As with many health-based professions, the field of massage therapy is heavily regulated. Although there is no national standard that prospective massage therapists must adhere to, most of the states in the U.S. require some sort of massage license or certification before practitioners are allowed to work with patients. For states that don't require licensing, it is still a good idea for prospective candidates to consider certification, since it can go a long way in finding better jobs, bringing in new clients, and staying abreast of changes and continuing education.

The Difference Between Massage Certification and a Massage License

Contrary to popular belief, massage therapy certification and licensing are actually two different things. Certification is the term used as an informal way of ensuring that a massage therapist has met a standard of excellence. It typically denotes that an individual has accomplished a certain level of education and experience, and also that he or she has passed some sort of exam. However, the exact nature of these qualifications is left up to the certifying organization, which is almost always a private, non-governmental entity that carries its own weight.

Professional licensing is similar but more formalized. It requires similar standards of education and experience, but it is upheld by governmental regulations and is required by law. For massage therapy, professional licensing occurs at a state- and/or city-based level (rather than a federal one), so the license requirements of each state vary.

Massage Therapy Requirements

Working as a massage therapist has less to do with the type of education obtained (such as a certificate, a diploma, or a degree) and more to do with the number of educational hours completed and the quality of the school. Most new massage therapists have to have a minimum of 500 hours of in-class training under a qualified supervisor. Courses must include an anatomy and physiology course in addition to the chosen type of massage therapy techniques. Some states require even more education – including New York, which stipulates that students must have had 1000 hours of training before they can even sit for the appropriate exam.

Accreditation through the Commission on Massage Therapy Accreditation (COMTA) is achieved only on an institutional level. If your school or massage therapy program is recognized, then you automatically get the certification that comes with it. Because COMTA is recognized by the U.S. Department of Education, graduating from a recognized school can offer an edge in finding employment; however, it may not count in all of the 39 states that require some type of massage therapist license.

All prospective massage therapy students should check with their state's licensing requirements before they choose a school. A course that fails to comply with state regulations often ends up being a waste of time, since a certain number of educational hours must be completed (or graduation from a COMTA-regulated school might be required) before individuals can even take the exam to get licensed.

The National Certification Board for Therapeutic Massage and Bodywork

The most recognizable certifying organization in massage therapy is the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). Certification through the NCBTMB requires 500 hours of massage therapy instruction, a passing score on their exam, and a commitment to the institution's Code of Ethics.

The NCBTMB offers two exams: the National Certificate Examination For Therapeutic Massage (NCETM) and the National Certificate Examination For Therapeutic Massage and Bodywork (NCETMB). These differ slightly in the types of questions asked on the exam; most of the difference lies in what each state requires for licensure.

Credentials through the NCBTMB must be renewed every four years. Within those four years, the prospective candidate must have worked at least 200 total hours in therapeutic massage and fulfilled the regulations for continuing education requirements, which are left up to the states to decide.

State and City Massage Therapy Regulations

Most of the licenses required to become a massage therapist are offered through each state's Department of Health. There are 39 states (including Washington, D.C.) that require a massage therapist license in order to work as a professional practitioner. Of these, a total of 33 states (again including Washington, D.C.) recognize the NCBTMB certification. The rules regarding the exact level of licensure required in each state – as well as any necessary continuing education credits or graduation from a qualified massage therapy school – can be found through the American Massage Therapy Association.

Further restrictions and license requirements may also be set up within city and county regulations. Most of these have to do with ensuring that the line between professional massage therapy and the sale of sexual services at so-called "massage parlors" does not get blurred.

Professional Associations

No matter what each state requires as far as licensing and certification, joining professional massage therapy associations is also a good idea for new practitioners. The American Massage Therapy Association is the largest and most general, but those with specific fields of study can also benefit from joining a group designed with their niche in mind. For example, the American Organization for Bodywork Therapies of Asia works just with Acupressure, Amma, Chi Nei Tsang, Medical Qigong, Nuad bo Rarn (Thai), Shiatsu, and Tuina.