Medical Massage vs. Wellness Massage

June 25, 2004

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	patient	client
dominant paradigm	scientific, problem-solving	intuitive, nurturing
reason for treatment	medical necessity	client request
focus	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
pricing	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)
payment	can take 30-90 days or longer	due at time of service
tipping	never/rarely	often
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
training	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
experience	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.