Massage Therapy: Riddled with Quackery
Stephen Barrett, M.D.
Massage is customarily defined as manual (by hand) manipulation of the soft tissues of the body for therapeutic purposes, using strokes that include gliding, kneading, pressing, tapping, and/or vibrating. Massage therapists may also cause movement within the joints, apply heat or cold, use holding techniques, and/or advise clients on exercises to improve muscle tone and range of motion. The best known forms are sports massage, which focuses on muscle systems relevant to a particular sport; and Swedish massage which uses long strokes, kneading, and friction techniques on muscles, plus active and passive movements of the joints. The term "bodywork" encompasses traditional massage, other touch therapies, and some methods that involve manipulation of imaginary forces to maintain or restore "balance." 
Ordinary massage and the legitimate practice of massage therapy should not be categorized as quackery. Massage can help people relax, relieve aching muscles, and temporarily lift a person's mood. However, many therapists make claims that go far beyond what massage can accomplish. And even worse, massage therapy schools, publications, and professional groups are an integral part of the deception.
There is no evidence-based reason to believe that massage can influence the course of any disease. Yet the American Massage Therapy Association (AMTA) Web site has claimed that that therapeutic massage can help with allergies, asthma, bronchitis, spastic colon, constipation, diarrhea, and sinusitis . The site also suggests that "massage is to the human body what a tune-up is to a car" and that "therapeutic massage can be part of your regular healthcare maintenance." And a 1997 AMTA booklet falsely states that massage can promote easier breathing, assist with removal of metabolic wastes, strengthen the immune system, and help prevent disease .
The following methods are an integral part of the massage therapy marketplace. None has a scientifically plausible rationale or has been shown to favorably influence the course of any physical ailment. Several are claimed to detect and manipulate subtle "energies" that have not been scientifically demonstrated. And none (except perhaps for the use of aromatic oils if clients enjoy their odor) has any rational place in the practice of massage therapy.
- Acupressure and shiatsu are often described as "acupuncture without needles." They are based on metaphysical concepts of traditional Chinese medicine, which holds that "life energy (chi or qi)" flows through hypothetical (imaginary) channels called meridians and that ill health is due to energy blockages and/or "imbalances." Practitioners claim to restore health by correcting these alleged imbalances. They may also use irrational diagnostic methods to reach diagnoses that do not correspond to scientific concepts of health and disease.
- Aromatherapy involves the use of aromatic oils from plants to affect mood or promote health. The oils are administered in small quantities through inhalation, massage, or other applications to the skin. Aromatherapy products include diffusers, lamps, pottery, candles, pendants, earrings, shampoos, skin creams, lotions, bath salts, and shower gels. The aromatic oils are alleged to contain hormones, antibiotics, and antiseptics, and to represent the "life force," "spirit," or "soul" of the plant. Some proponents claim that aromatherapy is a complete medical system that can "revitalize cells," strengthen defense mechanisms, and cure the cause of disease. Although pleasant odors may enhance a person's effort to relax, there is no scientific evidence that they can influence the course of any disease . In addition, some people are allergic to aromatherapy products or find that their irritate the lining of their nose.
- Colonic irrigation (also called colon hydrotherapy) is typically performed by passing a rubber tube into the rectum for a distance of up to 20 or 30 inches. Warm water is pumped in and out through the tube, a few pints at a time, typically using 20 or more gallons. Some practitioners add herbs, coffee, or other substances to the water. The procedure is said to "detoxify" the body. Its advocates claim that, as a result of intestinal stasis, intestinal contents putrefy, and toxins are formed and absorbed, which causes chronic poisoning of the body. This "autointoxication" theory was abandoned by the scientific community during the 1930s. No such "toxins" have ever been identified, and careful observations have shown that individuals in good health can vary greatly in bowel habits. Proponents may also suggest that fecal material collects on the lining of the intestine and causes trouble unless removed by laxatives, colonic irrigation, special diets, and/or various herbs or food supplements that "cleanse" the body. The falsity of this notion is obvious to doctors who perform intestinal surgery or peer within the large intestine with a diagnostic instrument. Fecal material does not adhere to the intestinal lining. Colonic irrigation is not only therapeutically worthless but can cause fatal electrolyte imbalance. Cases of death due to intestinal perforation and infection (from contaminated equipment) have also been reported .
- Craniosacral therapy (also called cranial therapy) is based on the notion that bones of the skull are movable and can be manipulated. Some practitioners claim to attune themselves to the patient's "rhythm" while holding the patient's skull in their hands. Some claim to improve the flow of "life energy," thereby curing or preventing a wide variety of health problems. Some claim to remove blockages to the flow of cerebrospinal fluid. Some claim to realign the skull bones. Actually, the bones of the skull fuse early in life and cannot be moved independently .
- Polarity therapy is a system of manipulation, stretching exercises, clear thinking, and diet, which claims to restore health by removing blocks and balancing the flow of "life energy" between the positive (head) and negative poles (feet) of the body. There is no scientific evidence that this energy flow exists. Yet a recent article in AMTA's journal claims that polarity therapy "will become one of the premier wellness modalities for the 21st century" and that "recent and intensified interest in polarity therapy stems from its increasing success in preventing or treating such conditions as stress, arthritis, frozen shoulder, chronic fatigue syndrome, cancer, trauma resolution and back pain." 
- Reiki practitioners claim harness and transmit "universal life energy" by placing their hands in specific positions on or near the body; or they can visualize special symbols that supposedly enable them to send "healing energy," even from far away . One form of reiki, The Radiance Technique, is claimed to be useful for mental, emotional, physical, and spiritual balancing. Some practitioners claim that Reiki can increase the healing energy of food . The existence of "universal life energy" has not been demonstrated.
- Reflexology (also called zone therapy) practitioners claim that each body part is represented on the hands and feet and that pressing these areas can have therapeutic effects throughout the body. Proponents claim that the body is divided into ten zones that begin or end in the hands and feet, and that each organ or body part is "represented" on the hands feet. They also claim that abnormalities can be diagnosed by feeling the feet and that pressing each area can stimulate the flow of energy, blood, nutrients, and nerve impulses to the corresponding body zone. Many practitioners claim foot reflexology can cleanse the body of toxins, increase circulation, assist in weight loss, and improve the health of organs throughout the body. Some claim that reflexology is effective against a large number of serious diseases. The pathways postulated by reflexologists have no anatomic basis; and no well designed study has demonstrated that reflexology is effective against any disease. Done gently, reflexology is a form of foot massage that may help people relax temporarily. Whether that is worth $35 to $100 per session or is more effective than ordinary (noncommercial) foot massage is a matter of individual choice .
- Therapeutic Touch practitioners claim to detect and correct "energy imbalances" by moving their hands above the patient's body. Healing supposedly results from transfer of "excess energy" from healer to patient. Neither the forces involved nor the alleged therapeutic benefits have been demonstrated by scientific testing. Moreover, a study published in 1998 found that 21 TT practitioners were unable to detect the experimenter's "energy field." 
Questionable Organizations and Standards
The main standard-setting organization for massage therapists is the American Massage Therapy Association (AMTA), which was founded in 1943 and represents about 47,000 massage therapists in 30 countries . AMTA's official publication, Massage Therapy Journal, has four issues per year. Most issues contain articles that advocate quack treatments, and all issues contain ads for dubious courses and products. The second largest professional group, the Associated Bodywork and Massage Professionals (ABMP), has about 37,000 members and publishes an equally low-quality magazine called Massage & Bodywork. A 2001 survey of ABMP members found that 44.6% of respondents said they used reflexology, 37.9% said they used "energy healing," and 30.4% said they used shiatsu .
In 1982, AMTA formed its Council on Schools to provide a forum for member schools to discuss the development of the field and to participate in workshops and seminars for massage educators. Member schools are required to operate a minimum 500-hour program of study and meet all legal requirements for operation within their jurisdiction. In 2001, there were about 350 members.
In 1989, AMTA established the Commission on Massage Therapy Accreditation (COMTA) which accredits massage therapy training programs . COMTA's accreditation standards do not required that teachings be scientifically valid or that quack assertions be accompanied by disclaimers. In other words, if a school wants to teach that nonmaterial "energies" exert therapeutic effects, it is not required to inform students that no such forces have ever been scientifically demonstrated. But even worse, if a school elects to offer a program in "Body Therapies of Asia," it is required to teach a long list of notions that do not correspond to scientific knowledge of human anatomy, physiology, health, and disease . And new competency standards scheduled to take effect on March 1, 2003, endorse these notions in even greater detail, as well as the use of sound and color therapies . According to a COMTA spokesperson, these standards were requested by the American Organization for Bodywork Therapies of Asia (AOBTA), which represents practitioners of various therapies that were rooted in ancient China. As of May 7, 2002, 19 schools were participating members of AOBTA's Council of Schools and Programs (COSP). The AOBTA Web site describes 13 methods which it says are "based upon traditional Asian medical principles for assessing and evaluating the energetic system and use of traditional Asian techniques and treatment strategies to primarily affect and balance the energetic system for the purpose of treating the human body, emotions, mind, energy field and spirit for the promotion, maintenance and restoration of health."  In line with this, a 2001 COMTA memorandum included "balanced energy flow" in a list of general benefits of massage 
About 65 schools now have COMTA accreditation. COMTA is not recognized by the U.S. Secretary of Education but in December 2001 was recommended for approval by the department's advisory committee. Since the Secretary has granted approval to an astrology school, there is no reason to believe that the unscientific teachings of massage therapy schools will prevent COMTA from being approved.
In 1992, AMTA initiated creation of the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB), more than 40,000 massage therapists are now certified . NCBTMB is recognized by an interdisciplinary organization called the National Commission of Certifying Agencies (NCCA). However, NCCA accreditation is limited to a review of the structure of the certification program and the process used to measure competency. It does not imply endorsement of a profession's core beliefs or examination contents .
As of December 2005, 36 states and the District of Columbia regulate the practice of massage therapy. Most have an independent massage therapy licensing board, but some use the state health department or another professional board for this purpose. All require at least 500 hours of instruction at an accredited school, but a few require as many as 1,000 hours . (A 500-hour course usually takes six months to complete.) In most states, NCBTMB's National Certification Examination for Therapeutic Massage and Bodywork is the standard for licensure. Yet NCBTMB appears to have endorsed many quack concepts! Its candidate handbook, for example, indicates that certification candidates are expected to answer approximately 15 questions about metaphysical concepts of traditional Chinese medicine, palpation to assess "craniosacral pulses" and "energy blockages," therapeutic touch, "energetic effects of nutrition," "manual contact and manual manipulation to affect . . . the energy system," and several other practices based on quack concepts .
Several years ago, a very bright young woman sent me a vivid report of her recent experience as a student. The dubious practices she encountered included acupressure, craniosacral therapy, ear candling, reflexology, muscle-testing for allergies, reiki, lymphatic massage "to remove toxins," and various other practices claimed to detoxify the body. Although she did not wish to provoke her colleagues, she did give me permission to post her account anonymously .
Using the Internet, I have examined the course offerings of dozens of massage therapy schools and found that nearly every one of them advocates and teaches one or more of the quack practices mentioned in this article. It would be interesting to know whether any of the accredited schools are entirely free of unscientific teachings.
The Bottom Line
Ordinary massage and the legitimate practice of massage therapy can help people feel better. However, many practitioners falsely claim to do much more, and the agencies that oversee the educational and licensing systems display no evidence of concern about this. If you seek help from a massage therapist, try to select one who does not espouse the irrational beliefs or practices mentioned in this article. Al Wuthnow, MS, CMT, who practices in Mill Valley, California, has summed up the situation very succinctly:
I've been astounded over the years at the outlandish claims made by many body workers. It's wonderful to get a great massage. It does increase circulation, gives temporary relief to pain, provides a sense of well being, and promotes relaxation, but I don't know of anything (other than the blues) that it has ever cured. People need to realize that just because it is a wonderful pleasure that does not make it good medicine. A few pointers for consumers:
- If the therapist tells you what is wrong with you, the therapist is probably wrong and breaking the law to diagnose.
- If the therapist tells you to take "such and such" to help your problem, don't do it until you check with a real doctor.
- If the therapist tells you to see a dermatologist because they are concerned about a mole on you back or elsewhere, DO IT!
- If a therapist asks you about a lump in your breast or elsewhere and it has not been checked out by a medical professional, it is probably a good idea to see your doctor.
- If your therapist is an ethical one, take a deep breath or two, and enjoy the massage.
- Claire T. Bodywork: What Type of Massage to Get—and How to Make the Most of It. New York: William Morrow and Co., 1995.
- Massage therapy: Enhancing your health with therapeutic massage. AMTA, 1999.
- A Guide to Massage Therapy in America. Evanston, IL: American Massage Therapy Association, 1997.
- Barrett S. Aromatherapy: Making dollars out of scents. Quackwatch, Aug 22, 2001.
- Barrett S. Gastrointestinal quackery: Colonics, laxatives, and more. Quackwatch, Nov 26, 2001.
- Barrett S. Craniosacral therapy. Quackwatch, Aug 21, 2001.
- Kennedy ED. Polarity therapy: "Going wireless." Massage Therapy Journal 40(4):60, 2002.
- Barrett S. A close look at reflexology. Quackwatch, May 6, 2002.
- Rosa L, Rosa E, Sarner L, Barrett S. A Close Look at Therapeutic Touch. JAMA 279:1005-1010, 1998.
- AMTA home page, accessed May 5, 2002.
- Member profile/survey results. ABMP Web site, accessed May 7, 2002.
- AMTA fast facts. AMTA Web site, accessed May 5, 2002.
- Policies, Procedures, and Standards Manual. Evanston, IL: COMTA, Oct 2000, pp 21-23.
- New competency standards (effective 3/1/03), pp 1-5.
- General definition and scope of practice. AOBTA Web site, accessed May 7, 2002.
- Schwartz J, Ostendorf C. Memo to COMPTA school owners/directors and other interested parties. Aug 21, 2001.
- Consumers' guide to therapeutic massage and bodywork. NCBTMB Web site, accessed May 5, 2002.
- Frequently asked questions. National Organization of Certifying Agencies Web site, accessed May 6, 2002.
- Massage practice laws information guide. AMTA Web site, accessed May 5, 2002.
- NCBTMB National Certification Examination Candidate Handbook. McLean, VA: National Certification Board for Massage and Bodywork, 1999-2001.
- Anon. A massage school experience. Submitted to Quackwatch in 1997.
Unfortunately, I don't believe there are any massage therapy schools free of unscientific teachings. I am qualified to comment, having completed what is probably the most scientifically sound massage therapy curriculum in the world: a 3000-hour training program in the most regulated jurisdiction for this profession anywhere (British Columbia, Canada). For about four decades, registered massage therapists here were regulated by the same legislation that applied to physiotherapists, and we were a part of the health care system and paid with public health insurance dollars. In 1995, the Government of British Columbia designated massage therapy as an independently regulated profession, with increased standards for training and certification. Certification now requires three years of training and extensive government examinations on anatomy, physiology, pathology, orthopedic assessment, and many physical therapies practiced in common with physiotherapists. The great majority of our practice is devoted to facilitating recovery from musculoskeletal dysfunction and injury.
In spite of this, my education was still sprinkled with seminars and classes on the likes of therapeutic touch and reiki, craniosacral therapy, and other questionable therapies discussed in your article—all presented without a whiff of scientific curiosity. Our knowledge of these subjects was NOT tested in our certification exams, which makes me wonder, in retrospect, why we students were not more openly outraged. Perhaps it was because many of the students were, not surprisingly, even more credulous than some of the instructors! One science-friendly instructor was once shouted down by most of my class because they were angry that he had presented scientific evidence that massage therapy does not meaningfully "increase circulation"—one of the sacred cows of the profession.
Thankfully, quackery as egregious as ear candling was never taught at my school, and I suspect that in general we were much more free of pseudoscientific teaching than most massage therapy students. However, there was definitely a small but steady supply of nonsense being taught—and if it was being taught there, I doubt that any massage therapy school in the world is free of it.
This page was revised on March 9, 2006.