What Massage Therapy Schools May Not Be Teaching (But Should)

We surveyed massage therapists on LinkedIn and Facebook to see if they could help us with this question: What was missing in your massage therapy education? What are massage therapy schools not teaching, but really should be?

Clearly this question and individual responses all depend on the massage therapy school. Many schools may cover the topics on this list. We recognize that every profession has its learning curve once you leave the classroom. There are some things you just have to learn on the job or on your own, or through continuing education. However, it's noteworthy that in our informal survey many participants mentioned the same gaps in their formal massage education.

So here they are: the things massage therapists wish they had learned back at massage therapy school, and what they think should be included in the curriculum to help new students entering the field.

1. How to File Insurance

Filing and billing insurance ranked high on the list of MTs we surveyed. Massage has not typically been covered by most health insurance policies. But the Affordable Care Act (ACA) or Obamacare may be changing that. Right now, it's not exactly clear how the ACA will affect massage. No one knows for sure at this point, but the ACA does have a section that appears to make provisions so that massage may be covered by health insurance plans in every state. This is a complicated issue that is changing rapidly and one best left to the experts, which may be one of the reasons it isn't a big part of the massage school curriculum.

You can learn more from experts on your own. Julie Onofrio and Vivian Mahoney have resources to help you get started billing insurance for your clients.

2. Research Literacy

Basic research literacy is an important skill for massage therapists, but it's one that isn't always covered in massage therapy schools. In order to build evidence-based practices, massage therapists and bodyworkers must be able to access, evaluate and use research results in real life. The Massage Therapy Foundation offers a Basics of Research Literacy course to help MTs build this foundation.

3. Business and Entrepreneurship

The MTs in our survey repeatedly mentioned business skills and entrepreneurship as lacking in their formal education. One of the text books that many schools carry is Cherie Sohnen-Moe's Business Mastery. If your school did not require this reading, you should purchase a copy. The book has detailed sections for creating a five year business plan and more.

"More on the business side. The school where I work does start out with ethics and business for the early part of the program, but I really would like to see more, later in the program, about marketing, setting up your own practice, continuing education and how that can be a benefit to your practice, things of that nature." -- Roseann Magda, LMT, ATP, a massage therapist and educator at Angel Therapy Practitioner

"..my curriculum spent lots of time on starting up your own LLC but little time on what to look out for as an employee: How to recognize if your employer is misclassifying you as an independent contractor and why it matters. Can your boss make you work for free (e.g. unpaid "promotional massages", cleaning or administrative work while off the clock, etc.)? Can your boss withhold charges to your paycheck to cover the use of supplies or damage to equipment? Who can you turn to if you believe your employer is bending or breaking employment laws? What's the legal difference between a demanding boss (not illegal) and a hostile environment (illegal, but often closely tied to discrimination).

Some clinics take advantage of their therapists because they can get away with it. Others do so unwittingly, thinking that it's just how the industry works. The more therapists and employers understand their rights and protections, the better the industry will be as a whole." --Lori Olcott, LMT at Elements Massage Highpointe

4. Case Studies and Legislation

Did you learn how to write case reports in massage therapy school, and how they can affect the profession? Case reports consist of detailed descriptions of an individual client interaction, along with a literature review of research on similar subject matter. In her article in the January/February 2011 issue of Massage Bodywork magazine, Diana Thompson calls on massage therapists to contribute case studies to the scientific literature.

"I ... encourage you once again to rise to the challenge, tell your stories, and inform our profession's body of knowledge.

I'll start by sharing why I am a proponent of case reports: I find this to be the perfect format for telling the powers that be (researchers, referring health-care providers, policy makers) who we are (complex and unconventional), what we do (more than just a back rub), why people choose us (we touch more than their physical pain), and how powerful intentional touch can be. It is a blessing not to be able to diagnose, leaving us free to see clients as human beings to partner with, whose stories lead us on a path toward wholeness, rather than only relating to the illness--something to name and conquer. Our stories will likely not focus on unusual conditions or describe novel treatment procedures, because our ordinary client approach is still unusual to many. Our job is to illuminate the reader of the totality of a massage or bodywork session."

5. Customer Service

Knowing how to perform massage does not necessarily translate to knowing how to have excellent customer service in your business. Our free guide to creating a welcoming a massage therapy practice addresses some of the issues that may not get covered in massage school classes.

6. Prenatal Techniques, Side-Lying Position

There are fancy massage tables made just for prenatal massage use, but many therapists prefer to use a sidelying position for a few reasons.

In this article on prenatal massage, Jules Moon, a prenatal massage therapist in Portland, gives her reasons for not using a "pregnancy massage table" in her practice:

My reasons have to do with the mechanics of the spine and abdomen. Pregnancy massage tables are only able to be customized to a certain degree, which means you will likely be lying over a hole that’s too wide, too narrow, too deep or too shallow for your body at any given stage in your pregnancy. Moon writes that she prefers "the sidelying position on my extra-wide massage table," along with various sized pillows for support of the spine and pelvis.

7. Self-care

Massage therapists spend much of their time helping others heal and using their gifts and skills to soothe pain and stress.

However, massage therapists need to care of themselves, too, and often the nuts and bolts of how to do this get overlooked in training! Self-care is an important part of a massage therapist's routine.

In this interview, Melissa Finley, creator of the uber-popular Anatomy in Motion app, shares her passion for self-care and how to make self-care a part of your lifestyle.

8. Clinical Assessment, Contraindications

Jean, an LMT in Hawaii, writes this about some of the new students she sees coming into her clinic where she works:

"I feel I had a pretty comprehensive education where I work now is a teaching/apprenticeship clinic. I'm not a teacher as I haven't enough years licensure. I work in the clinic as an LMT. The students are only learning the bare bones. They need to learn more about local and complete contraindications. I overheard one apprentice tell a client he didn't need to know her health history, just where it hurts. (I took him aside and explained the reason the health questions were on the intake form). I also believe how to deal with real world issues, such as whiplash, hernia, sciatica, etc., should be required learning in all states, at the basic level."

9. Knowing Your Rights as an Employee/Employer

One last great piece of advice comes from Lori, an LMT in Denver:

"My curriculum spent lots of time on starting up your own LLC but little time on what to look out for as an employee: How to recognize if your employer is misclassifying you as an independent contractor and why it matters. Can your boss make you work for free (e.g. unpaid "promotional massages", cleaning or administrative work while off the clock, etc.)? Can your boss withhold charges to your paycheck to cover the use of supplies or damage to equipment? Who can you turn to if you believe your employer is bending or breaking employment laws? What's the legal difference between a demanding boss (not illegal) and a hostile environment (illegal, but often closely tied to discrimination).

Some clinics take advantage of their therapists because they can get away with it. Others do so unwittingly, thinking that it's just how the industry works. The more therapists and employers understand their rights and protections, the better the industry will be as a whole."

What subjects, skills, and topics did you miss out on during school that you wish you had learned about? How have you continued learning about these new skills throughout your career? Share your thoughts in the comments below!