Massage Practitioner Qualifications, Scope of Practice, Draping, Boundaries and Consent

Your Rights in Plain Words

You decide what is touched, what is uncovered and when a session stops. A massage therapist should explain what they plan to do, ask your permission, cover the parts of your body that are not being worked on, and stop or change what they are doing if you ask. Where the practice is regulated, these are not courtesies; they are professional standards. The specific rules below come from the regulator in Ontario, Canada, and from US national sources. Rules differ by state, province and country, so check your own regulator.

Draping, Boundaries and Consent

Consent. Ontario's regulator, the College of Massage Therapists of Ontario (CMTO), requires the therapist to get consent before assessment or treatment begins, and to discuss six things: the nature of the treatment, expected benefits, risks and side effects, alternatives, the likely consequences of not having treatment, and the client's right to ask questions and to have treatment stopped or modified at any time on request. [1] Consent must be obtained prior to and throughout treatment, and the therapist must monitor the client and re-check consent when appropriate. [1]

Draping. The CMTO standard says the therapist must always drape the client unless the client arrives in suitable clothing and prefers to stay clothed, must discuss draping and clothing options with the client, and must explain which part of the body will be treated and whether touch will be on skin or through a cloth barrier. [2] Draping must provide an effective visual barrier. Areas not being treated stay covered, except the shoulders, arms, hands, neck, face and head, unless the client requests otherwise for comfort and gives informed consent. [2] The therapist must protect the genital area and gluteal cleft from exposure, must never touch the genitals or anus, and must not reach under draping or clothing without explicit consent. [2]

Sensitive areas. In Ontario, written or electronic informed consent is required before every assessment or treatment of sensitive areas such as the upper inner thighs, chest wall muscles and the breasts, and treatment must be clinically indicated. [3] If a draping or touch plan makes you uncomfortable, the CMTO standard says options should be offered, including care that does not require touch or work over clothing. [2]

Boundaries. Under the CMTO standard, sexual abuse includes touching, behavior or remarks of a sexual nature, and unwanted touching; touching a patient's genitals or anus is always considered sexual abuse; and patient consent is never a defense for inappropriate or sexual touching or relationships of a sexual nature. [3] Therapists are also required to disable recording devices in the room unless informed consent is given for assessment, treatment or educational use. [3]

Red flags anywhere. The behaviors that Ontario's standards prohibit, such as sexual remarks, touching without consent and uncovering areas that are not being treated, are sensible red flags anywhere. [3][2] A therapist who ignores a request to stop is not following those standards either. End the session. If you feel unsafe, leave and, if you are in immediate danger in the US, call 911.

Qualifications and Scope of Practice

United States. NCCIH reports that most states regulate massage therapists by requiring a license, certification or registration, and that training standards vary by state; most states that regulate require a minimum of 500 hours of training. [4] Another NCCIH page says that in states that regulate massage, 45 states and the District of Columbia, therapists must get a license or certification before practicing, usually requiring graduation from an approved program and passing an examination. [5] The two NCCIH pages were written at different times, so check the current rule for your state.

The Federation of State Massage Therapy Boards (FSMTB) says it supports the boards that regulate massage, and provides resources for consumers to learn about licensure requirements in each state and to verify license status. [6] The National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) is a private nonprofit founded in 1992 that offers a voluntary board certification. [7] To earn it, a therapist must meet educational requirements, pass a background check and pass an exam. [5] A board certification is not the same as a state license, and a license is what permits practice where one is required.

Ontario, Canada. CMTO says it regulates Registered Massage Therapists working in Ontario and offers a "Find an RMT" lookup. [8]

Elsewhere. We did not read regulator pages for other countries, so this page makes no statement about them. If your place has no regulation, you will need to rely more on the therapist's stated training, insurance and references.

Scope of practice. We did not find a general, verified statement of what massage therapists may and may not do that applies across jurisdictions. NCCIH advises not using massage therapy to postpone seeing a health care provider about a medical problem. [5] Ontario's standard also says a therapist must not use a modality or product for which they lack information about its risks and contraindications. [1]

How to Check Before You Book

• Ask which license, certification or registration they hold, and look it up with the issuing body (for example your state board, or the CMTO lookup in Ontario). [6]
• Ask about their training, experience and credentials, how many treatments might be needed, the cost and insurance coverage. [5]
• Tell them about medical conditions and pregnancy, and ask how draping works. [2]
• Do not rely on a "near me" listing or a business's own claims as proof of a license.

More general guidance: choosing a qualified practitioner, questions to ask before a session and informed consent in complementary care.

If Something Goes Wrong

Contact the regulator that issued the license: your state board or, in Ontario, CMTO. Sexual abuse of a patient by a regulated health professional must be reported by other Ontario massage therapists who know the name, according to the CMTO standard. [3] For other countries, find the regulator through the professional body or health department. For a health injury, see reporting adverse events from therapies and massage safety.