•Sensible advice for aches, pains & injuries

Modality Empires

A tradition of ego-driven treatment methods in manual therapy

1,400 words, published 2009, updated May 3rd, 2013
by Paul Ingraham, Vancouver, Canada bio
I am a science writer, a former massage therapist, and the Assistant Editor of Science-Based Medicine since 2009. I am nearly done with a long-procrastinated Bachelor of Health Sciences degree. I am a middle-aged runner and ultimate player with plenty of personal experience with athletic injury and chronic pain. Readers often want to know more about me and my qualifications, because my style and subject matter is controversial. Most importantly, yes, I used to actually believe and practice almost everything that I now debunk and criticize. I live by the ocean with my wife in beautiful downtown Vancouver.


“Modality empire” is my own term for an ego-driven proprietary method or mode of manual therapy — a sub-discipline — championed and promoted by a single charismatic entrepreneur. Most of the “emperors” have healer syndrome, lack humility, make big promises, and make their money from unusually expensive therapy, workshops and books. Professionals are sold on the opportunity to purchase credibility in the form of increasing “levels” of certification, but the quality of these certifications is completely unregulated and often dubious. A modality empire is as much a business model as a method of helping people. There is a lot of overlap between modality empires and quackery. Classic examples of modality empires include Ida Rolf’s ROLFING®, John Barne’s myofascial release, and John Upledger’s craniosacral therapy. Sometimes a modality empire is particularly unoriginal, re-packaging old ideas for a new generation of workshop consumers.

“Modality empire” is my own term1 for a proprietary method of manual therapy — a sub-discipline — championed and promoted by a single entrepreneur who usually suffers from a serious case of healer syndrome. If you have a chronic pain problem, this is an important concept to know about, because so many of the therapies that will be offered to you are the dubious products of modality empires. If you are a manual therapist, especially a massage therapist or chiropractor, you need to understand it too: continuing education should mainly be about acquiring knowledge, not buying the right to say that you use a trademarked technique.

While there are many taxonomies of alternative medicines, one thing almost all alternative therapies have in common is they are originally the de novo “discovery” of one lone individual.

Dr. Mark Crislip, “The Marshall Protocol” on Science-Based Medicine

Big promises and hard selling

Most modality empires make big promises of healing powers, and usually make their money by selling expensive therapy and workshops. Even if the brand isn’t strong enough to command high fees, they are inevitable if the business succeeds. Professionals are usually sold on the opportunity to purchase credibility in the form of increasing “levels” of certification, but the quality of these certifications is poor and (importantly) completely unregulated, and it’s debatable how much demand there really is for such dubious “credentials.”

Modality empires often revolve around an overly simplistic notion of how the body works and how it might be fixed. In particular, a substantial majority of modality empires are grounded in “structuralism”: the emotionally compelling idea that our problems are caused by being “crooked” in some way, and that all our problems will be solved when we are “straightened” by therapy. Unfortunately, there is a great deal of evidence that this view of chronic pain is not fruitful.2 Some classic examples of modality empires include:

There are many, many more. (There are some even better examples that I am unwilling to mention because they are infamous for being legal bullying of their critics.)

A lack of originality is another major characteristic. There isn’t much in the world of manual therapy that’s new under the sun, and many modalities are really just minor variations on generic old therapeutic concepts that no one should be trying to put a new name on. Some modality empires are particularly unoriginal, blatantly re-packaging old ideas for a new generation of workshop consumers, like Paul St. John’s take on trigger point therapy (St. John Neuromuscular Therapy™). And to the extent that they are original, they almost always rely on untested treatment ideas based solely on the experiences and pet theories of the founder, and probably wouldn’t stand up to science-fair level critical analysis.

Join me for a class in the Laura Allen Method, where you will learn how to slap the hell out of people claiming to invent new modalities. How many more do we need? Is there any real possibility that no one has done it before in the history of the universe? As an added bonus I will throw in my special class in Redneck Massage, where I will simultaneously perform cryotherapy and roll out those stress knots with a cold can of Pabst Blue Ribbon while I use duct tape to train your muscles. Whenever I perform a particularly impressive move, I will yell “Hey, watch this shit!” so you’ll be sure to repeat it exactly.

Laura Allen, Massage Therapist, sassing about modality workshops on her Facebook page, which racked up a whopping 230 likes, plus many dozens of supportive and appreciative comments

Modality empires are businesses

You can’t patent “nice”

Compassionate contact will always be by far the most important part of massage, no matter what alleged technical innovations anyone tries to sell.

A modality empire is as much a business model as a method of helping people, and perhaps much more. There is a great deal of overlap between modality empires and quackery. Please note that “overlap” is not a blanket condemnation: I am not saying that everything about modality empires is wrong, or that every modality empire is equally bad. Many modality emperors are also genuinely formidable innovators and experts, and much of value can be found in their methods and teachings.

However, as old joke about lawyers goes, “Only 90% of them are making the rest look bad.”

History has shown us time and again that what drives the popularity of a modality empire is not how well it works, but simply how well it is promoted. Once in a while, a well-promoted modality empires hits the big time and become full-fledged profession. Chiropractic is the most obvious example: it began as the modality empire of master marketer DD Palmer, and then his son BJ, and they spent decades pushing it to the status of a regulated profession. The Palmers were certainly entrepreneurial geniuses, but they also promoted many ideas that have been long since been abandoned as useless … even by some chiropractors.3

Why aren’t customers cynical about modality empires? A double standard

What puzzles me most about the promotion of modality empires is how effective they are at fooling people who are cynical about other kinds of businesses — both professionals and patients. Modality empires actually attract customers who hate The Man, corporate greed, and especially Big Pharma. Yet these “sensitive” consumers turn off their cynicism and give a free pass to most modality empires, even though they are — by definition — corrupted by ego (at least) and by massive profits in some cases. Why the double standard?

It’s just marketing 101. Modality empires are able to successfully cast themselves in the role of the underdog just by emphasizing how they are an alternative to everything the customer is cynical about Modality empires primarily exist to give people the health care they want, and not the health care that works — two surprisingly different things.— the target market is super cynical about “mainstream medicine,” and so it’s very easy for a modality empire to make itself look appealing by taking shots at mainstream medicine.

Also, the marketing of most modality empires is usually finely honed by market forces. That is, they primarily exist to give people the health care they want, and not the health care that works — two surprisingly different things, and history is packed with hair-raising examples.4 It really is the industry of emotionally appealing treatment ideas. The successful ones are successful precisely because they have found the right psychological buttons to push. Basically all modality empires are sold on the strength of an emotionally appealing idea or theme.

For instance, many of them are based on the idea of “alignment” — that if you are straighter, you will be healthier. As mentioned above, this “structural” view of pain is simplistic and generally false. The classic specific example is chiropractic, which, despite all of its pretensions, would never be able to survive as a profession without the simple, emotionally appealing idea that spinal alignment is vital to your general health. Clearly that is false, or every person with scoliosis or a simple spondylolisthesis (a scary-looking but generally asymptomatic condition) would be riddled with disease.5

About Paul Ingraham

I am a science writer, former massage therapist, and assistant editor of Science-Based Medicine. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook and Google, but mostly Twitter.


  1. Charmingly, I have now seen it used “in the wild” a few times. It’s catching on! BACK TO TEXT
  2. SY Ingraham. Your Back Is Not “Out” and Your Leg Length is Fine: The story of the obsession with crookedness in physical therapy and treatment for chronic pain. 12642 words. BACK TO TEXT
  3. The End of Chiropractic. Hall. 2009.

    A well-written analysis of the significance of an important paper written by three chiropractors and a PhD (Mirtz et al) about the scientific bankruptcy of subluxation theory.

  4. The colorful history of medicine and quackery is overflowing with people who “swore by” treatments that were bizarre and perilous. Even the worst had fans. People believe what they want to believe. For more information, see Popular but Weird and Dangerous Cures: The most dangerous, strange and yet popular snake oils and “treatments” in history, and why anecdotes and testimonials cannot be trusted. BACK TO TEXT
  5. SY Ingraham. Spinal Nerve Roots Do Not Hook Up to Organs! One of the key “selling points” for chiropractic care is the anatomically impossible premise that your spinal nerve roots are important to your general health. 2495 words. BACK TO TEXT