Massage, generally recognized as a form of therapy, is the practice of delivering pressure to body tissues, including muscles, connective tissue, tendons, ligaments, and joints, in order to promote a beneficial response. Massage is most often applied to the body with the goal (s) of healing injury, relieving psychological stress, managing pain, improving circulation, draining problematic lymphatic areas and relieving stress. The terms "therapeutic massage therapy" or manipulative therapy apply to massage when it is used to promote physical or psychological benefits.

A massage therapist's occupational duties vary by employment setting, geographic location (legislation often limits the services that therapists can offer), and the specific massage treatments that a particular therapist offers. Massage therapists briefly interview all clients to assess their treatment needs, explain the type of treatment that will be performed, and to ask the patient for input regarding pressure, temperature, location of discomfort, etc.

Due to the nature of the work (sometimes inconsistent and always physically demanding), massage therapists that work between 20 and 30 hours per week generally consider themselves to be employed full time. In addition to hands-on work, self-employed massage therapists devote time to the administrative aspect of their practice and must advertise and aggressively market their services to maintain their current clientele and to recruit new clients, all of which is unpaid. Entry-level therapists without an established clientele may spend an equal or greater amount of time marketing their services as they do providing direct services. For these reasons, it is common for individuals to pursue massage therapy as a source of additional income, or to have a part-time job outside of the industry as well, particularly in the seminal stages of a Massage Therapy career.

Significant Points

• Individuals most often pursue massage therapy as a career because they are interested in helping people achieve better health and they enjoy making people happy. Many massage therapists view themselves as healthcare practitioners, though the practice of massage as well as the industry has a history of being scrutinized and misunderstood.
  

• Some individuals closely associate the practice of massage with the sex industry. Others view massage as a hedonistic service without medical benefit. As a result, some individuals do not see massage therapy as a respectable career or as a healthcare career at all. Massage Therapy is categorized as an allied health occupation by the American Medical Association.
  

• Massage services have traditionally been offered in medical offices that utilize alternative and complementary treatment methods (chiropractic, sports medicine, rehabilitation clinics, Chinese Medicine, Naturopathic practices, etc.). Several local hospitals also have wellness programs that offer massage and other healing arts to patients with chronic or life-threatening health conditions (El Camino Hospital and Stanford Hospital offer massage therapy to patients undergoing certain types of treatment). Increased utilization of massage as a complementary therapy and the acknowledgment of the benefits of massage therapy by the medical community are helping to paint a more positive image of the industry.
  

• Brief chair massage sessions are increasingly offered in the work environment as a perk for employees, and massage services are also becoming more commonly available in shopping malls, grocery stores, and airports. The increased visibility of massage services in the public setting may lead to a greater acceptance of the practice of massage.
  

• The majority of massage therapists are considered self employed. Individuals that keep a semi-regular schedule in a spa or salon setting may pay station fees or receive a portion of their wages based on services rendered. Most massage therapists who work in a store front are considered to be independent contractors, thus self-employed.
  

• Individuals over the age of 55 constitute the fastest growing group of massage consumers (According to UCSF Center for the Health Professions). Physicians are increasingly recommending massage for senior citizens and the elderly.
  

• Reliable data does not exist on the number of massage therapists employed in California. UCSF Center for the Health Professions states "The California Labor Market Information Division reported in 2000 there were 3,680 massage therapists employed in the state. This estimate is likely quite low since employment statistics account only for MTs employed by firms subject to unemployment insurance reporting requirements. Most MTs are self-employed and thus excluded from labor market reporting. The size of the MT workforce in California could be between 14.000 and 24,000 practitioners."
  

• California is one of the few remaining states that does not regulate the practice of massage therapy. Massage therapists are instead regulated by county or city agencies and are required to obtain a permit and a business license certification or license to practice massage therapy. Local rather than state regulation is currently utilized to provide for closer regulation of Massage storefronts that might be used as a front for prostitution or illegal activity.
  

• Occupation attrition is extremely high-some organizations estimate that more than 30,000 therapists leave the profession each year - some due to temporary changes in life circumstances, more than 10,000 a year permanently. Reasons given for occupational attrition include: poor vocational choice; individuals underestimate the needs for marketing and other practice building efforts; individuals are unable to earn a steady sustainable income; injury; individuals are unable to sustain employment in the niche of therapy they find most fulfilling; and cut-rate massage operations driving out individuals who must charge a full-rate.
  

• Massage therapists must apply for training and licensing permits through their city’s police department. Certain criminal offenses may preclude some individuals from obtaining the required permits. Individuals with a criminal background should contact their local police department before investing in training.
  

• Individuals who work in sports massage and in medical facilities do not always receive gratuities, which can account for up to 20% of a massage therapist's income. Some medical facilities have a strict policy against accepting tips.
  

• Several individuals interviewed indicated that male massage therapists may be in more demand than female massage therapists in the sports medicine, eastern medicine, and physical rehabilitation/chiropractic environments. Female therapists may be in higher demand in the spa/salon environment. Several individuals indicated that there is a strong preference for massage therapists that are physically fit and conventionally attractive in most environments.
  

Employment / Wages

Though the demand for massage services is growing, the industry is still small. Vacancies occur most often due to separation, but according to the Bureau of Labor Statistics, the occupation and industry is predicted to grow more quickly than the average. Individuals interviewed thought this was also true for the Massage Therapy Industry in Silicon Valley. Massage Therapy is a revolving door occupation-meaning it is common for massage therapists to enter and exit the occupation more than once.

Employment arrangements and opportunities differ widely by work environment, as do earnings. It is therefore difficult to establish close parameters for an occupation with such pronounced degrees of variance, but some commonalities exist.

In general, Massage therapists can anticipate earning anywhere from $20-$45/hr without benefits. It is important to remember that most therapists cannot physically provide more than 30 hours of treatments per week, and most therapists are only paid for the treatments provided, so anticipated earnings should be calculated accordingly. Tips can account for a significant percentage of many therapists’ incomes (up to 20%), and some environments prohibit therapists from accepting tips (medical clinics). It is considered uncommon for therapists to receive medical benefits and it is common for therapists to work odd hours and to be asked to work on some holidays and weekends, even if that is not in keeping with their regular schedule.

According to individuals interviewed, success in this industry often comes down to ability to interview well, market oneself as a professional, connect with clients, and the willingness to keep up with the demands of the industry. Individuals who see Massage Therapy as an easily accessible career that requires minimal effort or skill need not apply-this is a competitive occupation and industry.

Some employers hire therapists to work a set schedule at a set hourly wage, plus tips. This arrangement may be less lucrative generally, but newly graduated therapists without an established clientele may start their career with an employer that pays an hourly wage without commission. Individuals who are struggling to build a clientele may also elect to work 1-2 days per week with an employer that offers this type of arrangement because it is a guaranteed paycheck. Some experienced therapists prefer to work in this type of arrangement instead of private practice because it does not require them to do aggressive marketing and they do not have to work undesirable hours to keep clients coming back.

The type of arrangement explained above is most common in medical clinics, chiropractic clinics and rehabilitation practices (note: tips are not always allowed in these environments and that is an important consideration), but spas also use this type of arrangement. Hourly compensation for regular, part-time assignments in the South Bay Area and Peninsula (under this type of arrangement) ranges from $25-$40.

Sometimes, massage therapists that work for a storefront operation (as non-owners) may also work on a commission-only or a flexible commission arrangement. In this model, the therapist earns an agreed-upon percentage of the sales from the services they provide, plus tips. They may or may not earn a higher commission or bonus for regular clients that they bring into the establishment. With time and experience, the individual can expect to earn a higher commission or larger bonus.

Competition for these types of positions is significant and employers often prefer to hire experienced therapists that have a pleasant appearance and a more polished demeanor. Employers may require NCMTB certification. Job prospects for men may be more limited in this environment. Massage therapist commission generally ranges from 35-60% of the cost of the treatment, which would usually amount to $30-$60/hr in this area (the cost of treatments is generally determined by length and type of service, and also varies greatly by prestige of the facility).

Some massage therapists are totally self-employed. These individuals independently rent a station in a salon or other storefront operation and generally do so only after they have an established clientele. In this arrangement, the therapist pays a set amount for rent to the store owner (rent could be over a thousand dollars in some locations), and then keeps all proceeds and gratuities. This type of arrangement often requires very long hours and aggressive marketing. Individuals interviewed indicated that this type of arrangement can often "make or break" an individual financially. Some individuals have a shared practice so that they can split the rent with another therapist.

It is somewhat common for individuals with a practice at a clinic or spa to 3-4 days per week at that location and then supplement their income and market their services by providing massage in a client's home, or taking temporary "gigs" at health fairs, work establishments, etc.

Education and Training

Massage therapy training is offered at community colleges, vocational and technical schools, and most frequently, in schools that teach massage therapy or healing arts exclusively. Though massage therapists may learn additional techniques on the job, they may not be trained exclusively through on the job training.

Educational programs consist of classroom training and an externship. Classroom instruction incorporates principles of anatomy and physiology, health, medical terminology, business practices, ethics, and teaches several basic massage techniques. Once a minimum of 100 classroom hours have been completed, students apply for a massage therapist trainee permit through the training provider’s city police department permit office. This allows the trainee to participate in an externship and to give massages in the training provider’s in-house clinic (they cannot be paid for these services).

The length of training varies and programs range in length from 200-1000 hours. Clients should be advised to pursue programs that are a minimum of 300 hours in length as this is the minimum requirement for some California city massage therapist permits, and it is strongly recommended that individuals entering this field pursue training programs that are 500 hours in length, as this meets the minimum educational requirement for the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) certifying exam, a widely recognized national credential for massage therapists (this credential does not substitute for the mandatory business license). Programs that are 500 hours in length will also offer additional training in multiple modalities, rather than just the basic training in Swedish and Chair massage modalities that is commonly taught in the 200 hour course of study.

It appears that success as a massage therapist has far more to do with experience, personality, and ability to build a practice, than it does with the prestige of the institution an individual attends. However, individuals that complete more hours of training and have more practice starting out generally have better technical skills as well as a higher degree of confidence.

Massage therapists can specialize in over 80 different types of massage, called modalities. Swedish massage, deep tissue massage, reflexology, and sports massage are a few well-known approaches to massage therapy. At minimum, therapists are generally proficient in Swedish, Deep Tissue and Chair massage and then train in one or several additional modalities that will make them more marketable in the area in which they desire employment. Some therapists take classes to learn additional modalities that correspond to their own personal philosophies as a healer or to keep up with the latest customer demands. Massage therapists do not have to be certified or licensed to perform specific modalities, so therapists may take a workshop over a weekend or learn a new modality at their place of employment.

Individuals intending to pursue employment in the spa environment may choose to focus on becoming experts in the modalities that are most marketable in that area, which are primarily Swedish and Deep Tissue Massage and then seek to become proficient in a specialty area of massage such as Hot Stone Massage or Maternity Massage to make themselves more marketable as an entry-level therapist.

It is a good idea for clients to get an idea early on which area of the Massage Therapy industry interests them most so they can work appropriate electives into their course load or take workshops in the massage community. The training provider’s career services office may be able to offer assistance with this as well. The resources listed at the bottom of this profile will also provide information on which modalities are used in specific environments.

Community college programs may be preferable to programs offered in other settings because they are generally less expensive, the anatomy and required science courses may be transferable if the individual chooses to pursue another career in allied health, and a certificate or associate's degree from a community college may be perceived to be a more professional, academic credential (which is an important consideration as this occupation is closely scrutinized by the public). It is unclear if there is an employer preference for community college graduates in the relaxation environments (spas, salons, etc.), but there may be some employer preference for community college graduates in the sports medicine and clinical office environment.

Certification and Licensure

The State of California does not certify or license massage therapists. This is a controversial issue among practicing massage therapists, as 34 other U.S. states do regulate massage therapists. At this time, massage therapists in California must have a business license and a special massage therapy permit to legally practice massage. Massage therapists apply for the business license and permit through the police department’s permit unit in the city in which they work. To qualify for a permit, massage therapists must submit proof of completion of the required hours of formal training from a massage therapy program (each city has a different minimum requirement, ranging from 200-500 hours-it is important that clients be eligible for as many job offers as possible, so this is another compelling reason to enter a program that is 500 hours in length).

The business license and massage therapist permit are mandatory, but massage therapists would be well advised to pursue the National Certification Board for Therapeutic Massage and Bodywork Certification (NCBTMB) upon graduation as well. The credential is awarded upon successful completion of a national exam only. To be eligible to sit for the exam, an individual must have completed a minimum of 500 hours of formal training from a recognized training program (BPPVE) and complete an application. After the applicant is approved for testing, the applicant may schedule a test time at a local testing center. Tests are available six or seven days a week, depending on the test site, and are entirely computer based with multiple choice questions. The exam covers six areas of content: general knowledge of the body systems; detailed knowledge of anatomy, physiology and kinesiology; pathology; therapeutic massage assessment; therapeutic massage application; and professional standards, ethics, business and legal practices. Some local employers require this credential of their therapists and the NCBTMB certificate is actually a requirement in all of the 34 states that issue a state massage therapist license. The NCBTMB is the only nationally recognized certifying group of massage therapists in the United States, though other local and regional groups exist.

Additional Resources

City Offices for Massage Therapist Permits / Business License
Campbell, Cupertino, Gilroy, Los Altos, Los Altos Hills, Los Gatos, Milpitas, Monte Sereno, Morgan Hill, Mountain View, San Jose, Santa Clara, Saratoga, Sunnyvale

Professional Associations

Associated Bodywork & Massage Professionals
American Massage Therapy Association
Commission on Massage Therapy Accreditation
Accrediting Commission of Career Schools and Colleges of Technology
National Certification Board for Therapeutic Massage and Bodywork

Information Resources

Massage&Bodywork.com
The BodyWorker Massage Modalities
UCSF Center for the Health Professions Report on Massage Therapists
Massage Today Magazine

Training Programs

Body Therapy Center Palo Alto

West Valley College Massage Therapy Program

National Holistic Institute-San Jose, Emeryville, San Francisco

Western Career College-San Jose