Whose Approval Do We Seek?

(An evidence-based view of the status of massage therapists)

By Rebecca Barnett

I am a bit of a broken record. Pretty much any time I’ve had the opportunity to speak to a big bunch of massage therapists or write to an audience of massage therapists on social media, I end up talking about professional esteem. I have done it so often that I am even starting to bore myself.

The self-image of many massage therapists is such #fakenews that I feel impelled to correct it, repeatedly and emphatically.

The idea that we’re the healthcare equivalent of the dog that gets kicked doesn’t stack up in my book. If I had a buck for every time I heard a massage therapist refer to the “stigma of the massage industry”, I would be a wealthy woman.

I am still not entirely sure I know what the stigma of the industry is.

As I have written on this blog before, most members of the public seem to go misty-eyed and wistful when you mention you’re a massage therapist, and quietly sigh, “I’d love to get a massage”.

The belief that we’re at the bottom of the healthcare system hierarchy seems to be substantially based around a pretty hefty obsession with third party payment – the deeply held conviction that massage therapy should be subsidised, either through Medicare, DVA, Workers’ Compensation, the NDIS or a private health insurance company.

Which is weird when you consider that those at the very top of the health professional pecking order (and the most highly remunerated in the healthcare biz) – medical specialists – don’t seem to be too bothered about the claimability, or lack therein, of the services they provide.

Talking About a Revolution

There’s a quiet revolution happening in front of us and, for some unaccountable reason, we keep averting our eyes. Maybe it’s because it seems counterintuitive or perhaps because it doesn’t fit with our negative self-talk, but there’s a reason why physiotherapists and chiropractors want to have massage therapists working in their practices, and the evidence of it is staring us right in the face.

The public demand for massage therapy is bloody high. We’re bringing clients to the door.

I talked a bit about this “hidden” revolution, way back in 2016.

At the time, I was quoting data from an unpublished patient survey conducted by AMT and from a study published in BMC Musculoskeletal Disorders about back pain consultations, which drew on data from the Australian Longitudinal Womens’ Health Survey.

That particular study showed something astonishing. Back pain consultations with any alternative health practitioner outgunned consultations with any medical practitioner by 30%. (75.6% of the 1310 of the mid-age women surveyed had consulted an alternative health practitioner for back pain, while 58.4% had consulted any medical doctor).

Let that statistic sink in for a minute.

Big CAM?

When do we start referring to the complementary medicine industry as Big CAM? For all the persecution and paranoia, it certainly seems like CAM is overplaying the “victim of the medical hegemony” card.

Let’s look specifically at the data on massage therapy from the same study: 43.1% (515) of the women surveyed had consulted a massage therapist for their back pain. Compare that to the consults with physio (36%) and chiro (36.9%).

Still wondering why so many chiros and physios are keen to offer massage therapy in their clinics?

In November 2018, a brand new paper on complementary medicine use in Australia was published, “Complementary medicine use in the Australian population: Results of a nationally-representative cross-sectional survey.” This study is much broader than the one quoted above because it doesn’t investigate a specific condition or gendered population. The data is a nationally representative sample of 2019 Australians over the age of 18.

So what does this study tell us? Well, for starters it tells us this:

“The findings of this study suggest that two out of three Australians use some form of complementary medicine. This figure is consistent with previous studies indicating that high levels of complementary medicine use are a firmly entrenched aspect of the healthcare milieu in Australia, with prevalence and utilisation levels that are both significant and consistent.”

Significantly, it also tells us this:

“Individuals in our study with a chronic disease diagnosis were more likely to use complementary medicine compared with the general population; a finding which was consistent across all categories of complementary medicine use examined. This finding concurs with previous Australian studies in discrete populations which suggested higher rates of complementary medicine utilisation among those with chronic or co-morbid conditions.”

And this is the “typical” profile of a complementary medicine user:

“Complementary Medicine users were more likely to be female, have a chronic disease diagnosis, no private health insurance, a higher education level, and not be looking for work.”

What did this study say about utilisation of massage therapy?

Massage therapists were the most commonly consulted complementary medicine practitioners (20.7%), outgunning chiropractic by a whopping 65% (12% of respondents had consulted a chiro). Perhaps more significantly, though, massage therapists were only marginally outstripped by consultations with physiotherapists (21.5%). Remember, this is a nationally representative survey of Australians and treatment utilisation across the entire spectrum of healthcare, without reference to any specific presenting health condition. When you consider how deeply embedded physiotherapy is within the Australian healthcare system, this result seems all the more breathtaking.

We massage therapists are effectively going toe to toe with physiotherapists in terms of the percentage of Australians showing up at our door. We’re killing it folks.

What should this evidence tell us about the regard with which the Australian public holds us? It doesn’t much feel to me like the picture of an industry burdened by unshakeable stigma. It feels like a sign of a profession slowly coming into its own in the public imagination and esteem.

We spend a fair bit of time thinking about the research evidence around clinical practice. Perhaps it’s time to invest a bit of time thinking about what the data says about where we are in real terms within the healthcare hierarchy.

Let’s all take a long hard look in the mirror. We’re looking pretty fine from where I sit.

There. I’ve said it yet again.

About the Author

As the self-titled accidental CEO of AMT, Rebecca Barnett clearly also suffers from a terrible case of impostor syndrome and should really stop apologising for her position. She remains a fiercely loyal champion of massage therapists in spite of this.