The final draft of the nation’s first Massage Therapy Body of Knowledge (MTBOK) document was unveiled on May 15 at the Highlighting Massage Therapy in Complementary and Integrative Medicine Research Conference. This presentation represented more than a year of debate and discussion over what the MTBOK should, and could, be. The result is a living document meant to define the profession’s “domain of essential information,” which includes the knowledge, skills, and attitudes deemed necessary to practice as an entry-level massage therapist. Creators of the MTBOK document say its goal is to create a common language about massage therapy and its professional standards, both for those within the profession, and those looking at us from outside the touch therapy world.

What is the MTBOK?

By definition, a body of knowledge—regardless of the profession—is described as a “compendium of what an individual must know and/or be able to do, to successfully work in a specific field.”¹ For the massage community, this information was typically formulated on a case-by-case, therapist-by-therapist, school-by-school, job-by-job, or state-by-state basis, with any congruence occurring by happenstance. The goal in creating the MTBOK was to create consistency in the various guidelines affecting therapists and to define what massage therapy is. A detailed and thoughtful body of knowledge, say the MTBOK developers, will ultimately help drive the recognition and growth of massage therapy.

The directive of the MTBOK development group was to create an inclusive, transparent conversation about guidelines that could be universally applicable and collectively agreed upon by all stakeholders in the massage profession, but which were also independent from the control or influence of any single group. The goal was to focus on entry-level massage practice guidelines, as well as create non-regulatory standards across the academic, research, and licensing arms of massage therapy.

More than a dozen organizations originally came to the MTBOK table in 2008 to develop consensus regarding definition and scope of practice issues, but only five entities transitioned into the overarching MTBOK Stewardship group meant to facilitate the process, including Associated Bodywork & Massage Professionals (ABMP), American Massage Therapy Association (AMTA), Federation of State Massage Therapy Boards (FSMTB), Massage Therapy Foundation (MTF), and the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). ABMP and AMTA provided the financial support and/or other assistance for the effort, but none of the stewards were involved in the development of the document. This distance was meant to ensure the document’s nonpartisan status. The central voices were those of the eight task force members, a group of diverse, uniquely qualified volunteers from a variety of massage and bodywork disciplines who were selected by the stewards. After the task force members’ deliberations, the document was subjected to two rounds of public comment.

After months of conversations and due diligence, the MTBOK group released its final document, which is meant to be “a living resource of competencies, standards, and values that inform and guide the domains of practice, licensure, certification, education, accreditation, and research.”² Mastery of this information, according to the MTBOK group, ensures the knowledge and skill sets necessary to effectively practice massage therapy at an entry level.

Why the BOK Path?

“There has been recognition over the years that a BOK is an important thing that helps define what a profession is,” says Chip Hines, project manager for the MTBOK group. Hines is a former senior federal government project manager, licensed massage therapist, and former advanced bodywork instructor at the Baltimore School of Massage. Using his certified project management expertise, he provided support to the MTBOK task force volunteers as they developed the guidelines. Hines says an increasing number of groups within the health-care profession have their own BOK to provide consistency on how things are approached and learned. Nurses, anesthesiologists, even podiatrists have their own BOK, which helps to define their work.

Many felt the time for a BOK within the massage community was long overdue. Part of the delay was likely the very thing that makes the profession special. “While the breadth and diversity of the MT profession is broad, it’s hard to pin down what massage therapy is and does,” Hines says. “But it was time to sit down and create a BOK to fully represent the field of massage.”

Hines says most BOK documents are built by the primary organization within a specific field, but massage therapy is too diverse for one voice to chime in alone. That is why all massage and bodywork stakeholders were invited to be part of the process. “We wanted a single source of information that would inform and guide the various domains of massage therapy,” Hines says. The acronym the group came up with for the domains was PARCEL—Practice, Accreditation, Research, Certification, Education, and Licensure. “I really like the approach that all those domains, which now largely operate independently, should have a single source about what massage therapy is and what it is not,” he says.

In an effort to get as much of the massage community involved in the process as possible, the task force twice asked for public input on the document over the past year; approximately 1,400 comments were submitted in response and discussed at length. The result is what the framers hope is an inclusive document, void of politics and agendas, that addresses in the most fundamental form what massage therapy is, what it looks like, and the knowledge and skills necessary to be an entry-level MT.

Hines says this is the first time that something like this has been built by and for the profession. “The stewards didn’t guide the information; this was the profession doing it itself.”

ABMP President Les Sweeney, NCTM, said the task force’s independence was crucial to the process. “ABMP was pleased to support the project as a steward,” Sweeney says. “We felt this was a great opportunity for the profession to take an important step forward, and we were delighted to support the process. Not every part of the MTBOK will be everyone’s cup of tea, but its development is a natural and appropriate progression for the field.”

Putting the MTBOK to Use

The hopes for the MTBOK are vast; the reality of those hopes are pinned on the massage community taking ownership of the document and its guidelines.

JoEllen Sefton, director of the Neuromechanics Research Laboratory and assistant professor of kinesiology at Auburn University, was one of the task force members who worked to create the MTBOK. She envisions the new guidelines being utilized by all facets of the massage community. “Educators could use the MTBOK to determine where current curricula and programs could use revision or development. Massage therapists and potential students can use the MTBOK to evaluate educational programs and determine which school best meets their needs,” she says. “The general public could also use the document to discover more about the massage therapy profession and our educational practice, standards, and values. Finally, lawmakers and those working to establish licensure and legislation could use the document to help establish standards, scope of practice, and educational requirements.”

Educational Impact

Michael Shea, a MTBOK task force member and founder of the Shea Educational Group, says the impact of the MTBOK could be significant. “It’s where the rubber meets the road,” he explains.

In the past, Shea says, massage therapy school curricula were guided by each school owner’s personality, background, and training. By meeting the new MTBOK guidelines, schools can know that while they can still make their curricula special and unique, they can also ensure their students are receiving entry-level skills, at the very least. “[The MTBOK] gives you the academic domain of the stream of information that feeds into the profession, that then streams into a standards of practice, then gets fed into a replicable curriculum,” he explains.

 “We want to get this into the hands of school owners, who then get it into the hands of their faculty, who then get it to students.” He says while the document lays out what entry level is, it also gives schools the opportunity to go deeper than what the MTBOK describes. For some schools, it might show them where they may be falling short in their curriculum. Ultimately, it opens the door to a more standards-based educational model. “It leaves open a great deal of possibility.”

For someone looking to enter massage school, Hines says the MTBOK will eventually prove invaluable. “When looking at your education, you should be able to find similarities. Schools should provide consistent curriculum from school to school, at least at a basic level. The accreditation process will then ensure schools are in line with the MTBOK.” Hines says the end result is a supplement to job surveys, not a replacement for it. “This is more what we think should be taught.”

Hines says the BOK begins to offer a consistency on how topics are approached, defined, and discussed. This doesn’t mean, however, that you create a cookie-cutter approach to education, for example. “In reality, you create a consistency in how massage is taught, even though the depth and way it is taught can be different, they should at least be discussing the same sort of information.” It’s about creating a consistency within the framework, and an expectation of some predictability, at least in the basics of massage training.

Task force member Kevin Pierce says it was his position as program manager of massage therapy at Anthem Education Group that prompted him to volunteer his time for the MTBOK. “I do a lot of development with curriculum at multiple campuses and across state lines. Having been a therapist myself and gone through the process and seeing the intrinsic challenges we face as a profession, and the mishmash of licensing and regulation we face, I saw [the MTBOK] as something very necessary for the coming years.”

Through the MTBOK, Pierce says he envisions schools will be guided to a more centralized and comprehensive level of standards-based education. The result will help students better compare schools and curricula, and as more schools join the conversation, the more the MTBOK can be refined.

Research Implications

With a background in research, Sefton says she is especially excited about the impact the MTBOK will have on the profession’s research arm. “As a profession, I believe our future will be determined by our ability to complete high quality research that supports our claims of therapy efficacy and benefits,” she says.

She explains that some researchers and legislators are trying to limit funding for the National Center for Complementary and Alternative Medicine with the reasoning that funding for CAM research is being wasted on sham treatments. “We must work as a profession for increased research support,” she says. “Health-care professions are defined by their research base. As massage therapists, it is important that we do our own research and drive our own profession forward, rather than letting physical therapists, physicians, or others guide our future.”

But Sefton does not intend for every MT to be entrenched in research. “Let me be clear—we do not want to make all massage therapists researchers. However, it is vital that as massage therapy professionals, we are taught to read the research, determine if it is good work, and if it is, utilize these findings and communicate the contents to our clients and to other health-care providers. This is the way we will drive and move our profession forward.” By advocating for research awareness within the profession, the MTBOK is helping move that effort nearer the goal line.

Changes to Entry level

Many MTs wonder how the MTBOK will change the profession today. “The MTBOK will not have an immediate impact on the practicing MT,” Pierce says. Entry level is not going to change that much, as the entry level described in the MTBOK is very consistent with the current profession standards, he explains.

“In order for a change to get into the system, it has to be recognized as a value, built into a curriculum, taught to students, and it will be a length of time before it goes to the core,” Shea says. The process of incorporating new guidelines takes time, Pierce adds. A curriculum adjustment typically takes a year to be incorporated into a school program. “That alone will prevent anything from shocking the system,” he says. Eventually the definition the MTBOK provides and the scope of practice guidelines will be better understood across the profession and within state laws. “The level at which these things are taught and enforced on a regulatory level is where you will see the biggest change,” Pierce says.

Legitimacy Strengthened

Part of the process of creating the MTBOK was understanding its potential to shape the future of massage therapy. “It’s a catalyst for further evolution of the profession,” Pierce says.

Susan Salvo, director of the Louisiana Institute of Massage Therapy and MTBOK task force member, says the massage community has needed a common body of knowledge for decades. “A BOK helps establish our recognition as a profession, helps to define differences between our profession and other professions, and will become a single source of information about what a professional needs to know and be able to do,” she says. “In my opinion, the MTBOK document will become the common language and standard(s) for the profession, and a single source of information as our profession moves forward. Accrediting agencies, state regulatory boards, and committees developing curriculum will look to the MTBOK as the official standards of our profession.”

When it comes to respectability within the health-care community, Shea says the MTBOK document will open doors to relationships with other professions. He says the document contains language that will be understood by all other health-care professionals, something he believes is a critical component in finding commonalities. “For example, I’ve worked with a lot of hospitals, and they want to know if we know their language,” he says. “Whether it’s the medical field or the psychological field, they see that we’re looking at these issues seriously through our BOK.” Shea says ultimately, the MTBOK could create a “tremendous boon” for clinical massage referrals.

“Our profession has long lacked a single, unifying standard that outlines the profession, educational requirements, and scope of practice,” Sefton says. “This has hampered our professional standing, acceptance, and development, and has fostered misunderstandings with other health- care providers.” Sefton says without such a document, it will be much easier for other professions to define massage therapy “and guide our future” for us. “It is vital that massage therapists guide the development and future of our own profession,” she says, and that’s what the MTBOK proposes to do.

Just the Beginning

Those who have worked on the MTBOK know that while the document is finished, the work has only just begun. “People need to know that the MTBOK should become a living document, and should not be put on the shelf and left there,” Hines says. The MTBOK will become the vibrant manifesto it is meant to be when the massage community embraces it, owns it, changes it when necessary, and lets it breathe. “This is a platform upon which we can build,” Hines says.

Sefton hopes the MTBOK will “serve as a basis for curricula and program development. It is vital that this effort continue and that the MTBOK become a living, evolving document that grows as the profession grows.”

Pierce says the MTBOK will not be a stagnant entity. “It will exist for the next 30 years, and who knows what the profession will morph into by then. It’s a stepping off point.” Ultimately, Pierce says, the MTBOK conversation is simple. “We aspire to elevate the standards in the massage profession to be greater than the current status quo.”

Hines says the concept of a living document is that it should change and evolve with where the profession should go, and not be tied to where it’s been. He says it’s the opportunity for holism that excites him most about the MTBOK. “Its biggest value is its potential for bringing the massage profession together as a community,” he says. “It should create consistency for what people think about massage therapy, what content should be in schools, as well as create uniformity within the accreditation and certification process.” Instead of these pieces all being disparate, the MTBOK is meant to gel the profession as a whole construct, he says. “It bridges the core between what people are doing today and what people think should be done tomorrow … a BOK that becomes recognized and accepted, and helps define you as a profession, which is one more step to legitimizing the profession.”

Ultimately, Hines says, “This isn’t the end. It’s just the beginning.”

 Karrie Osborn is contributing editor for Massage & Bodywork magazine. Contact her at karrie@abmp.com.

Notes

1. M.S. Rops, “Identifying and Using a Field’s Body of Knowledge,” ASAE Foundation, Washington, DC, 2002.

2. Massage Therapy Body of Knowledge, “Massage Therapy Body of Knowledge FAQs.” Available at www.mtbok.org/faq.html (accessed May 2010).