Depending on where you are in your career as a massage therapist, you may have wondered at some point which is the best path of study.
In Australia, we have three main qualification “titles” related to the field of massage therapy. These are: massage therapy, remedial massage and myotherapy. In this blog, we will attempt to define these three different qualifications and the professions associated with them. At this point in time, all three of these professions are in a critical stage of their development, for a number of reasons. We will explore these three titles and some of the critical changes we can expect to see in the future for the massage therapy industry.
In Australia, the entry level qualification is a Certificate 4 in Massage Therapy. The general expectation with a Certificate 4 qualification, is that you would spend around 6 months of full time study (don’t be worried if you did more or less, that’s a general guideline). For the most part, this training will give you good fundamental skills in the area of Swedish or relaxation massage. You may be lucky enough to learn aromatherapy, reflexology or potentially some other associated skills that may come from complementary therapies, or perhaps even beauty therapy massage.
If you are a massage therapist and wonder if what you do may somehow be less effective than remedial massage (or any other manual form of therapy) please don’t be concerned! Numerous studies (link, link) have highlighted the benefits of the Swedish style of massage, most notably for it’s effects on anxiety and depression. There have been some impressive results in short term pain reduction and there is really no evidence to suggest that the more complex techniques such as trigger point massage or myofascial release are superior, when it comes to pain reduction. In fact, it would appear quite the opposite. The “advanced” techniques of myofascial release (source) and trigger point therapy (source) are yet to show consistent levels of pain reduction in systematic reviews and meta analysis, whereas it is now generally accepted that moderate depth massage (such as Swedish technique) does achieve short term, clinically significant levels of pain reduction (source).
There is a very important place in the Australian healthcare field for massage therapists, massage does not need to be complex to be effective. But if you want to work with clients with health conditions, then it is important to consider higher levels of training than the Certificate IV, to ensure you are confident in providing safe massage practice.
The Diploma of Remedial Massage had become the industry standard for practicing massage therapists in Australia. As remedial massage is recognised by all of the massage associations and private health funds, in terms of offering a rebate for remedial massage. But what is the difference between massage therapy and remedial massage therapy? Well, to a large degree this depends on an individual practitioner. But from a qualification perspective, remedial massage should include the skills and knowledge to complete a thorough musculoskeletal health assessment, design an individualised treatment plan and use a variety of soft tissue techniques in a personalised manner.
Is Remedial the “be all?”
One of the key skills for a Remedial Massage Therapist has to be their ability to identify more serious injuries and then refer a client onto other healthcare professionals for diagnosis and where required management and treatment of injuries and pathologies. It is the opinion of this author that many massage therapists in Australia have slipped into the potentially dangerous practice of diagnosing, where it is not appropriate within the scope of massage. We need to remain mindful that as massage therapists we do not have the necessary training in pathology to understand and evaluate many of the assessment methods we may have been taught, based on rigorous scientific evidence. In fact, it would appear many Remedial Massage Therapists are unaware that many orthopedic special tests are outdated, horribly inaccurate and unreliable as assessment methods. (Source, Source)
Nearly all of the postural and movement based assessment methods used by massage therapists suffer from very poor reliability and accuracy, when it comes to identifying pathologies. It is for this reason that imaging is so important in the diagnosis of musculoskeletal injury. And even then, diagnosis is still not entirely accurate. Let’s avoid this minefield! Remedial Massage Therapists can be confident that their skills can offer real help to clients in pain, but they should leave the role of diagnosis to other health professionals, who have access to better tools of diagnosis such as imaging, blood analysis and other pathology testing.
A solution for extending the remedial massage mindset
For the Remedial Massage Therapist reading this article, who may be somewhat bemused or confused by these comments, to understand this perspective it will be very helpful to begin updating your knowledge of the science of pain. One of the big knowledge gaps for massage therapists is their understanding of the nervous system. Once we develop a better understanding of the nervous system (the primary system involved in the sensation of pain) it is likely that you will experience something of a “game changer” and lightbulb moment. Instead of an overly biomechanical focus on health assessment, you will start to consider a much broader perspective of the factors that can influence pain.
It is entirely likely that the effectiveness of massage for pain is due to neurophysiological effects rather than biomechanical ones. This is now well accepted in manual therapies such as joint mobilisation and joint manipulation. (Source)
That being said, Remedial Massage Therapists provide an incredibly valuable service to healthcare in Australia. It is common place to see Remedial Massage Therapists working alongside Physiotherapists, Chiropractors, Osteopaths and many other allied health practitioners. Remedial massage is well known, loved and well respected by the Australian public.
Myotherapy can be defined as the “evidence based assessment and treatment of musculoskeletal pain and dysfunction.” Most Myotherapists complete an Advanced Diploma of Myotherapy (which involves first achieving a Diploma of Remedial Massage). For this reason, there is a lot of crossover in the training between Massage Therapists and Myotherapists.
There are also two Degree programs for myotherapy in Australia, which do differ quite noticeably from the Diploma of Remedial Massage. It is this author’s opinion that there are three main areas of difference between myotherapy and massage that are highlighted in the degree program. These are: scientific literacy, exercise prescription and pain neuroscience education.
Many therapists may notice dry needling as being a significant difference between massage and myotherapy, but as dry needling training is accessible to Massage Therapists and many Myotherapists do not use dry needling as a regular intervention, this is less of a defining point at this time.
Scientific literacy is key to the development of myotherapy as an evidence based practice. Unfortunately, most Massage Therapists haven’t had the chance to learn about the scientific enquiry into musculoskeletal healthcare. In scientific enquiry, knowledge is constantly being challenged and updated. This means that as a therapist, what we might have thought to be an accepted truth 5 or 10 years ago, has often changed as new information comes to light. The role of posture in pain is one notable example. “Posture” and therefore mechanical loading of tissue, was thought to be one of the major causes of musculoskeletal pain, however, recent studies have failed to show that posture is a clear, consistent contributing factor in musculoskeletal pain. (Source, Source)
Instead, pain is much more likely to be linked to multiple factors for any individual. Those factors can include any combination of: localised tissue damage, inflammation, changes in function of the nervous system, mood, sleep, social stress and other differentials that can be unique to the individual. For this reason, Myotherapists are much more likely to consider a “holistic” perspective of a client, rather than a focus based solely around musculoskeletal and biomechanical factors. (Source)
What does the future hold?
There is a new massage qualification currently under development, an Advanced Diploma of Remedial Massage (see link to an AMT article on the topic). While the content of this qualification is yet to be defined, the complementary health industry reference committee has put together a 41 page industry forecast that has helped to identify the areas of need for massage therapists in the future (link). What has been identified is that with the demands of an ageing population, there is an increased demand on massage therapists to provide a greater level of care. To meet the increasing demands of massage therapists, it is important that training increases to meet these demands.
It is the opinion of this author, that massage therapy needs to match the broader healthcare sector and develop skills and training in the fields of pain management, exercise rehabilitation, palliative care, aged care, oncology care, mental health care and broader skills in disability services, in line with NDIS operations in Australia.
In most of these areas, this won’t mean that massage therapists need to develop a huge new range of skills, instead, there will be a need to develop a broader knowledge of the healthcare industry and develop the skills to operate in a variety of healthcare settings.
There is a real need for change in massage therapy in Australia. For far too long we have been overly focused on the machinery of the human body, the musculoskeletal system and forgotten about the “person” in the machine. All massage therapists have this in common, we are very well equipped to provide one critical component essential to all humans, that is care and touch. We don’t need to get caught up on complex biomechanical analysis, but we do need to understand people. People that may be ill, as well as healthy. This does mean a change in some of the fundamental paradigms of the massage industry and now is the time to embrace the “winds of change.”