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28 m a s s a g e & b o d y wo r k m a rc h /a p r i l 2 0 2 1 Moving Out of the Fringes Changing the Perception of How Massage Fits into Community Health Care By Cal Cates best practices | MASSAGE THERAPY AS HEALTH CARE Massage therapists are often considered members of the health-care workforce, 1 but in reality, we exist on the fringes. When it comes to state regulation, only about half of the states in the US recognize massage therapy as health care. (Remember the "essential" versus "nonessential" debate?) There has been a good bit of research about employer-sponsored health programs in recent years, and the narrative that emerges is that "health-care delivery [is] based on augmented physician-patient relationship and focused on personalized preventive health care." 2 That sounds a lot like massage therapy to me. Most services provided in health programs happen outside the direct supervision of a primary care physician and are led by allied health professionals like dietitians, exercise physiologists, or nurse counselors. Physician encounters are limited to patients with existing and serious health conditions. The bulk of patients are essentially working to never "qualify" for a physician visit in these programs. MASSAGE THERAPY AS PREVENTIVE CARE Lifestyle and behavior are primary indicators of long-term health. When policy think tanks and progressive research efforts look at how to build and maintain health, they look at prevention in terms of screening exams and lifestyle and behavior modification counseling interventions. 3 They are not thinking about massage therapists, but we are at least partly to blame for this. We have given them no Stress Then there's stress. The data about stress and massage are mixed and often target stress in health-care workers or in people living with dementia or cancer. We don't have much data about the effect of massage therapy on stress in ambulatory, ostensibly "healthy" people. By extension, we don't have data about how decreasing stress may keep these people from becoming part of the health-care statistics landscape. Stress creates a huge and understudied ripple in terms of health and disease. Stress itself has direct and specific effects, but many of the behaviors and symptoms that can be prevented develop in response to stress. To put it simply, unchecked stress results in behaviors that lead to illness. Behaviors like smoking, drinking alcohol, being sedentary, and habitual eating are inspired and magnified by stress. These behaviors can lead to high blood pressure and increased cholesterol levels. This dynamic paves a bumpy but clear path to conditions like heart disease and diabetes. 6 Annually, as many as 3.8 million people die from diabetes and dangerously high blood glucose levels. 7 In addition, one in every four US deaths is the result of cardiovascular disease. 8 reason to think about us as providers of a discreet clinical preventive service. The research funded to show the benefits of massage therapy is rarely about health-care savings, value, or promoting health in people who may be on a trajectory to develop chronic illness but who could remain healthy with the right support. We don't endeavor to capture the number of manual laborers whose injuries are privately and effectively managed by massage therapists. We don't look at how massage therapists are already improving outcomes for regular people who won't show up on a list of those affected by illness. We are also never measuring the value of massage therapists—only of the intervention. Chronic Pain The financial and personal impacts of chronic pain alone on individuals and our national economy are staggering. 4 A full 53 percent of American workers use their bodies in repetitive, weight-bearing, and potentially injury-inducing ways. 5 Admittedly, many of these people can't afford massage therapy (see my column about access in the January/February 2001 issue, "Equity in Massage Therapy," page 32), but those who do are likely "costing" the health-care system much less by staying out of doctors' offices and urgent care clinics and avoiding a path that would find them missing work or pursuing costly surgeries. So, if you don't wind up at the hospital or in physical therapy, you don't get counted, and neither does the person who had a hand in keeping you healthy and moving.

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