Per definition massage could be defined as manipulation of soft tissue which includes musculature and connective tissue. Another more detailed definition of massage is stroking, pressure and stretching of the skin and skeletal muscles.

First, one has to remember that there is an overlap between different massage methods. Some of techniques are more or less the same independently of the name of the therapist educational background or of the main philosophy of a particular school.

The Swedish massage I have my training in is systematically focused on working on the soft tissue and specifically on the skeletal muscles. But it must be emphasized that there is a difference between schools in Sweden how the Swedish massage is performed. This is by no means unusual in the case of manual therapy in general. For instance chiropractic and physiotherapy colleges can differ quite much in curriculum between each other. In Sweden every school has its own curriculum and will teach their students massage according to the schools on literature. In Sweden predominately the schools that have Swedish massage on the curriculum are private. Although some state-owned university programs like physiotherapy have a few hours of massage in their curriculum it is not any complete massage course compared to many of the private massage school. Before the 1970's physiotherapists in Sweden were well trained in massage but when physiotherapy became a more academic subject and programs were integrated within medical or health faculties there were a stronger demand that everything should be scientific based or evidence based. So the paradox today is that many of the private schools with no affiliation to university have the comprehensive programs in hands on massage training. But university programs in health and medicine are generally more extensive in science, medicine and human biology. Many of the private massage schools are under state supervision but this is more a bureaucratic formality and the authority really has no knowledge in manual therapy in general or massages therapy specifically. In Sweden the quality assurance of a massage curriculum is done internally by the school itself. But there are about ten schools today that formed the Swedish Massage Advisory Council.

The main aim of the Swedish Massage Advisory Council is to uphold the professional skills of a masseur or masseuse and the credibility of the business. The council quality assures schools. This is achieved by all students who are enrolled in a member schools can undergo a national test and receive certification as masseur. When council was formed 1998 there were an agreement that the title masseur or masseuse was the most commonly known title among the clients. This was the reason for that the title certified masseur or masseuse (in Swedish the word is the same for both gender) was established and marketed. Although today massage therapist is perhaps has higher reliability as a title. Massage therapy diploma is a title that every school or course provider can give without any reservation. The Swedish Massage Advisory Council has through it years established guidelines and minimum level of what massage therapist needs to know and how many hours of tuition is required in human biology, medicine, and massage and stretching. There are also requirements of clinical practice both supervised and done independently. All together there should a minimum of 390 hours of tuition and clinical practice. This is then examined when the students of the member school have passed a national theoretical certification exam. This exam is a multiple choice quiz with most questions is regarding the students' proficiency in anatomy. There is also a national practical exam on the students' skills in surface anatomy, massage and manual stretching. However we in the Swedish Massage Advisory Council has agreed on which muscles and their insertion and functions a massage therapist need to know there is really no consensus on the practical massage. There is also an agreement on which muscles a massage therapist should be able to passively stretch a patient but exactly how this is done regarding the position of the patient and therapist is something each school will decide. When it comes to the practical massage the guidelines is more indistinct.

According to the Swedish Massage Advisory Council a certified masseur or masseuse should have a good working and theoretical knowledge of the massage techniques effleurage, petrissage, frictions (circulatory drives with the tip of the fingers), vibration and tapotement. The therapist should be able to apply these techniques on an individual basis regarding the patients or clients request, health, physical constitution and any contraindications that might exist. But how the therapist adapts the massage techniques regarding depth and rhythm each member school will decide. Even the length of treatment session and the sequence of the techniques differe.

The purpose is that certified masseur or masseuse can give massage for pure relaxation as in a whole body treatment but the therapist should also be able to treat minor musculoskeletal disorders or rather muscle dysfunctions with more localized massage in combination with manual stretching techniques and advise in basic exercise and stretching. The predicament is that the definition of the classical massage techniques is not universal. For example petrissage could have one technique with circular movement with the contact of the palm but petrissage is also mentioned as an overall technique that includes variations of kneading or compressions. Another dilemma is that many schools have included other soft tissue or myofascial release techniques in the massage routine. And to make even more diverse every school make their own routine and there is no consensus on which massage techniques should be done on what body region. One example is that some schools teach their students tapotement could be performed on the lower body but other teach that tapotement can be done on the upper body as well.

All of the member schools of Swedish Massage Advisory Council have their own profile and specialization and most schools also graduate their students on a higher level than what is required. But unfortunately there are a lot of schools that are not members of the Swedish Massage Advisory Council. Some of these schools are still professional but others give away diploma after few days' courses without any examination. It is of course one thing to have shorter course for non professional use however it is not very serious if it is meant as course for professional use.

I have some experience of examination massage therapist who has been enrolled in other schools in Sweden than where I work and I have also had examinations of a few therapists from other countries. The therapist will be very good in the specific technique but it always looked more like an unspecific whole body treatment and the routine less rational with alternating from different regions. It is a vast difference in how the Swedish massage is performed. Neverheless a legitimate question is what the difference between what the schools teachers and what the individual therapists do. When I watch learning videos on Swedish massage I see the same thing the massage techniques is seldom systematically performed on specific muscles. It looks more like an unspecific whole body treatment. I am not saying this is wrong or bad. All touch therapy will generate physiological responses of the client or patient.

In conclusion Swedish massage is not as standardized as one could expect. This is also the fascination with massage since that it from a scientific perspective is a disadvantage.