Massage Therapy Business Tips

Staying Within Scope Of Practice for Massage Therapists

updated on

December 22, 2023

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.

What Is A “Scope Of Practice” For Health & Wellness Providers?

A scope of practice defines the procedures, actions, and processes that a healthcare professional is permitted to undertake in keeping with the terms of their professional license. It outlines the boundaries within which they must operate and specifies their qualifications and capabilities.

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 are much broader, and the limitations much more complicated. 

Physical Therapist Scope Of Practice

A physical therapist's scope of practice encompasses evaluating, diagnosing, and treating individuals to improve movement, reduce pain, and prevent disability. They employ techniques like exercise, manual therapy, and patient education, working within the framework of their specialized training and licensing requirements.

Personal Trainer Scope Of Practice

A personal trainer's scope of practice includes designing and supervising exercise programs to enhance physical fitness, strength, and overall health. They provide motivation, guidance on proper technique, and lifestyle advice, but do not diagnose or treat injuries or medical conditions.

Medical Doctor Scope Of Practice

A medical doctor's scope of practice involves diagnosing and treating illnesses, prescribing medications, performing surgeries, and providing preventive care. They are qualified to address a wide range of health issues, guided by their extensive education, clinical training, and licensing regulations.

Chiropractic Scope Of Practice

A chiropractor's scope of practice primarily includes diagnosing and treating musculoskeletal disorders, particularly those related to the spine. They use manual adjustment techniques, offer nutritional and lifestyle counseling, and may provide rehabilitative exercises, but do not prescribe drugs or perform surgeries.

Massage Therapy Scope Of Practice

A massage therapist's scope of practice involves assessing and treating clients through manual manipulation of soft body tissues. They aim to alleviate pain, enhance wellness, reduce stress, and improve circulation, but do not diagnose medical conditions or prescribe treatments outside of massage therapy.

Every profession has responsibilities and limitations. There’s a set guidelines 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 scope of practice for massage therapists involves using various techniques to manipulate soft body tissues for therapeutic purposes. Their practice, focusing on pain relief and relaxation, is governed by specific licensing and regulations, which can vary significantly by location.

The American Medical Association defines 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 scope of practice.

What Is The Difference Between An LMT And RMT?

The difference between an LMT (Licensed Massage Therapist) and RMT (Registered Massage Therapist) mainly lies in the terminology used in different regions and the specific licensing requirements. Both titles represent professionals qualified in therapeutic massage, but the standards and regulations may vary by location.

Scope of practice massage therapists

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

What Defines The Scope Of Practice For Massage Therapists?

The scope of practice for massage therapists is defined by several key factors: the state or country's specific regulations and licensing requirements, the therapist's individual training and skill set, and the particular environment or setting in which they work, such as clinics or spas.

1. The State And Country You Live & 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.

As a massage therapist, you're responsible for upholding a code of ethics for massage therapy. 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 & 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 impacts your scope of practice. This creates a bit of variation between 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 in are all factors that define your personal scope of practice. (It’s also important to have professional massage liability insurance in case you make a mistake.)

staying within 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 by using digital intake forms. When a client books an appointment, the software automatically sends consent and intake forms to new clients.

2. Add a Checklist of Contraindications On Your Intake Form

A smart way to avoid treating something outside your scope of practice is to make a list of things you can’t treat. You can do this by creating a medical intake form that lists contraindications. 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. Don’t want clients to have to sift through a ton of paperwork? No worries. ClinicSense uses “display logic” to filter out questions that aren’t applicable to specific clients, and prompts specific lines of questioning when a client answers “yes” to conditions/situations you need more information about.

3. Do An Assessment Before Treatment

Before you begin the massage, take time to have a conversation and do an assessment. Document your observations and assessment in a SOAP Note. 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.” This process will help you create an appropriate massage therapy treatment plan.

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

Use a SOAP Note Template to record comprehensive 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:

  • When you keep detailed notes, it’s easy to see what you were treating and why, at any given time. 
  • It also helps you pick up on patterns in the clients symptoms. 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.

What Tools Can I Use To Help Stay Within My Scope Of Practice?

ClinicSense is an invaluable tool for massage therapists striving to maintain their scope of practice. This intuitive platform simplifies obtaining informed consent, ensuring both therapist and client are on the same page before beginning treatment. 

With ClinicSense, creating detailed intake forms becomes effortless, allowing therapists to gain a comprehensive understanding of their clients' medical histories and be promptly alerted of any contraindications. This proactive approach enhances client safety and care. Furthermore, ClinicSense offers customizable SOAP Notes, an essential feature for meticulously documenting each session. ClinicSense not only aids in adhering to professional standards but also enhances overall client management, making it a must-have for any conscientious massage therapist. Start a free trial to see for yourself.


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