Medical Massage vs. Wellness Massage

The way I understand and practice them, medical massage and wellness massage are two entirely different services.

Medical massage is medical care delivered to a patient under the direction of a prescribing health care provider and typically paid for by a third party.

Wellness massage is a consumer service delivered to a client who pays for the service themselves.

The table below is my attempt to clarify and elaborate on the differences between these practices (another table illustrates how clinical massage and relaxation massage fit in). This is an early draft of a work in progress. If you have comments, criticisms, or suggestions please leave a comment below.

Medical Massage

Wellness Massage

commercial context

health care system

personal service industry

customer relationship



dominant paradigm

scientific, problem-solving

intuitive, nurturing

reason for treatment

medical necessity

client request


functional outcomes

client satisfaction

termination of care

maximum medical improvement (usually)

when client’s needs are met or change

primary massage treatment techniques

clinical massage techniques like myofascial treatments, deep tissue massage, cross-fiber friction, neuromuscular “trigger point” technique, and muscle energy technique

relaxation massage techniques like Swedish, deep tissue, circulatory massage, and craniosacral


rates set by UCR and RVU

rates set by the consumer marketplace

billing services

yes (discount for payment at time of service)

no (all payments due at time of service)


can take 30-90 days or longer

due at time of service




therapist accountable to

  • patients
  • IRS/state/local taxes
  • state/city licensing authorities
  • certification boards
  • referring providers
  • other HCPs involved with case
  • insurance companies
  • health care networks
  • attorneys
  • courts
  • independent medical examiners
  • auditors
  • clients
  • IRS/state/local taxes
  • state/city licensing authorities
  • certification boards

Medical Massage

Wellness Massage

time spent on documentation, coordination, and communication

5-20 minutes or more per session

1-5 minutes or less per session


basic 500-hour massage certification course plus advanced training in

  • orthopedic assessment & treatment protocols
  • pathologies and contraindications
  • medical terminology
  • pharmacology
  • documentation
  • communication skills

basic 500-hour massage certification course


need clinical and professional experience and/or an internship

can start practicing right after graduating from massage school

receiver’s emotional state/level of proactiveness

didn’t ask to be injured, may be depressed, anxious, or otherwise distressed by both the injury/accident and/or ensuing work, life, and health complications

proactively seeking care, typically healthy and active

physical demands on practitioner

can be heavy – orthodpedic assessments, muscle energy techniques, myofascial treatments, cross-fiber frictioning, and other injury-treatment techniques can be hard on your body

may be lighter – Swedish and some other techniques are less demanding, but deep tissue massage can be hard on your body

emotional demands on practitioner

can be heavy – patients can be disengaged, distraught, or otherwise unengaged or difficult to engage

typically light and/or manageable

client education

may be OK (therapist should ask the prescribing referrer about this), but shouldn’t contradict what the rest of the medical team is saying

OK within scope of practice (“drink plenty of water,” “do that stretch I showed you,” “put an ice pack on it,” etc.)

marketing model

business-to-business networking with referring providers, health care networks, etc.; many legal and ethical considerations regarding referral relationships, etc.

consumer marketing (much like a tax preparer, hair dresser, real estate agent, etc.); gift certificates, referral discounts, and other consumer marketing practices are OK

Medical Massage

Wellness Massage

Clinical Massage vs. Relaxation Massage

Two other terms often arise in the process of distinguishing between medical massage and wellness massage. I primarily use clinical massage techniques, and approach my work with a clinical intention, in my medical massage practice, but I also take a clinical approach with some of my wellness clients. Similarly, I primarily use relaxation massage techniques in my wellness practice, but sometimes doctors prescribe massage for its relaxation benefits, so I sometimes use it in my medical practice. Here’s a graphical look at this idea:

Commercial Context

Medical Massage

Commercial Context

Wellness Massage

Treatment Intention

Clinical Massage

Problem-solution, “fixing” approach. Many assessments and systematic application of clinical massage techniques.

Treatment Intention

Relaxation Massage

Intuitive, nurturing approach. Creative selection of techniques. Can be mellow spa-like atmosphere, meditative, chatty and educational, or lively and invigorating, depending on client or patient needs.