Now & Then
Two Decades of Changes Fuel the Massage Profession

By Karrie Osborn
© Massage & Bodywork magazine, October/November 2007

Of the five thousand years massage has held a place in human history, the most recent twenty have been especially important in determining what the massage profession would become.

Do we conform to a medical, personal service, or wellness model? Do we abandon the intuitive side of bodywork for science? Do we subscribe to standards and regulations or retain the creative, free-spirited nature of the work? Do we become a “real” profession or stay loosely organized? These were the big-picture questions being asked of those within the profession twenty years ago, and even still today. Over these past two decades, a tug-of-war has been played out in the United States between standards, regulation, credentials, and science on one side and healing, heart, freedom, and innovation on the other. Many have worked hard to seek compatibility between the two, but differing views of the field remain, and probably always will.

Despite the disparities, the massage profession prospered. Who would have predicted in 1987 that massage would stand as it does today? Who could have imagined that the number of massage therapists would increase eight-fold in those twenty years, or that the number of massage schools would grow from three hundred to more than fifteen hundred? Would we have believed that the regulation of massage would jump from thirteen to thirty-eight states, leaving much of the work’s “homemade” character behind.

The massage profession has seen significant changes over the past twenty years. A 1987 United States massage “yearbook” would have observed many longstanding massage schools whose founders cared deeply about the profession, the emergence of groundbreaking research from Tiffany Fields on the benefit of massage for preterm infants, and the introduction of a new massage association and publisher of this magazine, Associated Bodywork & Massage Professionals (ABMP), which—as part of its inclusive nature—opened its doors to therapists from every corner of the massage and bodywork profession. The yearbook’s practitioner gallery would have captured an incredible range of personalities—from old-line masseuses working at the local YMCA to zealous New-Age devotees combining healing touch with spirituality and consciousness raising.

The last twenty years has not come without its challenges for the profession. While massage was hardly unknown in 1987, it was a misunderstood and underutilized profession, with few consumers realizing the healthy benefits of massage. Prostitution was hiding quite effectively under the profession’s coattails, sullying public opinion and forcing legitimate massage therapists to defend their work on a daily basis. Gaining deserved respectability, while not a pipe dream, seemed a distant hope for the profession. Yet, here we stand with an increasing number of medical schools teaching doctors about the value of massage; hospitals offering massage services as part of recovery protocols and the acceptance of massage by the U.S. public higher than ever before. Today, massage is a multibillion dollar industry gaining health-minded converts every day. Let’s take a look at how the massage profession traversed this twenty-year journey.

This Time magazine reporter had it right, and the late 1980s undoubtedly marked a shift in where the profession was heading. Coming through the period of exploration and discovery that marked the ‘60s and ‘70s, massage was ready for change in the ‘80s. In her article, Anastasia Toufexis theorized it was the start of the fitness boom in the early to mid-80s and the “growing recognition of the importance of massage in high-caliber sports” that shifted the tide for massage therapy away from inferred impropriety and the eclectic factor toward one of health and respectability. Others credit the consumer’s disillusion with traditional medicine and healthcare as impetus for the growth of massage therapy. Another theory looks to increasing public awareness of New Age thinking in the late 1980s and the lumping of massage, bodywork, and other “natural” therapies in with this more spiritual line of thought. While those ties have faded, there is no doubt the massage profession benefited from that affiliation. Regardless the exact equation that fostered growth, what’s followed has been a steady, twenty-year climb in massage use and acceptance.

The entrepreneurial nature of this business that Toufexis referred to 20 years ago has remained unchanged. In fact, it’s a large part of what makes massage such a “trendy” occupation in today’s market and what helped create nearly 63,000 new massage graduates in 2006 (up from 37,625 in 1998).² Today, there are more than 250,000 trained therapists providing massage and bodywork therapies to the U.S. consumer.³ That’s up from 175,000 therapists in 2002, 137,390 in 1998, 54,000 in 1992, and ABMP’s estimate of 30,000 in 1987.^4,5

When we take today’s one-quarter million massage and bodywork therapists and stack them up against the overall complementary and alternative medicine (CAM) picture, we see how their number compares impressively to other key alternative healthcare groups: 62,000 chiropractors, 21,650 acupuncturists, and 3,000 naturopaths.⁶ Take it one step further and we see that massage scored higher in treating osteoarthritis and fibromyalgia than other traditional and over-the-counter drugs, general exercise, physical therapy, chiropractic, and acupuncture, according to a 2005 Consumer Reports reader survey.⁷ According to readers, hands-on therapies were “the stars of the alternative medicine show.”⁸ Indeed, massage is consistently finding itself at the top of the CAM hierarchy.

The profession has been on an upward trend the past twenty years and today ranks somewhere between an $11 billion and $15 billion industry,⁹ with the U.S. Bureau of Labor Statistics projecting it to grow faster than average, with an estimated 18-26 percent increase in job opportunities through 2014.¹⁰ According to the list of most-searched jobs on Salary.com, massage therapist was one of the hottest emerging job titles of 2005.¹¹

Helping those numbers along and strengthening the profession through its growing pains have been the continued efforts of local and national associations. Indeed, much of what has happened in regard to licensing, certification, and accreditation has been deeply influenced by these institutions. On a national front, the American Massage Therapy Association (founded in 1943) was the first to bring national support to massage therapists. It labored along without competition until ABMP came to fruition in 1987 (see more about ABMP’s first 20 years on page 23). With ABMP today earning the title of largest membership association, these two organizations currently represent a combined 117,000 massage practitioners and students.

In addition to the sheer numbers, what has changed considerably for the massage therapy profession since 1987 is how it’s viewed by not only the public, but by the medical community as well. In the Consumer Reports survey, for example, the growing acceptance of massage within the medical community was evident. Readers reported that massage ranked second among alternative treatments recommended by their doctors.¹² That’s a huge notch in the massage profession’s belt and a relationship that’s been sought after by elements of the massage community for decades.

Consumers are responding as well and today receive more than 230 million massage sessions annually,¹³ while more employers contract massage as an employee benefit, including 77 percent of the top 100 U.S. companies, according to Working Mother.¹⁴ Part of that attitude and behavior shift has come from us changing how we talk about massage, trying to define it more succinctly so that the massage uninitiated (whether it be a referring doctor or a nervous first-time client) can understand our language. When the massage profession was given a CAM designation in the late ‘90s, therapists began integrating more fully into that paradigm and leaving much of the New Age influence behind.

It’s all good news, but some would say we should be careful for what we wish. We’ve moved from the kids’ table to the grown-ups’ table, and now the debate centers on whether we’ve become too medically-oriented and have forgotten the very thing that makes us effective—the power of individual, focused, caring touch. As the profession continues to further define itself, we have to wonder if creating additional regulation will take away the creative aspect of the work by standardizing it or open the door to even greater consumer use and acceptance?

Quarter Million and Counting
As the profession has changed, so, too, have therapists who over the past twenty years have molded themselves in response to a new, earned sense of respectability. Their demographics, however, are trending much the same as they always have.

According to a 2007 ABMP member survey, today’s typical massage therapist is a female in the prime of her working years who sees her work as something of a mission.¹⁵ Working primarily in her own office, she averages slightly more than fourteen client contact hours per week, but wishes she had more. Most of the therapists surveyed reported supplementing their income with another job, at which they spend approximately twenty-five hours per week.¹⁶ The top five second occupations include office work, massage instruction, medical roles (including nursing), education, sales/retail, and skin care.¹⁷ The latter category has become so prevalent, in fact, that many massage therapists are getting dual licensed in skin care in order to offer a bounty of wellness options to their clients, as well as to make themselves more marketable to the spa community.

While the average age of ABMP practicing members is 42.6 years, a reasonable hypothesis is that the actual average age within the profession is somewhere around 36-40 years. In general, practitioners with greater life experience are more likely than their younger colleagues to appreciate the importance of having liability insurance and staying in touch with developments in the massage profession, thus the upward skewing of the ages of professional association members.

The spectrum and combination of the estimated 250 massage and bodywork modalities therapists practice is astounding. According to a 2007 Job Task Analysis Survey conducted by the Federation of State Massage Therapy Boards (FSMTB), the top five approaches used by therapists today include Swedish, deep tissue, trigger point, myofascial, and reflexology.¹⁸ In addition, the 2005 ABMP member survey also found a percentage of therapists incorporating sports massage, on-site/chair massage, and energy work into their practice.¹⁹ Today’s massage, bodywork, and somatic professionals are also well-educated. According to the FSMTB, 50 percent attended college or have an associate’s degree, while 43 percent have a bachelor’s degree or higher. Approximately half earned 500-749 hours of initial massage education, while 35 percent completed more.²⁰

With the 1990s came an interesting trend of “techies” escaping Silicon Valley (and its sister regions) and switching sides to a hands-on sort of world. Many reported that their career change was about finding personal connection in their lives again after years of wading through high-tech isolation. This market segment seemed to reflect a growing, overall trend of massage therapists coming to the profession as a second, third, or fourth career. According to the FSMTB, at least two-thirds of the therapists who responded to their recent job task analysis had two or more previous occupations before finding their somatic calling.²¹ In contrast, a growing number of today’s newly graduated massage therapists come to the profession as their first career. Some veterans are concerned that these new therapists, while still filled with heart and a passion for the work, might not have enough life experience to approach the profession fully.

Learning how to be successful business owners remains one of the greatest challenges for members of this profession who are typically a lot more comfortable touching people than taking their money. Some of these folks often need to be reminded that while their instinct is to share their healing gift with everyone they can, their skills are valuable and worthy of compensation. When it comes to income earned by massage therapists, there remains great debate about the true numbers. Laying the groundwork for the confusion and the overstatement of earning potential by massage therapists is the U.S. Bureau of Labor Statistics November 2003 report that showed the average annual income for massage therapists to be $29,250, including gratuities.²² According to ABMP, “The bureau derived this number by gathering data showing a mean hourly wage of $16.83 for massage therapists, then multiplying the hourly mean wage by a year-round, full-time hours figure of 2,080 hours.”²³

This has been misinterpreted by many, according to ABMP, because of a lack of consideration to the fact that the bureau’s numbers did not include the self-employed, encompassing two-thirds of the U.S. massage therapist population, and its mean annual wage was based on forty hours of massage work per week.²⁴ Analysis from the 2007 ABMP member survey found massage therapists reported an average income of $17,750, with a median income of $15,500.²⁵ What the late night commercials promoting massage training don’t tell student prospects is that the average first-year practice income for MTs is $10,053, reflecting the true challenges of establishing a massage practice.²⁶

As for tenure and length of career for massage therapists, high turnover rate remains a lasting, albeit unfortunate, trend in this profession. In a 2007 survey from the Florida Board of Massage Therapy and the Florida State Massage Therapy Association, half of all those who responded reported some type of injury related to performing massage therapy.²⁷ In addition to injury, burnout, poor business planning, and possibly an overestimation of earning potential are other factors contributing to the approximate forty-five thousand therapists who leave the profession every year, fifteen thousand of them permanently.²⁸

However, what has continued to fuel this profession, regardless of its challenges, is the caring, passionate way therapists go about their work. According to the FSMTB job analysis survey, 99 percent of respondents are happy to be in the profession, are proud of the work they do, like being a practitioner, and are enthusiastic about their occupation.²⁹

Creating a Future
One of the greatest areas of change for the profession has come in the education of massage therapists. In 1987, there were an estimated 300 massage schools in the United States,³⁰ although that number included state-approved and non-approved schools. A more reliable number comes from ABMP’s estimate of 240 state-approved schools in 1992,³¹ growing to 637 state-approved schools in 1998.³² That number has grown steadily over the years and now rests at 1,570 massage schools with state approval.³³

According to ABMP, schools that make up the massage universe today can be broken down into four categories: proprietary schools (essentially teaching only massage) account for approximately 60 percent of massage therapy schools, career schools (offerings programs in varying career subjects) represent 29 percent, colleges make up 11 percent, and public/vocational schools take up 1 percent of the pie.³⁴

Besides the obvious growth, the educational paradigm has also changed significantly over the past two decades. With the annual entry of massage therapists to the profession settling in around fifty thousand,³⁵ it wouldn’t be long before someone sat up and took notice. In fact, in just the past few years, several conglomerates have been buying out longstanding mom-and-pop massage schools, as well as some large groups of schools. While most of the brick and mortar has stayed intact, some say there is a different focus on numbers and a relinquishing of the heart and soul that used to walk the hallways of these schools. Still others say the changing face of education is allowing more people to enter the profession through the utilization of federal assistance programs.

An interesting indication of the settling of the profession is the fact that, while the number of schools has gone up, graduate numbers have gone down. The total number of graduates in 2006 was 62,784,³⁶ according to ABMP President Les Sweeney, NCTM, which is a decline of slightly less than 12 percent since 2004, when graduate numbers peaked at 71,272. Another aspect to consider is the number of massage schools, which, while continuing to grow over the last two years, slowed considerably from a 35.5 percent gain between 2002 and 2004, to a 7.8 percent gain between 2004 and 2006. “Our broad perspective is that the massage training universe may have overreacted to the growing consumer demand,” Sweeney says. “Some excellent training programs already in the market expanded and other well thought-out programs emerged. But programs also emerged that were less well-planned and more motivated by the trendiness of massage training.” In fact, Sweeney attributes earlier growth to a bandwagon effect. “This slowing of total school growth is especially telling,” Sweeney says. “It would not be surprising to see a further reduction in the number of massage training programs during the next few years. The landscape has become more competitive. Those with quality instruction, passion for the field, and effective student recruitment and support are more likely to thrive.”³⁷

As for the cost of a massage education, the range is as varied as the type of programs available to therapists. According to Sweeney, school surveys have shown that the cost of a massage education has gone up 25 percent since the association’s first measure in 1998. He speculates that today’s educational costs are on average about 50 percent higher than they were in the early 1990s.

Above all other factors, the certification and regulation of the massage profession over the last twenty years has created the most contention among therapists and the organizations that represent them, and likely the most benefits for improving consumer use and professional respectability. In 1987, there was no national certification and only thirteen states had massage licensing requirements.³⁹ By 1992, there were sixteen states with massage regulation, and the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB), which was designed as a certifying body that could administer a basic skills and knowledge exam for MTs, was unveiled. Today, the number of states regulating massage has grown to thirty-eight and we now have another player in the field of massage regulation—the Federation of State Massage Therapy Boards (FSMTB)—and a new entry-level test for therapists—the Massage and Bodywork Licensing Exam (MBLEx).

It’s worth noting here the side story. Made up of state massage boards, with help and guidance from leading educators, the FSMTB was formed in response to what some thought was a decaying, flawed system that was no longer responsive to the needs of therapists or the profession. This new coalition organization is expected to improve communication between states and eventually foster enhanced licensing reciprocity.

When the development of FSMTB was announced in 2005, Cliff Korn, industry leader and editor of Massage Today, wrote that it was “potentially the most significant massage news of the decade.”⁴⁰ Author Ralph Stephens says the FSMTB is representative of “a huge sea of change in our profession” that will bring about portability, standardization, and accountability in the regulation of massage.⁴¹

An attempt to create a similar alliance in 1999 failed because of a lack of financial backing and administrative support. This time, ABMP agreed to provide the initial seed money and staff support to get the federation off the ground while additional funding is secured.

The issue of regulation has been a tenuous one over the past twenty years, but it appears there might be more acceptance of it as time passes. Of those responding to the recent FSMTB Job Task Analysis Survey, 84 percent said licensing should be required across the nation.⁴² As regulation evolves, one question that will continue to be asked is, shouldn’t we create a multi-tier licensing designation? According to the survey, “Two-thirds of respondents think the field should not be separated into more than one licensure category, such as relaxation/medical or energetic/hands-on.”⁴³

Here Comes the Spa
We can’t begin to talk about the therapeutic work environment of MTs these days without noting the importance of spas to the profession. While most massage therapists are self-employed, spas have long offered a diverse opportunity for employment. Whether MTs were looking for specific geographic location, variety of work and services, or a foot into the profession, spas have offered that and more. As of August 2007, 14,615 spas peppered the American landscape, employing an estimated 234,588 people, according to the International Spa Association (ISPA),⁴⁴ and massage therapy remains the most requested spa service.⁴⁵ Spa industry revenues in 2006 reached $9.4 billion, down slightly from 2005 figures, but up from $7 billion in 2003. What witnessed surprising growth, however, were medical spas, which more than doubled their revenues from 2005.⁴⁶ Spas, along with another phenomenon—massage clinics following the membership model pioneered by health clubs—have become an important vehicle for bringing newcomers to massage, as well as giving new therapists an entree into the profession.

While working in spas offers lucrative employment for some and entry-level opportunities for others, most massage therapists have an independent practice from which they conduct business. A 2007 ABMP survey found that 57 percent of massages are provided independently—the largest share (36 percent) delivered in an independent storefront/professional office setting, 15 percent in the practitioner’s home, and the remainder at the client’s home.⁴⁷

Hospitals and other medically-oriented clinics offer additional opportunities for massage therapists, whether it be as part of an in-house integrative care team or as a member of the growing number of medical spas opening across the country. With the rise of medical massage, this will likely prove to be a widening opportunity for therapists.

Telling the Story
When massage therapists tried defending their work to the medical community twenty years ago, there was little academic research to help build an argument. Aside from an important study on massage and lymph in 1953,⁴⁸ and the still important, pioneering work of Ashley Montagu,⁴⁹ therapists often had to rely on anecdotal tales to convey the power of massage. Then, in 1986, the massage world was gifted with the work of Tiffany Fields, PhD, a researcher at the University of Miami School of Medicine, who later would establish the Touch Research Institute (TRI), “the first center in the world devoted solely to the study of touch and its application in science and medicine.”⁵⁰ Her first study involving massage focused on preterm infants and found that touch helped them gain weight and sleep better.⁵¹ In 1987, Fields followed up her work with another study on preterm infants and massage⁵² and has since explored the connections between massage and pregnancy, posttraumatic stress disorder, autism, HIV, leukemia, and much more.⁵³ Fields has without doubt influenced the massage profession in ways we can’t begin to imagine.

In spite of her work, there still existed a medical community left asking, “What’s all this fuss about?” Nursing journals at the time, however, were the dominant domain for articles on touch, and the work of Dora Kunz and Delores Krieger—Therapeutic Touch—was making great strides within this circle. Nurses seemed to be some of the first within the medical arena to tout the benefits of touching and massaging patients and remain great supporters today.

After years of calling for action, the massage community is more involved in research than ever before. The National Institutes of Health (NIH), through the National Center for Complementary and Alternative Medicine (NCCAM), has been adding research dollars to the massage question as well (for a full list of NIH clinical trials involving massage, visit Clinicaltrials.gov). From within our own ranks, the Massage Therapy Foundation (Massagetherapyfoundation.org) is devoted specifically to massage and bodywork and has been pushing the research envelope for years. And on an individual basis, more therapists than ever are noting case studies and learning the protocols for developing unbiased research opportunities.

It’s case studies, says Janet Kahn, member of the NIH National Advisory Council on Complementary and Alternative Medicine, that will continue to help legitimize the work of massage therapists. “Case studies demand that we observe carefully, objectively, and honestly,”⁵⁴ she wrote in 2006. “Clinical case reporting requires that we describe what we see, what we feel, what we do. It nudges us to explain ourselves. We are a profession that values intuition. I share that value. At the same time, I believe that we often misuse the term, relying on it as a way to avoid having to articulate what we have noticed that nudged us to make this or that treatment decision ... When we do stop to articulate things to one another ... we will do ourselves and our colleagues a great favor. We will begin to create the case-study literature that will in and of itself deepen our understanding of our work, and that may in time determine the next quantitative studies to be undertaken.”⁵⁵

Just as women make up the majority of massage therapists, they also make up the majority of massage consumers. Men are picking up the pace, however, with 13 percent reporting massage use, up from 8 percent in 2004.⁵⁷ Overall, 33.6 million American adults, aged 21 and older, received at least 1 massage in 2006—that’s 1 in 6 adults seeking out therapeutic massage. That impressive number is up nearly 9 million from 2004, translating to approximately 230 million massage sessions annually.⁵⁸

What brings people to massage remains much the same as years past. The largest segment seeks relaxation and restoration (30 percent), while nearly as many come for pain relief (29 percent).⁵⁹ What’s most interesting is that 28 percent get a massage because they received it as a gift.⁶⁰ It’s not much of a leap to assume that the massage-initiated are growing those consumer use numbers as they gently urge friends and family to try massage for the first time via a non-returnable gift.

The cost of a massage has rightly increased over the years as education and acceptance levels have grown, but seems to have settled into its price point. While there are still low-dollar options at massage school clinics, and franchise settings like Massage Envy set an hourly rate of $39, the median price for a one-hour massage today is $60.⁶¹ The average client payment for massage in 1998 was $41.19,⁶² and an informal survey of ABMP membership in 1988 found that the average cost of a massage session was $40.⁶³

Unfortunately, what hasn’t changed much over the last several years is that 90 percent of consumers have to pull those dollars out of their own pockets. So, while a slightly higher proportion of American adults received at least one massage therapy session in 2006 than accessed chiropractic or physical therapy services, it’s a choice rarely reimbursed by health insurance.⁶⁴ Most insurance companies haven’t yet made the intellectual leap to consider reimbursing for massage services as a contribution to sound preventative health practices. Even in the relatively rare precincts in which reimbursement is possible today, massage therapists have to ponder whether it’s worth becoming encumbered in the “back office” paperwork, coding, and referral thicket.

That doesn’t appear to be stopping consumers, however, from making CAM choices when it comes to their health. As healthcare costs continue to rise (by 2008, costs in the United States are estimated to reach $2.2 trillion, up from $1.6 trillion in 1998⁶⁵) consumers are looking for other means of sustaining their health. It’s why more than one-third of U.S. adults seek out healthcare alternatives spending, from $36 to $47 billion each year.^{66, 67}

Consumer Reports found that deep-tissue massage was one of the remedies its readers found most effective for back pain, arthritis, osteoarthritis, and fibromyalgia.⁶⁸ The 2007 ABMP Consumer Survey found that 16 percent of U.S. adults visited a massage therapist in 2006 and 38 percent had received a massage at some time in their life.⁶⁹ Of those who had seen an MT in 2006, the average number of visits was seven, which puts them on par with chiropractic and physical therapy services.⁷⁰ 

Sadly, the constraints consumers claim for not getting massage remain a real barrier to growth, but they also can represent a glass-half-full opportunity. Of the 62 percent of survey respondents who have never received a massage, 36 percent said they didn’t perceive a value to massage, or feel that it was necessary; 30 percent cited cost as a deterrent; and
37 percent said they just didn’t have time for a
massage.⁷¹ Add in the psychodrama of nudity, gender, and touch, and, despite the gains we’ve made, there remains a pretty steep hill to climb in terms of consumer perception.

The Path Ahead
There is no doubt that massage therapists have traveled long and far to get to this place in the road toward professionalism and respectability. Members of the massage and bodywork community have worked endless hours trying to get the allopathic community to pay attention to them, and now, at last, they slowly are. But do we celebrate or grieve? Is it good that we are on the medical radar, or have we now sacrificed the art and individuality that makes massage such a beneficial aspect of healthcare? Will our medical arm strangle the artist and the emphasis on connection and caring touch?

And what about the changing face of massage schools and their graduates? Is the current dynamic allowing us a chance to diversify the massage therapy population and standardize the field, or is it creating a new, less successful breed of therapist who might be entering the profession for the wrong reasons and not getting all the tools necessary to be successful?

For anyone who has been wading in these massage waters very long, it’s undeniable that there is great power—however we explain it or define it—in the work of massage therapists and bodyworkers. What’s even more exciting is that despite all those who want to jump on this trendy bandwagon for the wrong reasons, there are great educators and mentors in this field still performing and teaching massage for the right reasons, and there is certainly great work still left to be discovered.

Shortly before his untimely passing in 2006, Massage magazine founder and industry leader Robert Noah Calvert shared with us these words about the profession he so dearly loved. It’s a reminder of how valuable this profession really is:

“Massage has survived and continues to evolve because it is the most fundamental means of giving care, affection, and aid between human beings. Its healing qualities differ from those of other modalities because massage confers its benefits through the character and healing intention of those who give and receive it. The true value of massage comes from the intrinsic, inherent need of humans to have contact with one another.”⁷²

Karrie Osborn is the contributing editor for Massage & Bodywork magazine. Contact her at karrie@abmp.com.

Notes
1. Anastasia Toufexis, “Massage,” Time (March 9, 1987), www.time.com/time/magazine/article/0,9171,963729-2,00.html (accessed June 2007).
2. “A Changing Environment,” The ABMP School Connection, 5, no. 2 (Spring 2007): 1.
3. Number derived from ABMP’s January 2006 analysis based on state licensing lists, primary membership organization totals (ABMP and AMTA), NCBTMB certificants, and state populations. General receptivity toward massage in particular regions was also factored in.
4. “Trends in the Massage Profession,” ABMP’s 2006 Touch Resource Guide, 6.
5. Bob Benson, “The Massage Tapestry,” Massage & Bodywork 17, no. 5 (Oct./Nov. 2002): 16.
6. Numbers compiled by Associated Bodywork & Massage Professionals, 2004.
7. “Which Alternative Treatments Work,” Consumer Reports (August 2005): 70:39-43.
8. Ibid.
9. ABMP analysis calculated from contact hours per week (15.4), at an average rate of $60 per hour yields an annual 182 million sessions and $9.3 billion. A national consumer telephone survey of a representative sample of 1,008 adults aged 21 and older, conducted Jan 4Ð11, 2007 by independent, national public opinion research firm Harstad Strategic Research, Inc., Boulder, Colo., revealed approximately 230 million massage sessions were provided to American adults in 2006 at an average cost of $60 per session. These findings yield a $13.8 billion estimate. Under neither of these calculations, do massage therapists receive all these dollars; a portion accrues to spa owners, landlords, and medical professionals providing space and referrals. With additional payments for training, equipment, services, and marketing, massage is an $11 billion to $15 billion industry.
10. U.S. Department of Labor, Bureau of Labor Statistics, 2006-2007 Occupational Handbook.
11. “Dream Job: Massage Therapist,” Salary.com. www.salary.com/personal/layoutscripts/psnl_articles.asp?tab=psn&cat=cat011 &ser=ser032&part=par270 (accessed June 2007).
12. “Which Alternative Treatments Work,” Consumer Reports.
13. 2007 ABMP National Consumer Survey.
14. “100 Best Jobs,” Working Mother, September 2003.
15. 2007 ABMP Member Survey.
16. Ibid.
17. Ibid.
18. “The Federation of State Massage Therapy Boards Finds Profession Supports Licensure,” Federation of State Massage Therapy Boards press release (March 26, 2007), www.fsmtb.org (accessed June 2007).
19. 2005 ABMP Member Survey.
20. “The Federation of State Massage Therapy Boards Finds Educated, Satisfied Professionals,” Federation of State Massage Therapy Boards, www.fsmtb.org (accessed June 2007).
21. Ibid.
22. U.S. Department of Labor, Bureau of Labor Statistics, Occupational Employment and Wages, (November 2003).
23. “Explosive Growth Rate for Massage Training Begins to Flatten,” ABMP’s Massage Profession Metrics, www.massage therapy.com/media/metricsgrowth.php (accessed June 2007).
24. Ibid.
25. 2007 ABMP Member Survey.
26. Ibid.
27. Tina Beychok, “Survey of Florida Massage Therapists Provides Snapshot of Profession,” Massage Today 7, no. 5 (May 2007), www.massagetoday.com/mpacms/mt/article.php?id=13620 (accessed June 2007).
28. Bob Benson, “The Massage Tapestry.”
29. “The Federation of State Massage Therapy Boards Finds Educated, Satisfied Professionals,” Federation of State Massage Therapy Boards.
30. Anastasia Toufexis, “Massage.”
31. Bob Benson, “The Massage Tapestry.”
32. ABMP surveys of state-approved schools, 1998 to 2007.
33. Ibid.
34. “A Changing Environment,” The ABMP School Connection.
35. ABMP estimates.
36. Ibid.
37. Ibid.
38. National Institutes of Health. www.nlm.nih.gov/medlineplus/tutorials/massagetherapy/am019101.pdf (accessed June 2007).
39. Anastasia Toufexis, “Massage.”
40 Cliff Korn, “New Organization Formed to Benefit Massage Therapy,” Massage Today 5, no. 7 (July 2005), www.massage today.com/mpacms/mt/article.php?id=13235 (accessed June 2007).
41. Ralph Stephens, “The Shoe’s on the Other Foot Now,” Massage Today, 5, no. 11 (November 2005), www.massagetoday.com/mpacms/mt/article.php?id=13318 (accessed June 2007).
42. “The Federation of State Massage Therapy Boards Finds Profession Supports Licensure,” Federation of State Massage Therapy Boards.
43. Ibid.
44. International Spa Association 2007 Spa Industry Study, http://www.experienceispa.com/ISPA/Media+Room/Press+Releases/ ISPAs+13th+Annual+Media+Event.htm and http://www.skininc.com/news/9158826.html (accessed August 2007).
45. International Spa Association 2006 Spa-Goer Study, www.experienceispa.com/ISPA/Media+Room/Resources/Industry+Stats (accessed June 2007).
46. International Spa Association 2007 Spa Industry Study.
47. 2007 ABMP Consumer Survey.
48. E.C. Elkins, J.F. Herrick, J.H. Grindlay, et. al. “Effects of Various Procedures on the Flow of Lymph.” Arch. Phys. Med. 34 (1953): 31.
49. Ashley Montague, Touching, (New York; Harper & Row), 1971.
50. Touch Research Institute, www6.miami.edu/touch-research/about.htm (accessed June 2007).
51. T. Field, S.M. Schanberg, F. Scafidi, C.R. Bauer, N. Vega-Lahr,  R. Garcia, J. Nystrom, & C.M. Kuhn, “Tactile/kinesthetic stimulation effects on preterm neonates,” Pediatrics, 77, (1986): 654-658.
52. T. Field, F. Scafidi, & S. Schanberg, “Massage of preterm newborns to improve growth and development,” Pediatric Nursing, 13, (1987): 385-387.
53. For a list of TRI studies, go to www6.miami.edu/touch-research/research.htm#MTS.
54. Janet Kahn, “Research Matters,” Massage 119 (January 2006). www.massagemag.com/Magazine/2006/issue119/research 119.1.php (accessed June 2007).
55. Ibid.
56. Anastasia Toufexis, “Massage.”
57. 2007 ABMP Consumer Survey.
58. Ibid.
59. Ibid.
60. Ibid.
61. Ibid.
62. “Trends in the Massage Profession, ABMP’s 2006 Touch Resource Guide.
63. Associated Professional Massage Therapists and Bodyworkers newsletter, November 1988.
64. 2007 ABMP Consumer Survey.
65. Health Industry Today, October 1999; 62, 10.
66. D.M. Eisenberg, R.B. Davis, S.I. Ettner, et al. “Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up
national survey.” JAMA 280, no. 18, (November 11, 1998): 1569-75.
67. “More than one-third of U.S. adults use complementary and alternative medicine,” National Center for Health Statistics press release (May 27, 2004).
68. “Which Alternative Treatments Work,” Consumer Reports.
69. 2007 ABMP Consumer Survey.
70. Ibid.
71. Ibid.
72. Robert Noah Calvert, “A Brief History of Massage,” www.massage
therapy.com/media/experiencehistory.php.

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