Staying Within Scope of Practice for Massage Therapists

People seek out massage therapists for help with a multitude of ailments. Sometimes they are grasping at straws, trying to find something that will help. Your career depends on staying within the scope of practice for massage therapists. There will be times when you can help, and there will be times when you can’t. It’s important to know the difference.

All Health and Wellness Professionals have a Scope of Practice

When you earn credentials, those credentials signify what you’re qualified to do and what you’re not qualified to do. Credentials are those letters that come after your name on your business card: MT, LMT, CMT, RMT. You don’t want to lose those. If you practice outside your scope of practice, you could find yourself on the losing end of a lawsuit. 

In the realm of bodywork, there are many areas of practice. Each professional must stay within their scope of practice. If a patient presents with something outside of their scope of practice, they must refer patients to a qualified practitioner.

Here are some examples of scope practice for specific wellness professionals. Keep in mind these are very simplified explanations. The scope of these professionals is much broader, and the limitations are much more complicated. 

• A physical therapist is qualified to create an exercise regime to treat a physical injury, but they can’t prescribe drugs.
• A personal trainer can design exercise programs to reach clients' goals, but they can’t prescribe exercise as a treatment for an injury.
• A medical doctor can diagnose and prescribe medication, but they can’t perform open heart surgery without the necessary credentials.
• A chiropractor can manually manipulate joints, but they can’t treat a broken bone.
• A massage therapist can use orthopedic tests to assess an injury, but they can’t diagnose the injury.

Every profession has responsibilities and limitations. There’s a set guideline to follow, and a threat of losing their license if they don’t follow those guidelines.

What is the Scope of Practice for Massage Therapists?

The American Medical Association defines the scope of practice as “those activities that a person licensed to practice as a health professional is permitted to perform.”

That sounds pretty straightforward, right?

Unfortunately, for massage therapists, there isn’t a cut-and-dry set of rules for all therapists to follow. We don’t have a universal system that defines what massage therapists everywhere can and can’t do. That’s due to a few complications.

• Each state and country has its own regulatory boards and sets different rules for massage therapists.
• Not all massage therapists have the same level of training.
• Massage therapists work in a variety of work environments, and the environment impacts the scope of practice.

When determining what your scope of practice is, keep in mind yours may be different from other massage therapists. 

The scope of practice for massage therapists is defined by 3 things.

1. The state and country where you live and practice. You may have noticed not all massage therapists have the same credentials after their name. A massage therapist may be a Certified Massage Therapist (CMT), Licensed Massage Therapist (LMT), or a Registered Massage Therapist (RMT). Each one of those credentials have slightly different responsibilities and limitations. 

Check with your state regulatory board to find out what standards massage therapists are held to in your region. If you practice in Canada, CMMOTA published a scope of practice for RMTs.

2. Your training and skill set. Your state sets certain education standards for earning a massage therapy license. That’s the minimum amount of training you need to be qualified to practice massage therapy.

Most massage therapists go on to continue their education. This is where lines begin to blur. There are a wide range of massage modalities to study. Some modalities are for treating specific ailments, others promote a deep level of relaxation.

Other degrees, work experience, and education you have shape what you’re qualified to do. This results in massage therapists having very different skills, knowledge, and abilities. The scope of practice for massage therapists requires therapists to work within their own capabilities.

3. The environment in which you work. The setting you work in and other wellness practitioners you’re associated with impact your scope of practice. This creates a bit of variation in the scope of practice of individual massage therapists. 

A massage therapist working in a day spa has a different scope of practice than a massage therapist working in a medical setting. If you’re working in conjunction with other healthcare providers, your scope of practice may encompass working with people with sports injuries, chronic pain, and post-op patients. A therapist working in a spa offering massage for stress relief may not be qualified to treat people with injuries, even though they have the same credentials. 

Know Your Role: The Right Treatment at the Wrong Time Doesn’t Work.

Sometimes staying within your scope of practice isn’t solely about what conditions can be treated with massage therapy. It’s about understanding in what order treatment should progress. It’s important to know where massage fits into the overall treatment strategies for different conditions. When it comes to treating people in pain, just because you can, doesn’t mean that you should.

There are conditions where massage is beneficial right away. An example of this is when someone has a trigger point in a muscle. The muscle presents as being achy and weak. In this situation, the trigger point needs to be treated first. This means massage is the first step in treating the problem. Strengthening exercises are unlikely to increase the strength of the muscle until after the trigger point is treated manually.

On the other hand, some conditions are not contraindications for massage, but massage isn’t appropriate at certain stages. For example, if you suspect a client has a bulging disc causing their debilitating sciatic pain, you may need to refer them to a doctor – even though massage is effective in managing that sort of pain. They may need to be treated with steroids or PT before massage is beneficial. 

People seeking you out for pain relief depend on you knowing when and how you can help them. Sometimes, the best help you can offer is a referral to someone else. Don’t exaggerate your abilities. Your level of training, the modalities you practice, and the environment in which you work are all factors that define your personal scope of practice.

Create a System for Staying Within Your Scope of Practice

Most things are easier when you have a system in place. Systems prevent you from having to think through every situation. Creating a system for staying within the scope of practice for massage therapists involves automating part of the process. 

Follow these steps to create a system for your practice.

1. Create an informed consent form.
Outline your scope of practice within a consent form. Have them sign it before their first massage session with you. This ensures clients understand what you can help with and what you’re not qualified to do. Setting clear expectations is important, especially when treating people with pain.

You can automate this process with ClinicSense. When a client books an appointment, the software will automatically send the consent form, you created to new clients.

2. Add a checklist of contraindications on your intake forms.

A smart way to avoid treating something outside your scope of practice is to make a list of things you can’t treat. This is easily done on a medical intake form. If a client checks a condition that’s contraindicated, explain why you can’t treat them. Then, refer them to an appropriate medical professional.

This part of your system can also be automated with ClinicSense. Create an intake form, and send it automatically to new clients. This gives you a chance to review it before you see the client. This means you’ve covered your most important bases before the session even begins.

3. Do a thorough assessment before treatment.

Before you begin the massage, take time to have a conversation and do an assessment. Don’t rely solely on an intake form to gather the information you need. Create an assessment protocol that you do with each client. The protocol should include situational protocols that have a plan for how to proceed if certain symptoms present: “if this, then that.”

Clients presenting with new symptoms may not have a diagnosis for their pain yet. It’s not within your scope of practice to diagnose, but you can do assessments to rule out things you can’t treat. Assessment may include orthopedic tests, palpitation, and noting how the client describes their pain. If it doesn’t sound like muscle pain, refer them to someone else.

4. Document your assessment and treatment in SOAP Notes
Take comprehensive SOAP Notes in case your treatment is ever called into question. Keeping accurate records of what the client presents with is helpful in staying within your scope in two ways. 

a. When you keep detailed notes, it’s easy to see what you were treating and why at any given time.

b. It also helps you pick up on patterns in the client's symptoms. Those patterns can help you create a massage therapy treatment plan. They can also alert you that something more complex is going on and indicate you need to refer them to another health provider.

You can share your SOAP Notes (with the client’s consent) with their other healthcare providers when you refer them out. This facilitates a more comprehensive treatment for the patient and ensures all providers know their role in treatment.