by Paul Ingraham, retired massage therapist
In British Columbia, Canada, a registered massage therapist (RMT) is a health care professional with 2–3 years of training. Thus RMTs here are literally the best-trained massage therapists in the world. As great as that sounds, not all is well. This irreverent and quirky guide to massage therapy in the city of Vancouver is not all sugar and spice and everything nice. As a former member of the profession, with a busy downtown practice from 2000–2010, I have some cautions for consumers, and advice about how to find a good massage therapist here.
Vancouver is a New Age mecca. Nowhere else on Earth can you find more and better marijuana, you can’t huck a stick here without hitting a hippy, and there are more alternative medicine clinics than gas stations. The population of RMTs alone is enormous, never mind all the unlicensed “body workers”: masseuses, rolfers, reflexologists, acupressurists, lomi lomi practitioners, hot stone massagers, and so on and on.
If you want a massage in Vancouver, you have a lot of options.
Vancouver is one of the only places in the world where you have well-trained medical massage therapists working next door to sex-trade workers offering happy endings. There are spas here that exclusively employ RMTs — most notably Absolute Spa (which started the trend), just up the street from me — resulting in what is quite likely the best spa massage experience in the world.
Vancouver massage is schizophrenic: on the one hand, the profession here is progressive and more “medical” than anywhere else. On the other hand, it attracts practitioners who take their horoscope seriously and offer a many “therapies” of dubious value … at some of the highest prices anywhere.
The most expensive massage I’ve ever paid for was $110 for a psychiatrists’ hour (50 minutes), and the practitioner had Scientology posters, crystals everywhere, and enough essential oils to give an ox a splitting headache. Sure, you can encounter something like that anywhere — but Vancouver has more than its fair share.
Please beware of no-pain-no-gain “fascial release.”
Another “special” thing about the Vancouver massage scene is the prevalance of a brutally intense style of massage, much beloved by many RMTs here thanks to the influence of a popular instructor, Natale Rao. I did an internship with Natale and had more intensive and direct exposure to his style and ideas than most of his students, and I did not care much for it. We were cooly civil to each other for the duration of my internship, and then never spoke again: he didn’t like me, and I didn’t like him.
In my own career as an RMT, I met countless “refugees” from fascial release — patients who had terrifying experiences with amazingly rough treatment. This is hazardous to many patients for many reasons. While there are certainly some patients who like extremely strong handling, most do not, and it is often dangerous. I think it’s appalling that so many Vancouver RMTs fail to identify the patients who do not enjoy feeling like their skin and ligaments are going to rip.
More than one therapist has lost me as a client this way. One day one of my favourite therapists, a woman who had previously provided me with many pleasant massage experiences, announced that her enthusiasm for fascial therapy had been given a boost by a weekend workshop with none other than Mr. Rao. “Oh, Lord,” I thought. “Here we go.” She became fixated on my shoulder, where she believe she had identified a “restriction.” She plunged her fingertips deep into my armpit and — this is the incredible part — stayed there, virtually unmoving, for over 20 minutes. I politely protested during this time, attempting to communicate how little fun I was having, but she breezily justified her approach with glib no-pain-no-gain-isms: “it will feel so good when I stop, ha ha,” and “sometimes you have to break some eggs to make an omellette.” Holy shit, really? It was a miserable hour. I was sore for days without any apparent benefit.
I never returned.
For ten years, I listened to patients report similar experiences. I get “me too” emails from people reading this page. When I was in practice, I asked every patient if they had ever left a massage therapist and why. The most common answer?
“Too much pressure.”
In the Gulf Islands just offshore are two of the best flaky destination resorts in the world, like California’s famous Esalen. There used to be dozens or even hundreds of these hippy retreats around the world, but only a handful remain, and two are right here on our doorstep. At Hollyhock you can get your fill of drumming circles and shamanic healing workshops. And Haven is certainly the best place on earth to scream your troubles into a pillow in the middle of a circle of people you met two days before but already feel like you know better than your own family. If you like that sort of thing.
I do, actually.
I could really do without the New Age baggage, but I quite like Haven. A critical thinker can just ignore the sillier stuff and still extract tremendous value from most of their workshops. The real focus of Haven is the relationships and interactions with other participants (it’s actually a counselling school). I particularly recommend Haven for anyone struggling with serious chronic pain.
(Hollyhock is quite different. From what I know of it, Hollyhock is all New Age bullshit with nowhere near the personal growth substance that Haven has.)
Until 1995, RMTs were regulated by the same legislation that applied to physiotherapists, and were a part of the health care system. Then the Government of British Columbia designated massage therapy as an independently regulated profession with dramatically increased standards for training and certification. Massage therapists now have to have a 3000-hour (two year) education. Training includes:
When school is complete, students must pass gruelling certification examinations: nearly half of my class failed on their first attempt. I passed and entered the profession with some pride and accomplishment. I had learned a great deal — and proved it. However, there are reasons not to be so proud …
Musculoskeletal health care is surprisingly primitive, with many significant gaps in our knowledge of what works, what doesn’t, and why. Three years of training sounds pretty good, and it’s certainly more than most other places, but it’s actually not really all that impressive: every doctor has much more training and generally much higher scientific literacy than the vast majority of massage therapists (or chiropractors, or physiotherapists). Massage therapists really only have just a little basic knowledge of most pain problems and injuries.
And a little knowledge is a dangerous thing.
Few massage therapists are even remotely scientifically literate, but they think that they are because they sweated bullets through a few science classes (and barely passed). Most struggled not because the classes were hard, but because they were weak students to begin with who chose massage because it seemed more cool than becoming a dental hygienist.
When medical science contradicts the beliefs of therapists like this, they trash talk it as “just another kind of faith.” But when they think science backs them up — usually incorrectly — they are only too happy to claim science as their own. The result is truly crappy clinical reasoning, which is then passed on to the consumer in the form of expensive therapeutic recommendations with no basis in reality. And I’m being polite about this. If I were being less polite, I’d say that way too many massage therapists are about as bright as a sack of hammers, delusional flakes, arrogant beyond belief about their “power” to heal people, and unethically selling crap every working day of their lives.
For instance: in the summer of 2008 I traumatically dislocated my acromioclavicular joint, nearly destroying the ligaments and joint capsule. It was hanging by a (painful) thread. The diagnosis was blatantly clear. However, one RMT not only carelessly manipulated the shoulder, which I had carefully asked him not to do, but spent much of the hour playing Dr. House and cooking up diagnoses for it, all based on hopelessly wrong anatomy and pathology. It was a differential diagnosis train wreck. This guy not only didn’t know his shoulder anatomy, but had most of it bass-ackwards and still thought he was some kind of diagnostic prodigy. Although it was probably the most appalling displays of clinical ignorance I’ve ever witnessed, I’m sorry to say it’s not all that unusual.
And that guy wasn’t even a flake. He liked science — he just didn’t understand it.
Like all of “alternative” heath care, it turns out that my profession is dominated by people who believe that we should provide services that are an alternative to science, that science is the enemy. This unfortunate attitude is so pervasive that, over the years, my pride in being a massage therapist slowly evaporated away. I found it all so disheartening that I retired from the profession — it was just too full of crap.
So how do you find a good therapist? Politely stress test them.
When you start with a new therapist, ask for what you want. Be nice, but be demanding. In particular, be demanding about pressure. Ask for changes. Say things like, “That’s a bit too strong for me right there, could I get a little less?” If they give you a “no pain, no gain” response, say, “Sure, okay, that makes sense, but I’d still like a little break from the intensity for a couple minutes — I need to catch my breath and relax a bit.” Or, if it’s too fluffy a treatment for your tastes, ask for more pressure.
If your therapist doesn’t seem to hear you, or is dismissive, never go back. This is the single most efficient (and likely) way of eliminating therapists who aren’t worth paying.
Practically everyone needs a therapist who is competent in the assessment and treatment of trigger points (muscle knots). Especially if you are looking for help with a serious pain problem, you may wish to give this test openly before you even book an appointment: let your fingers do the walking, call therapists up, and just ask them if they know the work of Drs. Janet Travell and David Simons. Be open. Tell them you are looking for a therapist with specific skills. Be a consumer about it, and just ask: do they have the big red textbooks? Do they at least have a dog-eared copy of Clair Davies’ popular translation of the big red texts, The Trigger Point Therapy Workbook?
If they don’t immediately say, “Of course,” then thank them for their time and keep looking.
My alma mater, The Okanagan Valley College of Massage Therapy (OVCMT), is in the sleepy little town of Vernon. It’s a small school in a small town, and it has a lovely, relaxed atmosphere — sometimes almost catatonic, actually. Generally speaking the administration is excellent and easy to talk to. On the down side, OVCMT struggles to attract top-notch teachers, and I’m sorry to say that much of the instruction in my three years there was incredibly incompetent. I feel that I succeeded academically in spite of much of the instruction, instead of because of it.
The West Coast College of Massage Therapy (WCCMT) in New Westminster is large and impersonal in comparison with OVCMT. But, being in a big city with two universities and many colleges, they can attract much better instructors than OVCMT. That’s probably more important, so my vote goes to WCCMT, despite my warm feelings towards the Vernon school. There is also a campus of WCCMT in Victoria, if you prefer a medium-sized city.
The Massage Therapists Association of British Columbia has a good website. See also the College of Massage Therapists of British Columbia, responsible for regulation of the profession.