There is a need to define the frequently used term "medical massage." One proposed definition would require a medical massage therapist to have significantly more training to qualify for licensure. The curriculum for medical massage would include cadaver studies, chemistry and nutrition, as well as an internship. The state would provide a separate license for a medical massage therapist, which would allow the practitioner to bill insurance. The insurance component would compensate a therapist for the additional required education. A medical massage therapist would work with a patient's primary care physician to provide optimum health for the patient.

One of the most vexing issues facing the massage therapy industry today concerns the term "medical massage." All health care professionals know what it is, yet few are able to define it. Yet, when we as bodywork practitioners answer the question of what medical massage is, we will further the goal of legitimizing and establishing advanced bodywork in the health care environment.

Why is "medical massage" creating such a stir in the massage and medical community at large? Who should be allowed to practice medical massage and how? When is it indicated and when is it not? I attempt to answer these questions from the standpoint of a licensed massage therapist and a certified neuromuscular therapist who has been treating patients in New Mexico for the past 12 years. My opinions are based on practicing in both the massage and medical environments.

I have come to these opinions based on a sincere desire to see the perception, understanding and appreciation of bodywork advanced throughout the U.S. with some degree of uniformity. More importantly, the bodywork industry needs a universal definition so when a patient seeks out the services of a medical massage therapist he or she will know that therapist is licensed and properly trained to treat their pathology. It's important to define medical massage to both eliminate imposters and to protect legitimate medical massage therapists.

In my opinion, medical massage should:

• Be an accepted part of allied health care and physical medicine.
• Be a system of patient care and treatment based on a medical model that is scientific, hands-on and results-oriented.
• Be derived from a specific diagnosis that requires certain specific techniques or procedures to bring about a specific measurable response from the patient.
• Be a discipline that operates as a scientific system utilizing universally accepted medical terminology.
• Produce practitioners who participate in scientific research that demonstrates a measurable response to a patient's chief medical problem.
• Treat a variety of specific musculoskeletal indications with an educated understanding of how every system of the body is affected by every other system.
• Be a comprehensive set of contraindications for the modality as well.
• NOT be a system of diagnosis and treatment that relies upon the use of prescription medication to treat musculoskeletal related dysfunctions.

These days, many other definitions of medical massage are floating around the country. Some serve the limited financial gain of a person or organization promoting a particular definition. Some definitions state medical massage should only be practiced in a doctor's office under the absolute control of an MD or DC. If practiced in a PT clinic, it must be under the domain of a PT. One organization states only students who take their "national certification examination" in medical massage should be recognized as a medical massage therapist.

From an insurance billing perspective, there has been recent litigation attempting to prevent a bodyworker from filing insurance unless they are a "medical massage therapist." Fortunately, when the judge asked for a definition of medical massage and none could be offered, he ruled in favor of the massage therapist. It has become quite clear these definitions do not have at their core the benefit of the patient.

Under the definition I propose, an LMMT (licensed medical massage therapist) should be someone who has received training requiring more than the universal 500-hour training threshold that has become the norm for massage therapists. The curriculum should require more hours in anatomy and physiology, pathology, patient assessment, kinesiology, musculoskeletal anatomy, including cadaver studies, chemistry and nutrition. The curriculum would include alternative therapy electives, a segment on business and ethics, practice management and insurance billing.

I also propose a significant clinical practicum and internship. Included in this formula is a continuing education requirement that exceeds the current eight to 16 continuing education units required biannually by many states. The extra education can be accomplished within the context of a 2,000 to 2,400-hour program similar to the structure of training programs in place in Canada where 2,200 to 3,000-hour programs are standard.

An LMMT would have the option of practicing in a controlled environment such as an HMO, working in private practice or something in between. The state would be required to adopt separate licensure for LMMTs. Furthermore, the LMMT automatically should be included in the mix of approved therapies for insurance billing.

The benefits for patients and therapists are obvious. The patient will know his or her therapist is properly trained, qualified and competent to treat the condition they have been referred for. The therapist will have the satisfaction of knowing their training will bring measurable results to the patient and they will be compensated for their work by insurance. The insurance industry benefits by knowing an LMMT is ethically and legally following a standard of treatment and documentation. By arriving at a national consensus about the definition and training of an LMMT, the U.S. will have gained a cost-effective tool in containing spiraling health care costs.

A quality-driven, credible medical massage therapy program should be predicated on proper program development and organization complimented by a competent and experienced teaching staff and utilized in an active clinical environment. Too often, education and competency have not paralleled each other and curriculum has not been problem-centered and patient-based.

The following curriculum outline is designed to assist preeminent institutes for higher education in the medical massage industry. The medical massage program can be implemented in stages as instructors are trained and certified or offered as a comprehensive second-tiered advanced program.

Medical Massage Therapy Curriculum Outline

Anatomy and Physiology:

ACI-Cell anatomy and physiology
ACII-Systems of the body
ACIII-Musculoskeletal anatomy

Chemistry:

The chemistry and physiological processes of the body.

Pathology:

Musculoskeletal pathology and related disease processes.

Nutrition:

Nutrition and your patient. Pharmacological and nutritional interactions and outcomes.

Medical Massage Theory and Disciplines:

Assessment Procedures and Protocols
Integrative NeuroMuscular Therapy I-V/Certification Examination
CranioSacral Therapy I-V/Certification Examination
Myofascial Release I-V/Certification Examination
Trigger Point Therapy I-IV/Certification Examination
Visceral Manipulation
Lymphatic Drainage

Advanced Musculoskeletal Palpation:

Therapeutic Modalities

• Hydrotherapy
• Percussion and/or Vibrational Devices
• Cold Low Level Soft Tissue Lasers
• Electro Therapies

Cadaver Dissection I-V

Therapeutic Stretching

Medical Massage Clinical Practicum

Medical Massage Externship Program

Business and Ethics:

Insurance billing for the medical massage therapist.
Advanced medical terminology and charting.
Medical massage law and ethics.
Understanding your state licensing board.

Electives:

History of Medical Massage
Integration of Medical Massage with the Allopathic Community
Scientific Studies Validating Medical Massage
Introduction to Physical Therapy
Introduction to Occupational Therapy
Chiropractic Medicine and Medical Massage
Oriental Medicine and Medical Massage
Understanding Surgical Interventions in Musculoskeletal Pathology
Medical Massage for the Geriatric and Pediatric Population