Modalities Vs. Concepts in Massage Therapy

Mar 6 / Tania Velásquez
Originally published on March 6, 2017

Massage therapy has become a battle ground for modalities. Some claim to be new and others are considered more traditional. There are clever hybrids and tribrids of the different schools in between.The truth is, touch and manual therapy have been around since the evolution of hands and there's not much new under the sun regarding what we do with them.

It's all been done and touch will continue to be applied under all kinds of labels. It's fun to get creative with our hands as therapeutic tools and call it marketable stuff. Please let me know in the comment section if you've encountered the modality church phenomenon described below!

What makes a massage a modality?

I like to think of massage therapy as music (perhaps because I'm a musician, but painting, sculpting, engineering, and other analogies work just as well). As we know, music is comprised of basic beats/rhythms, notes/tonalities, and spaces in between called rests.

Certain combinations of beats and notes get categorized as different genres, or in our case, modalities. There is classical music, world music, metal, punk, free jazz, bebop, etc. Bodywork modalities are just as nuanced and varied.

We use methods from the East and West, both mysterious and medical. Ancient and modern. Experimental and clinical. There are almost as many theories as there are modalities, but touch is touch. Music is music. What matters is an understanding of the researched fundamentals to make it functional. Everything else is personal preference, still under investigation, or completely made-up.

Certification, shmertification

Diversity in practice is a wonderful characteristic of our profession. No one modality is better or worse than another. They can all be effective. They can all fall short. Positive outcomes are based on the following:

  • establishing a trustworthy therapeutic relationship
  • client beliefs and expectations
  • understanding the principles of physiology and touch
  • understanding the best applications of your particular "toolkit" (the how-and-when-to-use-or-not-use your choice of techniques)
  • perhaps, a little luck

    These understandings can be intuitive or cerebral, however, a good clinical outcome has nothing to do with a certification in one thing vs. zero certifications in anything. Certifications are a nice touch to hang on the wall and indeed note an accomplishment, but they are not to be credited as a justification for results. Not in this line of work.

    For what it's worth, I've gotten fantastic results from many uncertified novices who have no ego about it. And I've come out unaffected and sometimes worse at the hands of professionals who flash credentials like a badge of authority. Certifications are not exclusive qualifiers nor can they guarantee results.

The anatomy of a massage modality

In every modality fundamental concepts are at play the moment we put our hands on somebody. It doesn't matter if I'm performing Shiatsu or Swedish. Nerves light up when they are pressed or stroked, with or without lubricant. The sensations and combinations of tactile stimuli may translate differently in the brain, but pressure is pressure, stretch is stretch, warmth is warmth, traction is traction, and vibration is vibration.

There are also reflexes in the body we can learn to use to our advantage as we develop our sensitivity; like reciprocal inhibition, the crossed-extensor reflex, myotatic and tendon reflexes. Lastly, we can wrap all of the above in layers of neuroscience, psychology, and consciousness to make for a very rich palette of techniques with theoretical complexities. You can throw in toys like foam rollers, cupping, and IASTM (not an endorsement for any, just examples), still, the basic concepts are what hold up.

Different instructors will select certain basic bodywork elements and combine them in ways they have found to be effective. But guess what? All touch can be effective when applied appropriately and with genuine care. In all hands-on CE classes, you're basically learning a different take on touch.

This is a fantastic way to freshen our practice and pick up other ideas. It is invaluable to discover alternate ways of approaching the body. Learning cool moves, old and new, keeps us fresh, curious, and excited about our work.

Plot twist!

What happens when an instructor patents their preferred approach under the guise of "proprietary information"? I chuckle, lol. You can't exactly patent or trademark touch, silly goose. However, this flavor of instructor-with-guru-complex often succeeds in creating what Paul Ingraham calls a modality empire. (Thanks for calling it what it actually is, Paul!)

It is merely clever marketing of recycled manual interventions. The ™ symbol is added to aid in amassing a church of followers who will spread the gospel for their guru (as if their certification will spare them from ever having to exercise critical thinking in practice).

I am going to call this type of institution a modality church instead, because the dogmas often borderline on religious fanaticism. The majority of these dogmas have been systematically disproven or remain completely unproven. I'm not sure which is worse, but I'll bet you $50 a modality church guru will throw a belligerent tantrum if you challenge claims. Then they will invariably try to shame you for questioning them. Go on, try it!

Modality churches

What does it take to create a modality church?

  • Rename the basic reflexes using your own invented terminology. Make it sound "revolutionary".
  • Create your own cliquey modality language.
  • Insert sciencey-sounding word confetti that doesn't really mean anything and can't be specifically referenced.
  • Present your modality as if it were beyond the science and/or keep your methods very secret. The secrets will only be revealed after your students have taken all the modules of your modality. Be sure they never actually understand the explanations of how you say it works. Make them believe this is because they will never fully grasp the enormity of your therapeutic holy grail.
  • Use buzzwords to create an impression you're the modality master. Print many branded materials further affirming you as master.
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A physiotherapist from the United Kingdom by the name of Adam Meakins, whipped up this hilarious modality grid. You can use it to create your own modality lol (seriously don't, I think we're all set with "new" modalities).

Of course it's perfectly fine to do this and I've taken a couple of classes that sound like they were pulled from that funny meme. I even enjoyed them and learned lots of useful tidbits.

Labels help us categorize approaches. However, realize trademarks significantly help in charging heaps more for a course and creating a crazed cult following that's shuns science. Remember: you can trademark a name (that's fine) but you cannot trademark any sort of touch. And believe me, people have tried to.  

The modality church guru

I like to make up names for my therapeutic hand jives, too. The difference is I wouldn't call a manual application my unique invention nor claim the rights to how you, as a participant in a class, should reference it. But many will try to do exactly that.

When the creator of a modality church assumes the grandiose personality of an infallible know-it-all-touch-inventor (instead of someone you invest in to share useful chunks of actionable information with clarity), you have yourself a modality church guru.

Unfortunately, there is no shortage of useless information and word confetti. For example, consider obvious nonsense like astrology massage that is being peddled as valid continuing education for our healthcare profession (barf, don't get me started).

It's fine as a hobby, but a laughable idea in a professional practice. I can't list examples of a specific modality church because several "gurus" have literally resorted to bullying and suing people who debunk their claims or leak their "secrets". That is not a battle I choose to pick today... ain't got time for dat.

Buyer Beware

I write this in the hopes MT professionals become more selective about the classes and concepts they invest in.

That's right: CONCEPTS. I wasn't always so skeptically discerning and have flushed plenty of money down the toilet on bogus classes. So, before plunking down your hard earned dollars on a CE course, I encourage you to dig into the underlying concepts the instructor offers in relation to that modality.

Manual therapy techniques are not new anymore. So how are they presenting the concepts of their application? As theory or fact? As gospel or as an interesting perspective? Is it plausible? Ask for the research, then go a step further and research their research.


It would thrill me if somehow the term modalities could be changed to this-is-how-I-like-to-do-it-ies, because that is basically what they are. It is much more accurate.

They're just how a particular instructor offers approaches, and those approaches should be based on solid science (we would think). My OPEN Bodywork class is basically about how I like to work it and why, based on sound science and reason.

Modalities are not to be confused with specializations, like oncology massage or chronic pain relief. Nor should they be confused with traditional systemized approaches like Nuad Bo Rarn/Thai massage or Shiatsu, whose foundations are based in spiritual and religious philosophies (i.e., Thai massage has its roots in Buddhism, and Shiatsu is based on the Chinese system of acupressure which is founded on Confucianism, but neither are based in physiology).

And it would be justified and more appropriate if they were taught solely as the cool philosophies they are.

Having an appreciation of the philosophy of a traditional approach is wonderful and beautiful, but philosophies are not the fundamentals. They are merely intangible beliefs that cannot be substituted for a very tangible understanding of physiology. Beliefs vary widely and often on any given day. Human physiology does not. It's the only constant we can trust in our work. The rest is just personal adornment.


Modalities are not to be confused with the underlying concepts of how their applications may work. It is important to understand the difference.

For example, I can petrissage a trapezius and offer 2 explanations:

  1. I am squeezing energy out of the meridians found in that muscle and also stretching the fascia that reaches into their lower back. This works by combining an ancient philosophy with a modern theory. You have to learn it the way I tell you. I'm actually the only one who's ever figured out how to move my hands in a way that effects both meridians and fascia. You can learn how to do this by taking my FascioMeridian™ Release class: Level 1, 2, and 3-15 (feel free to steal that name, it's not really trademarked, yet, haha).

  2. I highlight theories according to current research that can be applied to any modality. I prioritize creating an environment of trust by honoring an individual's needs and requests. Manual applications work because favorable signals are registered by nerve endings, then processed by the brain. Safe, skilled touch feels really good and this in turn communicates a relaxation response to the whole body. I share my favorite manual approaches to accomplish this and you are free to use them as you like.

So, here is where I leave you. How will you invest your time and money in future education? Wherever it is, may you invest in yourself with eyes wide open :)

This is an expansion of this post I made on the Pinpoint Education Forum. Please join us on Facebook if you haven't already!