In last month's editorial, I wrote about aspects of massage therapists' scope of practice, and I took pains to use the term "massage therapy" to mean manual therapy other than PT or chiropractic. This kept me from getting involved in the larger question of which disciplines should, or do, constitute the umbrella term "massage therapy," both in discussion and in regulation. This month, I am discussing just that issue and, despite the knowledge that many will disagree with my stance, will argue that many of the disciplines now clambering to exempt themselves from massage regulation are unjustified in doing so.

I say this not because I think that the many disciplines are in actuality "massage," but because they do fall under the umbrella term of massage therapy in the context of regulation and/or licensing. Many who say they "don't do massage" are defining massage as palliative rubbing and rightly insist they do something more and/or different. To me, the problem is the term itself. It brings baggage and misunderstanding. As proud as I am to be a massage therapist, I think that if the laws licensed those of us who use structured touch to enhance the health and well-being of our clients as manual and energetic therapists instead of "massage therapists," I doubt we'd have the angst, breast-beating, gnashing of teeth and similar signs of irritation as to whether or not we fell under a state massage licensing law. (Or at least the volume would be less.) I believe that it's not the exemption policies which need legislative correction, but rather the umbrella term that regulates a broad, effective, but poorly defined profession.

Exempting some, but not all, hands-on practitioners is a disservice to the public. In many cases, the public goes to receive care from a wide diversity of manual therapists interchangeably. They will see a Shiatsu practitioner, Rolfer or Neuromuscular therapist for exactly the same reasons they see massage therapists. Excluding just those who choose not to call themselves massage therapists from massage regulation removes oversight and the ability of administrative adjudication of public complaint. The cost to states, counties, cities and towns would likely increase exponentially if they had only police law enforcement and the court system to deal with suspected personal violations and complaints. Complaint handling by state massage board hearings has long been an able and cost-effective way to serve the public good.

My own state of New Hampshire recently had a senator introduce a bill to exclude Rolfers, Trager practitioners, Reflexologists, Shiatsu practitioners, Polarity therapists and Reiki practitioners from the state massage regulations. The senator left word on my answering machine that the bill was introduced at the request of a constituent, a Reiki practitioner, who didn't want to comply with the requirements to get licensed as a massage therapist, and further said that the bill was designed to exclude all those not doing hands-on work on the body. While I agree with and encourage regulation that excludes those who have neither the intent nor actual practice of hands-on work, the current wording of many of our state massage regulations does not accomplish this goal. Even though Polarity therapy and Reiki have been administratively excluded from New Hampshire's massage law for years, I would argue that all of the six practices mentioned in the senate bill are hands-on, and those other than Polarity and Reiki meet the practice act definition of massage in New Hampshire. In its licensing law, New Hampshire defines "massage" in part as "the application of a system of structured touch which includes holding, pressure, positioning, or causing movement, by manual means, for the purpose of promoting, maintaining, and restoring the health and well-being of the client," and "massage therapist" as "a licensed individual who performs massage for compensation," and that "a massage therapist uses visual, kinesthetic, and palpatory skills to assess the body."

I submit that Rolfing, Trager, Shiatsu and Reflexology are all the application of a system of structured touch; all include holding, pressure and positioning, and/or cause movement by manual means; and all are used for the purpose of promoting, maintaining and restoring the health and well-being of the client. Practitioners of Rolfing, Trager, Reflexology and Shiatsu also use visual, kinesthetic and palpatory skills to assess the body.

So, if my hypothetical proposal to call ourselves manual and energetic therapists comes to fruition, a better professional definition might look like this: the mobilization of soft tissue (e.g. muscle, fascia and body fluids etc.) or energy flow to restore normal systemic and biomechanical/functional use. It can be used to assist in the treatment of most musculoskeletal and associated problems and contributes toward improved circulatory, lymphatic, energetic and neurological functioning. It can be stimulating or soothing depending on the technique, depth and speed used, and is both safe and effective when carried out by a trained therapist who, with the cooperation of the client/patient, helps to create balance and harmony from within.

I hope some of the last several states to come online with state licensing laws are brave enough to incorporate some of these precepts in their thinking. The public will be better served. The state that is now large on the radar screen is California. Last month, a front-page article in Massage Today promoted compromise and a moving forward with California legislation. Back in the April 2003 issue of Massage Today I wrote: "California, the most populous state, arguably has the most massage therapists per capita of any of the 50 states. The raw numbers alone make California's actions watershed events. This time is particularly unique in that California is in a place like none other to be a leader and example to other states in appropriate levels of regulatory oversight. Those on the extreme edges of both arguments see the regulation issue in black and white terms only. If one listens to these individuals it seems more likely that California will be a laughingstock than a leader. California is no different than any other governmental entity in that the determination of issues come in many shades of gray, and the sooner those carrying the banner of either 'edge' compromise or get shunted to the parking lot, the better the massage situation will be for both practitioners and the public."

Unfortunately, it appears that in the three years since I wrote that, little action has taken place to enable a workable solution. The hard-line "edge" players have been successful to date in keeping California from looking or acting like a leader. The whole profession, however we define it or whoever falls under its umbrella, is still watching with anticipation. Maybe we should just call it something other than massage.

Thanks for listening.

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