Positive Health Online

A question which I am regularly asked deserves an honest answer. "How do you find the standard of massage therapist here compared with elsewhere?" A diplomatically evasive answer usually (depending on where I am when the question is asked) allows an escape from what could prove an otherwise embarrassing response. The truth is that standards of training in the UK compare badly when contrasted with some European countries and more notably with what is found in North America.

In the USA itself standards also vary, since individual states demand quite large differences in their training requirements (ranging from 900 hours to none at all), and almost none of the US standards equate with what is generally agreed to be the highest standard of all - the Canadian (which itself is not uniform but which is uniformly better than anywhere else). In Canada (British Columbia at any rate) there exists a 2200 hour training requirement (with plans in place for over 3000 hours of class time).

Think about that as you ponder your training choices in the UK, where several hundred hours in class to learn massage is regarded as a pretty intense level of training and many courses function on under 100 hours!

Now it is true that there is massage and massage, and that training requirement for what can be termed 'wellness (relaxation) massage' (where the therapeutic intervention component is either totally absent or minimal) does not need to be as lengthy or broad as a massage training which focuses on preparing the therapist to handle specific problems (recent trauma for example). In the latter case a high level of clinical expertise is needed both in assessment, evaluation and diagnosis as well as in the acquisition of a wide range of bodywork skills which extend beyond basic traditional, or Swedish, massage methodology.

Canada seems to have sorted itself out in this regard and their standards of training and practice are second to none, and should be examined by legislators and all UK schools teaching massage – as well as by prospective massage therapists.

Other initiatives deserve mention, for example the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB), which has been established in the USA and which evaluates a core level of knowledge in therapists (initially a voluntary process but slowly becoming a requirement). NCBTMB does not assess current skills but helps to weed out those whose training in core subjects (anatomy, physiology, pathophysiology, etc) is inadequate.

In the UK what do we have? There exists the possibility of National Vocational Qualifications (NVQ) standards becoming a benchmark.

This is the nearest equivalent to the US model, and it is to be hoped that its standards will be high and not reduced to the lowest common denominator, although this remains to be seen.

The example in the UK of osteopathic and chiropractic regulation should inspire the leaders of the massage profession to action. They might consider defining a scope of practice, along with a well thought out set of competencies (standards) which all therapists should reach. This would help define a basic core of knowledge and abilities which schools would have to teach. We might then begin to see the true value of massage therapy which has potentials beyond the imagination of many of its practitioners.

The bottom line, of course, comes down to safety and efficacy, the ability to recognise what not to treat, what conditions and patients to refer (and where), and the competence to safely and beneficially handle neurological, or inflammatory, or post-surgical, or acutely traumatic, or chronically painful or fibrotic or psychologically induced conditions, among others.

Research in the US – largely by the Touch Research Institute at the Miami School of Medicine – has validated the benefits of massage in a host of conditions ranging from AIDS to fibromyalgia, burns patients to premature babies.

There are, of course, patches of excellence in the gloom of UK massage therapy – for example the efforts made by the Fellowship of Sports Masseurs and Therapists which has painfully and efficiently hauled its membership standards to a level which bears some comparison with that of the best in the US (and which has been active in consultation with Government regarding national vocational qualifications). In addition massage therapy degree courses (BSc) now exist for nurses, which will help ensure that standards of massage provided by that important profession evolve and improve.

So the answer to the question I am often posed as to comparisons, is that many British massage therapists practise to a high standard, and can compare favourably with the best anywhere, however, the majority have poor training and they and their patients deserve better.

If massage therapy is ever to be incorporated widely into mainstream settings in the UK, NHS or private, criteria generally have to rise.

For this to happen the profession has to set its own agenda – including establishing basic massage therapy competencies, standards (including compulsory continuing education), regulatory machinery and goals.