Massage is not for maintenance

Misused and underappreciated, massage is now a part of the problem

In the early days of professional practice, I offered a 2-hour systemic “maintenance” massage session. The idea was to give the whole body a good working over in order to balance tissues, improve circulation and nerve conduction and to get ahead of any potential problems. And, I encouraged receiving these kinds of sessions every 4-8 weeks, depending on the person.

More than a decade later, after thousands of hours of hands-on time and committing to deep study of traditional medicine systems, I have changed my view. While I have seen that massage does offer the benefits I just mentioned, the benefits are maximized not in maintenance application, but rather, in treatment. Every session should have a specific objective to address a specific need and be customized to the particular individual.

Focused treatment work on a specific problem area, coupled with addressing root cause issues such as posture and movement quality, has more potential for health benefit to the whole body, and person, than simply applying a rote, generalized routine that does not take any of the particulars into account. And yet, this is what people have come to believe massage is: a service or a self-care indulgence.

And while I am disappointed to say it, when it comes to the current concept of the “maintenance massage,” I tend to agree.

While there is nothing wrong with relaxation services, the prevalence of the concept when it comes to manual therapy has eclipsed the full potential of its therapeutic application, which has led to an increasing underappreciation and disrespect for manual therapy as a whole as well as limited awareness of its medical applications and successes.

Unfortunately, the public misperception and misuse of massage for maintenance and relaxation alone is encouraged and propagated by massage therapists and massage schools themselves due to lack of training requirements. In the US, some states have no educational requirements for massage therapists; for those states that do have requirements, the majority have a minimal 500 hours.

Despite the passion and care for others that most massage therapists I know have, this sort of basic massage education cannot equip a new massage therapist with the skills needed to conduct a thorough assessment and to create a treatment plan, let alone the technique set required to address a wide range of problems. To do so would require many more hours of training as well as personalized guidance from a clinical practitioner. Unfortunately, this type of learning is not often available or pursued.

A lack of robust educational opportunities, i.e. confidence in skillset, binds the majority of massage and manual therapists into keeping their practice focused on generalized sessions, or the aforementioned maintenance massage, rather than on elevating massage therapy to its highest potential in treatment; one that includes a holistic view and knowledge of lifestyle interventions in addition to robust assessment and treatment skill.

By contrast, in traditional medicine systems, massage is part of a broader medical system, offering a range of tools and experienced knowledge. Sessions are focused on addressing acute and chronic issues at the root cause, including postural, movement and lifestyle issues. These are the practices that we actually use for maintenance of our body and person: appropriate and correct exercise, diet, daily habits, proper breathing, etc.

Continuing to offer massage as maintenance promotes the idea that wellness is passive and that we can maintain our health by simply relaxing and letting someone else do the work. This idea of massage, and of health, presents many problems.

Instead, the role of the manual therapist could be to treat problems and identify their causes so the the person coming in for a session can take remedial action within their day to day lives. With a shift in perspective on both the part of the average massage therapist and consumer, therapeutic massage has the potential to be part of a holistic and comprehensive solution for long term health.

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