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Summer 2018: This article was originally published in Massage & Fitness Magazine. Graphics were not included in the original article.

Massage therapy worldwide comes in many forms. Prior to my profession being labeled as high risk for exploitation by human traffickers, the only paid touch services that came to mind for me was differentiated by bodywork modality or body region being touched. I was in tune with my community’s legal, educated, and paid massage therapists and bodyworkers, whose diverse backgrounds are rich in history and culture. Unfortunately, I recently learned that human trafficking has been proliferating in my neighborhood’s personal touch services in the form of both labor trafficking–the most extreme degree of labor exploitation–and sex trafficking.

 Foot rub parlors (also known as foot spas, mall massage places, reflexology relaxation spas) and massage parlors that exploit the workers have been around as long our profession, but the difference in our modern era is the degree of organization and proliferation that has come  about because of sophisticated criminal networks making bank off human labor by cutting out the largest expense: paying the worker. (1)

Trafficking has become big business for criminal networks because social and communication technology allows traffickers to network across large regions, internet advertising directly to the customer keeps the advertising targeted and out of the public eye, and the trafficker’s use of organized business models that treat humans as commodities. A debasement of our humanity, trafficking also distorts markets and tears at our profession’s economic fabric. Traffickers do not contribute to the positive economy by paying business taxes and with no wages or freedom of movement the workers have no opportunity to participate in the positive economy. Trafficked workers cannot purchase goods and services, pay rent, or sign up for classes that would advance their economic opportunities.

During a session recently, a client brought up a concern relating to a back massage she received at a “reflexology spa” and asked me did I think it was weird that when she tried to tip, the worker said “No, lady take the tip. Not me” and pointed at a lady standing nearby.

She said “I wanted to be sure the worker got the tip and that’s why I was insisting on handing it directly to her.”

I thanked her for opening up to me about her experience. I said not only was it strange about the tip but did she also know that it is illegal to receive a massage on her back or have anywhere touched but her feet when receiving services from these places?

She said had no idea. After all it’s in the services menu and they offered it as an add on to her foot services. She frowned and asked why are there rooms in the back for the massages if they are illegal? I then shared with her that not all businesses have good intentions and in fact she was probably serviced by a trafficked worker and explained that trafficking is another word for modern day slavery. Someone who is not paid, who is paying off a debt they were never required to pay in the first place, and who will only receive a portion of that tip that was paid or none at all. I asked if it was likely she offered a bigger tip because the price of the back massage seemed too low for good enough pay? She shared that yes, that is exactly what she thought and gave a $20 tip.

I know this client very well, so I opened up and asked her why she didn’t come to us more frequently if she needed more back massages? Her answer was because it wasn’t that she needed them but that they were nice to have when offered. She didn’t expect much from them except relaxation but when she comes to us she expects a therapeutic treatment. I shared that she can see any one of us at my business, something she has refused to agree to in the past and insists on seeing only me for the services. Does she not see how her choices to visit the deep discount places hurt my ability to keep my therapist’s booked and therefore affects my ability to remain in business?

After all our newest therapists could benefit from working with her and offering their relaxation massage expertise. The thought had not occurred to her. In the case of the foot spa, I asked that she not feel ashamed for not knowing about the trafficked people. North Carolina’s business laws and owner accountability laws are so weak that she can easily be misled by people who abuse others. I asked that she just keep in mind that my business and its workers will always honor the full breadth of massage, from mind to body and techniques can change with her daily needs. She said she would think about it but that the fees we charge are just too high for her to justify coming in to relax “just because”. I asked her to consider that we do not solicit tips and she could have paid exactly the same (fee + tip) as she paid at the business that has slaves for workers. The difference in the two businesses being that the therapists who work for my business are paid a living wage.

During another client’s first visit she commented that the place she normally goes to was just shut down for sex trafficking. In reality, the business was shut down for trafficking in both sex and labor but the client tuned into the sex trafficking charges. I have found it common that most people I talk to listen up when they hear about the most egregious acts against humanity but fail to pay attention to the sinister impact of doing day-to-day business with traffickers for basic services like a foot or back massage. The client continued by saying that when she found out about the sex trafficking she was horrified.

But she felt better about things when she realized she did the workers a favor “because the ladies never had to do that sort of stuff to me so at least I gave them a break when I was on their table.” Her comment left me feeling disheartened by her oblivious and selfishness view of the world. Imagine what it would be like to massage a woman who is ooh-ing and ahh-ing and asking you to press harder and massage longer in this place or that spot. And knowing that when you are done with her, the lady goes about her free life and you are left to work off that debt to your handler, and most likely the next service you perform is on your back with a man who sees you as a means to an end? And at the end of your never ending day, your paycheck is $0.

I couldn’t believe I was hearing about these things in my town! Among big cities, I can see a person getting lost in the underworld but a small town like Cary, North Carolina, that prides itself on it’s quaint shop local feel? And in North Carolina, a state that has had licensed massage and bodywork therapy for 20 years? Cary is a town where there is very low unemployment, plenty of economic stability, opportunities to advance one’s education and upward mobility, and reasonable housing prices. Yet it too has a human trafficking problem. In fact, human trafficking seems to be universal and is prevalent and impactful to varying degrees in all countries.

According to Polaris Project, a US national anti-trafficking organization, North Carolina is 8th in the nation for reports of human trafficking for both labor and sex trafficking. (2) Our county, Wake County, is rated the second most active county for labor and sex traffickers in the state. My group massage practice is one mile from downtown Cary and 1.5 miles from the central police station. Within a 2.5 mile radius there are 5 identified sex trafficking parlors and 1 hybrid sex and labor trafficking massage parlor (table massages in the front, hidden sex stalls in the back), and 1 hybrid sex and labor trafficking reflexology relaxation parlor (chair massage in the front and hidden sex stalls in the back). The Cary police claim to be keeping an eye on 5 known businesses related to trafficking in touch services, specifically the ones known for sex trafficking. But that is the extent of their efforts and they have shut down zero businesses.

Human trafficking is forced labor by coercion, intimidation, debt bondage, forcing one to work in a manner that is against their will such as providing sexual services, restraining the individual by way of chemical substances, physical restraints, such as chains are rare but escorting workers when they are off the premises such as to hospitals or to a grocery store and other forms of restricting movement are more common, and confiscating a passport and visa so the worker cannot leave. (3) Unusual living situations such as living on site in a back room of a storefront reflexology spa, unusual hours such as being put to work at any hour of the day instead of set work hours. For example, a woman in these situations may have to service a visitors at 10am, 1pm, 2:30, 7pm, and 3am. When they are not serving a visitor they are to remain on site. Interaction with outsiders is limited. If they live and work in the same place, they are seen very little by the outside world. If a foreign worker, their understanding of the language being spoken by the outside world is minimal and the minimal is encouraged by their handler rather than language integration being encouraged.

They are told they owe a debt to the sponsor for bringing the worker into and settling the worker in the country, and they must pay back that debt before earning a living. (4) Their opportunities to get out from the deplorable conditions they find themselves in are either working their way into a support role–where they may manage one of the storefronts or handle other trafficked workers–or death. They are untraceable.

Massage therapists could stand to have a real conversation about labor exploitation and the economic forces that drive illegal businesses into town. Setting conscience aside, does it matter to our profession that organized criminals with a black market business model have hijacked a segment of our scope of practice? What impact does this have on our industry and growth? Does it have any impact on available supply of licensed workers, interest in joining the field, overall industry attrition, and turnover?

Labor abuse in the periphery of our field also affects the newest therapist. They have little opportunity to build a client base if the clients who expect the least are getting their massages from trafficked laborers at an unsustainable price.

Given the number of clients I’ve spoken to and learned how much they enjoy foot rub parlors and cheap and convenient relaxation stations, I’m not convinced that I will stop the growth of labor trafficking in my state solely by asking my clients to do the right thing, but it is the least I can do to help keep the conversation alive until the momentum builds up enough for the public to be ready to make a change in how they choose to behave.


Laura Landsiedel Ford is a therapist with 22 years experience and has owned a group practice with a business partner for 14 years. She is director of Bodywork Therapy Seminars, an affiliate of her company Hands On Health, LLC. She is a NCBTMB continuing education provider who has taught locally and internationally at the New Zealand College Of Massage. One of Laura’s greatest passions is informing the industry regarding professional concerns, from designing massage practices in unusual environments to exploring the impact of grief on caregiving. Laura can be reached at Learn more about massage therapists who fight the impact of human trafficking by joining the group, Look Before You Book A Massage, on Facebook.


  1. Smith DM, Smith JM, Baxter D, Spronken-Smith R. Drive for legitimation of massage therapy in New Zealand. International J of Therapeutic Massage and Bodywork [Internet]. 2012; 21-29. Available from:
  2. National human trafficking hotline data report. Polaris [Internet]. 2016 [cited 2017 May 8]. 9 p. Available from:
  3. Trafficking in persons report. US Department Of State [Internet]. 2015. 382 p. Available from:
  4. Bhoola U. Report of the Special Rapporteur on contemporary forms of slavery, including its causes and consequences. United Nations General Assembly: Human Rights Council [Internet]. 21 p. Available from:

Bodywork Therapy Seminars continuing education newsletter





Since the early spring of 2000, Triangle area health care professionals, including students of massage and bodywork, have increasingly demanded more frequent and sophisticated levels of continuing education to advance their careers. With new research and a renewed spotlight on the sports and medical massage fields, our profession no longer lies under the shadow of obscurity.

Over the past 10 years, North Carolina has seen a steady increase of interest around the profession. In fact, North Carolina joined 40 other U.S. states, along with over 35 other countries, which regulate bodywork practitioners — thus contributing to the explosion of consumer confidence, service providers, and practices in the massage industry.

This regulation and industry growth has greatly benefited massage therapists in that there is much more variety in continuing education (CE) opportunities. Therapists no longer have to travel across the country to learn from industry experts, as these knowledge leaders are emerging all across the United States, especially here in North Carolina.

Bodywork Therapy SeminarsToday’s CE student demands a much more sophisticated and professionalized atmosphere where techniques and tools are readily available for them, and industry knowledge leaders are there and willing to assist students in grasping and mastering complex concepts which they can quickly put into play at their respective practices.

Bodywork Therapy Seminars is excited to announce that just in time for our Fall 2014 semester, we will be celebrating our continued success and professional evolution by opening the doors of our new school; custom designed for dedicated bodywork professionals.  The school is 1.3 mile from I-40, located on Chapel Hill Road in Cary NC, and is just minutes from landmarks such as Crossroads Plaza, SAS institute, and the North Carolina Fairgrounds.

Bodywork Therapy Seminars is also excited that our new school will be adjacent to the brand new Hands On Health practice (coming September 2014), which will include six treatment rooms within the massage clinic. The unique partnership between Bodywork Therapy Seminars and Hands On Health, along with the ambiance and unique design of the building, will offer continuing education students exposure to both our teaching practice and our established and well-respected massage therapy practice. What better way is there to lead today’s advancing professionals than to show students the academic and practical execution of standards of care in action?

Hands On Health and Bodywork Therapy Seminars, with the support of our loyal clients and students, are excited to bring this Education-and-Practice-Based model to the Triangle community.

Watch our construction unfold! Follow for frequent updates.

We look forward to teaching and empowering all the fabulous massage therapy professionals that reside in North Carolina and from afar!

— Tammy Campbell and Laura Landsiedel