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Editor's Note: Some letters have been edited for space and clarity.

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The Breast Massage Controversy Continues

Dear Massage Today:

I have been a New York state licensed massage therapist for nearly 5 years. This is the first time I have felt compelled to respond to something I have read regarding our profession. I read Mr. Korn's July editorial (www.massagetoday.com/archives/2003/07/10.html), together with his responses to questions he received regarding that editorial in the August issue (We Get Letters and E-Mail, www.massagetoday.com/archives/2003/08/17.html). I am appalled by his comments that "female massage therapists regularly get massage from therapists specifically trained in breast massage to enhance their breast health."

First of all, I receive regular massages from colleagues, and NEVER have I received a breast massage from them. Second, please show me some statistics that indicate breast massage "enhances breast health." (This sounds very much like a male chauvinistic statement.) Third, since when is breast tissue considered "muscle" and therefore subject to massage? Naturally, there is underlying muscle tissue and I have, in fact, utilized massage in this area for female clients following mastectomy. But, the breast tissue itself is NOT muscle. And lastly, NYS law prohibits breast massage - period. I have never performed massage on breast tissue and would not even suggest it to anyone - even with a "specific informed consent." I don't want to lose my license.

I might agree, slightly, if Mr. Korn were suggesting that female massage therapists, who do regular self-breast examination, have heightened palpation skills and notice irregularities more readily than the lay person, but even this statement is suspect, as any woman who practices regular self-examination knows when there is an irregularity in her own breast tissue.

Your Mr. Korn is full of bad advice and bad knowledge. I think his advice is dangerous, and I hope he doesn't practice massage in NYS.

Jody Learned, LMT
New York

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Cliff Korn responds:

This writer's concerns are exactly the type of undereducated thought processes that stimulated me to suggest that people need to avail themselves of skilled touch in the first place. I will respond point-by-point:

First, I fully believe (and am not at all surprised) that this individual has never received breast massage from her colleagues.

Second, statistics abound on the benefits of breast massage. It has been given attention in Massage Magazine, the Massage Therapy Journal, and taught at the AMTA's Annual Convention. ABMP's 2003 Touch Resource Guide lists breast massage in its "Techniques" section and defines it as: "Specific kneading, rubbing and/or squeezing strokes applied to the soft tissue of the breast to increase lymph and blood flow. As poor circulation to this area can produce uncomfortable symptoms, and breast scarring caused by surgery and/or trauma can cause painful syndromes and obstruct blood and lymph flow, breast wellness becomes increasingly important." Breast massage is part of the lymph drainage technique taught by Dr. Bruno Chikly; it is also the sole topic of Canadian registered massage therapist Debra Curties' seminal work, Breast Massage. Where has this writer been in her brief massage career?

Third, since when is massage only indicated for muscle tissue? Has this writer not heard of connective tissue, the lymphatic or circulatory systems, etc.? Where is it written that only skeletal muscle tissue is subject to, or benefits from, massage?

This writer proves a point I have always believed: A quality massage education is not tied to hours. New York has a 1,000-hour licensing requirement, and I daresay that most massage therapists with far fewer hours of schooling are well versed in this writer's shortcomings.

Lastly, the writer should go back and reread her NYS regulations where she'll find the following statement: "When massage of breast tissue is therapeutically indicated, the female patient/client must be fully informed and give consent before the therapist undrapes the breast for treatment (www.op.nysed.gov/mtguide.htm)." 

So, I don't think that I am "full of bad advice and bad knowledge," and I stand by my initial recommendations.

Cliff Korn, LMT
Editor, Massage Today

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"Have you had problems with the NCBTMB?"

Dear Massage Today Readers:

We are seeking the pros and cons of those who certify through the NCBTMB. Our experience has shown us no difference in competency or quality between those who do and do not certify; moreover, we have found NCBTMB's testing process to be untimely and not cost-efficient. We are compiling a record of problematic experiences candidates have had, and would appreciate any experiences candidates would like to share. Our hope is to one day have an examination process that will indeed credential a therapist of higher competency, whether it be through improving NCE or creating another [test]. We look forward to your feedback.

Selena Belisle, President
Massage Works, Inc.
335 Washington Street
Braintree, Ma 02184
Phone: (781) 356-7654
E-mail: contact@massageworks.com
www.massageworks.com

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The following letters were not published in the print version of Massage Today.

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In Support of Breast Massage

Dear Editor:

I am not a massage therapist, but I am married to one. I just read the letters to editor in the August issue (www.massagetoday.com/archives/2003/08/17.html), and I felt that I had to respond.

The breast is made up of tissue, nerves, lymph glands and the other good things that make up the rest of the body. For years I have suffered from breast congestion -- that is, tender breasts caused by lymph blockage. The breast is part of the body. Men have them too and they get theirs massaged! Women's are just a bit larger. We are told to check our breasts every month for changes; however, the breast changes day to day.

We can massage our own breasts, but the leverage acheived by someone standing over is much better. When my breasts are tender, a good breast massage relieves any lymph blockage and takes the tenderness away. As long as the touching of breasts is limited to sexual connotation, a woman will never get a good body massage. A breast is an extension of the female body -- nothing more. The mind needs to be open and trained to think of it in that matter. When a massage therapist gives a massage, he or she should maintain a professional state of mind and should be able to touch any part of a woman's body.

If we trust our doctors to touch our breasts and be professional, then a professional massage therapist should also be allowed to touch breasts in a therapeutic setting. Massage is for the wellness of the body, and the breasts are part of the body!

Kathie Haber
Petersburg, Tennessee

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A Difference of Opinion

Dear Editor:

Cim Roesener of Kansas should relax (We Get Letters and E-mail Online, www.massagetoday.com/archives/2003/09/12.html).

Roesener wrote about the "mistake" that "excessive limitations on massage therapy's scope-of-practice [was] being imposed by the state legislature," charging that SB 225 passed in Kansas with ineffectual monitoring and opposition from massage therapy associations.

I'm guessing Roesener has misread the bill and is unaware of the legal context for massage in Kansas that prevailed before the bill was even written, and continues today. The purpose of SB 225 as far as massage therapy is concerned was to liberalize the law, not make it more strict. The bill merely takes the words of the existing Kansas exemption, now in the healing arts licensing law (§65-2872), and applies it to physical therapy. Here is the exemption language in Kansas' healing arts legislation, which matches the quote Roesener lifted from SB 225:

"(f) Persons who massage for the purpose of relaxation, muscle conditioning, or figure improvement, provided no drugs are used and such persons do not hold themselves out to be physicians or healers."

There's nothing new in it, regardless of how limited one might think the imputed scope of practice is. Instead of wondering about professional associations not lobbying against this exemption, massage therapists should actually see this as a small step forward.

For quite a long time, Kansas has been the original "freedom-of-access" state, at least as far as exempting massage therapy goes. Still, SB 225 reminds us that freedom-of-access laws as passed in Minnesota and California are not doing enough of a favor for massage therapy if they only provide exemption from one or two laws that require physicians to be licensed.

Massage therapy needs to be exempted from physical therapy; chiropractic; naturopathic; acupuncture; and even cosmetology laws. None of that will handle the problem of exemption from local county and city parlor laws, however. So in the end, perhaps Roesener and I do think favorably about state licensure. Most massage therapists see it is the cleanest means of providing freedom of access to a broad scope of massage therapy, for both levels of government.

John Fred Spack
Columbus, Ohio

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"A 'regulated profession' is the basis for the public's assurance of quality-of-practice"

Dear Editor:

I am a Registered Massage Therapist licensed in British Columbia and Ontario, Canada, and am American. I read with concern the clause in the new Arizona legislation that refers to sexual impropriety (July issue, www.massagetoday.com/archives/2003/07/01.html), which [prohibits] massage therapists [from committing such acts], then continues on to detail inappropriate sexual behavior. I understand both sides of the concern.

On the one hand, it should not need mentioning because of the ethics [massage therapists] uphold; on the other hand, there is a need to let the public know they are protected and when the line has been crossed. However, there is a sneaky insinuation in the law that massage therapists are really NOT safe or at least not to be fully trusted. In Canada, we went through this, too.

When I entered the profession in 1983, I would get a telephone call every couple of weeks asking, "how the girls are." After all my training and the difficulties of starting up a new practice, it made me disgusted and frustrated. It is different now, twenty years later. We have a College of Massage Therapists (board of massage therapy) in British Columbia and Ontario legislated by the government, whose mandate is to protect the public. The very fact we are a "regulated profession" is the basis for the public's assurance of quality-of-practice and legal recourse for malpractice of any kind. The bylaws mention "sexual abuse" by name, along with a list of other potential legal and ethical violations. In other words, this is just one of many ways in which the public is protected.

Such wording and legislation exists in other regulated professions as well. In BC, there is no "dirty laundry list" of illegal sexual acts needed to define sexual abuse. There is zero tolerance for sexual abuse; however, there is a way of phrasing the law that is sufficient to protect the public without being an embarrassment to the profession. And, bottom line: it works.

A regulated college or board is a necessary growing stage in any health profession. Self-regulation that is monitored by the government (not to be self-serving) can be a benefit to both the profession and the public. Being American, I understand the distaste for "over-regulation." On the whole, I would say that there can be balance between freedom and discipline, as there always must be.

May you find your balance unique to your American situation.

David Dressler, BA, RMT
Canada