover the costs of what they feel is health beneficial treatments (90%-94%). In fact when 1,014 adults were asked to whom they would go if they had pain their response as follows; pain medication (28%), massage therapist (28%) than a Chiropractor (11 percent), physical therapist (8 percent), and acupuncturist (3 percent.) Massage Therapists are by far the most popular kid in class metaphorically speaking. It could be further argued that no additional educational requirements are needed or additional divisions within the massage profession created. The typical massage therapist relieves client’s pain (93%) from their medical conditions (46%) with the current educational training (500 hrs ave) and it should be covered by major medical insurance (68%).” Since Massage therapy is not covered by most insurance plans Massage therapists earn, on average, an annual income of just over the poverty line.

“Despite the popularity of massage and the modalities apparent effectiveness are massage therapists paid enough for their good work? Chiropractors earn three times more per client hour and 6.8 times per year than the massage therapist who with her husband is earning 8% below the national median income for a married couple. Although the chiropractor is much better educated than the massage therapist, and must pass the costs onto the consumer the chiropractors net practice and individual income profits are as aforementioned. That is even if you factor in the additional educational costs chiropractors net hourly and yearly income is many times the massage therapist. Typically Chiropractors spend a lot less time with their patients (10 to 15 minutes). If massage therapists could bill and get paid for their services by major medical insurance they would likely see an increase of approximately 38.4% (based on the average chiropractic billing) of their income ($32,506+$12,482.30=$44,988.3), which with her husband’s income would total $72,879  ($27,891+ $44,988.3=$72,879.3). $72,879 would at least be 11% above the median income ($72,879-$65,946=$6,933/$65,946=.11). If our massage therapist were to work full time which may be possible given clients ability to use their insurance to pay for treatments MT income would increase dramatically. With a 38.4% increase in hourly income and a full time 35 hour a week massage schedule she could earn $78,915.2 per year just on her own without her husband’s income ($31.33*.384=$12.03+$31.33=$43.36*35=$1517.6*52=$78,915.2). This would be 20% above the median income without her husband’s income, who could now become a stay at home dad ($78,915-$65,946=$6,933/$65,946=.20). With her husband’s income added the total household income would be $106,806.2 ($27,891+ $78,915.2=$106,806.2). This would be well above the median income for a family of two. Our massage therapist’s gross individual practice income would be well below the average net practice income of our typical Chiropractor. The mean Net practice income of the typical chiropractor is $148,625 which is 88% ($148,625-$78,915.2=$69,709/$78,91=.88) above the gross practice income of the massage therapist ($78,915.2).”

Given these economic facts and hypothetical clinical realities why haven’t the some 250,000 professional massage therapists gotten better pay and benefits. The answers are likely complex but worth exploring. Once individuals who practice massage (see profile of typical Massage Therapist below) are understood political science can begin to analyze how groups of people can be mobilized to exercise collective power.[3] [4] One obvious take away, since women account for a majority of Massage Therapists, women are paid 17.7% less than men, and according to the most recent Census Bureau data from 2018, women of all races earned, on average, just 82 cents for every $1 earned by men of all races.

The profile of the typical Massage Therapist is as follows; “45 year-old married women (78%-83%) part time secretary/massage therapist with 500 hours of massage therapy training, 2 years of college (AA Degree), 5.6-7.8 years’ experience, who lives in (California, Florida, Texas, or Washington,)[5]. She works doing massage or a combination of massage related activities approximately 15.38-15.4 hours per week working both in a spa/chiropractors office or as a massage teacher (23%) and in private practice. She does 39 actual massages per month or 9.75 massages per week. She practices mostly Swedish massage (37%), deep tissue/neuromuscular (34%), Myofascial therapy (6.4), energy work (3.4%) and sports massage (3.1%). She charges her private clients $58 per hour. Between her private practice and independent contractor (spa/chiro=she is paid per client) work she makes an average of $23.66-$39 ($31.33 mid-point) per hour with a median income per year of $14,500-$29,250.[6] [7] ($21,875 mid-point) With her other secretarial job (25 hours per week) she earns a total of $32,506. The total household income including her husbands is $60,397 ($65,946 is considered a nationwide median income level for a married couple). She is probably pretty tired at the end of her workweek. She likes doing massage therapy because of the flexible schedule and alternately wants more clients but dreads increasing her workload (55%). Doing massage she has found is hard physical labor and you can only work on so many people a day or week without becoming exhausted. Most of her existing clients refer new clients. This means the hourly pay should be increased. It would be difficult for single women to survive on her own on the current Massage Therapist salary. 

“Does massage really help people with their medical conditions? The Massage Profession needs to do a literature review and perhaps more research to find out. Consumer surveys only tell us that our clients think so. Does increasing the educational hours of the therapist improve the effectiveness of treatment? Are chiropractors, for example, comparatively more effective than massage therapists in relieving client’s pain from a medical condition? Has this comparative research even been done? One hypothesis is this; Metabolic disturbances in connective tissue which cause most of the mild to moderate pain people seek out soft tissue professionals for, is corrected by general massage techniques (neurological reflexes on the skin increase circulation to deeper connective tissue) and does not require specialized massage training. Why Do We Hurt? These massage techniques are more effective than chiropractic, physical therapy, acupuncture, or even more specialized massage techniques (Orthopedic massage ect). The notion that more education is needed or the professional restructuring is based on reasonable but factually incorrect fixed ideas. Philosophical Basis... Educational institutions, seminar leaders, and the spa industry probably benefit financially. These political/economic forces may even perpetuate these fixed ideas. In other words, businesses, which sell education or profit from cheap labor, may not want to support a counter intuitive or a financially inconvenient truth. Recall this is only a hypothesis (generally stated). The benefit of researching the truth of this hypothesis to the typical massage therapist is tremendous. Instead of working 2 or more jobs and still living significantly below the median income level she could have a comfortable life with less work and more profit. Our well-loved massage therapist could move out of her apartment, buy a home in the suburbs, get some health insurance, get her teeth fixed and send her kids to a private school. If she doesn’t much like her husband she can drop him too.”