What type of massage therapy should doctors refer their patients for treatments? Part 3

by: Boris Prilutsky

Having devoted forty years of my life to the wonderful occupation of massage therapy I naturally often think about this profession at large and find myself deeply concerned with the direction it takes in the country where I live and work. My books, articles and medical massage educational videos are an outlet for me to share my thought, knowledge, and concerns with the rest of the professionals in the field and, hopefully, try to make a positive impact on it; for isn’t making a positive difference in occupation that you love, is the goal of every thinking person. This article is no exception.

In several latest articles I expressed a concern about the poor state of the massage industry in the present modern market economy and exposed the reasons of why this state is so poor. I also presented an opinion, in which direction the industry should go in order to be successful, and offered a series of practical steps in achieving it.

In short, my solution to a situation is to shift public perception of massage industry from the “feel good” often even “happy ending” theme to a much more serious perception of it as a part of medical industry.

In my recent article Is massage therapy recognized as a methodology of treatment? I outlined reasons why Massage therapy, despite all its health benefits, is only partially recognized by the medical community and was stating that if we are to survive as an industry, we need to cardinally change medical society’s as well as general public’s perception of massage therapy.

However, while I was writing this article, I didn’t know about the research article”Massage Therapy Attenuates Inflammatory Signaling After Exercise-Induced Muscle Damage” published in “Science Translational Medicine”

As I described it in the previous 2 parts of this article, the publication in “Science Translational Medicine” puts massage therapists at large in a much more advantageous position in regards to the medical field, thus offering an additional great opportunity to get a position within healthcare system, to survive as an industry, and to sustain ourselves as individual practitioners. The article disclosed massage therapy a valuable medical resource and, being published in one of the central medical publications, changed the perception of many doctors and other medical professionals in regards to massage as industry. In fact, the article made the medical field susceptible to the idea of hiring massage therapists as the part of their medical stuff or offering them referrals. So the time to act is now.

In which way referrals from medical doctors and other health care practitioners makes huge different in our practice?

With my arrival to the USA, I started working for a physical therapy department, which allowed me to develop financially sustainable, private practice, based on constant referrals from physical therapists, medical doctors and chiropractors. That’s why what I would discuss below isn’t a speculation, but a personal experience.

When doctors referring patients, patients arrive with a different mindset, which is extremely important. Your task is to explain and reinforce doctors’ directives:”in order to reach sustained results, you have to receive, at least, 10 treatments twice a week.”

Also, make it clear that even after receiving 10 treatments, implementing home programs and feeling very good, in order to prevent painful symptoms from coming back, it will be beneficial every 2 or 3 weeks to come for a full body stress management massage.

Let’s say you’ve developed 10 sources of referrals from health care professionals. Conservatively speaking, each source would refer you two new patients on weekly basis. With such a schedule, treatments made twice a week, will keep you very busy. I would recommend to use my advices on how to contact and talk to medical doctors as I described in part 2 of this article.

Of course, no amount of publications is going to matter unless we deliver results. Orthopedic massage modalities such as, lymphedema management techniques, trigger point therapy, fascia/muscles mobilization, hot and cold application, 50% of procedure time implementation of petrissage, etc., is not some new protocols or techniques. This is scientifically developed and for many decades clinically proven working methodology, leading to results. All mentioned modalities, address the causes of symptoms, including pain and dysfunctions. Implementing this methodology we achieve fast and sustained results.

What does it mean “sustained results”?

When testing treatment results, in any research control group, on average, 30% of “feeling better” reports are attributed to placebo effect. The distinction comes in evaluating objective factors such as range of motion.

Of course, if a patient says “s/he feels better” I am not about to challenge this; better is better. But please don’t let this keep you out of focus. We are not only after instant “feels good” results that last short period of time. Our ultimately goal is to achieve long lasting results.

If a methodology of treatment does not address causes of pain and dysfunctions in an adequate manner, in most cases, sustained results would not be achieved. Patients would come back to consuming painkillers, antidepressants, sleeping pills, etc. as well as being tempted to say: ”I tried massage, and, in the beginning it helped a bit, and then all symptoms came back.” This kind of statements are the most damaging and false impressing of what massage therapy is really all about, which is to apply adequate treatment and achieving long lasting, sustained results.

What can confuse or stand on the way of medical doctors giving us referrals?

As I stated in the part 1 of this article, the fact that our industry uses 1000 alternative names for massage therapy, i.e. has no standard naming convention, is very confusing both for the general public and healthcare professionals.

A few examples include neuromuscular therapy, soft tissue release therapy and myofascial tissue therapy. I always ask myself: “How else neuromuscular stimulation is provided if not by means of massage?” or “How else soft tissue (including myofascial tissue) is released if not by means of massage?” Why not call it “massage?”

Such excessive subdivision does not contribute to a more uniformed recognition by the general public and medical community and, in fact, may confuse those we’re trying to educate, as well to receive referrals. If this was up to me, I would stick with the following naming convention — if stimulation is enacted through the mobilization of soft tissues by means of massage, then I’d call it “massage therapy.” For example: neuromuscular stimulation medical massage, myofascial tissue release massage therapy techniques, etc

I know there is no one term to fit all the cases, but if you provide therapy by means of massage then why not call it simply massage therapy, medical massage, neuromuscular stimulation medical massage, myofascial tissue release massage therapy techniques. In such a case confusion would be avoided – the simpler the better.

I actually believe in simple approach to massage therapy, and even called my book : ”Simple approach to medical massage.” “Simple approach” does not actually mean simplified version of scientifically developed protocols. It is just very simple to understand and perform not complicated techniques that are equally as effective.

More so, I don’t think it is possible to have 1000s different concepts and approaches in treating the same abnormalities. The nature of pathologies and pathogenesis in cases of skeletal muscular / back and limp disorders, in most cases, are the same. In most cases, they expressed as a lymphedemas formation, tension within muscles and fascia, developing of trigger points, and significant decrease in blood supply.

The nature of healing and recovery process is also the same. Unless applied techniques address mentioned above abnormalities in adequate manner, results cannot be sustained. Surely the techniques could be somewhat different. But how many variations could there be – a thousand?

One of my “social media” opponents, in regards to learning quoted the following motto coined by MIYAMOTO MUSASHI, the martial arts master and artist of his trade, as well as a teacher: “The purpose of today’s training is to undo what we learned yesterday.”

However, what is applicable in one field is not quite applicable to other, especially in such a conservative field where experimental failure might easily inflict a loss of human life. Fitness and martial arts is a different business. In medical science what we learned yesterday, assuming it was clinically proven, is a good enough for today and maybe forever. Surely, life goes forward. But applying to the medical science I would try to rephrase MUSASHI’s phrase in the following way. “The purpose of today’s training possibly can be a platform to new studies and maybe discoveries of tomorrow.”

All new discoveries/theories must be clinically proven as safe and effective methodologies, and it takes time. Also, by nature of things, one can improve his/her shape and martial arts techniques considerably fast. This speed and approach is not applicable to medical physiology. Not much new could be implanted in long-ago established physiological effect of massage data, pathology, histology, etc. Therefore, if you practice methodology that producing sustained, side effect free results there is no need to constantly look for alternative methodologies.


Dear friends,

I’m not full-time continued education provider but also a practicing massage therapist. All what I am proposing is proved to work, including my recommendation how to take advantage on publication in “Science Translational Medicine.”

Incidentally, recently, a group of scientists from Cedars-Sinai medical Center it Los Angeles conducted significant studies on the effects of a Single Session of Swedish Massage on Hypothalamic–Pituitary–Adrenal and Immune Function in Normal Individuals. In case and if you will decide to follow my advices , in addition to Tarnopolsky/Melov research article ,I would recommend to refer MDs to read preliminary study report published at the “National Institute of health Public Access Author Manuscript. “

Doctors respect and would read this publication, and will consider you as a medical massage practitioner.

Doctors don’t like to be lectured, about medicine therefore just briefly mention that in this study scientist tried to determine the effect of massage on arginine-vasopressin (AVP), adrenal corticotropin hormone (ACTH), cortisol (CORT), circulating phenotypic lymphocytes markers, and mitogen-stimulated cytokine production.

As a result it caused a significant effect size decrease in AVP, it increased the number of circulating lymphocytes, and much more.

Integration with healthcare and medical society is not a leap of faith or a speculation, but a practical consideration based on the successful experience. I am the founding director of South California Health Institute, also known as a Institute of Professional Practical Therapy, school of massage, physical therapy aide and chiropractor assistant program. During 18 years, many practitioners graduated from this school, which were prepared to work as an independent massage therapist and, at the same time, to work in a medical office setting.

The school has thousands of registered employers: such as SPAs, massage centers, medical doctors, physical therapists, chiropractors, clinical psychologists, nurse practitioners. Following my footsteps, the school graduates, have made and continue making successful careers, helping many patients, as well as earning a solid income, allowing them to support themselves and their families.

I strongly believe that SPAs and massage centers should approach healthcare society for referrals. I also believe that massage schools should adjust curriculum to prepare graduates for work in health care system.

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