What is "medical massage"?

Updated: Nov 30, 2021

In the four short years I've been practicing, I've encountered countless definitions and ideas about what makes medical massage different from any other massage. It seems to be over-generalized to some and ridiculously defined for others. I've worked in spas and offices that either had no idea there was an actual practice called "medical massage" or the owners defined it as a practiced ONLY reserved for therapists that graduated with a ridiculous number of qualifications (usually unrelated to massage). It really is a MESS and the only one who pays a price for this mess of confusion is the client. Why? Because it creates multiple attempts to explain what is wrong and how to fix it without a consistent approach the client can see and rely on between therapists. It becomes exhausting for a client and breaks down trust for the profession and exhausts the enthusiasm a client might have for getting better.

Here's the definition I was taught when getting my certification and I belief it to be the most clear and useful: Medical Massage uses the classic clinical model of 1) physical assessment, 2) therapy or treatment, and 3) remedial exercises.

SIMPLE AS THAT. When you know something well and clearly enough, explaining it to another will usually be simple and clear. If you have to use multiple ways to explain something, then you probably don't understand it well yourself.

When I first started in massage, it bothered me that the widely embraced method of practice was taking the client back to the room, asking a few questions to make sure no harm was done, and getting on with a very generalized, full body massage. There was little time spent figuring out exactly what the problem was or how to help it. Even more rare was seeing a massage therapist actually ask what therapies had been used before. That has always struck me as the most ridiculous because it seems like the most obvious way to avoid what hasn't been working for the client thus far. Even when I was worked on by a very highly rated therapist that placed "medical massage" on par with being a doctor, the therapist did no assessment, nor ask about medical history, nor even provide remedial exercises. Don't get me wrong, the therapist had given an excellent massage. Though, the point is about providing a clear framework for what makes medical massage different than a massage for general wellness.

The benefit of creating a clear framework for medical massage vs. a general wellness massage allows massage therapy a bridge between complementary/alternative medicine and allopathic/traditional medicine. The traditional medical system lacks the fluid and empathetic approach of complementary medicine (not to mention the manipulation of soft tissue) while complimentary medicine lacks the empirical approach of traditional medicine. Massage therapy has made great strides in the last 20 years with teaching its students physiology and assessment in order to avoid harm, but there is immense room for using assessment for providing treatment on a more regular basis in treatment.

Assessment is when the therapist guides the client in movements with different limbs or areas of the body in order to understand the severity of damage, type of tissue damage, and even exact muscle to address. An assessment can be done without providing a diagnosis. Providing a diagnosis can not be performed by a Massage Therapist. Assessment simply allows a therapist to hone in on the work needed or to make a referral. An example of an assessment I have used before a session is when a client came in complaining of pain in her ankle. She mentioned that she was working her yard and rolled on her ankle. The pain did not start until a few hours later and it has continued ever since, most noticeably when she rotates it. The fact that the pain did not start until hours later and was most noticeable in certain movements indicated a possible medium sprain/strain to me. The client mentioned that even though she had not seen a doctor about it, she thought massage would be more useful. Without indicating my idea of what could be wrong, I asked the client to sit on the table and very slightly apply resistance to my hand with her ankle. Without applying even slight pressure, the client was in visible pain. This was a clear way to confirm with the client that it was not a good idea to get a massage but instead to see her doctor. I explained how getting a massage would possibly make it worse. By doing the short assessment, she could see that I was not going to assume anything and that in referring her to a doctor first, her safety was my priority. After a week, she returned with a wrap on her foot, confirming that she did sprain her ankle and it couldn't be worked on for a few weeks. She was happy that I sent her away to see her doctor and that I avoided causing more pain.

Another assessment was when a client came in with pain and lack of range in her arm and shoulder. I asked her to slowing raise one arm and then the other in all directions. Using a goniometer, we measured each movement and I wrote down her numbers so she could see what the differences were from the first session to the last. She told me that she was diagnosed with frozen shoulder and that the doctor confirmed it was appropriate to get a massage. Once assessment was completed, we discussed exactly what areas I would address each session and for how many sessions. Each session was specific to that area. After a few weeks, we would assess again and notable differences in range gave the client confidence and assurance. When she started feeling like she was far enough improved, we went back to full body massages.

So, a structured, clinical approach does not deplete from the benefits of a therapeutic massage. It does provide a kind of common language for clients to follow from one field of health to another though. It creates a focused atmosphere specific to injury and limiting or acute pain. I hope this becomes a growing topic of conversation in the massage therapy field. It could possibly lead to a widening scope of practice and more dialogue between complementary and allopathic medicine. At the end of the day, the highest goal is a successful approach for the clients benefit.