How Sticky is Massage?

by | Jan 9, 2012 | Business

Stickability ImageIn the world wide web, “stickiness” refers to how long you can keep a user on your website or how often you can get them to return. It is a measure of user engagement and loyalty.

So how loyal and engaged, that is to say, how sticky are massage customers? Judging by the frequency with which Americans get regular massage, the sad answer would have to be that massage is not very “sticky” at all. [Note: If you want to bypass the calculations and jump to the bottom line numbers, scroll down to the last three paragraphs.]

There are only two professional consumer surveys done for the massage profession. The one commissioned by the American Massage Therapy Association (AMTA) is annual and the other, sponsored by the Associated Bodywork and Massage Professionals (ABMP), is biennial.

While neither of them explicitly states how often American adults get massaged, with a bit of combining and extrapolation of the two surveys, we can arrive at a reasonable approximation.

The most recent ABMP survey reports that, of the number of people who actually got a massage in 2010, their frequency of utilization was as follows:

  • 22% had 1 massage
  • 22% had 2 massages
  • 28% had 3-5 massages
  • 6% had 6-10 massages
  • 17% had 11-20 massages
  • 3% got 21 or more massages

The previous ABMP survey, for 2008, reported these percentages:

  • 32% had 1 massage
  • 21% had 2 massages
  • 35% had 3-5 massages
  • 5% had 6-10 massages
  • 5% had 11-20 massages
  • 2% got 21 or more massages

Now, since both the AMTA and ABMP surveys report the total number of adults getting a massage in a twelve month period, we can use the percentages above to get a range of how many total U.S. adults appear in each frequency category. In the AMTA survey, the total number of adults getting massaged ranges from a high of 24% in 2007 (pre-recession) to their current figure of 18% (between July 2010 and July 2011, unchanged from the prior 12 months). The ABMP figures are strikingly lower. In their latest survey only 16% of US adults got a massage in 2010, up from 14% in 2008.

To chart it out I multiplied the ABMB frequency of utilization percentages by the percentages of people in the U.S. reporting they received a massage in the two time periods surveyed by each organization. Here are the results of each survey by category.

Frequency of Massages Per YearAMTAABMP
2007/08 – 24%2010/11 – 18%2008 – 14%2010 -16%
1
Massage		7.7%5.8%4.5%3.5%
2
Massages		5.0%3.8%2.9%3.5%
3-5
Massages		8.4%6.3%1.0%4.5%
6-10
Massages		1.2%0.9%0.7%1.0%
11-20
Massages		1.2%0.9%0.7%2.7%
21+
Massages		0.5%0.4%0.2%0.5%

Hang in there. We are almost to the finish line. While I wish that the ABMP survey had broken out the specific number of people who got 3, 4 or 5 massages in a year, using the data we have, we can sort the frequency into three sub-categories:

  • Infrequent users – 1 or 2 massages per year
  • Occasional users – 3-5 massages per year
  • Regular users – 6 or more massages per year (less than the average number of haircuts per year)

With these definitions and using the best case ABMP figures, we can see that, at the most, only 4.2% of the adult population in the U.S. are regular users of massage. The best case data from the AMTA puts the percentage at 2.9%. Ouch! No wonder the associations do not make it easy to get this number and prefer us to focus on the 16 to 24% who got at least one massage in a year. In another article I make the case that this lack of loyalty and engagement, of “stickiness,” is primarily a result of the high price of massage and discuss what we can do to make massage more affordable and accessible.

One final note: We need to have better data and better analysis of the data we currently have. We can’t make good decisions about our future unless we have good data. The calculations above should have been readily accessible to anyone. The glaring discrepancies in the results between the two surveys should be explainable. The ABMP should be congratulated for the relatively comprehensive and transparent way in which it presents its data compared to the AMTA. However, I would urge both organizations to make all of their raw data from every study they commission available to anyone for analysis. The truth is out there, we are just having a hard time finding it.

Moving Massage from Acceptability to Accessibility

by | Jan 9, 2012 | Bodywork, Politics

Acceptability-to-Accessibility ImageFor as long as people have been paying for therapeutic massage services, practitioners have feared being mistaken for prostitutes. That fear was the primary driving force that, in 1983, led the American Massage Therapy Association to re-brand “massage” into “massage therapy” in an attempt to define it as the health care profession. [Related article] I call this quest for professional legitimacy the “acceptability” strategy.

Within a decade this strategy was almost universally embraced by massage schools, educators, associations, regulators and vendors serving the industry. It seemed like an obvious strategy and the perfect solution. In point of fact, it was remarkably successful at validating therapeutic massage in the public mindset.

Unlike 20 years ago, nowadays no one blinks twice when a young woman announces her desire to attend massage school–no snickers, no raised eyebrows. The public generally perceives that there is a clear distinction between adult entertainment massage and therapeutic massage. The battle for acceptability has, for the most part, been won.

But now there is another front that needs our attention. What I call the “accessibility” problem.

While we have steadily increased the numbers of people who want a massage, the number of people who actually can get a regular massage has barely budged from less than 5% of the US adult population [see related article]. The reason is painfully simple. Massage therapy is  too expensive.

Since I am writing to a primarily professional audience, let me do a quick reality check. How many readers pay full price for at least one massage every two months? How many of your friends do? If you are at all like the typical massage practitioner in my continuing education classes, you can’t afford to pay $65 for a regular table massage, and neither can your friends. The primary reason people don’t get a massage is because they can’t afford it.

The only two significantly expanding models for massage services are the pay-by-the-month model pioneered by Massage Envy and chair massage in malls delivered by Chinese immigrants. What they both have in common is that they are lowering the price of massage.

Those of you who have experimented with online coupons also know what I am talking about. Discount massage shoppers rarely turn into full price regular customers. The only people who pay full price for regular table massage are the very wealthy, the very fanatical, and the very desperate people in pain.

While turning “massage” into “massage therapy” made our services more acceptable, it did little to make them more accessible. In fact, there is a case to be made that the effort to make massage into a health care profession has actually limited its growth.

Massage as health care

When you define massage as massage therapy in a health care context you are defining it as a treatment. The problem is that most massage is not performed as a health care treatment. Most massage, according to consumer surveys, is done for health promotion and relaxation. That has resulted in a huge disconnect between what massage practitioners think they are selling and the general public is looking to buy.

Massage schools graduates are encouraged to believe that they are training to become a health care professional–sort of junior physical therapist. [Indeed, I just searched “Physical Therapy Training” in Google and one of the three sponsored ads at the top was for a massage school.] But the reality is that the vast majority of graduates, if they are lucky enough to be working at all, will be doing massage, not massage therapy. While it may increase school enrollment to have them think otherwise, it does nothing for their level of frustration when the inner image of practitioners does not jive with their outer experience.

For massage customers, particularly new ones, defining massage as therapy often leads them to believe they have to have something wrong in order to get a massage. Every day that I work in a chair massage studio new customers invariably feel obligated to have a physical problem before they step through the front door.  “I woke up with a pain in my neck/back/shoulder,” being the most common statement.

Massage as personal care or fitness

If we want to make massage truly accessible, we need to recognize the difference between massage as a health care service and massage as a personal care service.

Defining massage as a health care profession only makes sense for that small, highly trained and experienced segment of practitioners that actually performs massage as treatment and for that small fraction of the public that actually needs and wants to pay for that service. Massage therapy should be defined for what it actually is–medical massage–and we should require far more than the standard 500 hours of training. Something closer to 2,300 or 3,000 hours of the Ontario and British Columbia models would be appropriate.

I admit that I am very conservative on the issue of training but, in my experience, 500 or 600 hours of training to become a massage therapist is totally inadequate, does nothing for creating credibility as a health care profession and sets totally unrealistic expectations for massage school graduates, the vast majority of whom will never make even a part-time living doing massage.

“Massage therapy” should never have been defined as entry-level into the profession. It is not. Plain old circulation/relaxation/prevention-oriented “massage” is entry-level. Let students focus on learning how to touch and be touched [Related article].

Massage has always rested comfortably in the personal care services arena along with spas, hair salons and nail studios. Over the past twenty-five years, massage has also grown up with the wellness and fitness industries. These two economic sandboxes are where the majority of massage practitioners should be playing and it is the kind of massage that massage schools should be selling and teaching.

Radically reinventing an industry

Knowing what we now know, if I was creating the U.S. massage industry from scratch, here is how it would be structured:

  • Entry-level into the field should be a 200-hour course in chair massage.
  • Table massage would be a second, optional level of training. Add on another 300-hours to make the current 500-hour standard and have the focus be on training practitioners to be wellness educators as well as table practitioners.
  • Massage Therapy would be true medical massage and require at least a masters level program.

There are some strong arguments for making chair massage entry-level. For the industry, chair massage provides a strong foundation:

  1. Chair massage is what the general public can afford and, because there is no disrobing or private rooms required, is more likely to try.
  2. Because it is affordable, people will get massaged more regularly.
  3. People who have had a chair massage are more likely to consider having a table massage or massage therapy.
  4. The net result will be far more work, more jobs, more successful students, and more sales for chair and table manufacturers.

For the budding massage practitioner, starting with chair massage will eliminate a lot of needless heartache and financial burden:

  1. Since there is really no way of knowing whether you will like doing massage professionally until you get into massage school, a 200-hour tuition mistake is a lot less painful than a 500-hour mistake.
  2. More students will be able to afford to go to massage school without going deep into debt and actually make a living doing upon graduation.
  3. After they are making a living doing chair massage, chair practitioners can save up money to pay for table massage school without taking out loans.
  4. It is easier for entrepreneurs to open chair massage businesses than table massage establishments resulting in more jobs.

The bottom line

Can my ideal industry model become real? Realistically, I doubt it. The massage schools, associations and regulatory agencies are far too entrenched to consider reforming the profession so radically. The quest for acceptability as a health care profession continues to be seen as the primary goal. Too bad. A lot of people just need to feel better through touch.

Make Your Business Persistent with Consistence

by | Dec 19, 2011 | Business

Note: This is the third in a series of four articles called “C”-ing Your Way to Success about  the value of Conviction, Clarity, Consistency and Change-ability in business.

In a sense, consistency is the practical result of a commitment to clarity in your business. As you become clear about the complex nature of the services you provide and the market you have targeted, each small component of your business will add to and reflect the overall purpose and function of your business as a whole.

Consistency has something to do with integration. When anyone encounters a small part of your business, they encounter the whole. Each component reflects the larger service vision. Let’s briefly examine some of these elements.

  • Language: How you talk about your business needs to be consistent with the overall intention of your work. I once saw a flier advertising a massage chair that was comfortable and easy for the “patient” to use. Since the rest of the text did not lead me to believe the business was targeting their chair exclusively for use with sick people, the choice of that word was clearly inconsistent.
  • Marketing tools: Your brochures, business cards, letterhead, advertising, and even phone manner should all present the same image and message about the conviction and intention of your work.
  • Professional tools: Do you use the right equipment in the right way for the market and service you have chosen? Do you use paper towels, disposable face cradle covers or linens for you head rest? Each has a place in the appropriate practice.
  • Environment: Does the environment you create for your practice support or detract from your service goal? If customers find parking a hassle to find, they may feel the frustration is not worth the effort. Or perhaps they don’t feel safe walking in your neighborhood and it makes them nervous to think about leaving your office. For the internal environment, make certain that the flowers and air are fresh. Walk into your bodywork environment with beginner’s eyes and see what type of impression it makes. What do they see, hear, or smell? Get a massage on your table to see what the client will be looking at and experiencing for the length of the massage.
  • Personal style: Some people simply, who function well doing chair massage in the workplace are like fish out of water at a convention center. A New Yorker  may have to be toned down his or her personality a bit to be effective in California. What is your personal style? Does it fit well with the overall focus of your business?

Thomas Alva Edison portraitConsistent persistence
 According to Thomas Alva Edison, “Genius is one percent inspiration, ninety-nine percent perspiration.” That perspiration is what I call persistence and persistence is just another facet of consistency and is an essential element for business success.

Consistency brings an essential level of stability and predictability to your business operations for yourself and your clients. Without consistency clients wouldn’t know when to call for an appointment or how to budget their time and money to make certain your service is a regular part of their lives. They also wouldn’t feel comfortable referring your service to a friend if they thought you were unreliable. Consistency means creating and sticking close to a business plan. How many clients can you expect to have this month? What will your expenses be? What type of referral network do you need to set up?

If you know you need to send out appointment reminders every week or make a presentation to the local nursing group in order to keep clients coming in, then do it. There are no shortcuts to doing what needs to be done. If you pay strict attention to accomplishing the small details of your marketing strategy, you will find yourself worrying less and less about cash-flow crises. If you take care of your bookkeeping every week, you will have little to fear from the IRS or the phone company.

When you operate a business with consistency it is easier to make changes and know whether or not they are effective. If everything is done differently every day, it is impossible to develop true expertise or intuition because you never know which actions cause which results. In a similar sense, consistency puts the qualities of conviction and clarity into a feedback loop. If a particular marketing approach does not seem to be working, perhaps it is because it is inconsistent with your overall vision or is not being communicated clearly to your market. Consistency provides a check and balance system for your business.

A good recourse policy is the best guarantee of consistency. Having a recourse policy, such as a money-back guarantee, says that you believe in the quality of your service and trust that the client will appreciate it. When you trust a client, particularly a new one, it is easier for them to trust you. If you don’t have a recourse policy there is no way for client feedback to alert you to problems with your business.

The impact of consistency on the success of your business is undeniable. Consistency provides the nuts and bolts, day to day operational stability that keeps you going in the direction intended. It is a type of consciousness that brings together the motivation provided by conviction and the communication provided by clarity into an organized plan of action. Without consistency your business is merely a ship without a rudder, tossed about by the waves and going in no particular direction.

“How often should I get a massage?”

by | Dec 19, 2011 | Business

This is one of the most common questions I hear from customers. It’s an important question and the response needs to be considered carefully because the answer will set the character and tone of all future interactions with that customer. I am going to offer a response that I have found creates the healthiest relationships with my customers.

The real question

Any question containing the words “should I” is always directed toward someone the inquisitor thinks is an “expert,” that is to say, someone more qualified then himself or herself to offer an answer. And, while some of my egocentric, “Dear Abby” parts just love it when people ask my advice and treat me as an expert, the truth is, in this case I am not.

I actually feel totally unqualified to tell someone else what his or her needs are in the way of massage or touch.

Perhaps I would feel differently if I were a massage “therapist” treating a particular problem or condition and could guarantee that a fixed number of sessions would result in the problem being resolved. But I am not a therapist. I am a simple massage practitioner providing structured touch to people who are seated in a chair or laying on a table and want to feel better.

From that perspective there is only one, quite definitive way to respond to the question, “How often should I get a massage?” and that is by asking for more information.

“If time and money weren’t considerations,” I query the customer, “how often would you like to feel this way?”

While this reply often engenders momentary confusion, the reply, often accompanied by a little laugh, is most often something along the lines of, “Why, every day, of course.”

Thus, the customer arrives at the best answer to their original, literal question, but we are not quite done yet. We still have to find the answer to the underlying question that they were also asking. “So now we know how often you should get a massage.” I say. “Now factor in time and money and you can figure out how often you can get a massage.”

Don’t miss the moment

Since skilled touch practitioners are primarily educators, let’s not miss this significant “teachable moment.” By not answering their question directly, we teach people some important lessons:

  1. They are the ones in charge of their bodies, not some perceived expert.
  2. For better or for worse, they are in charge of the feelings inside their bodies.
  3. They can change how they feel for the better at any time utilizing a simple tool called “massage.”

Realizing that, to a great extent, how one feels physically and mentally is a choice can be transformative. The pace of change in the external world is so fast that literally no one can keep up with the flow of information and innovation that surrounds us leaving most of us feeling powerless and out of control.

But, what we do have control over is our internal, subjective world. Massage is an effective tool for managing our inner experience in a way that almost always effects our external world for the better. Structured touch reduces stress, induces the relaxation response and allows us access to states of awareness that enhance our coping, caring and problem-solving abilities.

Don’t tell your customers how much massage they need. Let them tell you and you will probably end up with more frequent visits from people who understand the true, personal value of massage.

How Massage Became Therapy

by | Nov 28, 2011 | History, Politics

The year was 1983 and the oldest national association of massage practitioners was about to change the face of an industry by turning “massage” into “massage therapy.” This is the story of what led up to that moment.

The association making this pivotal shift was founded in 1943 by a group of 29 graduates of the College of Swedish Massage in Chicago. Originally calling itself the Association of Masseurs and Masseuses, fifteen years later it had changed its name to the American Massage & Therapy Association (AM&TA). Now, in 1983, the group was poised to take the conjunction “and” out of the middle of their name and become what we know today as simply the American Massage Therapy Association (AMTA).

The rationale for the name change was simple–to address the two primary forces that had always plagued the growth of massage: public perception and economics.

Managing the image of therapeutic massage has always been a public relations nightmare. There are only two occupations where skilled touch is the primary modality of service delivery. One is legal and (in most places) the other is not.

The confusion in the public mind between “adult entertainment” massage and “therapeutic” massage has been around in one form or another for centuries. Indeed, the mere mention of the word “massage” in 1983 was enough to provoke what was then called “the snicker response,”  as word evoked images of “masseuses” in skimpy outfits plying their trade late into the night in sleazy massage “parlors”.

While the mass media served up this image in large portions, it also offered a second association in movies and television: that of massage as a luxury service for the rich and famous. If one got past the first association, the second inevitably got in the way of people identifying with massage because the service was, quite simply, unaffordable for the vast majority of Americans.

So, in the early 1980’s the thought was, let’s reposition massage in the public mind and kill two birds with one stone. If massage could be turned into a legitimate health care profession, then people would no longer presume that massage practitioners were prostitutes. Likewise, as a health care service, massage could be covered by third party payments, as was already the case in some Canadian provinces.

And so, the name was changed and what was once two, massage and therapy, became one—massage therapy. In the next article, I will analyze the impact of this well-intentioned decision and argue that this minor alteration solidified a strategy that has had only limited success and, in some ways, has actually inhibited the effort to bring skilled touch to the masses.