LSSM essential information

Soft Tissue Therapy is emerging as a new category within modern healthcare as the most effective treatment for people suffering with minor and chronic muscular pain. These are by far the most common of all injuries which, although considered medically minor, can badly affect a person’s life. So the demand for good treatment is immense.

Soft Tissue Therapy is built around a set of hands-on techniques which have been developed over very many years based on the excellent results they achieve. These were once used in Physiotherapy but this changed in recent times with it now becoming an exercised-based therapy without these hands-on techniques. This created a vacuum in the market for these traditional and highly effective clinical skills and Soft Tissue Therapy is now filling that vacuum.

The injuries Soft Tissue Therapists treat are often caused by lifestyle factors which people cannot easily change, so therapists also provide regular preventative and maintenance treatments which generates even more work for them. It also includes Sports Massage which adds yet another lucrative market for their skills. And on top of all that it feels good so people really like it, enjoy it and want it.

It is much quicker, cheaper and easier to train to be a Soft Tissue Therapist than a Physiotherapist or Osteopath and has a greater market potential.

Soft Tissue Therapists work in the private sector and are mostly self-employed. Charging from £50 for an hour’s treatment, seeing only four clients a day for five days a week will earn a therapist £50K a year. And it can go up from there.

If you want a rewarding and stimulating lifetime career helping people suffering with pain and injury, Soft Tissue Therapy could be the best choice you will ever make.

Here is a list of the Ofqual qualification Levels taken from the Government website What qualification levels mean: England, Wales and Northern Ireland - GOV.UK (


Level 3

- A level

- Access to higher education diploma

- Advanced apprenticeship

- AS level

- International Baccalaureate diploma

- Level 3 NVQ


Level 4

- Certificate of higher education (CertHE)

- Higher apprenticeship

- Higher national certificate (HNC)

- Level 4 NVQ


Level 5

- Diploma of higher education (DipHE)

- Foundation degree

- Higher national diploma (HND)

- Level 5 NVQ



Warning – If a qualification is not accredited by an Ofqual approved Awarding Body you cannot trust the Level they say it is. The Register of Regulated Qualifications: Home page (


Level 3 is equivalent to school A level which only covers basic massage for healthy people with no injuries. Level 3 Sports Massage should not really exist because people seeking Sports Massage will nearly always have a musculoskeletal problem that is beyond this level of training.  


Level 4 and 5 top-up courses that continue from Level 3 suggest that they train therapist to work on a clinical level treating injuries. But the underpinning knowledge and understanding jumps tenfold when treat people who have pain and injury. To properly achieve this, these top-up courses would need to take longer than the basic Level 3 training and involve significantly more in-depth study of anatomy, physiology and clinical procedures.


Level 4 and 5 qualifications that that stand alone and are not top-ups from lower level, deliver all the training at the higher level right from the start.


For the most in-depth BTEC Level 5 Soft Tissue Therapy qualification, which includes Sports Massage:

London & Southampton –

Exeter & Bristol –

Oxford –

Cambridge -


What is Soft Tissue Therapy

Soft Tissue Therapy has evolved over the last 30 years through the work of a small group of pioneering therapists who kept increasing their clinical skills so they could meet the needs of their clients better. And those needs have also changed because Physiotherapy in the UK no longer includes the highly successful hands-on techniques that Soft Tissue Therapists now specialise in.

Soft Tissue Therapy is emerging as the only one using a range of hands-on skills that have proved effective in treating people with minor and chronic pain and injury for a very long time. Everyone gets these aches and pains during their life and so the carer and income potential for Soft Tissue Therapists is very strong.

It includes:

  • Therapeutic massage for improved general health and wellbeing as well as symptoms relating to other medical conditions.
  • Sports Massage as part of a support package to help athletes prevent injury and enhance performance
  • A range of massage techniques to improve the recovery from acute and chronic injuries.
  • A range of assessment methods to determine whether Soft Tissue Therapy is appropriate and devise a suitable treatment plan for the individual client.
  • A range of advanced soft tissue techniques to improve joint and fascial mobility.
  • A range of Neuromuscular techniques to improve function movement.
  • Rehabilitation: Offering advice on a range of remedial exercises and lifestyle factors aimed at speeding up recovery, preventing injury as well as improving posture, performance and function.


These are all put together within a Biopsychosocial framework of care. It is a person-centred approach to the assessment, treatment and rehabilitation of musculoskeletal pain and injury.


"We don't treat injuries; we treat people with injuries."

Sports Massage Training Scam

By Mel Cash

I have overseen the training of thousands of successful Sports Massage therapists since I started the industry with the first ever training course in the late 1980’s (and I’m still a hands-on therapist today). But it saddens me to see how many training organisations have now jumped on the band-wagon and the competition between them has turned into a race to the bottom with their short and online courses.

Okay, it’s not really a scam because they are not intentionally trying to rip you off but they just don’t understand how Sports Massage needs to be taught and so they give out misleading information. They say you can be a successful professional therapist with their ‘qualification’ but it is with a level of training that I know is inadequate for the job and will be a waste of money for most people who do these courses.

They may be good enough to give a very basic general massage to active people who have no injuries and are in good health. But it can be hard not to cross that line and many do, going beyond their training, scope of practice and insurance cover, with potentially serious consequences. But if they stay within this limited scope of practice the market is so small that there is little chance of earning very much.

Mistakes to avoid

Short and Online courses:

You can only learn practical hands-on clinical skills on a classroom-based training programme taught by successful therapist/tutors who can help you develop you own abilities and share their clinical experiences with you. Here you also have the opportunity to practice with fellow students and share the learning experience with them. And it must take time (at least 6 months) to practice to develop the good quality hands-on skills and clinical awareness that is essential for success.

We would never recommend online courses because you might think you are doing what you see on the screen but how can you tell? Who’s there to spot and correct your mistakes? And the video may show what to do with your hands but what about the way you move the rest of your body? Training videos can be very good for additional learning support but they should never replace the classroom experience.

Live online classes, even one-to-one, don’t work either. During the Covid lockdown we tried this but it was never a very effective training method compared with the classroom experience.

Qualification Levels and Accreditation

Many courses claim to be Level 3 or 4 or 5 but unless they are properly accredited by an Ofqual recognised Awarding Organisation this claim is meaningless and should not be trusted. You can check this yourself at  The Register of Regulated Qualifications: Home page (

Level 3 Sports Massage

Under Ofqual regulations, a Level 3 qualification is equivalent to a high-school A level and is only enough for basic massage on healthy and uninjured people but they don’t tell you this and let you assume something more. But those seeking Sports Massage treatment usually do so because they have a minor (or more) injury and are therefore outside the scope of practice and training for a Level 3 trained therapist.  

Boasting of a 95+% pass rate

This claim means either the course is so basic and easy that it is virtually impossible to fail, or that it does not matter how well you do on the course because they will give you the qualification regardless. No respectable training provider should make such a claim.

Based on my 35+ years of clinical and teaching experience I believe that if you want a viable career opportunity in Sports Massage then don’t be tempted by a short and/or online course because it will not give you the skills and knowledge you need to succeed.

For the most in-depth professional training in Sports Massage and more:

London & Southampton –

Exeter & Bristol –

Oxford –

Cambridge -


The Pioneer of Sports Massage

It all began in September 1989 with the first ever course teaching Sports Massage, based on the first book with this title, written by Mel Cash who still overseas all our training. This was also the first massage school to have proper external validation with BTEC [Why we Chose BTEC] to ensure we maintained a high quality of training. This first six-month course was rated by BTEC at Level 4 which is equivalent to the first year of a University degree course.

Other sports massage schools

The London School of Sports Massage was an instant success and we were soon operating at full capacity but the market was obviously growing further afield and inevitably more Sports Massage schools emerged to meet this demand. But these were disappointing because they were just modified versions of the basic massage they used to teach. Their courses were only rated at Level 3, which is equivalent to a school A level, and this is not high enough to provide a proper Sports Massage service. And at this level, the scope of practice is limited to treating people who don’t have any injuries and this is not what people expect from Sports Massage.

Expanding our qualification

To give more people the opportunity train in Sports Massage at our level we set up the Institute of Sport & Remedial Massage ISRM. This became our BTEC centre which then allowed more schools to run the same qualification. This is very carefully controlled by Mel who provides all the necessary tutor training and support to ensure consistent quality across all our schools. 

Sport and Remedial Massage

Over the years, Mel and his team of tutors all continued to improve their own clinical skills so they could meet the needs of their clients better. They were developing greater assessment, treatment and rehabilitation skills which we wanted to add into our training. So accompanied by a new textbook in 1996 from Mel, we set a new nine-month qualification called Sport & Remedial Massage. This build on the original course with a more in-depth focus on treating people with minor and chronic injuries.

Pioneers of Soft Tissue Therapy

With these higher skills, as therapists we were often now achieving better results with people in chronic pain than they had with any other injury therapy. We also found that many of our therapists were now doing more work with clients who did not do sport but had pain caused by other lifestyle or medical factors.

So over several more years, our tutors and therapists gained a huge amount of clinical experience treating the widest range of conditions. To incorporate this increased level of understanding and skill we developed a new one-year qualification called Soft Tissue Therapy, along with another textbook in 2012 from Mel with the same title. This latest version of our qualification develops a much deeper understanding of pain and injury, with more advanced clinical skills to treat them with. BTEC graded this at Level 5 which is equivalent to the second year of a university degree.

We took the word “massage” out of the qualification’s title because it no longer defines the work we do. Although it is still an important part of many treatments, and many of our therapists practice Sports Massage as well, we don’t always have to use it. We have a wide range of other hands-on techniques and clinical skills which can be a more appropriate and effective way of treating some clients.

Unlike most of modern healthcare, we don’t train therapists do treat “injuries”, we teach them how to treat “people” with injuries because even if the injury is the same the people are always different. This is what makes our Soft Tissue Therapy qualification so outstanding and what brings our therapist such successful results.

There is no International recognition for any professional qualification in any profession. All countries and States have their own regulations and there is no internationally recognised standard for anything.

Some training organisations include the word ˜International" in their title but this only means they are involved with training in some other countries.

When our therapists go to other countries we do whatever we can to support them by sending the details of our qualification to that authority but it is up to them whether to accept it or not.


To be a licensed massage therapist in the State of New York you have to have done a 1,000-hour training course but in California it is only 500 hours.

Canada requires a two year full time training to be a licensed therapist but their curriculum includes many advanced subjects that are only taught to Physiotherapists in the UK.

In Europe, unlike the UK system of Common Law, countries are based on a Statutory legal process which only allows a medically qualified practitioner (Doctor, Physiotherapist or Osteopath etc) to diagnose and treat any injuries. Our qualification includes the treatment of chronic pain and minor injury which is not really allowed there. Some countries enforce this strictly but we hear of other countries (or regions) that seem to have a more relaxed attitude. You could still work under the massage therapy title but without promoting your additional skills.

Our latest understanding is that in Australia and New Zealand, to be a registered therapist there you have to have a ‘transcript’ which is a document you can only get from a training school in that country. So you have to go to one of their schools and get them to award you with a transcript based on your prior learning with us.



At LSSM we get many students who tell us they have wasted their time and money doing massage courses that try to teach hands-on skills online. Please don’t make the same mistake.


You may think you are doing a technique in the same as shown on the screen but how can you tell?

The screen may only show you what the tutor is doing with their hands but you may not see how they move their whole body which is just as important.

No two people are the same and there is no technique that is exactly right for everyone. Even if you copy what you see on the screen exactly it is unlikely to be exactly right for you.

You need to learn hands-on techniques in a classroom environment where experienced tutors can give you individual guidance. And you can practice on a variety of other students to give you a wider and more realistic learning experience.

Why I’m happy to call myself a Soft Tissue Therapist. By Imi Testa

I quite often read or hear in therapy forums, blogs or podcasts how other therapists can be “more than just a massage therapist/soft tissue therapist”, or how manual therapy is passive and of little value. I see massage therapists aspiring to be Physiotherapists and (and I am absolutely guilty of this) saying “I’m just a massage therapist”. Others advocate for our training to become a degree qualification and that the fact that we don’t hold a degree means that we are of lesser value. I disagree.

Whilst I absolutely bow to the fact that Physiotherapists, Chiropractors and Osteopaths have a much higher level of training and responsibility than we do and that we absolutely need higher levels of regulation (although not as high as chartered professions as we don’t hold as much responsibility), I do not believe we need degrees and I do believe we add enormous value to the industry.

Here’s why:

Degrees are expensive in both money and time. This makes them prohibitive for many. It also raises the charge that those having them may ask for their services once qualified. Many people who work as massage/STT’s work part time alongside other jobs or childcare commitments. The cost of a degree would not make this an attractive option.

It is a vocational job. Whilst we must follow in our practice and narratives the latest evidence and continue to work to update and expand our knowledge, being able to read, digest and argue the minutiae of academic papers is not essential for us. Does this mean we are less than – no, the skill set we bring is just different. I do think we have lost the respect for vocational craftsmanship and non-academic skill that we once had. The chef who can turn everyday produce into a delicious meal, the care worker who can meet the needs of the most challenging patient with kindness and dignity, the artisan craftsman, the hotelier who can anticipate the wants of their guests before they ask. The skills that we bring are not in the modalities or styles of touch, but critical thinking, the nuance of reading body language, of listening to our clients (really listening), customer service, assessing (not diagnosing) and ruling out red flags and referring if needed, networking so we have the absolute best list of practitioners to refer to, being able to work together with many different people with whatever priors they bring to our clinics and building that precious balance of therapeutic alliance rather than either dictate treatment or not earn their confidence and trust. And the touch itself. Yes, I believe there is huge skill in this, not in any modality, but knowing and adapting how we touch each client in each moment with them to help facilitate positive changes. Being able to make touch feel safe, good, non-threatening, confident, calming. Yes this should be alongside assessment, safety, movement and supporting self-efficacy.

For many of “the worried well” who make up the majority of our clients this is all they need. Reassurance, validation, as Greg Lehman would say “calming shit down and building shit back up again”, cheerleading and installing confidence and resources in their own capabilities for self-management. This can save the time and resources of those higher qualified than us to help those who have more complex needs or who only have the financial option of the NHS.

So yes, I am going to work much harder at not saying I am “ONLY” a Soft Tissue Therapist.


Our journey began in September 1989 when LSSM started the first Sports Massage qualification in the UK. It was based on the first book on Sports Massage which I wrote and had published the year before. It was a 6-month course and although it was called “Sports Massage” it already included some advanced techniques such as Muscle Energy Technique and Soft Tissue Release. It was also the first externally validated qualification of its kind.

In those days Sports Massage was a good fun job and we were kept very busy because there were not many of us around. But that soon changed as other schools jumped on the bandwagon, still teaching basic routine massage but with a bit more ‘force’ and they calling that ‘Sports Massage’. So there were more and more therapists chasing the same amount of work. We were also realising that although it was a fun job, because clients mostly wanted treatment in the evenings and weekends this wasn’t giving us such a good personal lifestyle.

As Sports Massage Therapists we were not trained to treat injuries but this didn’t stop injured clients turning up for treatment. LSSM were the pioneers of this new profession and we were still learning and developing our clinical skills. To be able to treat injuries we were told we had to become Physiotherapists, Osteopaths or Chiropractors but our injured clients had often been to see these therapists already but it had not been effective (not to imply that these therapies don’t work, just that they don’t always work). So why should we train in the same way to fail the same people? We needed to find our own solutions.

We further developed our clinical skills so we could better meet the needs of the injured clients who were coming to see us, and with this we were achieving better results with a broader range of musculoskeletal problems. This opened our doors to a much wider clientele with more and more non-sports people seeking our help. This was also giving us much better lifetime career potential. So, in 1995 we extended the course to 9 months with more advanced clinical skills and we re-named it Sport & Remedial Massage (BTEC Level 4).

The start of the 21st Century saw other changes with financial pressure on the NHS making it less able to fund the treatment of minor and chronic musculoskeletal injuries.  Alongside this there were also changes in the way Physiotherapists were being taught, with less hands-on skills and, without the demand from the NHS, less emphasis on treating minor and chronic injuries. So people with these problems were finding it harder to find good effective treatment.

In response to this we continued to develop the qualification and in 2008 extended it to one-year and BTEC upgraded it to Level 5. Since then we have further refined it with more assessment, treatment and rehabilitation subjects and in 2015 the qualification was renamed ‘Soft Tissue Therapy’.   

This new title more accurately reflects what we now do because we are no longer defined by the word ‘massage’. We use an extensive range of other hands-on techniques and, when necessary, can perform highly effective treatments without using any conventional massage strokes. We also include a lot more exercise, movement and active lifestyle advice. We now offer a new type of therapy that can effectively treat a wide range of physical injury problems with people of all ages and from all walks of life.

So where do we go from here?

Our Soft Tissue Therapists are now the only ones in the UK who are properly trained to treat minor and chronic injuries using these traditional hands-on methods. Gradually more and more of the general public should recognise this and be able to benefit from it. Doctors who see patients with these injuries have limited options within the NHS. Most know that a long wait to see a Physiotherapist who is exercised-based and does not offer hands-on treatment it is not the best answer. They should consider referring these patients to our Soft Tissue Therapists who have both the time and the skills to provide the best care for these patients.

There are so many different sports massage courses available these days and they all offer the expectation that with their certificate you can become a successful therapist. This suggests that you only need a certificate to succeed but can it really be that simple? The fact is that clients don’t come to you because of the certificate on your wall. In truth they probably won’t know what it means or how reputable the awarding body is anyway. The only thing that really matters is the quality of the treatment they get. And the only way to become a successful therapist is by achieving good result by safely assessing and effectively treating a wide range of different clients. This can only come about through good quality in-depth training, and the better the training the more likely the success. It’s that simple!

I have spent the last 30 years trying to lead by example by improving standards and the quality of training in my own organisation. But without statutory legislation to regulate our profession few, if any, have followed us in this way. Instead, I believe there has actually been a general decline in the quality of sports massage training in recent years.

In some ways this reflects today’s society where people want the convenience of doing things online and they expect to get quick results. This has encouraged many schools to run shorter courses and use more online training instead of classroom sessions. This can be a lot more profitable for the school but this is at the expense of the good quality training a therapist really needs to succeed.

You cannot learn the practical hands-on skills for massage or soft tissue therapy by watching pre-recorded movie clips. You may think you are doing it the same way as shown on the screen but it is hard to spot your own mistakes. Your hands may be doing the same thing but what about the rest of your body? Even if you do manage to copy the movie clip exactly this won’t be right either. Not only do therapists each have our own unique strengths and weaknesses but no two clients are ever the same either. So there will never be one single best way to perform any technique and no set routine will ever be exactly right for an individual client. The demonstration you see on the screen might only best suit that tutor and it may not be right for you.

The only good way to learn these skills is in a proper traditional classroom environment where you can practice with fellow students and have experienced tutors observe and guide you. Good tutors will help individual students develop their own style which suits them best and it has to be wrong for everyone to follow a single example.

I can understand why people are tempted to find a shorter, more intensive course because they want to start working with it as soon as possible. But unfortunately it really does have to take a lot of time and practice to develop a good quality of touch, tactile sensitivity and hands-on skills. Ideally, students should learn techniques in the classroom and then go away to practice them on friends and family so they can consolidate these skills in a real life setting. These will then become a strong foundation for more advanced techniques to be learned at the next classroom session. It also means they can discover for themselves the limitations of some of the basic techniques and so the more advanced techniques they learn later will give them real answers to real problems.

It also requires a lot of theoretical knowledge to become a good effective therapist and the more you understand about how the human body functions and dysfunctions the more likely you will be to succeed. Unfortunately, we have not yet evolved with a USB socket in our head so we can’t simply download the information we need. Instead we still have to do it through traditional study methods which take a considerable time to do properly. These are the reasons why it normally takes our students at least a year to complete their Level 5 Soft Tissue Therapy training with us and it is why so many of them become so successful. I am convinced that any course that takes less than six months cannot be long enough to properly acquire the necessary skills and knowledge to succeed.

When I look at the different sports massage courses out there I am shocked by some of the poor examples I see. There are courses that are mostly, or even entirely, done online and there are some intensive courses that take as little as just one week with little or no underpinning academic study involved. I have seen others where the students get extensive course notes given to them and they only have to fill in some missing words and basic facts to complete the academic part of the training. All these courses will give you a certificate but I doubt that any will lead to any proper career success.

 Short intensive courses with a lot of online content may be very tempting but in reality they are most likely to be a waste of time and money because they don’t provide enough skill and knowledge to enable you to succeed as a therapist. A good career needs a good investment and the cheaper easy options are a false economy because they just don’t work!

Sports Massage aims to support the specific needs of a client’s sporting activities. But unless you are dealing with an elite/professional, most people do sport as part of their lifestyle and so sports massage should only be part of the job.

Sports massage alone can be a good fun job but after a while it gets repetitive and is not the stimulating lifetime career that many of us want. Athletes are not all young fit and healthy either, they may suffer with pain and injury which has little to do with their sport. And the rest of the population who don’t do sport can also suffer with minor and chronic musculoskeletal pains. They all need good effective hands-on treatment but where can they get it. Physiotherapy training no longer includes the manual techniques we use even though they have proved to be so very effective.

Soft Tissue Therapy has evolved from Sports Massage and is now becoming the only therapy that used these hands-on techniques to treat minor and chronic injuries. It does this in a way that can help people from all walks of life, suffering with the widest range of musculoskeletal problems, caused by any of life’s stresses. And we don’t just treat “injuries”, we treat “people” with injuries because everyone is different and should be treated as an individual person, not just an injury.

Sports Massage should be part of support package for athletes and is much more than just giving a good massage. It is about injury prevention and enhanced performance by carefully planning treatment as integral part of training. To do this the therapist needs to be confident in assessing risk factors for injuries and provide appropriate treatment and advice. Athletes will undoubtedly suffer injuries so sports massage must include the treatment of minor injury problems. To be able to do this well, you need good in-depth training.

Level 3 & 4 Sports Massage training

Under the Ofqual criteria that awarding bodies like VTCT/ITEC follow, a Level 3 qualification should be equivalent to a school A Level. But this is not high enough to able to provide a proper Sports Massage service. And at this level, the scope of practice is limited to treating people who don’t have any injuries and this is not what people expected from Sports Massage.

A Level 4 Sports Massage qualifications should be equivalent to a Higher National Certificate (HNC) and will include the assessment skills and treatment techniques needed to provide a proper Sports Massage service. But these qualifications are normally delivered as a short additional course on top of the Level 3. Although the extra subjects appear to meet the requirements, they are built on a weak Level 3 foundation of knowledge and understanding. It would be more effective if they were a complete integrated Level 4 courses where the underpinning knowledge and understanding are all delivered at Level 4.

Our BTEC Level 5 qualification in Soft Tissue Therapy

This is equivalent to a Higher National Diploma or a Foundation Degree and because Soft Tissue Therapy involves much more than Sports Massage it can only be achieved at this higher level.

ISRM only operates a fully integrated BTEC Level 5 qualification in Soft Tissue Therapy (which includes Sports Massage). This means that all our lessons are geared towards the Level 5 outcome.

So from the start we teach good functional anatomy and advanced massage techniques to give the course its solid foundation, we then build on this with a deeper understanding of pain and injury, all within and evidence based framework.

Treating people with injuries is a central theme throughout our course. Our Customised BTEC qualification has evolved through our success as clinical therapists, as well as current evidence, so we know how to focus our training on the skills and knowledge that the therapist truly needs.

We are a small independent training provider that has developed its own unique customized BTEC qualification. This has been evolving since 1989 through the clinical experience of Mel Cash and his expert team of leading tutor/therapists. As they have developed their clinical skills over many years to offer ever better treatment to the actual clients that come through their door, they have added these skills into our training programme. So our qualification has been built only on the proven techniques and methods that we know work well in the real clinical environment and help our clients the most.

Our qualification has also responded to developments in modern healthcare because as therapists we have seen how our client base has changed. When we began in 1989 our job was mostly Sports Massage because the National Health Service used to treat all the common injuries. But with cutbacks in NHS funding it can no longer afford to do this so now it is the 90% of the population who don’t do sport who now need our help.

As the pioneer of the profession we have responded to this and have moved beyond sports massage to develop Soft Tissue Therapy with the aim of safely assessing and treating all manner of minor and chronic injuries. Sports massage may still a valuable part of our work but we now do so much more and this is what makes our unique Soft Tissue Therapy qualification a far more rewarding and valuable career.

Where Modern Sports Massage began

By Mel Cash

It all began in the early 1980’s when, as a very keen Marathon runner and Triathlete I discovered the benefits of self-massage. Without any training and using the simplest massage techniques I found it really helped me recover better from long hard training sessions. Surely massage was something all us athletes would benefit from but why couldn’t I find anyone out there doing it for us? At that time, I was also looking for something meaningful to do with my life and there it was, I had found it with a passion, I wanted to be a massage therapist working with athletes. Not just the top elite’s but also this new group of keen amateurs like me. But how could I do this?

Massage Schools

There were a few massage schools around which were mostly teaching a type of massage more suited to the Spa and leisure industry. The notion of “sport for all” and the “fitness industry” was only just starting in those days and there wasn’t an established market yet for what I wanted to do.

To get me started I went to one of these massage school where I learned the basics skills and got a certificate but there was nowhere else to go to learn anything more. So the only thing I could do was get started as a massage therapist and learn what I needed to know as I went along.

How Sports Massage began

This was still a time when the word “massage” was commonly associated with the sex industry so I started to call my work “Sports Massage” because it sounded good and gave “massage” a fresh new respectable image. The term itself is actually meaningless because you cannot massage a sport and as a therapy it involves much more than just the massage.

I had good natural ability and instinctively kept developing my skills in innovative and creative new ways that worked better with my clients. For example, I had only ever seen massage done with the client laying prone or supine until the day I realised I could get into some deep hip muscles much better with them laying on their side. And this developed into many new techniques and positions to work with. To this day I still believe that as therapists we can always discover more and improve our skills further, we can never know it all or ever reach perfection.

I started off treating members of my athletics club and one of them had a friend in the Royal Ballet so I soon had clients from there too. My name got around and I was getting some elite clients, ranging from the then British Heavyweight Boxing champion Frank Bruno to the World renowned prima Ballerina Sylvie Guillem (and they don’t come more different than that). At the same time, I was still treating recreational athletes and helping a wide range of people to live more physically healthy and active lifestyles. This also included treating people suffering with pain and dysfunction caused by more serious and sometimes terminal medical conditions.

And all this top quality experience was adding hugely to my depth and range of clinical skills.

But I also needed to learn more on an academic level to support my hands-on skills and as luck would have it at the time I was sharing a flat with a medical student who also did a lot of sport. He was happy for me to borrow any of his books and was also a willing person for me to practice on. But even better, in those days there wasn’t the security we now have at public buildings and so there was nothing to stop me going with him and sitting in to some great lectures on orthopaedic medicine.

My learning adventure also led me to some Osteopathy books which covered more advanced soft tissue techniques that went beyond the scope of massage. They dealt with the way the nervous system controls the muscles and offered a more profound way of treating injury and dysfunction. I taught myself these techniques from the books but with modifications that were more suited to the athletes I was treating. By adding Neuromuscular techniques and Muscle Energy Techniques to my massage skills I was becoming a unique and very effective Sports Massage therapist.

The first book called “Sports Massage”.

In 1986 I met a medical doctor from Finland who specialised in sports medicine and strongly supported the use of massage. With the credibility of a doctor and his academic knowledge to back me up I was able to persuade a publisher to sign us up to write the first ever book called “Sports Massage” which came out in 1988.

The First Sports Massage School

The book became a rallying point for a few other like-minded massage therapists who contacted me because they were trying to follow the same path. I was no longer alone and a real market was starting to emerge for sports massage. It now needed to be developed through a good quality training course. So with their support and encouragement I set up the London School of Sports Massage and we started the first ever sports massage training course in September 1989.

So what is Sports Massage?

Right from the start I saw sports massage as part of a support package for athletes and something much more than just a good massage. My overall goal was always to help athletes and dancers prevent injury and enhance their performance. Sports massage can greatly improve the recovery from training and this is the most important way of preventing common overuse injuries. This means it needs to be carefully planned as a regular and integral part of a training programme and not just a random treatment.

A skilled therapist is also able to assess the condition of the tissues, feel the affect training may be having on them and identify potential injuries the athlete may not be unaware of yet. This can then lead to good effective preventative treatment and advice. But athletes do still suffer with injuries so treating minor and chronic injuries is also an integral part of the job.

Sports Massage also has to include more than just the traditional massage techniques because there are also Neuromuscular techniques which have such great potential when treating athletes.

Other sports massage schools

The London School of Sports Massage was an instant success and we were soon operating at full capacity but the market was obviously growing further afield and inevitably more Sports Massage schools emerged to meet this demand. But these were mostly a disappointment to me because they were just modified versions of the old basic massage they used to teach. They were not teaching sports massage as part of a support package for athletes as I had always intended it to be.

Developing into Soft Tissue Therapy

We have moved on a long way over the decades (I can hardly believe it’s been so long) and much has changed. Physiotherapy training became less and less hands-on and become more and more exercise-based. This meant that clients were coming to us with the minor and chronic injuries that we used to expect a good hands-on Physiotherapist to deal with. In response to this we were continually acquiring new skills and knowledge which made us ever more effective at treating these injuries.

As we developed our clinical skills and responded to the changes in the market for treatment our scope of practice also grew to meet the needs of the wider population and not just the sports sector.

In 2012 my fourth book came out and was the first (and so far only) with the title “Soft Tissue Therapy” and at the same time we changed the name of our qualification to Soft Tissue Therapy as well. This is a far more advanced therapy which aims to treat the widest range of minor and chronic musculoskeletal problems across the whole population. It still includes Sports Massage because many of us still work with athletes but this is now just a small but important part of the job we do. 

Career success in Soft Tissue Therapy

A successful career can only be built on a solid foundation. To achieve this we do not teach you routine treatments because no two clients are ever the same. Nor do we teach you how to perform a set of standard techniques which can only be repeated in the same way. Instead we give you the principle building blocks of the techniques so you can adapt them to suit the specific needs of the individual client. Our tutors can do this extremely well because they have decades of clinical and teaching experience to share with our students.

As part of the ISRM training students have to complete 100 practice treatments outside of the classroom. This not only helps develop technical skills but also teaches you how to communicate and get clients. At this early stage of your career you will mostly do Sports Massage (or Deep Tissue Massage for non-athletes) which is the perfect environment in which to perfect your skills. It should also mean that when you qualify you will already have a client-base to start build on.

As you learn more assessment and treatment methods and achieve much better results with client’s more complex injury problems your reputation for this type of work will then spread. You start to attract more clients who need treatment for injuries rather than just a good massage. With this your career should really start to take off because everyone suffers with some aches and pains so they are all potential clients. It also makes it a much more stimulating career because every day is different with a wider range of clients and a multitude of different problems to tackle.

The sports massage you started with as a student tends to be evening and weekend work which is not ideal for a lifetime career. But when someone has a painful injury they will be willing to have treatment during regular working hours which gives you a more viable working life.

So how does it work?

Although some ISRM therapist have full-time jobs with professional sports teams or private sector injury clinics, the vast majority are self-employed and work in a variety of situations. Some run clinics from their home if they have a room to spare, most others rent rooms at health clubs and/or work part-time at private clinics alongside Physiotherapists and Osteopaths. Many also visit clients in their homes which can be very lucrative.

Very many of our graduates go on to make a good living as Soft Tissue Therapists but a lot have gone on later to study Osteopathy and have become even more successful by having both sets of skills.

ISRM therapists often combine Soft Tissue Therapy with sport/exercise qualifications or with other forms of bodywork like Pilates, Feldenkrais method or the Alexander technique.

We don’t train therapists to do a job, we aim to give them a stimulating and rewarding lifetime career and our BTEC Level 5 Professional Diploma in Soft Tissue Therapy is the only one of its kind in the UK.

Online Learning

To devote as much time as we can to the practical hands-on training in the classroom, most of the underpinning theory and knowledge is taught through online written assignments. Great Soft Tissue Therapists don’t always have such strong academic skills. So although there is a lot to learn our assignments have been very carefully designed to make it as easy as possible to learn without being too academic. All questions have guidance notes with resources and references to help find the information needed and tutors are available to give extra support if necessary.

Online Video Library

Our students have free unlimited access to our Video Library which currently has over 50 videos which are all exclusive to ISRM. Especially made for us, they cover all aspects of our Soft Tissue Therapy qualification.

All practical hands-on techniques are taught in the classroom with supervision and guidance from highly experience tutors because we know that this is the only effective way to teach them properly. The videos provide additional support to the classroom experience and do not replace any classes.


Why you need to learn so much theory

Many Soft Tissue Therapists start their careers doing Sports Massage because this is environment they are already involved in. So they may expect to have clients who are generally quite fit and healthy with a few aches, pains and minor injuries from doing their sport. For this a student may start off thinking they don’t really need too much underpinning knowledge or study because they only need the hands-on skills.

But sports people are not all young fit and healthy. Some may have more long-term chronic pain which can be quite complex to treat, perhaps involving posture, occupational stress, past injury or even medical issues. And good therapists soon find their reputation spreads beyond the sports sector with clients coming from all walks of life with an ever widening range of injury problems to treat. To be successful at all this a therapist really does need a good level of knowledge and understanding.

Our BTEC Level 5 qualification is equivalent to the 2nd year of a university degree and Soft Tissue Therapy training cannot be achieved with anything less than this because of the amount of knowledge and understanding that it needs.

There are now many short intensive massage courses which I suppose fit in with modern-day life expectations. People want fast-food or instant results and they don’t want to wait for anything anymore. But you only get what you pay for!

Massage is a skill and it takes real time to develop a real skill. It also takes time to properly study all the underpinning knowledge you need to become a good and effective therapists. You just cannot get this from a short intensive course. Too many people have done these courses but where are they now? Very few actually succeed and become professional therapists with a lifetime career. But it is worse than that because these inadequately trained therapists do try and for as long as they last they do poor quality treatments which can ruin the reputation of the whole profession.

It may look good when you see that you can do a short massage course and immediately get work through an online booking agency but it’s nowhere near as good as it looks. These agencies charge the client on average £49 for a massage at their own home. I used to charge £50 for this service when I started my career over 30 years ago! These agencies are badly devaluing the massage profession and they can only do it with cheap poorly trained therapists.  And it’s not a very dignifies way for a professional to work, dragging a massage couch around on the London Underground for only £37 a treatment. If you devote yourself to them full-time, if you are good and lucky you might just about make a living wage. But the agency makes over £10 to automatically process each booking and they are laughing all the way to the bank.

Short intensive course may look good at first but they usually turn out to be a complete waste of money. If you want a stimulating and rewarding lifetime career you have to make a good investment which means at least a year of quality training and nothing less will do.

LSSM has been going for over 30 years, built on the pioneering work of its principal tutor Mel Cash. He wrote the first ever book on Sports Massage in 1988 followed by the first text books on Remedial Massage (1996) and Soft Tissue Therapy (2012).

We are unique because we have developed our own customised BTEC qualification based on the clinical experiences that Mel and his incredible team of therapist/tutors. Many have been teaching with him for decades, they are all leading soft tissue specialist and several are now also great Osteopaths. The team has been together for so long they are like a family and the fun they have working together soon rubs off on the students. We believe you learn best when you are having fun doing it.

Our BTEC Level 5 Soft Tissue Therapy qualification is the only one of its kind in the UK and cannot be compared with the more common ITEC/VTCT and other Sports Massage courses because these are more limited in their scope of practice. Our course has been developed with two key aims:

  • To train therapist to best meet the needs of today’s clients
  • To give therapists the most stimulating and rewarding life-time careers.

And we are very proud of the way we are achieving both of these.

We call it “Soft Tissue Therapy” because we are no longer defined by the word ‘massage’. We include advanced techniques which improve the way the nervous system makes the muscles work and so have a much more profound effect than just massage. These can also be done through clothes if necessary which is particularly useful when treating elderly or disabled clients.

Soft Tissue Therapy is all about treating and preventing minor and chronic injuries caused by any of life’s stresses, including medical conditions, so it is something that just about everyone needs at some time. These problems are no longer being properly dealt with by the NHS because of funding cutbacks so demand for the work we do is now growing strongly.

And we still do Sports Massage!

We began in 1989 as the very first school in the UK to teach Sports Massage. This original 6-month course is still the foundation and first part of the one-year Soft Tissue Therapy course we run today. So by the time students are half way through the Level 5 course they can already work effectively as Sports Massage Therapist and could start earning money then*. And when they gain their Level 5 they can advertise as both Sports Massage and Soft Tissue Therapists.

*Student can obtain Professional Indemnity Insurance for this.

BTEC is the largest Government-backed awarding body in the UK with their qualifications taken by millions of students a year. We chose them because they would validate Customised qualifications. This means that we are free devise our own qualification, as we believe best, and then they evaluate it (at level 5) and carry out a thorough annual audit to ensure we maintain this high standard. This has enabled us to keep developing the qualifications over the years, continually improving the quality of training in response to changes in the healthcare market and so our therapists can better meet the needs of their clients.

Customised qualifications are not on the National Framework which means that no college/University can just take it ‘off the shelf’ and teach it. It can only be delivered with our approval. This is because we believe that the hands-on skills can only be taught properly by therapist with successful clinical careers in the real world and this is not always possible in higher education establishments.

A Customised qualification does not give automatic points towards a university degree but it is usually taken into favourable account when applying for a related degree qualification such as Osteopathy.

Physiotherapy has changed a lot over the years. Originally it was taught through a hospital-based training programme and it was a very practical hands-on therapy. Now it is far more academic with a university degree training which this has changed it into a mostly exercise-based therapy with very little, if any, hands-on treatment. This is a great pity because a lot of people want to work with their hands and have the instinctive skills to do this very well. The old traditional hands-on techniques that Physiotherapists used to use are still as effective today as they ever were, also patients still like them and respond very well to them. Indeed, we now put on special Soft Tissue Therapy courses for recently qualified Physiotherapist who desperately want to develop these hands-on skills again. They do this because they prefer to work in this way and it brings them far greater success in the private sector where hands-on treatment is still in great demand.

Soft Tissue Therapy (STT) training is far less academic and instead it puts into practice the most effective traditional hands-on therapy techniques. Although STT’s cannot work with serious injuries in hospitals they are able to treat the most common of all minor and chronic injuries, aches and pains that everyone suffers with at some time in life. It is the most hands-on of all therapies and can be thoroughly enjoyable to do. Not only do STT’s treat the immediate problem but they also look for the root causes of injury, such as poor posture, past injury or occupational stress factors. This gives it the longer term aim of preventing injury and improving overall physical wellbeing. And although there are very few ’jobs’ in STT it does offer huge potential in the private sector with many full and part-time options.

Physiotherapy training takes three years on a full-time degree with tuition fees of nearly £30,000, plus living costs. At the end of this, most take up jobs in the NHS starting at around £22,000pa. Although this may give some job security and employee benefits it is not the working environment that everyone wants in their life. Soft Tissue Therapy training only costs around £3,000 on a part-time (usually weekends) course taking no more than a year. It is far more suited to those who enjoy using practical hands-on skills rather than those with a more academic tendency. 

Right from the start (in 1988) Mel Cash developed Sports Massage as part of a support package for athletes and something much more than just a good massage. The overall goal has always been to help athletes and dancers prevent injury and enhance performance. Sports massage can greatly improve the recovery from training and this is the most important way of preventing common overuse injuries. To do this, treatment needs to be carefully planned as a regular and integral part of a training programme and not just a random treatment.

A Sports Massage Therapist also needs the skill to be able to assess the condition of the tissues, feel the affect that training may be having on them and identify potential injuries that the athlete may still be unaware of. This can then lead to good effective preventative treatment and advice. But athletes do still suffer with injuries so treating minor and chronic injuries is also an integral part of the job.

To succeed at this, Sports Massage also has to include more than just the traditional massage techniques because there are also some advanced Neuromuscular techniques which can have more profound effects on the treatment and prevention of injury as well as functional performance

I can admit to having very little formal education in human anatomy. I didn’t get on well with school when I was a kid and lost interest in biology when I had to learn about the Amoeba (I’ve still never met one!). It was not until I was in my 30’s and started my massage career in the mid-1980’s that human anatomy became an important and fascinating subject to me. But in those days, massage training only covered anatomy on a very basic level (unfortunately it still is in some places) but I desperately wanted to understand more. So instead of learning what teachers thought I should know, I had to go out and discover what I needed to know for myself. And this was all based on my desire to better meet the real needs of my clients. And it’s been a great learning adventure.

When I started this journey the first thing that influenced my understanding was my awareness of evolution (I’m a fan of Charles Darwin and I’ve even visited the Galapagos Islands). The human body has evolved into what we see today and every part of it is there for a reason. It has all evolved to meet our lifestyle needs in the best and most efficient way. Or has it? In our lifetime we can only see a snapshot of evolution and it won’t stay this way forever. There could be some structures in the body that we don’t use as much as we once did and they could be evolving out. At the same time undoubtedly new changes will be slowly evolving in. After more than 30 years this fundamental understanding of evolution is still helping me better understand human anatomy and how it functions.

Our big problem is that evolution is an incredibly slow process but our lifestyles can change very quickly. For millions of years we Homo-Sapiens lived a simple foraging and hunter gatherer lifestyle with very little change. The evolutionary process could keep pace with the gradual changes and slowly adapt to make us better able to thrive in our environment. The modern society we see today only really got going about 15,000 years ago, starting with the agricultural revolution. Since then our lifestyles have been changing at a rapid pace which evolution cannot keep pace with.

Throughout history we have seen technological developments, like the industrial revolution, cause drastic and sudden changes to lifestyles and work practices. This has never been more so than with the computer which took over the workplace in little more than a decade, and the result has been dramatic. Now millions of people spend 8+ hours a day, 5+ days a week doing sedentary jobs sitting behind a computer performing a limited range of repetitive movements. But evolution hasn’t prepared us for this, we are still better suited to a more active hunter gatherer lifestyle. Sitting behind a computer or standing in a shop for most of your waking life is not what our bodies want to do and this leads to aches, pains and injuries. They usually start off as minor issues which, without good treatment or some sort of corrective exercise, can develop into more chronic or serious problems which in turn have a wider effect on lifestyle and general health. 

So a pain-free life seems to be impossible for most people living in the modern developed world despite (or maybe because of) all the labour saving devices we surround ourselves with. This also means that as therapists we often cannot achieve a real cure because the client has to go back to work and repeat the process which causes the problem. But I suppose this also means that we will never be out of work.

Coming soon! More articles which follow on from this theme.

If you like this, you may be interested in the live performances by Mel and his amazing team of tutors at LSSM. For more information, see


How Sports Massage came about. 

The term ’Sports Massage’ appeared as the title of my first book in 1988 and it was the right title for the book at that particular time. Back in the 1980’s the most common use of massage was in the sex industry (No! That’s not how I started). So we needed an abstract title which gave the instant message that this was a modern new approach to massage that had nothing to do with sex.

‘Sports Massage’ was never indented to be a descriptive title because it is meaningless. You can’t massage a sport! You can only massage a person who happens to do sport, as well as the many other activities in their life.

My first book ‘Sports Massage’ (Ebury Press) was never about how to do massage anyway. It described how to use massage and other more advanced techniques to improve the recovery of common sports injuries.

So how did ‘Sports Massage’ become a mini-industry?

Organisations that were already training massage therapists for the spa, beauty and leisure industry started to teach the same basic massage routine but with much more heavy pressure and called it ‘Sports Massage’. Because it has no real meaning who could say this was wrong, and with the newly emerging fitness industry at that time it really caught on.

Misled by ‘Sports Massage’

Many people are being misled by the term ‘Sports Massage’. Injuries in sport are common so it is easy to imagine that Sports Massage will be able to treat these injuries but this is not true. All that it really offers is a deep massage without the assessment and treatment skills need to safely treat any injuries.

Regular ‘Sports Massage’ is very good for athletes, and anyone else, to help them stay on top form and injury free. But what if someone has an injury? With sports massage they just get a deep massage and have to hope for the best!

Is Sports Massage a good job?

It is a good job if you love sport but most clients want to see you in the evenings and weekends which may not be such a great lifestyle. Also, only a small proportion of the population do regular sport so the market is quite limited in real terms.

What is Soft Tissue Therapy?

This is on a much higher clinical level and sports massage is just one small part of it. The aim is to treat all minor and chronic injuries whether cause through sport or any other lifestyle factor, using massage and other more advanced techniques. It also aims to identify the underlying causes of injury and offer more long-term improvements in physical wellbeing and injury prevention.

Everyone suffers with these injuries at some time and they can badly affect their quality of life but treatment is often hard to find. Main-steam medicine may be good at treating more serious conditions but who deals with all these minor and chronic injuries?

Career potential in Soft Tissue Therapy

Soft Tissue Therapy has evolved as the answer. It is a safe and effective way of helping all people with minor and chronic injuries and it offers the therapist a truly stimulating and rewarding life-time career with the greatest potential.



Aches and pains are an inevitable part of modern life whatever our age and lifestyle. The human body is an amazing self-repairing organism but it isn’t perfect and can’t always fully fix all the accidents and injuries we get. And the older we get the less well it can repair so the cumulative effect of postural and occupational stresses as well as the legacy of past injuries eventually take their toll. We all know deep down that we won’t live forever but we want to believe our body will keep going at 100% until that time comes, but it sadly doesn’t. Although that backache, stiff shoulder or painful knee isn’t going to kill us it does affect our enjoyment of life on many levels. They are not usually severe enough to justify drastic medical treatment so we just have to suffer with them. Or do we?


Soft Tissue Therapy is not a miracle cure but it can often come pretty close to that. It involves a range of advanced hands-on techniques, including massage, which have been developed to improve the body’s healing potential and reduce many painful symptoms in our muscular system. Beyond this, the properly trained therapist also tries to identify the underlying causes of these problems and offer advice on exercise or lifestyle which can overcome the difficulties and achieve more profound improvements in your quality of life.


So don’t put up with those chronic aches and pains that get you down, find yourself a Soft Tissue Therapist.

Regulation, Recognition or Acceptance 

I think it is time for a fresh new approach and we should get away from the terms Recognition and Regulation which have so much baggage attached to them.


All we really want is ACCEPTANCE.


We have already come a long way in establishing Soft Tissue Therapy without the help or favour of others. We have done it on our own through the good work we do and by actually succeeding in the private healthcare marketplace. We only exist because there is a genuine demand from the public for the work we do.


Mainstream medicine should accept us for who we are and what we do. Soft Tissue Therapy is unique; no other modality uses the same range of techniques with such a high level of expertise so we are not competing with others medical professionals working the same way. We offer something different which has great therapeutic potential, which supports and complements the rest of musculoskeletal medicine and it deserves its place in modern healthcare.


We can and should be able to all work together for the greater good. All we want is ACCEPTANCE.

The views and opinions in this essay are entirely my own, and not reflective of any Professional Association.


Statutory Regulation in the field of

Soft Tissue Therapy/Sports Therapy/Massage Therapy

By Matt Scarsbrook, July 2020


This mini essay is designed to provide practicing therapists a clear understanding of the work that a Professional Association (PA) (also known as a Professional Body) does, and how that compares to a Union.  It further explores the landscape of the Soft Tissue Therapy/Massage Therapy/Sports Therapy industry (collectively referred to as MT in this essay), including the PA’s, the General Council of Massage Therapists (GCMT), the Complementary and Natural Healthcare Council (CNHC), and provides a clear overview as to why this industry will not become either regulated or mandatorily registered.


TL:DR The ISRM, STA and key other PA’s are working harder than ever to try and support members, and are not in a position to give a continuous running commentary on discussions and progress because that takes away from the work actually getting done, but they do report progress once it has been consolidated.  What might seem like several days of no news is actually hours and hours of conference calls at all levels and an enormous amount of development work, and those involved feel a huge sense of responsibility.  Our industry is comprised of at least 12 PA’s (not including regional bodies such as the Scottish Massage Therapists Organisation (SMTO) or overlapping fields such as Bowen and acupuncture) and a voluntary register(the CNHC) that accepts therapists from an incredibly wide range of professions.  Trying to achieve a consensus is a challenge, to say the least.  The Union proposed by the Association of Physical & Natural Therapies (APNT) is highly unlikely to amount to more than another PA, but this will of course be monitored.  Further, we are never going to be a regulated industry with a mandatory register.  The Government has made it clear it has no interest in further regulation in the Health & Social Care sector. From my perspective, further regulation is not necessary in MT, but whether you agree with this or not, since it will not happen we are best off putting our efforts into more constructive matters..  Continue reading for the full picture.



The Bigger Picture


To begin, a PA is in effect an organisation set up by an individual or group.  As defined by the Science Council in the UK; “A Professional Body is an organisation with individual members practicing a profession or occupation in which the organisation maintains an oversight of the knowledge, skills, conduct and practice of that profession or occupation.” (1)  The Quality Assurance Agency for Higher Education (QAA) defines professional bodies as “Independent membership organisations that oversee the activities of a particular profession and represent the interests of its members.  They may offer regulation or certification of unregulated occupations on a voluntary basis.” (2)


In short, this means that membership of a PA is entirely voluntary, and your continuing membership is reliant on you complying with the rules and regulations of your chosen PA.  The PA will have been originally set up to represent the interests, and oversee the conduct of a specific group, usually defined by their qualification.  As there is no single route to MT in the UK, with different schools teaching different approaches, different modalities and qualifying their students to different scopes of practice, there have naturally arisen a wide range of PA’s covering the professional interests of all these practitioners.  Clearly, the more broad a single PA’s membership base in terms of qualification, the more difficult it is for that PA to provide comprehensive guidance.  The more narrow and specific the PA’s membership, the greater the number of PA’s required to cover the industry.  In addition there are naturally going to be disagreements as to which is the “correct” way to govern an area of the industry, so PA’s with overlapping memberships are created.  The members themselves can “vote with their feet” by choosing which, if any, PA’s to join.


In this set up there is no “Lead PA”, all are equal regarding their influence on the industry.  It is the members of a PA who determine the influence by choosing and following the guidance of the PA that best represents their needs.  There have been attempts in the past to bring some collaboration between PA’s in a formal way, which is where the GCMT features.  This is not a “governing body of the massage industry” (3) but instead a forum designed to allow direct discussion between PA’s involved with Soft Tissue Therapy, Sports Therapy andMassage Therapy.  Whilst a potentially good idea, by its very nature it is voluntary and therefore limited in its scope to shape the industry as a whole unless it can convince all PA’s to provide representation.


The CNHC is a voluntary register (seeing the theme here?) set up to allow practitioners to “demonstrate to the general public and other healthcare providers that they meet UK-wide standards of practice in their work” (4).  My personal experience has been that the accredited register is not recognised by regulated healthcare practitioners (which begs the question where is the “marketing” for this that would benefit registrants) and that during the coronavirus pandemic the primary drive of the CNHC has been to try and convince Government that their registrants, who comprise a whole host of modalities, are key workers, just like the NHS.  This is something I personally believe to be an absurd sentiment;  there are no circumstances under which a reflexologist’s work can be called “urgent” or “frontline”,and we risk losing credibility in our practice by trying to assert such a view.


The latest announcement in trying to bring some unity to the industry is from APNT and their suggestion of a union (5).  Whilst I can’t speak in much detail on this as the details are yet to be released, I can give a general overview of where unions sit in relation to PA’s. 


Fundamentally a union represents the voices of the employee’s to the employer.  Their origins trace back to the 18th century where the industrial revolution was just getting underway and men, women and children were exposed to horrific working conditions.  As individuals they needed to like it or lump it, but en mass as a union they could have some influence on their employers.  You may be starting to see a slight issue here.  MT’s, by and large, are self employed.  For those who are employed there already exist enormous general unions like Unite, who will support their members in any industry.  But for the self-employed, the basic concept of a union falls flat.  Existing versions in the wider UK are more akin to memberships offering legal advice, training advice and sometimes financial support.  Their lobbying efforts are directed to Government but in a world where the loudest voice wins, they need to have a very broad base of members to get the numbers needed.  And, once the membership base is broad, the message becomes broad and lacking in focus, and specific industries and groups cannot be represented effectively.  The union does not have any power to set professional governance - that is the job of the PA.  To take the Chartered Society of Physiotherapists (CSP) for example, they exist as two distinct branches - the PA and the Union.  The PA sets the governance and professional conduct for the members.  The union side represents members interests in employment such as working conditions and support in disciplinary hearings.  So for self-employed MT’s, the PA provides everything that is needed.  It will be with great interest that I watch the development of the APNT’s union plan, to see what value it truly provides the MT industry whilst representing a very broad group of practitioners, but but my concern is it will simply become another form of PA.


So what about regulation (which leads to mandatory registration)?  This is a common question within the complementary care industry, and particularly during the Covid-19 pandemic when regulated practitioners such as Physio’s and Osteo’s can work but none regulated MT’s cannot.  An element that is often referred to is that Physio’s are degree educated where MT’s are not, they are vocationally educated.  The obvious exception here are Graduate Sports Therapists (GST).  However this is not a discussion on whether there should be a distinction made in the scope of practice between GST and vocational Sports Therapists (ST), because I feel that this particular issue misses the point when it comes to regulation.  Because regulation is not simply set on the level of education of the practitioner.






Statutory regulation of certain healthcare professions is a mix of historical context (The Medical Act of 1858 initially established what eventually became the General Medical Council, with acts of parliament for the regulation of midwives and nurses coming in 1902 and 1919 respectively) and the obvious need to protect patients and the public from harm.  It ultimately comes down to the risk of harm by any one profession.  MT is a very low risk profession when compared to something like medicine. 



According to the Department of Health and Social Care, regulatory bodies:

  • keep a register of qualified professionals who are fit to practise so that patients and service users know who is and who is not qualified;
  • set the outcomes required from undergraduate (and in some cases postgraduate) education and training that must be met before registration is granted, as well as inspecting education and training providers;
  • set the standards of conduct, performance and behaviour expected of a registered professional so that they deliver care safely and effectively;
  • operate a system to ensure that registered professionals continue to meet these standards, that their knowledge and skills are up to date, and they remain fit to practise; and
  • take action to restrict the practice of a registered professional where the required standards of conduct, performance or behaviour are not met. (6)


With the removal of the underlined section, I hope you’d agree that this is essentially the role performed by PA’s in MT, although their ultimate action is restricted to removal of membership rather than the legal right to practice



Fundamental changes to the regulation of healthcare professionals began as early as 2008 with The Health and Social Care Act.  In February 2011 the then coalition Government published a document called Enabling Excellence; Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care Workers (7).  In it they state “Delivering safe and effective care will continue to be the driving principle behind professional regulation.  However, the regulatory framework is also complex, expensive and requires continuous Government intervention to keep it up to date. More generally, reducing regulation is a key priority for the Coalition Government.”


The argument for this reduced regulation was to encourage more responsibility by individuals for their actions, and to reduce cost and complexity in the economic climate of the time.


In 2015 the Professional Standards Authority published a paper called Rethinking Regulation.  In it they point out that the nine healthcare regulatory bodies in the UK “have a common set of functions yet there are differences in legislation, standards, approach, efficiency, amongst others.”  (8) So when MT’s ask for regulation, what precisely do they mean?  The executive summary of this paper states; “Health and care regulation is incoherent and expensive and there is little evidence for its effectiveness; if it was going to improve care it would have done so by now. It’s time to rethink regulation.”


Most recently in July 2019, the Government published the paper; Promoting professionalism, reforming regulation - Government response to the consultation (6).  In the executive summary they state; “The UK’s model of professional regulation for healthcare professionals has become increasingly complex, outdated and is seen as adversarial and legalistic. This makes it difficult for regulators to be responsive to the changing needs of the healthcare environment, to support the development of a flexible workforce and to protect the public in the most effective way.”  The paper continues by laying out the steps the Government is taking to reform and reduce regulation in healthcare in the UK.


From these documents spanning the past 12 years, it is quite obvious that the Government has no interest in further regulating healthcare by extending it to sectors currently unregulated, and it is in fact taking active steps to deregulate it.  It could be argued that they have good reason!  So the lack of regulation in our industry is not because the PA’s don’t want it, it’s because the Government doesn’t want it. 


Also, I think it’s clear that “regulation” is not necessary for MT.  As noted by the Professional Standards Authority; “Calls for statutory regulation are often made by those referred to as ‘aspirant groups’, reflecting an out-of-date view that regulation is a badge of professional status and something to be achieved, rather than a system to be applied where risks justify its intervention. Whether and how a group is regulated should not be based on how successfully or how determinedly that group aspires to it. The decision should be based on what form of assurance is the right one for the nature of the risk of harm that the practice in question presents to the public. Statutory regulation should be preserved for those professions for whose practice it is the most effective risk management approach.” (8) 


We pose a relatively minor risk to our clients or the public and our PA’s perform all the duties of the regulatory bodies.  In fact, to become regulated would by definition reduce the ability of the PA’s to make meaningful changes in our profession in any sensible and cost effective timeframe.  Regulation is also expensive - the average annual membership fee for the General Osteopathic Council is £560 (9), and for the General Chiropractic Council £800 (10)!  Whilst it seems attractive during Covid-19, as this seems to be the bar set by the Government regards returning to work, it would be a very expensive, convoluted short term fix that left us with a very expensive, convoluted long term faff.  Plus the Government have no interest in it.  So I consider it time to drop this line of enquiry once and for all - it’s dead, let's move on and focus our efforts on more realistic and beneficial goals.


For me the first such goal is achieving a level of recognition for our work from the Government and public at large.  It is quite right that we are appalled by the reference to us being “massage parlours”.  But what, as a profession, can we do to improve that image?  For a start we can look at the differences between MT and regulated healthcare.  What major difference stands out? To me, the key one is the use of evidence based practice.  If we want to be taken seriously we need to stop promoting anything not properly supported with evidence, such as “negative energy”, “releasing fascia”, “breaking down scar tissue” and “accelerating healing”.  If we want to be viewed as professionals we need to represent ourselves as professionals, using the correct language, and being accurate and evidence based in our claims.  This is something that every single member of the MT profession can do.  They can educate themselves, bring themselves up to date with what the evidence says is really going on under our hands, and embrace it.  Our training schools can stop teaching outdated concepts and, in some cases, pure fantasy.  And then we can stand proud as professional practitioners alongside, and complementary too, mainstream healthcare. 


To the world at large, maintaining high quality standards means providing consistent standards of treatment with expectations in results based on clear evidence. Only once this is set as the objective is it worth discussing how this objective is to be achieved, and how as an industry we can govern our practices.


Response from Mel Cash, ISRM, LSSM


I must thank Matt for this excellent essay which I believe very accurately describes the situation regarding regulation and recognition in our profession. But it is hard to come away from this feeling encouraged because it all looks so negative, nothing seems to work for us.


So where do we go from here?

I think it is time for a fresh new approach and we should get away from the terms Recognition and Regulation which have so much baggage attached to them.


All we really want is ACCEPTANCE.


We have already come a long way in establishing Soft Tissue Therapy without the help or favour of others. We have done it on our own through the good work we do and by actually succeeding in the private healthcare marketplace. We only exist because there is a genuine demand from the public for the work we do.


Mainstream medicine should accept us for who we are and what we do. Soft Tissue Therapy is unique; no other modality uses the same range of techniques with such a high level of expertise so we are not competing with others medical professionals working the same way. We offer something different which has great therapeutic potential, which supports and complements the rest of musculoskeletal medicine and it deserves its place in modern healthcare.


We can and should be able to all work together for the greater good. All we want is ACCEPTANCE.






  1. Science Council (2020), Our Definition of a Professional Body [online] Available at: (Accessed: 6 July 2020)
  2. Quality Assurance Agency for Higher Education (2018) UK Quality Code for Further Education, Part A: Setting and Maintaining Academic Standards [online], Available at: (Accessed 6 July 2020)
  3. The General Council for Soft Tissue Therapies (2020) GCMT Mission Statement: Aims & Objectives [online] Available at: (Accessed 6 July 2020)
  4. Complementary & Natural Healthcare Council (2020) Apply to Register with CNHC [online] Available at: (Accessed 6 July 2020)
  5. Association of Physical & Natural Therapists (2020) Join The UK's First and ONLY Trade Union
    for Remedial Manual & Natural Therapists in Private Practice
     [online] Available at: (Accessed 6 July 2020)
  6. Department of Health and Social Care (2019) Promoting Professionalism, Reforming Regulation [online], Available at: (Accessed: 6 July 2020)
  7. Secretary of State for Healthcare (2011). Enabling Excellence: Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care Workers [online] Available at: (Accessed 6 July 2020)
  8. Professional Standards Authority (2015) Rethinking Regulation [online]. Available at: (Accessed: 6 July 2020)
  9. General Osteopathic Council (2020), COVID-19: Registration Fees [online] Available at: (Accessed 6 July 2020)
  10. General Chiropractic Council (2020), Fees [online]. Available at: (Accessed: 6 July 2020)

Level 3 is equivalent to a school A Level and it teaches you to give a routine massage treatment for sport, relaxation, beauty or similar.

Level 4 is equivalent to a school a Higher National Certificate or university entry standard and this teaches some more advanced technique which can help in the recovery of common injuries.

Level 5 is equivalent to a Higher National Diploma or a Foundation Degree and at this level will you learn how to assess, treat and rehabilitate a wide range of injuries.

All awarding bodies (BTEC, ITEC, VTCT, etc) have to use the same criteria when approving qualification Levels and so they must all be equivalent to each other. 

Some training providers offer a pathway up through the grades but this means you learn anatomy and massage at a very basic L3 which is not sufficiently for the clinical skills needed at L5. An integrated Level 5 qualification teaches the foundation subjects at the right clinical level needed for the advanced training to follow.

Some people want to dismiss Soft Tissue Therapy because they say there is no scientific evidence to prove that it works, but this is a crazy argument. It may be impossible to do a double-blind trial on a physical therapy because people undoubtedly know if they are getting real treatment or not, but it is completely wrong to assume that it does not work only because it cannot be tested in the conventional way. Instead you have to look at the anecdotal evidence and to do this you have to consider every human being that has ever lived on this planet!

Any human being who has an ache or pain will instinctively give it a rub (self-massage). In fact, try not rubbing it! It is impossible not to. Similarly, if you feel stiff you will naturally and instinctively stretch the area. Again it is impossible not to! If you have an injury you know instinctively that you have to rest the area for a while and then slowly build yourself back up to normal activity. These self-help remedies are all part of the body’s natural ability to heal itself. They pre-date modern science by tens of thousands of years and we all know they work. Massage, stretching and rehabilitation advice are the main cornerstones of Soft Tissue Therapy so to suggest that the therapy does not work is a complete nonsense. We all know it works because we all do it ourselves.

But the average person may only get a few injuries during a lifetime and this is not enough to develop real expertise in these natural remedies. All that Soft Tissue Therapy has done is take these natural remedies and study them, develop them and perfect them to get the best results. People with injuries go to Soft Tissue Therapists because they have the expertise to do it better than they can do it themselves, and because you can’t massage your own back!

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