Clinical vs Spa Massage Therapy

In the massage industry, there is a split between clinical (medical) and spa (personal services) massage. This separation can be confusing for both clients and therapists; knowing the distinctions between the two industries can help you understand what area is best suited for you, as a potential client or practicing massage therapist.


Basic massage education, usually around 500-600 hours, allows a new therapist the opportunity to get a position in a spa setting, begin practicing, and build upon their skill set. This experience and continued education in a spa setting is necessary when the massage therapist wishes to advance their career into a clinical setting. Substantial continued education is necessary to be qualified to practice in a clinical setting; this generally includes an advanced knowledge of pathology, kinesiology, and more.


Credentials are an important distinction between clinical and spa massage. To practice massage in a spa, a therapist if often required to be licensed and carry liability insurance. When it comes to clinical massage, additional credentialing may be required. This can include a National Certification, additional professional certificates, continued education hours, and in some cases, professional licensing (such as nursing or physical therapy).


The type of modality practice (such as Swedish, Cranio Sacral, Trigger Point Therapy, Lymphatic Drainage, etc.) does not classify a massage therapist as clinical or spa. Spa massage therapists and clinical massage therapists alike practice a wide variety of modalities. The difference between the two is the focus of the modality.

For example, a spa massage therapist’s end focus is on the overall satisfaction of the client and the reassurance that they will return. Sessions are often geared toward putting the client at ease in a calm, private environment with details such as aromatherapy, music, linens, and more. The sessions are charged based on a set number of minutes.

Clinical massage, on the other hand, focuses on functional outcomes. Results must be measurable, and a therapist uses modalities based upon evidential reason. The client’s satisfaction is not assessed until they complete a certain number of treatments or achieve a specific therapeutic outcome. The length of sessions are often shorter than spa massages, and prices are often defined by insurance companies in 15-20 minute increments.


Basic massage education will include the proper way to maintain records of informed consent, contradictions, and limited SOAP note documentation. The focus for both clinical and spa therapists is to ensure public trust and safety.

For spa massage therapists, documentation of time and place of a session is generally all that is required to be ethically sufficient.

For clinical massage therapists, further documentation is crucial, and it is just as important and the session itself. Referrals are important, as clinical massage is often practiced in team-based settings (physical therapists, acupuncturists, occupational therapists, psychologists, etc.), and a therapist must know when to refer their clients out and when to communicate that your skill set may be a more suitable therapy.

Whether it be clinical or spa, both areas of massage therapy accomplish a great task – providing the client with a tool that will improve their health, well-being, and life.