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Massage Today
March, 2006, Vol. 06, Issue 03

Education – Where Does Advanced Begin?

By Ralph Stephens, BS, LMT, NCBTMB

I primarily spend my time as a continuing education provider for the profession of "Therapeutic Massage and Bodywork." To be approved by our national certification board (NCBTMB), a continuing education course must be "based on continued competence and enables the certificant to build on their knowledge, skills and abilities." That sounds great.

However, there is a problem. What knowledge, skills and abilities do all massage therapists have? Too broad of a question? OK then what knowledge, skills and abilities do all massage therapists certified by the National Certification Board for Therapeutic Massage and Bodywork have?

How can a course be developed to continue the education of a therapist when there is no definition or standard of what entry-level education is? What techniques, muscles and bony landmarks do all schools teach? What can you count on every massage therapist to know? Where does advanced training begin? Sadly, as much as I love to teach advanced techniques, I continually must teach the difference between effleurage and deep friction; that deep friction is a technique, not how hard you press, because it can be done quite lightly. The majority of therapists don't know correct body mechanics, such as how to stand and how to align the thumbs to prevent injury. Not one therapist in a recent class I presented could accurately palpate the quadratus lumborum. Three participants were instructors at the host school. Everyone in the class was a licensed therapist, a graduate from a COMTA accredited school, and had passed the NCETMB.

It's not that I mind teaching these things. I am delighted to teach whatever is needed to help therapists more effectively help more people. However, it would be nice to get beyond thumb alignment being continuing education someday. Until then, I will, of course, continue to bring therapists up to speed on body mechanics and palpatory skills that should be taught in massage school as I teach the advanced techniques.

It might be said that NCBTMB has defined entry-level education from the results of their job task analysis surveys. However, those definitions include many techniques peripheral to massage. A therapist can pass the exam by getting all the esoteric questions correct and not know much anatomy. The body of knowledge covered by the NCE is so vast and varied it can only be tested superficially. Further, it can only be taught superficially. No massage school can teach it all, in any depth, in 500 hours.

When the national certification program was expanded (during its creation) to include everything for everyone, it became nothing for anyone. But, it's legally defensible. So, we are back to the question: What can you reasonably assume all massage therapists know when you are creating a continuing education course? Sadly, the answer is nothing. You cannot assume everyone knows deep friction from effleurage (basic massage strokes). You have no idea what muscles a particular therapist knows how to palpate accurately. There is no common working posture taught universally, and some schools teach none at all. Some entry-level programs get all jacked up and teach NMT or other advanced techniques without teaching the foundational basics like strokes, body mechanics, anatomy and palpatory skills. As a result, they grind out undertrained, overconfident graduates, most of which flounder until failure in one to three years. Schools have created a perpetual motion machine because a rapidly expanding profession can never be staffed when there is this high of a dropout rate. Students typically model the values, awareness and vision of their instructors. Until we can find a way to improve the level of the typical instructor in the typical massage school, it will be difficult to improve the quality and longevity of the entry-level therapist. Of course, there are great instructors and great schools, but they are the exception, not the norm. This is true in any profession, but in our case the norm is very low. The norm has to be raised.

The massage school community needs to let go of, among other things, the vague anatomy standard based on hours, and agree that an entry-level therapist will know a defined list of terminology, contraindications, muscles (O.I.A.), bones, bony landmarks, working postures and massage techniques. Everyone must know the list to graduate and to become licensed or join a professional membership organization and get the beloved insurance policy. We don't have to go overboard. The list doesn't have to be that long - after all, it's entry-level - but it needs to be established and enforced. Of course, a school could teach more depending on its program. The public needs to be able to count on the fact that all massage therapists at least know a common body of knowledge and terminology. So do physicians, those Gods of Allopathy we so desperately seek referrals from. This might help us get more.

I am not about to propose the list myself. It's not the place of one person to do so. It should be the assignment for a group like the Council of Schools or some other body of professional massage educators to hammer it out. Does this mean I am advocating standardized education? Yes, but only to the degree that all students learn a core body of knowledge. Beyond that, every school could do its own thing. Think there is any chance this might happen?

Sadly, I do not see any chance in the current system, but I have high hopes for the new Federation of State Massage Therapy Boards and the licensing exam they are considering helping to bring a better-defined entry level. As a great spiritual teacher once said regarding a seemingly impossible situation, "There is always hope."

Unfinished Business

In my last column, I shared some information on aspartame and its potential relationship to cancer. Now there is more. It seems mixing aspartame with monosodium glutamate (MSG) causes nerve cell damage, especially in developing nervous systems. The dosage a child might get in a drink or junk food snack can interfere with nerve signaling systems and can actually stop nerve cell growth. Learn more at

The organic food system is under attack and is being co-opted by petrochemical-based agri-business. Your help is needed. This same site can fill you in if you care to know. Quality food is the necessary foundation for physical health, just as quality thought is basic for energetic health. Our access to quality organic food must be defended for the sake of our children and the eco-system of the world. Don't wait - it may soon be too late.

Try This

Stubborn sternocleidomastoid muscles can sometimes be convinced to relax by working the sternalis and the upper half of rectus abdominis. Want more? Let me know. Oh, and please send me your favorite therapy tip or trick so I can share it with others so we can all help more people. Send it to .

See you about May Day with another basket of goodies.

Click here for more information about Ralph Stephens, BS, LMT, NCBTMB.


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