When massage therapy evidence is not evidence for massage therapy

By Rebecca Barnett

Is it possible to assert that “massage therapy evidence is not evidence for massage therapy”?

Sophist: It is

Objector: How?

Sophist: ‘Massage therapy’ defines a practice; ‘Evidence’ defines research. Specifying research is not specifying practice. Hence, ‘Massage therapy evidence is not evidence for massage therapy’.

Objector: ‘Massage therapy evidence’ is not the same as ‘no evidence.’ Is not ‘no evidence’ the same as ‘not evidence’? But ‘massage therapy evidence’ is the same as ‘evidence for massage therapy.’ Why is ‘massage therapy evidence’ ‘not evidence for massage therapy’?”

Sophist: “If you want evidence for effectiveness, massage therapy evidence from allied health practitioners will do. If you want massage therapy evidence from massage therapists, evidence from allied health practitioners will not do. If ‘massage therapy evidence’ were the same as ‘evidence for massage therapy,’ then you want the same thing. If it were the same thing, then it would not matter whether the evidence comes from a massage therapist or an allied health practitioner. If it makes no difference, then evidence from allied health practitioners will do.”

Objector: If massage therapy works, why does it matter who performs it for the evidence to be valid?

Sophist: Evidence for massage therapy is only valid when the massage is applied by someone who is not a massage therapist.

Objector: Why does it matter who performs the massage?

Sophist: When an allied health practitioner applies massage, their professional standing lends credibility. But when a massage therapist applies massage, it is considered merely anecdotal or unscientific.

Objector: So, even if a massage therapist achieves the same results, their work is not considered evidence?

Sophist: Correct. A massage therapist’s work is seen as lacking rigour, while an allied health practitioner’s massage is viewed as grounded in clinical expertise.

Objector: But if the massage itself is the same, should the practitioner matter?

Sophist: Logic would suggest it does not, yet perception dictates otherwise. Evidence is only acknowledged as valid when it fits the framework of allied health, even if the technique and outcomes are identical.

Objector: Then how can massage therapists ever provide evidence for their own profession?

Sophist: Only when their evidence is reinterpreted or validated by those outside their profession. Until then, massage therapy evidence remains evidence for the practice of others, not for massage therapists themselves.

Objector: I see now. Massage therapy evidence is only considered true evidence when removed from the hands of the massage therapist.

Sophist: You understand well. Such is the paradox of perception.

NDIS Policy: an inexorable pancake?

OK. Firstly, I need to apologise sincerely to the Chinese philosopher Gongsun Long for torturing the famous white horse dialogue to within an inch of its life. In my defence, it seems a remarkably apt rendering of correspondence recently received from the outgoing NDIS Minister, Bill Shorten, responding to a request for recognition of remedial massage within the NDIS.

Screenshot of letter from NDIS MInister Bill Shorten. The key points are summarised in the text of the blog.
Screenshot of the second page of letter from NDIS MInister Bill Shorten. The key points are summarised in the text of the blog.

Here is the key takeaway of Bill Shorten’s letter:

For evidence-based therapy to be funded through the NDIS, there must be evidence that the therapy helps participants. Massage is funded as a support only when it is part of a management plan delivered by an allied health practitioner. In other words:

  • Evidence-based supports can only be delivered by an allied health professional.
  • Allied health professionals can provide massage as part of a management plan, so it appears to be evidence-based in that context.
  • Presumably, therapies are no longer considered “evidence-based” when performed by someone who is not an allied health professional.

This policy creates a frustrating paradox: those most qualified to deliver massage therapy are not recognised by the National Disability Insurance Agency (NDIA) to provide it.

The NDIA is yet to release the Operating Guidelines that would officially clarify the position on remedial massage therapists within the NDIS subsequent to new legislation that came into effect in early October 2024.  The updated guidelines were meant to be published in early December 2024 but their publication has now been delayed until March.

Once AMT has wrangled the beginning of 2025 into submission, we will be working up the second phase of our NDIS campaign. With a federal election on the horizon, we have a unique window of opportunity to bend the ear of Members of Parliament and prove that a white horse is still a horse.

Please stay tuned.

About the author

Rebecca Barnett was a big fan of Mr Ed when she was a kid. After all, a horse is a horse of course of course. She also appreciates that Gertrude Stein knew a thing or two about naming things for what they are.

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Comments

  1. louella jolly
    28/01/2025 - 9:40 am

    Thanks Rebecca & AMT for your advocating & time chasing this issue.
    A conundrum indeed considering AMT were successful in onboarding us with AHPA to have us recognised & approved for the home care packages.
    A similar process is required for the NDIS.
    If the government & NDIS bodies are able to recognise us in the same capacity, (as meeting the requirements) then that will be a big win for us.
    On wards & up wards.

  2. Andrea Rivas
    28/01/2025 - 9:55 am

    Thank you Rebecca for always advocating for our Industry. It is so unfair that patients always tell us they see much better results with experienced and fully qualified RMT than when they seen by a Physio or Chiropractor (in some occassion for more than 5 visits with them) We are the last option.
    It is pretty obvious to me “Bureaucracy” and there is still a luck of Education even with politicians, to understand the results we do achieve.
    They obviously prefer to promote Allied Health practitioners (AHPRA) Recognised, due to a protected title not our level of experience we have. I don’t know they might get commissions from them or they are just plain bizarre in their way of thinking.
    In a way they do not respect their own grandmothers. Their great great grandmothers or grandmothers that knew what spices, plants or herbs to use to cure them naturally. Instead of saving millions of dollars in natural ways of healing and I feel this is what will make us poorer and sick in this country

  3. Enjoyed the conversation; feel the frustration. Does the fact the the NSW work cover authority approves and funds the provision of remedial massage services to its clients carry any weight in this battle? (In another era, I provided approved massage services to a person in receipt of an NDIS package.)

    • It’s a mixed bag. Some knowledgeable people have suggested that this can be used against us, given how the NDIS cuts have been executed i.e. the government will trot out the argument that participants can access services through other insurance schemes. Yes, it’s nonsense but not more nonsense than Shorten’s response.

  4. You STILL rock, Rebecca.
    I love your article and frustrations in the NDIA/BS saga.
    Alright.

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