Massage therapists need to know much more than how to relieve stress or loosen a tight shoulder. Therapists need to understand how the body functions, and how each of the body's systems affect the rest of the body. In addition, massage therapists need to know how to note what takes place during a massage session in order to chart progress, list modalities used, and remember preferences specific to each client.
This training requires hundreds of hours of study time, both in the classroom and in homework. In fact, states that regulate massage require transcripts showing a minimum number of hours of formal education. The average number of hours required is about 500, with 2 states requiring 1,000 hours of formal education. Most states also mandate a minimum number of hours of education in a particular topic, such as 200 hours in anatomy and physiology, 75 hours in business or 30 hours of ethics training.
Massage school teaches more than just massage. Students can expect to learn such basic steps as how to set up a massage table, how to assess a client, how to take notes on a massage session, and often how to run a small business. Students receive detailed training in anatomy, physiology, kinesiology and pathology. These skills are key in a massage therapist being able to effectively treat a client.
Students typically start learning massage techniques starting with Swedish massage. The long, flowing strokes are similar to what we experienced as children when our parents gave us back rubs, and the therapeutic benefits are quick to come. From here, students learn modalities such as deep tissue massage, trigger point and chair massage. Students can learn prenatal massage, sports massage and stretching. Each of these modalities is useful in a particular situation. Each therapist needs to learn when a modality is or is not appropriate, such as whether deep tissue work is appropriate for a pregnant client. (It's not.) This training forms the basis for a massage therapist's education and practice.
Before a student can effectively work on a client, she needs to know the parts of the body and how everything fits together. This education goes beyond upper and lower arm. The student needs to know the location and action of every muscle and bone in the human body. This amount of detail is necessary for a massage therapist to be able to isolate a muscular problem and treat it effectively, without wasting the client's or therapist's time.
The therapist needs to understand how all the body parts work together. This is physiology, or the study of the functioning of organisms. How does the body convert food into energy, and how is that energy used by muscles? Massage therapists should have an understanding of how all of this functions.
For massage therapists, it is just as important to know how the body works as it is knowing how to massage. It's not uncommon for a client to complain of pain when a particular action is performed, such as swinging a golf club or walking up stairs. A massage therapist needs to be able to effectively identify what bones and muscles are involved in a particular movement in order to effectively massage the problem. Kinesiology is the study of the function of the mechanics of the human body. It's how we move, and what causes each and every movement. Massage students get a complete education in kinesiology in preparation for their career as a therapist.
Because a massage therapist works directly with the client's skin and body, the massage therapist must be able to recognize a wide range of conditions, ranging from fractures to skin conditions to illnesses. The therapist must know whether massage is appropriate for a given condition, what modalities should be avoided, and whether the client should go home or see a doctor.
One of the requirements of a massage therapist is keeping treatment notes on every client for every session. Students learn to use a standardized format for notes called SOAP notes. SOAP is an acronym meaning Subjective, Objective, Assessment and Plan. Subjective means anything a client tells the therapist, such as, "My shoulder hurts when I raise my arm above my head." After that is the Objective, or anything a therapist observes. Take our client who can't raise his arm above his head. A therapist might ask the client to raise his arm as high as he can without pain, then as high as he can with pain. The therapist would note how high the client can raise his arm. She might also note any postural deviations, limping or other concerns. Assessment is when the therapist puts the subjective and objective notes together to determine what is going on and how best to treat it. Finally, there is the Plan. This is where the therapist notes what is next for the client, whether it is steps to be taken by the client on a daily basis, or what needs to be done during the next massage session.
Most massage therapists work independently, or at least make part of their work independent from the spa or doctor's office. This could be anything from working out of the home to having a clinic space or massage room, or even doing "outcall" work in a client's home or hotel room. Massage therapists need to understand the basics of running a business, including marketing, accounting, purchasing and management.
Massage therapists can find themselves in uncomfortable situations when dealing with clients. There is a myth that massage therapists are sex workers, or there is an expectation of sexual services. Ethics help create the barrier between the myth of sex and the reality of therapy. Codes of ethics dictate what behavior is or is not expected or permitted by a therapist, including how to speak to a client, how to deal with illegal or immoral requests and how to behave when dealing with the public. Typically these rules are based on general laws of the land, but can also contain ideals of behavior to justify the public trust and protect the therapist and client.