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THIS COURSE FULFILLS YOUR PROFESSIONAL ETHICS REQUIREMENT Chapter 1: Ethics in Massage Therapy (Mandatory)
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[2 CE hours] This course addresses a range of issues that should concern a professional massage therapist and introduces a number of concepts important to the ethical practice of massage therapy. Successful completion of the course equips massage therapists with the basic concepts and rationale for ethical decision-making in their practice, to help them navigate unknown ethical territory, identify questionable behavior, and identify “red flags” that signal potential conflict, as well as the steps involved in resolving these issues. Equally important, it will help therapists know when to seek professional guidance with a supervisor or mentor or turn to other appropriate resources for professional assistance. THIS COURSE FULFILLS YOUR FLORIDA LAWS AND RULES REQUIREMENT Chapter 2: Florida Laws and Rules for the Massage Therapy Professional, Update (Mandatory) 24 [2 CE hours] This course is intended to instruct the professional through a self-paced study on Chapters 456 and 480, Florida Statues and the rules promulgated by the Board. Additionally, this course provides learners with the ethical codes of conduct for massage therapists and information on ethical decision making. [2 CE hours] This course will focus on awareness of human trafficking for massage therapists and provide information on how to identify possible trafficking victims, steps to report cases, and information about resources available to assist victims. The course will also, review techniques traffickers use to force, defraud, and coerce individuals into slavery, and to keep victims captive, and the traumatic effects of trafficking. THIS COURSE FULFILLS YOUR PREVENTION OF MEDICAL ERRORS REQUIREMENT Chapter 4: Preventing Medical Errors for Healthcare Professionals (Mandatory) 100 [2 CE hours] The purpose of this course is to provide licensed practitioners with information concerning the current state of medical errors, the impact of medical errors on the safety of patients, and the importance of establishing and working in a culture of safety. Contributing causes and types of medical errors are reviewed. Strategies to reduce or prevent medical errors, and improve patient outcomes, are presented. Methods to identify, analyze, and report medical errors are reviewed, populations at risk for medical errors are identified, and patient safety initiatives including education for the public and healthcare professionals are explored. THIS COURSE FULFILLS YOUR ELECTIVE REQUIREMENT Chapter 5: Introduction to Pharmacology for Massage Therapists 119 [4 CE hours] THIS COURSE FULFILLS YOUR HUMAN TRAFFICKING AWARENESS REQUIREMENT Chapter 3: Human Trafficking in Florida: Modern Day Slavery (Mandatory) 92 This course is intended for all manual therapists that use massage as part of their practice. It gives a general outline to the contraindications, precautions, and considerations connecting medications and massage therapy. The course informs the therapist with pertinent information about pharmaceuticals that can interact with their treatment in an easy understand layout. Final Examination Answer Sheet 140
©2025: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials.
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MASSAGE THERAPY CONTINUING EDUCATION
Book Code: MFL1225B
What are the requirements for license renewal? Licenses Expire Frequently Asked Questions
CE Hours Required
Mandatory Subjects
24 (For the 2025 renewal cycle, your classroom hours may be taken by distance learning)
2 hours Professional Ethics 2 hours FL Laws and Rules
Licenses expire August 31, every odd year
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Chapter 1: Ethics in Massage Therapy (Mandatory)
MFL02MT
Florida Laws and Rules for the Massage Therapy Professional, Update (Mandatory) Human Trafficking in Florida: Modern Day Slavery (Mandatory)
Chapter 2:
MFL02FL
Chapter 3:
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Chapter 4: Preventing Medical Errors for Healthcare Professionals (Mandatory)
MFL02PM
Chapter 5: Introduction to Pharmacology for Massage Therapists
MFL04PH
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Update for the 2025 Renewal Cycle All your hours may be completed online. This change will allow the twelve required hours of classroom hour (in-person, or live) courses to be taken as distance learning courses. Please note that these courses must be approved as “Relevant to and focused on massage therapy techniques, skills and protocols.” How do I complete this course and receive my certificate of completion? See the following page for step-by-step instructions to complete and receive your certificate. Are you an Florida board-approved provider? Colibri Healthcare, LLC is approved by the National Certification Board for Therapeutic Massage and Bodywork (Provider #450215-06). Most states accept courses approved by this board. Florida Board of Massage Therapy (Provider #50-4007). Are my hours reported to the Florida board? Yes, the Florida Board of Massage Therapy uses CE Broker to track and verify your compliance. Colibri Healthcare, LLC will report your hours electronically to CE Broker within two business days. Remember, do not forward your CE documentation to the board, keep your certificate in a safe place for your records. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Massage-Therapy you will see our robust FAQ section that answers many of your questions. Simply click FAQs at the top of the page, email us at office@elitelearning.com, or call us toll-free at 1-855-769-9889, Monday - Friday 9:00 am - 6:00 pm EST and Saturday 10:00 am - 4:00 pm EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory topics (as these are subject to change), and the amount that may be completed through home study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file. Disclosures Resolution of conflict of interest Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Sponsorship/commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners. Licensing board contact information: Department of Health | Florida Board of Massage Therapy 4052 Bald Cypress Way, Bin C-06 | Tallahassee, FL 32399-3257 I Phone: (850) 245-4161 I Fax: (850) 412-2681 Website: https://floridasmassagetherapy.gov/
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Book Code: MFL1225B
MASSAGE THERAPY CONTINUING EDUCATION
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MASSAGE THERAPY CONTINUING EDUCATION
Book Code: MFL1225B
Chapter 1: Ethics in Massage Therapy (Mandatory) 2 CE Hours
By: John Vinacci, LMT Learning outcomes
After completing this course, the learner will be able to: Outline key principles of professional ethics in massage therapy. Define the concept of power dynamics. Course overview This course addresses a range of issues that should concern a professional massage therapist and introduces a number of concepts important to the ethical practice of massage therapy. Successful completion of the course equips massage therapists with the basic concepts and rationale for ethical decision-making in their practice, to help them navigate unknown ethical territory, identify questionable behavior, and identify “red flags” that signal potential conflict, as well as the steps involved in resolving these issues. Equally important, it will help therapists know when to seek professional guidance with a supervisor or mentor
Distinguish between transference and countertransference. Describe the nature of the fiduciary role. List four ways practitioners might work outside their scope of practice. or turn to other appropriate resources for professional assistance. This ethics course: ● Explains concepts important to ethical theory and practice in professional massage therapy and bodywork. ● Examines the value and function of ethical codes and professional standards of conduct. ● Emphasizes the delineation of boundaries that define the therapeutic relationship.
INTRODUCTION
practice of massage therapy and bodywork, necessitating the development of sound ethical decision-making skills. Ethical practice also involves technical competence and knowledge specific to massage and bodywork. A professional therapist provides significant mental and physical health benefits to clients, drawing on competency gained through education, certification or licensure, and experience. Today, massage and bodywork practices are integrated into many multidisciplinary approaches to mental and physical health. Therefore, professional practitioners must understand various massage and bodywork modalities to effectively treat a wide range of mental and physical disorders.
Ethics is a branch of philosophy that addresses systematic approaches to moral issues and dilemmas. It encompasses the rules or principles that govern right conduct and includes the study of morality (Dail, 2012). Professional massage and bodywork therapists are responsible for adhering to ethical principles and standards of conduct established by their professional, educational, and certification organizations. Establishing clear boundaries in professional relationships with clients is crucial for the safety of both the therapist and the client. These boundaries ensure that therapists operate within their scope of practice, which is defined by their education, training, and certification, in accordance with the code of ethics and professional standards. Ethical dilemmas may arise in the
STATISTICS
The primary reason people received massage was for health and wellness reasons as follows: ● 63% of adult Americans who had a massage in the 12 months leading up to June of 2020 received it for medical or health reasons, such as pain management, soreness/stiffness/spasms, injury rehabilitation, or overall wellness. ● 92% of consumers believed that massage was effective in reducing pain and 93% believed it to be beneficial to health and wellness. ● 45% of massage consumers got a massage for relaxation and/or stress relief in 2020. ● The U.S. Bureau of Labor Statistics predicts an increase of 21% in Massage Therapist jobs between 2019 and 2029, with 34,400 jobs created during that time period (Bureau of Labor Statistics, 2019).
The following data, compiled by the American Massage Therapy Association (AMTA) from U.S. government statistics, consumer surveys, massage therapists, and recent clinical studies on the efficacy of massage, provides an overview of the current state of the massage profession. Released in 2021, these statistics highlight the public and medical acceptance of massage therapy's value and the growing consumer usage of massage therapy in the U.S. (American Massage Therapy Association, 2021). Understanding these statistics is crucial for practitioners to stay updated with the evolving profession, which necessitates an increase in their knowledge of ethical practice and their role in integrative healthcare.
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Massage in health care More Americans are discussing massage with their doctors or health care providers (AMTA, 2021a): ● In 2015, more than fifty-one million American adults, 16% of the population, had discussed massage therapy with their doctors or health care providers. ● Of those who discussed massage with their doctor or health care provider, 69% of their doctors or health care providers referred them to a therapist, strongly recommended massage therapy, or encouraged them to get a massage. ● While physicians in 2015 led the way in recommending massage, 49% of chiropractors and 43% of physical therapists also recommended massage therapy when their clients discussed it with them. State regulation of the profession ● 44 states and the District of Columbia, Puerto Rico, and the US Virgin Islands regulate massage therapists through licensing requirements. ● 46 states have practice law and regulation of some form. ● In states that regulate massage therapy, massage therapists must meet the legal requirements to practice, which may include minimum hours of initial training and passing an exam.
● More referrals come from chiropractic offices than other sources, with 11% of survey respondents reporting receiving referrals at least once per week, and another 25% receiving referrals several times per month. ● 55% of massage therapists received at least one referral every six months or less from a hospital or medical office in 2015. ● Nearly two-thirds of adult Americans would like to see their insurance cover massage therapy. ● The vast majority of massage therapists, 96 percent, believe massage therapy should be considered part of the health care field.
● In states that do not regulate massage therapy, this task may fall to local municipalities. ● Most states that license massage therapists require a passing grade on the Massage & Bodywork Licensing Exam (MBLEx), or one of two exams provided by the National Certification Board for Therapeutic Massage & Bodywork.
RESEARCH ON MASSAGE THERAPY
● Easing alcohol withdrawal symptoms. ● Decreasing pain in cancer patients. ● Fibromyalgia relief. ● Migraine relief. ● Treating muscle stiffness or spasms. ● Injury recovery or prevention. ● Pregnancy and pre-natal topics. ● Effects on general well-being. ● PTSD symptom management.
The therapeutic benefits of massage continue to be researched and studied. Recent research has shown the effectiveness of massage for the following conditions (AMTA, 2021a): ● Cancer-related fatigue. ● Low back pain. ● Osteoarthritis of the knee. ● Reducing post-operative pain. ● Boosting the body’s immune system functioning. ● Decreasing the symptoms of carpal tunnel syndrome. ● Lowering blood pressure. ● Reducing headache frequency.
● Autism in children. ● Treating depression.
Massage therapy for regular health maintenance (AMTA, 2021a) According to the 24th annual consumer survey sponsored by the American Massage Therapy Association, 75% of individuals surveyed claimed their primary reason for receiving a massage in the previous 12 months was health or wellness (49%) or stress related (26%). The reported medical reasons included massage for pain relief, muscle soreness, stiffness, or spasms. The consumer survey also included the following results:
● 93% of individuals view massage as being beneficial to overall health and wellness. ● 92% of consumers surveyed believe that massage can be effective in reducing pain; with an additional 25% stating that they have used massage therapy for pain relief.
Frequency of massage (AMTA, 2021a) ● According to the AMTA 2020 consumer survey, an average of 21% of consumers received at least one massage in the year prior. ● As many as 38% of adults reported that they have had a professional massage in the past. ● In July 2015, 20% of women and 22% of men reported having a massage in the past 12 months. Massage use among male consumers was higher than that of female
consumers, a change from previous consumer report findings. ● Spas continue to be the most frequent sites for massages, with 41% of consumers having had a massage there in 2020 and 23% reporting that a spa was the location for their most recent massage. ● The average consumer received 3.5 massages in the past year. ● Overall, 63% of consumers received a massage for health and wellness reasons, with pain relief, pain management, soreness, stiffness, spasms, relaxation, and stress reduction being the primary reasons that consumers sought out massage.
Americans’ reasons for getting massages are changing (AMTA, 2021a) ● Instead of seeking massage therapy solely for relaxation and pampering purposes, individuals are clearly turning
to massage therapy to assist with medical conditions. ● As few as 28% of individuals believe massage therapy is only a form of pampering, with 83% of consumers responding that massage therapy should be considered a form of healthcare.
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Consumers are discussing specific medical conditions with their doctors (AMTA, 2021a) ● 57% of respondents discussed pain relief or pain management with their doctor. ● 47% discussed soreness/stiffness/spasms. ● 43% discussed relaxation or stress reduction. Health care providers recommending massage as a viable form of treatment for the conditions discussed above (AMTA, 2021a)
● 36% discussed injury recovery or rehabilitation with their doctor.
○ 24% were strongly recommended to get a massage. Physicians were the most likely health care professionals to recommend massage to their patients (50%), followed by physical therapists (36%) and chiropractors (24%).
Health care providers and doctors are more commonly viewing massage therapy as a legitimate option to address health concerns: ● A total of 18% of consumers reported discussing massage therapy with their doctors. Of these consumers: ○ 25% were referred to a massage therapist.
PRINCIPLES OF PROFESSIONAL ETHICS
● Accurately inform a client or patient about the intended course of therapy and acquire their consent prior to the massage. ● Properly drape or cover clients or patients to ensure their safety and comfort in accordance with local and state laws. ● Provide therapy only in regard to what clients or patients request and respect their desire to stop therapy at any time for any reason. ● Withhold therapy for a client or patient if a medical condition indicates possible contraindications. ● Refuse to diagnose possible medical conditions, and instead refer the client or patient to a physician for a proper assessment. ● Maintain and continue to develop skills through regularly scheduled continuing education classes. Regarding business practices, a massage therapist shall: ● Provide therapy regardless of a client or patient’s gender or ethnicity. ● Provide a safe and secure setting that meets local and state health code regulations. ● Maintain adequate liability insurance in accordance with local and state laws. ● Maintain accurate records that pertain to appointments, billing, taxes, and legal obligations. ● Keep confidential all client or patient information, except when required by law enforcement officials. ● Securely store and destroy when necessary all client or patient files. ● Honestly and accurately represent experience and credentials as well as services when advertising and marketing. ● Refrain from any and all illicit, illegal, or prohibited activity. ● Conduct business transactions with honesty and integrity, disclosing fees for services clearly and concisely. ● File all applicable state and federal taxes. ● Refrain from the defamation of other therapists and health and wellness providers. ● Treat all coworkers, employers, and employees with respect. ● Clearly define the expectations of employees with a precise job description and internal company policies (if having employees). Regarding client/patient interactions, a massage therapist shall: ● Act in a manner conducive to the best interests of the client or patient while safeguarding the reputation of the massage profession. ● Ask only for information that is relevant to the practice of massage or a course of therapy.
Ethics refers to the principles of morally right or good conduct, specifically when two or more people are involved. Professional ethics in massage therapy is the application of guiding principles of right conduct to the study, practice, and business of massage therapy. Unlike personal morals, which are flexible and open to debate, professional ethical codes ar e formally defined, mandatory standards of conduct established by and for members of professional associations to ensure quality and integrity in the profession (Thiroux & Krasemann, 2014). Because virtually all state licensing authorities, certifying/ accrediting agencies, and professional associations establish their own standards of conduct and ethical guidelines for their members, massage therapists need to refer directly to the organizations and academic or training institutions with which they are affiliated, as well as state, local, and national associations, to review the ethical guidelines that apply. This course is based on standards of ethical behavior embodied in both the American Massage Therapy Association (AMTA) and National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) Code of Ethics and Standards of Practice, and common to the ethical codes of other agencies regulating massage therapy (AMTA, 2010). A code of ethics states the ethical responsibilities of the massage and bodywork professional. Standards of practice further establish the expectations of professional conduct in regard to the law, confidentiality, business practices, roles and boundaries, and prevention of misconduct (NCBTMB, 2017). This course intends to clarify the meaning of statements and concepts central to the ethical practice of massage therapy. Broadly speaking, the code of ethics for massage therapists covers three areas of concern: ● Self-conduct in relation to performing a massage. ● Self-conduct in business dealings. ● Self-conduct when interacting with clients both in a professional setting and within the public arena. What follows is a generalized code of ethics for massage therapists based upon the ethical standards set forth by many professional massage therapy schools, professional massage therapy organizations, and massage licensing boards (AMBP, 2022; AMTA, 2010). Regarding the practice of massage, massage therapists shall: ● Provide the highest quality massage therapy for clients or patients seeking a professional service. ● Practice only techniques they are trained, qualified, or otherwise certified to perform. ● Project a professional appearance by being punctual, well-groomed, free of odors, and wearing clean clothes.
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● Respect a client or patient’s privacy by not disclosing sensitive information discussed during therapy. ● Refuse to engage in any and all sexual relations with a client or patient unless such a relationship exists prior to the onset of therapy. ● Refrain from providing therapy when either the therapist or client/patient is under the influence of drugs or alcohol (except for prescription drugs). ● Refrain from providing therapy if a client or patient is physically or emotionally abusive in any respect. ● Refuse any and all gifts that are intended to influence a course of therapy or that result in personal gain. ● Retain the right to refuse therapy for reasonable causes, such as unwanted sexual advances made by the client.
Self-Assessment Quiz Question #1 Regarding business practices, all of the following are appropriate except: a. File all applicable state and federal taxes. b. Refrain from engaging in all illicit and illegal activities. c. Provide therapy solely for the gender of the therapist’s choice. d. Refrain from the defamation of other therapists.
THE PRACTITIONER-CLIENT RELATIONSHIP
The principle of beneficence requires massage therapists to do good or what will further the patient’s interest. The principle of nonmaleficence requires massage therapists to avoid harm to the patient, or what would be against the patient’s interests. Both principles rest on the fundamental importance of what is in the patient’s interest. The first is the positive requirement to further the patient’s interest. The second is the requirement to refrain from doing what damages the patient’s interest. Different claims covered by the principle of beneficence may come into conflict and force difficult choices (Sohnen-Moe & Benjamin, 2013). Ideally, therapists’ relationship and interactions with clients is a partnership that promotes healthy behaviors; leads to sound, informed, healthcare decisions; and ensures the client’s voice is heard. The client’s best interests should always be the therapist’s primary goal and the guide for all actions and decisions. If therapists ever suspect they are acting out of an unhealthy need or motive, or feel the interactions or relationships with the client are impeding rather than facilitating the therapeutic process, they should seek assistance and/or supervision. Massage therapists can consult a professional massage therapy organization for guidance, supervision, and other professional resources (Allen, 2019). The following sections discuss key points of ethical massage therapy practice in more detail. Once massage therapists successfully complete an approved training course, written examination (state and/or national), and, in some cases, a practical evaluation, they are deemed competent in the subject area of massage therapy despite the fact that specific skills, training, and knowledge base may be very different from that of other practitioners. 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). 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).
The nature of the practitioner-client relationship is a fiduciary one. This means the client trusts that the practitioner will act in the client’s best interests, and it is the practitioner’s duty to do so. This concept is central to professional practice and the therapeutic relationship. While the practitioner and client share the same primary concern and objective—the client’s welfare—it is the practitioner, by virtue of their professional status, who is ultimately responsible for the client’s safety, security, and well-being. Practitioners also bear the burden of accountability because they are often viewed by the client as being in a position of authority or power over the client (National Ethics Committee of Veteran Health Administration, 2003). Massage therapists treat individuals ethically not only by respecting their decisions and protecting them from harm but also by making efforts to secure their well-being. Such treatment falls under the principle of beneficence. The term “beneficence” is often understood to cover acts of kindness or charity that go beyond strict obligation. In this context, beneficence is understood in a stronger sense, as an obligation. Two general rules have been formulated as complementary expressions of beneficent actions in this sense: (1) do not harm and (2) maximize possible benefits and minimize possible harms (beneficence and nonmaleficence) (Shmerling, 2020). Accountability Professional organizations protect public safety by certifying the competence of their members through licensing and continuing education requirements. Accreditation and professional affiliations maintain quality control and show accountability to clients, colleagues, and the profession as a whole. They confirm that massage therapists abide by prevailing health and safety standards, conduct themselves in accordance with relevant legislation and/or professional regulations, and possess the specialized knowledge and skills in their field (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).
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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?
Misrepresenting one’s educational achievements, credentials, or abilities is a serious breach of responsibility that endangers client safety and reflects poorly on the 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,
HEALTH AND SAFETY
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 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.
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 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
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Book Code: MFL1225B
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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). ● For clients taking multiple drugs for multiple or chronic conditions, complete a new health history form every 3-4 months. ● Accept the limits of your knowledge and avoid comments or questions about drugs that have been prescribed for a client and refer client questions back to the prescriber. ● Do not offer personal opinions regarding immunization, herbal supplements, pain medication choices, or any other choices made by the client. Interview guidelines for drug use Discuss the following questions for each drug: ● Why was this drug been prescribed? ● How do you take this drug? Identify IM, IV, implantation, or transdermal patch sites and avoid by at least a hand width. ● How often do you take this drug? ● Have you taken this drug today? ● Have you noticed anything different since you started taking this medication? ● If the client does not know the answers, ask who/which doctor prescribed it and seek further information is necessary. ● Keep inhalers handy. ● Keep emergency medications handy. ● Be sure to identify symptoms that may indicate a medical emergency in relation to the client’s condition, for example seizure or angina, and have an emergency plan in place. ● Clarify that providing service in case of known non- compliance may compromise client safety and your licensure. ● Advise that certain modalities/techniques maybe contraindicated, and that treatment may not be safe without compliance. ● Reports of pain, muscle, or joint stiffness unsupported by objective assessment indicate deferral of massage, and referral to the prescriber. ● Alert client that drug-related side effects alleviated by massage may return after massage, for as long as this drug is taken. Care for specific medical conditions and pharmacology effects Always be sure to remain within the scope of practice and consult supervisors, state regulations and other healthcare providers if uncertain about treatment related to medical or pharmacological cases. Never proceed if uncertain about the health, safety or best practice for the client. Integumentary issues of the skin and appendages may present as: bruising, rash, lesions, dryness, epidermal fragility, hypersensitivity, or a lack of touch sensitivity: ● Keep touch a hand-width away from a bruise, rash, or lesion. ● Gently palpate to assess perception of sensation on the skin. ● Assess skin turgor (elasticity) by gently pulling up a fold of skin; if it remains raised, skin is dehydrated and fragile. ● Ensure sufficient lubrication.
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 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. ● Establish the level of compliance for each drug. List the side effects experienced by the client. Discuss whether side effects are discouraging compliance. Ask if client has consulted prescriber or dispensing pharmacist about side effects. The client may not realize that other drug options in same class may not cause similar side effects. ● Inquire about any medication changes before each session, document drug and/or dosage changes. ● Have you noticed anything different since you started taking this medication? The client may not connect emerging signs or symptoms with this or another drug: ● Reinforce the importance of accurate information for client safety and comfort.
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Book Code: MFL1225B
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● In case of hair loss on the head or body (alopecia), respect client’s wishes about having head exposed, covered, and touched as the scalp may be itchy or tender. ● During the hair loss process, avoid the use of lubricant. ● Body-wide hair loss leads to easy chilling; offer the client a blanket. Musculoskeletal issues may present as: muscle pain, joint stiffness, or a risk for spontaneous fracture: ● Defer and refer: Muscle pain cannot be objectively verified by your assessment, especially for a client taking cholesterol-lowering statins. ● Avoid deep pressure, vigorous ROM, and stretches on clients taking corticosteroids for longer than two weeks, or anti-osteoporosis drugs. Gastrointestinal issues may present as: dry mouth, nausea, acute or chronic diarrhea, or constipation: ● Dry mouth: Offer the client water partway through a session. ● Nausea, chronic diarrhea: Avoid prone position, excessive touching of the abdomen, and rocking or jostling the client. ● Acute diarrhea is a contraindication to massage. ● Constipation: Offer a massage of the abdomen. Neurological issues may present as: headache, dizziness, drowsiness, and an inability to provide accurate feedback about pain, pressure, or temperature: ● Headache: Offer a scalp massage and encourage deep breathing. ● Dizziness: Avoid flat supine or prone positions, and rocking or jostling strokes. ● Drowsiness: Ask if the client wishes to end with stimulating strokes. ● Altered perception of sensation: Avoid extremes of touch, pressure, and temperature. Cardiovascular or hypertension issues: ● Avoid deep pressure and sustained gliding strokes. Hypotension issues: ● Ensure adequate warmth. Be prepared to assist the client on/off the table, and around the treatment space. Anemia issues: ● Ensure adequate warmth and avoid overtiring the client, if they are fatigued. Endocrine Hypoglycemia issues: ● Ensure that the client has a source of sugar on hand and if not, offer non-diet soda or fruit juice. Hyperglycemia issues: ● Refer for evaluation by primary health care practitioner. Case study A massage therapist works at a spa where he believes the employer’s standards for cleanliness do not meet professional standards. The employer does not require oil or lotion containers to be cleaned as they are filled or at the end of the work day, does not require massage room surfaces to be cleaned on a daily basis, does not send dirty linens to a laundry service to be sanitized, and only requires hot stones heated in water to be sprayed with a disinfectant between clients.
Respiratory issues may present as: Shortness of breath, wheezing, chest tightness, and coughing: ● Elevate client’s torso to 45 degrees when supine. ● Address hypertonic muscles of respiration. ● Slow pace of strokes to encourage deeper respiration. Lymphatic/immune system issues, or edema: ● Elevate affected extremities, except if congestive heart failure (CHF) is diagnosed. ● Increased susceptibility to infection, with a decreased ability to fight infection. ● Defer massage if you or a household member has been exposed to any infectious condition. ● Follow standard precautions for the prevention of transmission of pathogens in treatment space. Additional side effects Disrupted thermoregulation issues: ● Warm client? Use lotion and 100 percent cotton sheets. Gently blot excess perspiration, and be aware that chilling may follow. ● Chilly client? Warm client directly, not treatment room. Insomnia or agitation issues: ● Slow pace of strokes; avoid friction, vibration, and percussion. ● Ask if client prefers to be lulled to sleep or stimulated at session end. Fever or flu-like symptoms: ● Fever is a contraindication to techniques with circulatory intent. Mood swing issues: ● Assess medication compliance. ● Remain neutral; accommodate behavior within acceptable boundaries and workplace policies. Fatigue issues: ● Shorten session duration; limit techniques that require client participation. Utilizing drug information in patient assessment: ● Investigate possible side effects for each drug. ● Visually assess skin for areas to avoid. ● Identify cautions/contraindications. ● Describe available modalities, techniques. ● Discuss and obtain informed consent for safe, effective treatment. Apply information to the treatment plan: 1. Select case profile: Identify cautions or contraindications created by health conditions. 2. Research each medication; summarize its side effects. 3. Draft a treatment plan that addresses: a. Cautions, contraindications.
b. Medication side effects. c. Therapeutic intentions. d. Assessments, positioning/draping. e. Modalities/techniques.
Reflection Are there any state or federal regulating bodies that govern proper sanitation procedures in a healthcare setting? In the potential absence of regulatory codes, whose responsibility does the client’s safety become? Analysis The answer to this problem may lie in each state’s particular regulations or the regulations suggested by each state’s massage licensing board, although it should be noted that the suggestions for cleanliness advanced by a massage therapy board may not have legal precedents.
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Book Code: MFL1225B
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