A quirky guide to Massage Therapy services in Vancouver, Canada

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. That’s pretty great, but 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.

What’s unique about massage in Vancouver?

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 more progressive and medicalized than anywhere else in the world. On the other hand, it still 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.

Hello, my name is John, and I’ll be your fascia ripper today

Please beware of no-pain-no-gain “fascial release” — a common style of treatment in Vancouver.

Another special thing about the Vancouver massage scene is the prevalance of a brutally intense style of massage, much beloved by many RMTs here.

I have experienced these treatments myself, and I also met countless “refugees” from fascial release while working as a therapist — patients who had terrifying, traumatizing experiences with amazingly rough treatment. This is genuinely hazardous to many patients for many reasons. For example, chronic pain often has a neurological component, which can be seriously exacerbated by overly strong treatment.

While there are certainly some patients who like extremely strong handling, most do not, and it is often dangerous. RMTs should be able 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. “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, almost 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 omelette.” 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.”

Hippy heaven on our doorstep

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 mostly just New Agey with none of the genuine counselling substance that Haven has.)

So just how well-trained are massage therapists in BC?

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 (three 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 …

Some problems with massage therapy in BC

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, practical experience with many more and much sicker people, and generally far higher scientific literacy. Massage therapists really have just a little basic knowledge of most pain problems and injuries.

And a little knowledge can be a dangerous thing.

Few massage therapists are scientifically literate, but they think that they are because they sweated bullets through a few science classes (and barely passed). Many struggled with the training not because the classes were particularly hard, but because they were weak students to begin with who chose massage therapy 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 poor clinical reasoning, which is then passed on to the consumer in the form of many expensive therapeutic recommendations with no basis in reality. Consider this example of gross incompetence …

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 told him to avoid — 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. He would have failed any basic test of shoulder anatomy; he 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 arrogance and ignorance I’ve ever witnessed, I’m sorry to say it’s not really unusual, and I’ve often heard worse.

And that guy wasn’t even a flake. He actually liked medical 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.

Finding a good therapist: the high-maintenance test

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. Don’t be shy.

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.

Finding a good therapist: maybe the right clinic is the answer?

Sometimes people wonder if a particular clinic is the answer to finding a good therapist. It’s a good idea … in theory. In practice, I really can’t recommend a clinic in Vancouver. Therapists of widely varying quality come and go constantly at all clinics — they’re just renters, paying for the space. There’s never any serious cohesion or clinic “philosophy” to speak of, no real clinical quality control. Many clinics certainly aspire to that ... but how clinic owners define quality usually differs radically from how I would define it.

For instance, I know of one clinic in particular that is certainly quite idealistic, but they also rent to a number of professionals that I would describe as total quacks peddling things that should be illegal. And one of the best and most rational massage therapists in the city that I know of — booked solid and not taking new patients, of course — works in a clinic with an old-school Jesus-freak of a chiropractor who sells dodgy supplements!

So you want to become a massage therapist

Where should you go to school? There are two schools. 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.

Where can I get more information about massage therapy in British Columbia?

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.