distance is quickly minimized for the sake of treatment. In fact, the amount of personal space is reduced even before a massage session begins, as therapists welcome clients and subsequently review their intake information. During the massage itself, the distance of personal space is reduced to skin-on-skin contact. Although there is an agreement between the therapist and the client to reduce the amount of personal space during a massage, this is not an invitation by either party to circumvent any or all physical boundaries. The focus of both parties should be on therapeutic goals that are established in part by standard protocols for physical safety. Such protocols include but are not limited to consent for working sensitive areas such as the abdomen, gluteals, and female pectoralis muscles, what part of the therapist’s body touches the client, not touching the client inadvertently with loose clothing or hair, keeping a client draped in accordance with local laws and regulations, how the draping is moved, not working underneath draping, reassuring clients that they are allowed to remain clothed, and reassuring clients that they are empowered to stop the massage if they feel uncomfortable during the session. By respecting and adhering to such protocols, particularly with new clients, therapists establish the boundaries for future sessions (Fritz & Fritz, 2020). Treatment planning and pharmacology An important element of safety, informed consent, and client welfare is the consideration of medical conditions and pharmacology when determining the plan for massage and bodywork care. The increasing demand for massage and bodywork for a variety of physical and medical conditions through integrated, multi-disciplinary approaches to health care requires competency in the area of pharmacology. The following Centers for Disease Control and Prevention statistics outline the prevalence of prescribed drug use in the U.S. today (Centers for Disease Control and Prevention, 2019): ● 48.6% of Americans have taken a prescription drug in the past 30 days. ● 88% of those 65 years and older have taken a prescription drug in the past 30 days. ● 24% of Americans have taken three or more prescription drugs in the past 30 days. ● 12.8% have taken more than five prescribed drugs in the past 30 days. The massage and bodywork professional must realize that many clients are taking prescribed medications that may impact the type of modalities, procedures, positions, duration, and frequency of care they plan. The professional must have information on drug administration routes, drug interactions, dosages, adverse reactions and allergies, safety considerations, medical conditions being treated, and other health care providers to contact for further information. Treatment planning guidelines related to client drug information include the following (Goodwin, 2016): ● Carefully review the health history form during the interview with the patient. ● Request that the client bring the prescription drug bottles to the initial appointment and list the condition each medication treats. ● Note dosage and frequency for each drug. ● Include the prescribing physician’s information for each drug. ● If the client has pills they cannot identify, in pill organizers for example, the website www.drugs.com provides pill identification. ● Be sure to get information on over the counter medications, supplements, and vitamins being taken.
Practitioners must have the skills and knowledge to assess a client’s condition and provide safe and appropriate therapy. They must be attuned to verbal and nonverbal client feedback and alert to possible contraindications for massage. Sometimes these decisions are less than clear- cut, requiring a bit of research or consultation with medical personnel more familiar with the client’s condition. Massage therapists should never allow the client, the client’s relatives, or even the client’s doctor to pressure them to proceed if the therapist has any doubts regarding the safety of a specific procedure for a specific client. Therapists are ultimately responsible for any injury sustained by the client during or resulting from massage and the medical and legal liability associated with it—even if the client’s physician specifically recommended or prescribed the bodywork (Fritz & Fritz, 2020). If massage therapists have strong concerns about the client’s health related to medication or procedures received through another source, they should suggest that the client have a trusted healthcare professional review the course of treatment. Pronouncements like this should not be made flippantly, as they could be the basis of legal action against the therapist for practicing medicine without a license. If therapists believe a client has a serious medical condition or may have suffered an injury, they should tell the client immediately and refer the client to the appropriate healthcare professional. Therapists should not discuss the condition with the client’s doctor or anyone else unless they have explicit permission from the client to do so. Therapists should document the referral and the reasons for it in the client’s record (Fritz & Fritz, 2020). Massage therapists should keep scope of practice in mind when they give advice or make recommendations to clients. While listening attentively to a client is a relatively risk-free venture, sharing opinions is not. Depending on the topic of conversation and the therapists’ specific comments, they may be engaging in high-risk behavior whenever they have casual conversations with a client. Therapists should resist requests for advice in any subject outside of their areas of expertise, even though it is natural to be drawn into discussions with a client, especially a client they’ve come to know well (Fritz & Fritz, 2020). Advice can be a dangerous and slippery slope for practitioners, in large part because they may have some knowledge and experience regarding a health-related topic, but that topic may not be strictly within their scope of practice. Therapists who have found an effective nutritional supplement or exercise program that relieves the same symptoms the client is experiencing may have a strong impulse to share that information with their client. Therapists may also want to warn the client away from a health regime that they consider ineffective or potentially dangerous (DiSilvio, 2023). When giving their point of view, therapists should make sure they delineate a professional recommendation, based on years of experience and study, from suggestions or opinions of a more personal or general nature. They should help their clients distinguish between subject matter in which they, the therapist, are not professionally qualified. If a health or medical issue is outside of a practitioners’ scope of practice, they should recommend that the client see a qualified health professional regarding the matter (DiSilvio, 2023). Safety is not limited to hygiene, skill, and scope of practice concerns, however. For example, when considering the importance physical boundaries play in maintaining a safe environment for the client, in American culture, the generally accepted rule for personal space puts approximately three feet between one person and another. However, this
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