What is Remedial Massage?
When attempting to define Remedial Massage it is important to understand who uses the term and for what purposes. As massage is not a regulated industry in Australia, Massage Associations and Private Health funds have seen it necessary to create their own professional standards and minimum training requirements. In that context, Remedial Massage is a title given to a Massage Therapist that has performed a certain amount of training at a certain quality at an approved Registered Training Organisation (RTO). This includes a minimum amount of training in ethics, standards of practice, anatomy, pathophysiology, practical massage skills and student clinic practice hours. After this training, the therapist may apply for membership with an organisation such as Massage & Myotherapy Australia (MMA) which will then keep their details up-to-date with private health funds such as Medibank, Bupa and HBF. These associations and funds will also require a current senior first aid certificate and a certificate of currency from an insurance provider.
Continuing Professional Education for Remedial Massage Therapists
In addition to the requirements just mentioned, a practitioner needs to remain relevant by ensuring they complete a certain amount of Continuing Professional Education (CPE). In the case of Massage & Myotherapy Australia, CPE comes under 4 broad categories:
- Professional & Technical
- Non-Technical: Personal Effectiveness
- Non-Technical: Business
- Professional Engagement & Industry Content.
CPE from these areas could include anything from attending conferences and courses to buying books or producing a business plan.
The Short, Simple Definition for Remedial Massage
Essentially, the defining element of Remedial Massage in Australia is that to qualify for joining an association and offering private health fund rebates, the associations and health funds must consider you a qualified Remedial Massage Therapist by their own definitions and standards. Medibank - Australia's largest private health insurance provider - defines Remedial Massage as follows: "Remedial massage is the systematic assessment and treatment of the muscles, tendons, ligaments and connective tissues of the body to assist in rehabilitation, pain and injury management." (Medibank 2017) Due to the lack of regulation, there is no law preventing any practitioner calling themselves a "Remedial Massage Therapist". They may also develop treatment plans, use similar modalities and achieve successful outcomes for their clients but they will not be able to offer private health fund rebates.
Remedial Massage in Other Countries
Remedial Massage is the chosen title within Australia, other countries use other titles such as:
|Canada||Registered Massage Therapist||RMT|
|New Zealand||Remedial Massage Therapist||RMT|
|New Zealand||Certified Massage Therapist||CMT|
|Washington State (USA)||Licensed Massage Practitioner||LMP|
|Most of USA||Licensed Massage Therapist||LMT|
|South Africa||Therapeutic Massage Therapist||TMT|
What is the Difference Between Remedial Massage and Relaxation Massage?
Some people like to define Remedial Massage in contrast to other styles of massage such as Relaxation Massage. The "Remedial" in the term Remedial Massage refers to the fact that it is aiming to treat one or more specific defined conditions. Some examples could include muscle spasm, postural issues or tension headaches. Relaxation massage on the other hand generally treats the whole body and aims to relax a person. Because Remedial Massage claims to be able to assist in the treatment of specific soft tissue conditions, there is an emphasis on assessing the issue, measuring the pain, discomfort and/or restricted range of motion, applying specific techniques tailored to the issue and then measuring the result. If the desired results are not achieved after carrying out the treatment plan, the therapist should refer the client to a Physiotherapist, GP or other highly qualified health care professional.
Which Modalities are Included within Remedial Massage?
Remedial Massage is not just one technique. Remedial massage therapists are usually trained in many different techniques or modalities such as:
- Deep Tissue
- Trigger Point
- Myofascial Release
- Sports Massage
- Manual Lymph Drainage
- Postural Analysis and Integration
- PNF, MET (and other active stretching techniques)
- Chair Massage
- Pregnancy Massage
Is Remedial Massage Effective? And if so for What Conditions?
There isn't a great deal of depth and breadth in the research for the effectiveness of massage. There is actually evidence that the 'advanced' techniques used by remedial massage therapists are no more effective that Swedish Massage (Ingram 2017) You may wonder why someone trained as a remedial therapist would be writing about that? The answer is that it's important for us to be critical of our professions otherwise we are letting confirmation bias get in the way of real science. Does that mean Remedial Massage is worthless? Certainly not. There are areas where massage seems to work quite well and on top of that, it's important to remember that just because there isn't currently strong evidence to support the usage of Remedial Massage to treat many ailments doesn't mean that evidence won't become available in future as more resources are put into massage research.
I’m now going to outline what I think are the main benefits of massage based on both scientific evidence and subjective experience.
The Latest Objective Research
In 2015, the Australian Government Department of Health published a comprehensive review of natural therapies called the "Review of the Australian Government Rebate on Natural Therapies for Private Health Insurance". Studies on the effects of massage for 46 clinical conditions were submitted. These included references to 99 Systematic Reviews (SRs) which included 158 random controlled trials (RCTs) involving more than 8,884 participants. Of the 46 conditions studied, 43 were discarded due to the inadequate quality of the RCTs. I will now summarise the findings of the few conditions that did have moderate quality evidence provided.
Moderate Quality Evidence
1. Chronic Low Back Pain - ReliefThe review found "Moderate quality evidence that massage is effective in providing immediate-term relief in patients with chronic low back pain". This relief refers to a reduction in the short term bothersomeness caused by Low Back Pain for people with chronic, non-specific Low Back Pain.
2. Pre-term Infants - Reduced Time Spent in HospitalThe review found a small body of low-quality evidence that suggests massage therapy may be effective in reducing the time pre-term infants spend in hospital.
Low Quality Evidence
3. Acute Low Back Pain - Immediate, Short-term Pain ReliefThere was a small body of low quality evidence which suggested that massage therapy may be effective in providing immediate, short-term pain relief for patients with acute low back pain.
4. Pre-term Infants - Weight Gain in Pre-term InfantsThere was a small body of low quality evidence which suggested that massage therapy may be effective in improving weight gain in pre-term infants. and two of those areas are for depression and anxiety. A meta-analysis completed in 2004 found that "Reductions of trait anxiety and depression were MT's largest effects" (Moyer CA, 2004).
Experiential and Subjective Effects
Remedial Massage can be Very Relaxing
Even though many trained Remedial Massage Therapists don't want to be compared in any way to those practicing relaxation massage, the fact remains that many people find Remedial Massage relaxing as well. Even though many of the techniques can be painful, the prolonged body contact and rhythmic motions whilst laying in a relaxing position often leads to the activation of the relaxation response in subjects receiving a remedial massage. Many people find that towards the end of a 60 or 90 minute massage, their digestion improves and they feel very grounded and relaxed. With stress being at epidemic levels, we should not be down playing that effect of what we do. RELAXATION IS A REMEDIAL EFFECT. Imagine if you were never relaxed, it could lead to all manner of disease and health issues.
Remedial Massage can Be Highly Enjoyable
It's common in our modern world for us to reward ourselves with things that are not health. The usual suspect would be junk food. We may say to ourselves "If I can complete this challenging task that I don't really want to do then I will 'reward' myself with a bar of chocolate" This sets up a pattern of rewarding good behaviour with things that may have a negative health impact. What about rewarding yourself for your achievements with a massage? Because massages feel great for many of us, they promote the release of hormones that make us feel good. The hormone oxytocin, for example, is associated with the positive feelings of bonding with other human beings and is shown to be increased by massage (Uvnäs-Moberg, K. 2004). So rather than taking drugs, eating bad food and partaking in other counterproductive rewards, massage may be an excellent choice for a truly positive reward.
Despite the lack of high quality evidence for the effectiveness of Remedial Massage for specific health conditions, the industry is growing rapidly. If there is no objective benefit, then people are certainly willing to vote with their wallets on the subjective benefits that they experience. Since massage is not a university level qualification, there is not a great emphasis on funding high quality research in the area so for now it seems we will have to decide for ourselves. Humans have been receiving massages since we first existed. Many mammals massage each other and evolved to be rewarded for this form of physical social contact. The government will continue to question the efficacy of Remedial Massage and the Massage Associations will continue to attempt to promote the industry as being effective. As it stands, you can still claim your remedial massage treatment with most health funds as long as you have it as one of your extras.
Australian Government Department of Health (2015). Review of the Australian Government Rebate on Natural Therapies for Private Health Insurance. Canberra, pp.10, 85-101. [Accessed 2 JUL. 2018].
Medibank's Remedial Massage Definition and Requirements for Benefit Payment. (2017). [ebook] Melbourne: Medibank. Available at: https://www.medibank.com.au/Client/Documents/Pdfs/Remedial_Massage_Definition.pdf [Accessed 9 Nov. 2017].
Ingram, P. (2017). Does Massage Therapy Work?. [online] Pain Science. Available at: https://www.painscience.com/articles/does-massage-work.php [Accessed 9 Nov. 2017].
Moyer CA, e. (2004). A meta-analysis of massage therapy research. - PubMed - NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/14717648 [Accessed 20 Jun. 2018].
Uvnäs-Moberg, K. (2004). Massage, relaxation and well-being: a possible role for oxytocin as an integrative principle?. pp.190-208. [Accessed 2 Aug. 2018]