How to Become a Massage Therapist

By: Katherine Rush, PT

Last Updated: Dec 10, 2018

Nothing feels better than a good back rub. But modern massage is about much more than pleasure and relaxation. A growing number of doctors, physical therapists and chiropractors are integrating massage and bodywork into their care. And as the elderly population grows rapidly in coming decades, massage may help millions to age more comfortably.

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Massage therapists are health care workers who manipulate the body’s soft tissues (including muscle, lymph and connective tissue) to promote wellness, relaxation and healing. Most are skilled in several modalities, or massage techniques, such as Swedish massage, sports massage, deep tissue massage or trigger point therapy. Massages can last from five minutes to 90, depending on the setting and the client’s goals.

Here are just a few of the things massage therapists do every day:

• Take clients’ health history and assess their goals for therapy
• Deliver massage and therapeutic touch treatments
• Provide wellness information to clients, which often includes tips on posture and stretching
• Teach stress management and relaxation techniques

In addition, self-employed massage therapists handle their business operations, which include billing, marketing, scheduling, cleaning and inventory.

The need for trained massage therapists is growing. More and more health care professionals are prescribing massage as a therapy for sports injury, chronic pain and headaches. Skilled massage therapists can help to reduce the side effects of cancer treatments, assist children with sensory disorders, and even ease the pain of childbirth. Gentle massage has been shown to enrich the lives of older people, including those with Alzheimer’s disease and related dementias.

A career in massage therapy can be hugely rewarding, and most therapists report a high level of satisfaction with their jobs. They love helping their clients achieve new levels of healing, relaxation and well-being. The social nature of massage makes it a great choice for “people” who value interaction and physical contact. Massage also offers a flexible schedule and the chance to practice in a variety of settings, from nursing homes to cruise ships.

Workplace Details

Most massage therapists work in several places, according to the American Massage Therapy Association (AMTA).

Health care settings where therapists may work include physician practices, chiropractic practices, physical therapy practices, hospitals or nursing homes.

Therapists are also employed by health clubs, hotels, cruise ships, massage franchises and sports teams. Some travel to private parties, conferences and sporting events to offer their services.

According to the AMTA, massage therapists work an average of 17 hours per week, which includes both massage time and business functions like billing and marketing. About half practice massage as a second job. Schedules are generally quite flexible, especially for self-employed therapists who can set their own hours. (This is less true in health care settings, where scheduling revolves around patient care.)

Most massage therapists serve all types of clients. Advanced training makes it possible to specialize in working with infants, children, pregnant women, the elderly and people with certain medical conditions.

Hover over any state to explore local income and job growth data.

According to the US Bureau of Labor Statistics (BLS), the median annual pay for massage therapists is $39,860. The lowest-paid 10 percent of therapists earn a median income of $19,720, and the highest-paid 10 percent earn a median $74,870.

When considering these figures, it’s important to bear in mind that most massage therapists work part-time and pay varies considerably across settings. Therapists working for a franchise might make as little as $15 per hour. Those in high-end spas can make considerably more, especially with tips. And self-employed therapists charged an average of $68 for an hour of massage, according to the AMTA.

Earning power generally increases with experience. It takes time to build up a robust clientele and repeat business. Certification can also boost earnings by allowing therapists to accept clients’ health insurance plans. (The number of plans covering massage is currently small but expected to grow in coming years.)

The future is looking bright for massage therapists. According to the BLS, employment of these professionals is expected to grow by 22 percent between 2014 and 2024, far faster than average. This trend is driven by a number of factors, including the growth of the spa industry and the availability of affordable massage franchises.

The profession is also getting help from health care professionals. Doctors, chiropractors and therapists increasingly include massage in their treatment plans. The growth of the elderly population is another boon for massage therapists. Older people are discovering the many physical and emotional benefits of massage. Hospice, palliative care and eldercare programs are increasingly incorporating massage into their services.

To improve their job outlook, massage therapists should consider pursuing Board Certification. Credentialed therapists are listed in NCBTMB’s searchable online database. Certification also allows therapists to accept some insurance plans. The AMTA Job Bank provides helpful resources for therapists who are looking to advance in their careers.

Admission to massage training programs generally requires a high school diploma of GED. Aspiring therapists can prepare in high school by taking classes in biology, anatomy, physiology and business.

Formal education in massage therapy is a prerequisite for licensure in most states. Massage therapy training programs are available through public and private career colleges and massage therapy schools. Certificate programs take 500-1,000 hours to complete, depending on state requirements. Some schools also offer two-year Associate of Science degrees. Curriculum typically covers anatomy, physiology, pathology, kinesiology, assessment, bodywork techniques, business knowledge and professional ethics.

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The National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) oversees massage schools to ensure that they meet basic curriculum requirements. In many states, candidates must graduate from an NCBTMB-assigned program in order to sit for the licensing exam. The Commission on Massage Therapy Accreditation (COMTA) provides additional voluntary accreditation for massage therapy training programs.

A good massage therapy program involves supervised, hands-on training appropriate to the student’s skill and educational level. Many programs include an internship, and therapists often seek additional supervision and volunteer opportunities before their first paid employment.

Board Certification as a massage therapist is voluntary, but opens up many opportunities. Certification streamlines the licensure process in many states. Some health insurance policies only cover massage by certified therapists.

NCBTMB administers the NCB, or Board Certification credential. To qualify, candidates must:

• Pay a $250 fee
• Complete 750 hours of initial and continuing education
• Complete 250 hours of hands-on massage experience within six months of graduation
• Pass a background check
• Obtain CPR certification
• Commit to uphold NCBTMB’s Standards of Practice and Code of Ethics
• Pass the Board Certification exam

Certification lasts for two years. NCB therapists must engage in 24 hours of continuing education every two years to maintain the credential.

Forty-four states and the District of Columbia regulate massage therapists. Depending on where you live, this could mean anything from meeting rigorous licensure requirements to simply registering yourself prior to practice. Please note that some cities and counties have additional requirements.

For licensure, candidates must prove that they’ve met the state’s educational requirements (usually 500 to 1,000 hours of formal training) and pass an exam. The most common tests are:

• Massage and Bodywork Licensing Exam (MBLEx), administered by the Federation of State Massage Therapy Boards
• National Certification Examination for Therapeutic Massage (NCETM), administered by NCBTMB
• National Certification Examination for Therapeutic Massage & Bodywork (NCETMB) administered by NCBTMB

Massage therapy offers a number of opportunities for growth and personal enrichment. With over 80 massage modalities in existence, there’s always something new to learn. Therapists can also focus on a clinical area like cancer care, sports massage, infant massage and even specialized sensory massage for children with autism spectrum disorders.

The majority of massage therapists eventually establish a private practice, even if they continue to work in other settings on the side. Franchising is another option - chains like Massage Envy, LaVida Massage and Zen Massage provide considerable startup assistance for new owners. Serving as a consultant to hospitals, nonprofits, spas and fellow massage entrepreneurs is also an option.

Many massage therapists find fulfillment in supervising the work of others. Some manage hospital-based massage programs, spa-based programs or cruise ship services. Others enjoy passing along their knowledge as massage instructors.

When beginning your massage therapy career, your first step should be to check state and local regulations. All but a few states now require massage therapists to be licensed. To be eligible, you’ll need to complete a massage therapy certificate program ranging from 500 to 1,000 hours in duration.

Most massage therapists train at private massage schools, but a few public two-year colleges also offer massage training. Before enrolling in a program, verify that it’s recognized by your state’s licensing board. Otherwise, you could end up with a worthless certificate.

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It’s also worth noting that not all massage therapy certificate programs are created equal. The National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) and the Commission on Massage Therapy Accreditation (COMTA) both endorse programs that meet basic curriculum and hours requirements. COMTA also offers more rigorous voluntary accreditation to schools that meet high quality standards.

Massage therapy students study the following subjects in the classroom:

In addition, students perform a certain number of massages under supervision of a licensed therapist. Many massage schools run community massage clinics in order to provide students with hands-on training opportunities.

An associate degree is a good choice if you want to:

• Add advanced massage techniques or additional modalities like wellness coaching to your practice
• Study communication, business, behavioral science, and the humanities in more depth
• Pursue a bachelor’s degree in the future (ask your school about articulation agreements and credit transfers)

Associate degree programs specifically in massage therapy are rare. However, many community colleges offer a holistic health major for students interested in integrated health careers, including massage therapy.

Holistic health coursework typically covers:

It’s important to note that earning an AAS in holistic health may not meet your state’s licensure requirements for massage therapists. To find out if additional classes are required, check with your academic advisor or state licensing board.

The National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) offers a voluntary board certification credential for therapists who demonstrate a commitment to continuing education, practice excellence, and ethics. In order to become board certified, you must document 750 hours of formal training and 250 hours of work experience. Candidates must then pass an exam and background check and sign an ethics agreement.

NCBTMB also offers several specialty certifications. To earn the following, you must complete an online course and pass an exam:

• Massage therapy for integrative healthcare
• Sports massage
• Military veteran massage
• Clinical rehabilitative massage

Many massage therapy schools and foundations offer specialty certifications. Before paying for a credential, make sure it’s worth the money and will help you meet your goals. Do some research and talk to current practitioners and clients. When possible, get a massage so that you can experience the approach as a patient.

The following are just a few organizations offering advanced certifications for massage therapists. Candidates must typically complete a training course and pass an exam.

Liddle Kidz Foundation specializes in therapeutic massage for babies, children, and teenagers:

• Certified Pediatric Massage Therapist
• Certified Infant Massage Teacher
• Hospital-based massage therapy
• Touch therapy for kids with a variety of conditions, including autism, trauma, and cancer

Rolf Institute on Structural Integration uses deep tissue massage to release tension and realign the body:

• Basic rolfing structural integration
• Rolf movement
• Advanced rolfing

Rosen Institute promotes wellness through a combination of movement and bodywork:

• Rosen Method Bodyworker
• Rosen Method Movement Teacher

The Compassionate Touch Certified Practitioner credential may be useful for therapists who plan to work with the elderly or in hospice or palliative care settings.