(This episode of The Rub podcast was originally aired February 14, 2024)
Welcome to The Rub: a Healwell podcast about massage therapy. We say the quiet things loud, have a hunger for change and a desire to connect the dots. I'm your host, Corey Rivera, and in today's episode I'm going to tell you Healwell's views on the life-changing experience that is massage therapy.
This is going to be a quick tour of some very big ideas, like the difference between massage and massage therapy and how massage therapy is more complex than you might think. It wouldn't be a Rub episode if we didn't include something at least slightly controversial, so we'll talk a little about massage and sex at the end.
All of the topics I'm going to touch on today are quite large and deserve far more attention than they're going to get.
A Systems Perspective
I spend a lot of my time thinking about problems from a systems perspective, which is basically a 30,000 foot view. This means, while I consider the people involved, I also consider the unspoken rules we as a society operate under.
At least once a week at Healwell, someone makes a reference to the fish being the last to notice the water. The water we humans swim in are our social norms and often we've been in them so long they've become difficult to notice and it can be incredibly challenging to imagine something new without someone else pointing out a different path. I can't tell you how much I appreciate your willingness to explore this less-traveled road with me.
Massage vs. Massage Therapy
The general definition of massage, according to Miriam Webster, is “to rub and knead a person or part of the body with the hands.”
Massage is something everyone can do.
It doesn't take training to put your hands on someone's shoulders and make like they're a nice lump of artesian bread dough. Oddly, it's the familiarity of that experience that makes it hard to explain the differences between massage and massage therapy. If that wasn't a big enough hurdle, massage therapy means different things to different people. Most people define massage therapy by the last experience they had with it, and that includes the layman bread dough stuff.
Why People Seek Massage Therapy
But let me tell you some reasons people see a massage therapist.
First, the lighter reasons:
Because they're on a cruise
Because it's their bachelorette party
Because they traveled by train, plane or automobile
Because their chiropractor recommended it
Because their wife bought them a gift card
Because they want to do athletic stuff harder, better, faster, stronger
Then there are stress-related reasons:
Because they can't sleep
Because the holidays are coming up
Because the holidays are here
Because the holidays just passed
Because massage therapy keeps them going
Because massage therapy slows them down
Because they're pregnant
Because they just had a baby
Because they have a baby and they haven't slept in days
Because they need a time away from their children
Because they're a caregiver
Then there are some serious health reasons:
Because they've been in a car accident
Because they have burn scars
Because they have surgical scars
Because they had surgery
Because they have cancer
Because they had cancer
Because the lymphatic system is overwhelmed
Because they've been hospitalized
Because they're on dialysis
Because they get migraines
Because they have a lot of pain and don't want to use opioids
Because they clench their teeth
And then there are the deeply personal reasons:
Because they're depressed
Because they're lonely
Because someone close to them died
Because they feel disconnected from their body
Because they've experienced trauma
Because nobody else in their lives touches them
Because their massage therapist listens to them and their doctor doesn't
Because they feel safe with their massage therapist
Because they've tried everything else and it didn't help
What do all these things have in common? The person experiencing them didn't go to their friend or family for a shoulder rubbin'. They went to a professional, someone they thought they could trust with their bodies and their feelings, someone who has the training and experience to take care of them in a way that they can't take care of themselves.
The Academic Definition
Massage therapy isn't just rubbing. If you want to get super academic, which I always do, there's a definition we use in research from a paper by Dr Ann Blair Kennedy1.
Bear with me, it has three semicolons and several commas.
"Massage therapy consists of the application of massage and non-hands-on components, including health promotion and educational messages for self-care and health maintenance; therapy, as well as outcomes can be influenced by therapeutic relationships and communication; the therapist education, skill level and experience; and the therapeutic setting.
As far as academic definitions go, this one's pretty concise, but let's break it down a little bit.
Massage therapy is hands-on, but it also involves talking and feelings.
Massage therapy can be for self-care or for health, both of which are very broad categories which you know from your long experience being a human.
Massage therapy is more or less effective depending on a lot of factors, including the therapist's education and skill and where the massage is taking place.
Its effectiveness also depends on the relationship between the massage therapist and their client.
Beyond the Physical
For a long time our medical philosophies have concentrated on the physical. We treat wounds and cure diseases. We create medications and surgical procedures to help fix people.
But in all that flurry to cure and fix, we lost sight of the care part of healthcare. We separated people into pieces, a philosophy known as reductionism. This attitude is part of the western dominant medical model called European biomedicine.
There are ideas that address people as a whole, particularly in palliative care. Massage therapy at its best intrinsically does this.
A Complex Biopsychosocial Intervention
Massage therapy is what's known as a complex biopsychosocial intervention. (Try saying that three times fast.) It addresses the realms of the physical- or, biological, the mental- or, psychological and the interpersonal- or, social. Add them together and you get biopsychosocial.
If that sounds heavy, don't worry, it is.
Addressing a whole person is a lot more complicated than treating pieces, and there's a vast ocean between saying you want to take care of a whole person and actually pulling it off.
The Challenges of Being a Massage Therapist
When people marvel at the difficulty of being a massage therapist, they often ask if our hands hurt, because that's what makes them stop rubbing someone's shoulders, and the answer is yeah… sometimes. We learn how to use our bodies to help take the strain off our hands. We find tools and techniques that might suit our style, but really there's only so much you can do with a neck that doesn't require the specificity of fingers, and if everybody you see in one day has a neck thing going on, well, that's the way the cookie crumbles.
But remember, massage therapy is a complex biopsychosocial intervention. The psycho and social parts are of equal importance and the training for those is much more nebulous than learning how to palpate a bicep muscle. The physical parts of people are constant like a box of crayons, but people's internal lives are a complicated rainbow that's constantly shifting.
So massage therapists need training and listening and responding. We need to understand how to emotionally regulate ourselves, because part of massage therapy is helping your client with their own emotional regulation. We need to know how to work with a person who is directly in front of us, who in all honesty might push some of our buttons. We need compassion and empathy, but having compassion is not a skill. The skill is knowing how to respond when a client suddenly tells you about a traumatic experience, and that requires training and practice.
A Divided Profession
You should know that massage therapy as a profession is incredibly divided. We've already talked on this podcast about the disagreement over how many hours an entry-level education program should be.
We could also, and will eventually talk about:
How the profession struggles with how massage therapy should be studied
How dangerous or safe it truly is
Our scope of practice
What effects massage has on parts of the body and mind
Who should be performing massage
Who should be getting massage
How much massage therapists should get paid
Why people decide to be massage therapists
The best hands-on techniques
Our place in healthcare
The best ways to teach massage
We don't agree on anything, and none of that addresses the institutions that make decisions for the profession or what motivations they might have for the ideas they promote.
Those institutions include, but are not limited to the seven national organizations, the massage franchises, physical therapists and chiropractors, the National Institute of Health, academia in general, and all the beliefs about medicine and health we get from European biomedicine, like the belief that massage therapy is nice to have or a luxury. This is actually really indicative of a bunch of social attitudes in America. It brushes up against our ideas about poverty and poor people, about suffering and what it means to be sick, about service work, about capitalism, and about pleasure.
Addressing the Elephant in the Room: Massage and Sex
And speaking of, when this podcast was released, apple's Podcast's algorithm immediately started recommending a podcast that is in the Not-Safe-for-Work category. This frustrated me mostly because we chose to be in the health and fitness category and the algorithm completely ignored that.
But you know what? We get that all the time and it's a problem, but probably not in the way you think.
So I want to take a few moments to talk about that Not-Safe-for-Work thing. Before we get all serious. Here are a few of my favorite euphemisms: knocking boots, rolling in the hay, Netflix and chill, hanky-panky, shagging, amorous congress, and the mattress mambo.
Okay, ready? This is a problem, but I don't believe it's a moral problem, which is how it's usually framed. (I am aware that this topic is a tangled web of emotion and panic.)
Today, I want to talk a tiny amount about why our social system puts massage and sex in the same boat, and I'd like to be crystal clear that I am talking about consenting adults who chose their profession the same way you chose yours. This is not a discussion about trafficking or non-consensual activities of any kind.
The relationship between massage and sex is a social issue because, as the descendants of Puritans, we have very rigid ideas about sex and touch and anything else remotely related to those things. Our society has ideas about jobs involving touch being bad and dirty and low.
This shows up in European biomedicine in a big way, where a defining part of the medical hierarchy is how little you touch your patients. Think about it. Doctors touch patients less than nurses, who touch patients less than certified nursing assistants. But touch is literally vital for human survival. Remember when I said that some people see massage therapists because nobody else in their lives touches them? This is a very real problem, known as touch deprivation, touch starvation, or the very vivid "skin hunger. Just hearing me say those words out loud probably made you a little upset.
The idea of paying for touch is even more complicated than the need for it. We have a lot of ideas about paying people for tasks considered to be domestic or care-based, and the loudest idea is that we shouldn't pay people at all.
The massage versus sex conversation has more twists than a Sherlock Holmes story and it's just as foggy. But one thing is very clear: framing it as a moral problem is exactly what the current system wants. Moral panics prevent nearly all conversation from even starting, so the system in place will stay exactly as it is. It is the perfect defense mechanism.
Here at Healwell, we prefer to face difficult conversations head-on. As Executive Director Cal Cates would say, "discomfort means you're headed in the right direction. Just stay with it.”
If you take nothing else away from this episode, please take this: Sex workers are not the enemy of massage therapists. Sex work is work, and the people who do that work deserve the same protections as everyone else. They deserve safe work environments, they deserve not to be harassed, they deserve agency and choice, and the topic of massage and sex deserves careful, calm, thoughtful and thorough consideration.
Conclusion
I'm going to end this episode the way I began it, with a tasty food metaphor.
This episode is like the flaky outside layer of a giant onion. We're going to give this onion all the respect it deserves, but that vegetable is going to get peeled. There may be irritation and there may be tears. I might slice it too fine or too thick, and there's a good chance my cutting board is too small, but we'll make it to the core together and then we'll plant it and grow new onions.
And now I'm getting carried away, so I'll stop there. If any topic in this episode jumped out at you is something you want to know more about, please send us an message.
There's a lot to cover, and knowing what you're interested in will help focus my magpie tendencies. If these are topics you want to talk about with other people, you should join us in the Healwell Online community. We're excited to meet you and thank you for listening.
Kennedy, LMT, BCTMB, DrPH, A. B., Cambron, LMT, DC, MPH, PhD, J. A., Sharpe, PhD, MPH, LMBT, P. A., Travillian, PhD, NA-C, LMP, R. S., & Saunders, PhD, R. P. (2016). Clarifying Definitions for the Massage Therapy Profession: the Results of the Best Practices Symposium†. International Journal of Therapeutic Massage and Bodywork, 9(3), 15–26. https://doi.org/10.3822/ijtmb.v9i3.312
Share this post