massage profession as a whole. If a subject is outside a massage therapist’s area of expertise, they should not hesitate to say so. The therapist should then direct the client to the appropriate informational resources or professional services. Massage therapists should make sure any information or suggestions they pass along are supported by the professional community and recent research findings and are appropriate and safe for the client (DiSilvio, 2023). Consult the state of licensure including rules, restrictions and regulations concerning massage and bodywork for definitions and limits to the scope of practice. Many states that regulate massage therapy align the functions of diagnosing, prescribing and treating with the practice of medicine, and prohibit massage therapists from using these terms to describe what they do (Lee, 2016). For example, advertising that massage therapy can treat stress may be in violation of some states’ laws (Armstrong, 2012). Questions to consider about scope of practice include the following (Lee, 2016): • Does the state regulate or prohibit certain spinal manipulation, cupping, intraoral massage or Gua Sha, which is a Chinese method that involves scraping the skin with a flat tool to relieve pain, aid circulation, and remove toxins? • Does the scope of practice involve teaching exercises to practice at home without supervision? • What are the parameters of evaluation and assessment vs. Diagnosis? • What type of muscle testing is permitted? • If the practice is multidisciplinary, how do chiropractic assistants, Emotional Freedom Techniques (EFTs), PT, OT, and Certified Athletic trainers (ATC) interface to deliver safe and legal services to clients?
Licensing agencies and professional societies establish standards of quality and professional expertise in the field and ensure that licensed individuals keep pace with recent developments through continuing education requirements (Sohnen-Moe & Benjamin, 2013). Scope of practice Scope of practice refers to massage therapists’ area of competence, usually obtained through formal study, training, and/or professional experience, and one for which they’ve received certification or other proof of qualification. Unlike other standardized training programs or fields of study, schools of professional massage therapy and state requirements vary significantly in the number of necessary hours of study and curriculum. Some schools provide substantial training in specialized procedures, such as lymphatic-drainage techniques or hydrotherapy, while others may only touch upon these subjects, if they are discussed at all (Calvert, 2002). Massage therapists who choose to provide services they are not appropriately trained or competent in make a dangerous personal decision that undermines the profession and may carry weighty legal implications. Personal levels of discretion and ethical standards will largely determine the manner in which massage therapists advertise their services, describe their education and professional experience, and list credentials. Therapists must decide if they can rightfully claim substantive experience in a discipline for which they’ve attended a three-hour workshop or watched a series of instructional videos, or when they can properly call themselves an expert in one modality or another (DiSilvio, 2023). Misrepresenting one’s educational achievements, credentials, or abilities is a serious breach of responsibility that endangers client safety and reflects poorly on the Practitioners must abide by industry standards of safety and hygiene. Client draping, towels, the massage table surface, and other relevant items or materials must be cleaned according to accepted standards of sanitation and meet all legal health and safety requirements (including universal precautions relating to communicable diseases). Practitioners should know how to cover cuts and use sanitizing supplies, such as disinfectant hand wipes, effectively (Fritz & Fritz, 2020). Healthcare Consideration: Information on universal precautions relating to communicable diseases can be found on the Center for Disease Control and Prevention’s website under “Disinfection & Sterilization Guidelines.” The Occupational Safety and Health Administration also provides guidelines on their website under the regulation header “Sanitation” in regard to worker safety (CDC, 2024). 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
HEALTH AND SAFETY
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
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Book Code: MMD0926
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