Massage Therapy's Mainstream Moment
Research, Reality, and Professional Gaps
The landscape of American healthcare is quietly shifting, and massage therapy sits at the center of this transformation. Massage therapy is, in fact, the tip of the whole health spear, as Tracy Gaudet, whole health pioneer and generally wise and generous human, recently suggested during her keynote presentation at the International Massage Therapy Research Conference this past May.
In May of 2024, a couple of scholars from Baylor University (not massage therapists) published a paper called “Prevalence and determinants of massage therapy use in the U.S.: Findings from the 2022 National Health Interview Survey.” The authors unpack the data from the 2022 National Health Interview Survey (NHIS) to suggest that it reveals who's using massage therapy, and they also challenge us to reconsider where massage therapy fits within our healthcare ecosystem.
Let's address the elephant in the room: this groundbreaking analysis of massage therapy usage data comes to us courtesy of researchers from religious studies, medical humanities, psychiatry, and behavioral health. While it's always nice to have allies championing our cause, one has to wonder—where are the massage therapists in massage therapy research and in this conversation about where we belong? This paper has merits and it’s also a little bit like another table at the years-long picnic where everybody else is eating massage therapy’s jurisdictional lunch while massage therapists fight amongst ourselves about whether or not the mustard should have seeds.
Speaking of limitations, let's talk about the survey itself. The 2022 NHIS gave respondents exactly three riveting choices when describing their massage therapy use:
Did they use a "practitioner of massage therapy" (which we know is deeply problematic to define)?
Did they seek massage for pain?
Did they seek massage for overall health?
That's it. End of story. It's like asking someone to describe their entire relationship with food using only "hungry," "not hungry," or "sometimes hungry."
The Numbers Tell a Story (And It's a Good One)
If the NHIS is accurate, more than one in ten Americans—11.1% to be exact—visited a “practitioner of massage” in the past year. 6.0% sought massage specifically for pain relief, and 8.5% used it for "restoring overall health." These aren't small numbers. We're talking about millions of Americans who said they seek out massage as part of their health maintenance routine. Of course, when there are only really two choices for why you sought out massage and they didn’t include “it was a gift,” “I was treating myself,” or other common reasons people seek massage, we have room to wonder a little bit.
The authors also open their paper with an appropriately meandering exploration of published definitions of massage and massage therapy. The definition we use at Healwell,1 which resulted from what the authors refer to as “an influential best practices symposium held in 2010” is cited in this paper and is the only one of which I am aware that mentions the physical aspect of massage therapy (the rubbing part) as a clearly important trapping of massage therapy, but then goes on to include the many other psychosocial and interpersonal aspects of this broad discipline we call massage therapy. Alas, this definition is seldom the shore from which researchers of massage therapy set sail. Most of the definitions that exist focus on the manual, soft tissue manipulation aspects of this otherwise complex psychosocially oriented discipline.
The Privilege Problem (Or: Why Most Massage Therapists’ Clientele Looks Like a Whole Foods Checkout Line)
Here's where it gets interesting: the demographic patterns reveal something profound about how massage therapy functions in American society.
The research reveals an uncomfortable truth—massage therapy use correlates strongly with socioeconomic advantage. Women and those with higher incomes are significantly more likely to seek out massage therapy. Perhaps most tellingly, people who rated their health as "excellent" (13.7%) were more likely to visit massage therapists than those rating their health as merely "good" or "very good" (11.2%) and people who rated their health as “fair/poor” were even less likely (6.8%) to seek out (or maybe have access to?) massage therapy.
The people who feel fantastic are more likely to get massage than those who feel merely okay or who are possibly really struggling to feel okay. It's like the healthcare equivalent of the rich getting richer, except with lotion and ambient music.
This pattern suggests massage therapy isn't primarily serving those with the greatest medical need. The authors make it crystal clear: the main determinants of use are NOT the presence of illness or functional disability. Instead, massage therapy appears to be functioning as a wellness service for the already healthy and financially comfortable.
Even kookier than that?-- Common reasons for seeking massage therapy found in other research include:
Referral from a medical provider
Self-referral as an adjunct to other care
General wellness
Self-actualization
Spiritual growth
That’s a seriously varied bucket list of expectations from “a practitioner of massage therapy.” To make it even more complex, a review of studies looking at mechanisms of action tell us that the basic science of massage therapy's therapeutic mechanisms is grounded in kinesiology, biomechanics, and the nervous and endocrine systems. So, yeah. That does mirror this wide array of potential expectations and avenues to entry that clients report.
There are two main problems here:
The serious equity issue that is borne out by data that show the people most likely to access these scientifically-grounded benefits are those who already feel excellent and who have money to burn.
Massage therapists simply aren’t trained to meet all of these needs.
What’s in a name?
The study makes a compelling case: we need to stop thinking of massage therapy as "alternative medicine." Thank you, academic researchers from completely different fields, for stating what massage therapists have been saying for decades!
Instead, the authors argue it should be understood as an allied health profession, similar to physical or occupational therapy. This isn't just semantic—it's a fundamental reframing of the profession's role. And, before all of the occupational and physical therapists get their hackles up, let’s remember that there’s enough air for everyone. We don’t do what they do and they don’t do what we do. In the vaunted Venn diagram there is undoubtedly some overlap, but that overlap could easily be characterized as opportunities for synergy and collaboration instead of competition if we could all just simmer down.
The authors describe massage therapists as "board-certified professionals," which sounds impressively official until you realize that board certification is voluntary for massage therapists—just like it is for doctors—and frankly, it's a pretty low bar in massage therapy. The requirements of massage therapy board certification are less than what’s required for basic licensure in some states.
The authors also note that more than 90% of massage therapists report being "trained" in eight or more modalities which we know from being “out there in the market” are often sold as stand-alone products or hybrids. Unlike doctors, who might specialize in cardiology or dermatology, massage therapists are apparently Renaissance people who've mastered everything from Swedish to hot stone to craniosacral therapy in weekend workshops. (Hats off the minority of MTs who have completed additional evidence-based, rigorous training in adjuncts to massage therapy. You know I’m not talking about you.)
Here's the uncomfortable truth: massage therapy should not and cannot be reduced to the status of a technique or modality. It's a broad discipline, just like medicine. But when practitioners market themselves as experts in nearly a dozen different approaches, it muddies the waters about what massage therapy actually is and what it can reasonably accomplish. And it most definitely muddies the waters of what any client can expect when they seek out “a practitioner of massage therapy.”
The Integration Gap (Or: When Research Meets Reality and They Don't Shake Hands)
Here's where theory meets reality, and spoiler alert—they're not besties. Despite growing recognition of massage therapy's therapeutic potential, research findings haven't been widely integrated into massage therapy delivery or clinical standards of practice. And very, very little of that research examines the massage therapist’s potential. It’s all about what happens when a person rubs another person this way or that way, in this place or in that place. There's a disconnect between what we know about massage therapy's benefits and how it's actually taught and practiced within the profession.
The other strongest predictor of massage therapy use captured in the NHIS isn't health status or medical need—it's the use of other complementary or integrative practitioners. This suggests massage therapy exists within a parallel healthcare ecosystem that doesn't always communicate with conventional medicine. It's like having one good language but everyone insists on speaking in different dialects, neither of which is well understood by the users of the other. Think traditional French versus Québécois.
And here's the kicker: usage studies don't track impact or benefit. The fact that 11.1% of Americans visited a massage therapist tells us absolutely nothing about whether those visits actually helped anyone or if they served the intended purpose that inspired the client to seek out massage therapy in the first place.
Did it “work?” Did they make and have another appointment? Did they try once and now they’re on the hunt for a “practitioner of massage therapy” who fits their custom needs? Studies of utilization trends are one very small piece of the puzzle. They’re not a Rosetta Stone.
Clinical Expectations and Personal Connection
This paper out of Baylor and the broader body of research both hint at something practitioners of massage therapy have long understood: therapeutic relationship matters. Personal characteristics of massage therapists, including their communication style and practice environment, create clinical expectations that influence session outcomes. This speaks to massage therapy's unique position as a hands-on, relationship-based intervention in an increasingly technological medical landscape, but that’s not what we’re taught to be in massage therapy school and that’s not how we’re understood broadly. We rub your muscles. You feel good. End of story.
But it’s so not the end of the story.
Moving Forward: Recognition and Integration (With a Side of Professional Reality Check)
The data suggest we're at a crossroads. Massage therapy has achieved significant mainstream adoption—but primarily among those with the resources to access it. Meaningful integration of massage therapists into healthcare will require us to address both professional preparation and accessibility.
The authors make a case for acknowledging massage therapists "as providers of a widely used and increasingly mainstream category of therapy and as worthy of acceptance by the medical orthodoxy as professional colleagues."
Again, it's refreshing to have outside voices validate what the profession has been advocating for years. Though one does wonder what might happen if massage therapists themselves had more prominent voices in academic research about their own field.
But let's be honest: massage therapy is not ready for its close-up, Mr. DeMille.
The profession has some heavy lifting to do when it comes to standardizing and fer-crying-out-loud ELEVATING education, clarifying scope of practice (with real research and by learning from/working with other more well-defined disciplines that have already done this work), and establishing more rigorous standards before it can truly stand shoulder-to-shoulder with other allied health professions. The public has put their cart before our horse, but we can change that.
The Path Ahead
As massage therapy moves from the margins to the mainstream, several questions demand attention:
How do we make massage therapy (and massage therapists) more accessible to those who might benefit most from its therapeutic effects?
How do we better integrate massage therapy research findings into clinical practice and create research that matters to this implementation?
And how do we bridge the gap between massage therapists and conventional healthcare providers to create truly integrated care?
Oh, and here's a radical thought: How about we get more massage therapists involved in research of their own profession? You don’t need a PhD, my friends. You have ideas about this stuff? Let’s get those ideas out there! (Healwell can show you how! It’s more fun than you think…and so are we.)
The 2022 NHIS data suggest Americans are ready for massage therapy to take its place alongside other allied health professions. The question is whether our healthcare system, our research institutions—and the profession itself—are ready to embrace this evolution with massage therapists as active participants rather than passive subjects.
The numbers don't lie: massage therapy is no longer alternative—it's mainstream. Now we need our healthcare policies, insurance systems, clinical standards, and yes, academic research teams, to catch up with this reality. There is work to do on all fronts.
Don’t say “That sounds hard.” Let’s get to work.
“Massage therapy consists of the application of massage and non-hands-on components, including health promotion and education messages, for self-care and health maintenance; therapy, as well as outcomes, can be influenced by: therapeutic relationships and communication; the therapist’s education, skill level, and experience; and the therapeutic setting.” (Kennedy, 2016)
🫶🏼 Let's get to work!
How dare people read this before me smh my head