Massage Today
Massage Today dotted line
dotted line

dotted line
Share |
  Forward PDF Version  
Massage Today
July, 2014, Vol. 14, Issue 07

Forced Work Reduction for Massage Therapists

By Massage Therapy Foundation Contributor

Contributed by Derek R. Austin, MS, CMT, BCTMB, CSCS, MK Brennan, MS, RN, LMBT, and April Neufeld, BS, LMP

This month's Massage Therapy Foundation research column looks at the factors that lead to the reduction of work hours for massage therapists and bodyworkers due to injury, referred to as injury-forced work reduction (IFWR).

Massage therapy and bodywork are considered to be very physically demanding professions. The authors cite that 80% of people who begin careers as massage therapists and bodywork practitioners drop out after two years. Previous research has shown a high risk for musculoskeletal disorders among massage therapists, including carpal tunnel syndrome and low back pain. There has been little research to date, however, on what demographics, work attitudes or perceptions make a massage practitioner more likely to become injured. This new research from the team at Temple University hopes to illuminate some of these issues.


The article, "Correlates of Injury-forced Work Reduction for Massage Therapists and Bodywork Practitioners," was published in the International Journal of Therapeutic Massage and Bodywork (IJTMB) in 2013. (Free full text is available from IJTMB.) The authors define injury-forced work reduction as a "work-related injury adversely affecting the hours worked or number of clients treated." The authors tested two hypotheses. Their first hypothesis (H1) was that accumulated costs – the amount of time, personal effort, education, money and training that a practitioner has invested in their occupation – would be associated with injury-forced work reduction. The authors further hypothesized (H2) that physical exhaustion – including body fatigue, low energy, tiredness and work exhaustion, mental frustration, feeling overwhelmed and being emotionally strained – would both be associated with injury-forced work reduction.

massage therapist - Copyright – Stock Photo / Register Mark An online survey was conducted in the fall of 2006 by the Federation of State Massage Therapy Board (FSMTB) about Career Patterns (CP) along with their Job Task Analysis (JTA). The JTA required approximately 45 minutes to complete followed by 15 minutes for the CP survey. There were 2,089 massage therapists and bodyworkers who completed the CP survey, making up approximately 3% of the 75,000 practitioners contacted across the United States. The survey was made up of questions organized into five groups: 1) Control/demographic variable set; 2) Work attitude/perception variables set; 3) Accumulated cost variables set; 4) Exhaustion variables set; and 5) Injury-forced Work Reduction (IFWR). IFWR was measured by two questions: "I can no longer work the hours I previously worked due to occupational injury," and "I can no longer treat as many clients per day due to work injury (e.g., carpal tunnel syndrome, lower back pain)." Most items were measured using a Likert scale, where 1 = strongly disagree, 2 = disagree, 3 = slightly disagree, 4 = slightly agree, 5 = agree, and 6 = strongly agree.


Overall, the researchers found "high levels of job satisfaction (5.47/6) and affective occupation commitment (5.44/6); low levels of accumulated costs (2.76/6), continuing education costs (2.77/6), and physical exhaustion (2.46/6); and very low levels of work exhaustion (1.75/6) and IFWR (1.84/6)." Affective occupation commitment was measured with questions such as, "I strongly identify with the massage/bodywork/somatic therapy occupation." Continuing education costs were measured with questions such as, "It costs too much for me to take required continuing education." In general, massage therapists and bodyworkers, or at least those who responded to the survey, are satisfied with their jobs and identify with their occupations. They also have generally low levels of costs invested, costs associated with continuing education, mental and physical exhaustion and injury.

The authors used a stepwise regression model to evaluate their hypotheses. In other words, they added each variable set to the model one at a time in order to control for demographic and other variables. Among the control/demographics variables set, being female and having more years in practice were significantly associated with IFWR. None of the individual work attitude/perception variables were significant. Having more continuing education costs but not accumulated costs was significantly associated with IFWR, partially supporting the authors' first hypothesis (H1). Physical exhaustion and work exhaustion were both significantly associated with IFWR, supporting the authors' second hypothesis. Overall, 34% of the variance in IFWR was explained by all of the variables that were studied, and physical exhaustion was the single greatest contributor to IFWR.

The authors note that their finding of physical exhaustion relating to IFWR had the strongest support and was consistent with other research on the physically demanding nature of massage therapy and its occupational risks. Work exhaustion had a significant independent positive association with IFWR. Thus, both physical wear and tear and the mental fatigue of work exhaustion appear to increase injury risk for massage therapists and bodyworkers. The authors speculate that such mental fatigue may be related to particular work factors, including isolated work settings, physical concerns and possibly public misconceptions about the nature of massage therapy or bodywork. The authors conclude that taking breaks between patient appointments and varying the techniques used could improve a massage therapist's physical and mental energy and thereby limit these risk factors.

The authors compared this research to their previous research on massage therapists and bodyworkers. They write, "None of the four work attitude and perception variables that each significantly impacted being forced to stay in occupation (i.e., job satisfaction, affective occupation commitment, occupation identification or limited occupation alternatives) had a significant impact on IFWR in this study." IFWR appears to be a separate variable that is highly influenced by certain types of accumulated costs (specifically, the perception of high continuing education costs), physical and work exhaustion, being female and working for more years.

There are several important limitations to this research study. Chief among them is that correlation cannot be separated from causation because this research is a cross-sectional study. In other words, it is possible that higher IFWR causes higher physical exhaustion, and not the other way around. The authors also did not identify specific injuries among the massage therapists and bodywork practitioners surveyed. Finally, the respondents were self-selected, and participants could possibly have different characteristics than the overall population of massage therapists. For example, a massage therapist who has reduced his or her work hours due to carpal tunnel syndrome may not volunteer to complete a one-hour online survey.

For massage therapists and bodyworkers, it is worth further investigation as to the short career span for practitioners and what preventative measures can be taken. Addressing IFWR and any of the contributors to it would be beneficial, especially as the authors also cite an expected growth in massage therapy and bodywork by 20% between 2010 and 2020.

Not sure what to make of a regression analysis, correlation, confidence interval, p-value or t-test? The MTF offers an easy-to-use online course, where you will learn basic research vocabulary and concepts, how to use various databases to look up research, evaluate published research articles for their validity and apply research findings to massage practice to improve outcomes. Basics of Research Literacy is an online, 8-hour, NCBTMB-approved workshop that teaches massage therapists and educators how to incorporate the principles of research literacy into your practice and teaching.

To learn more about the effects of massage therapy, you can review the Massage Therapy Foundation article archives, read accepted MTF Research Grant abstracts, or search PubMed for massage therapy studies.


  1. Blau, PhD, G., Monos, PhD, C., Boyer, PhD, E., Davis, JD, K., Flanagan, PhD, R., Lopez, PhD, A., & Tatum, PhD, D. (2013). Correlates of Injury-forced Work Reduction for Massage Therapists and Bodywork Practitioners. International Journal Of Therapeutic Massage & Bodywork: Research, Education, & Practice, 6(3), 6-13. doi:10.3822/ijtmb.v6i3.199.

Click here for more information about Massage Therapy Foundation Contributor.


Join the conversation
Comments are encouraged, but you must follow our User Agreement
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.
comments powered by Disqus
dotted line