Authorized Activities within Professional Practice: Updated November 7, 2024

PREFACE

Definition

A scope of practice highlights the professional activities permissible by respective legislation and/or education skills and training certifications. It provides an external boundary within which graduates of the profession work. An individual therapist’s scope of practice may vary somewhat from others within the profession, as professional development may provide them with advanced skills in specific areas of practice. However, the scope of practice of an individual therapist may not exceed the scope of practice of the profession.

Introduction

This Scope of Practice document is developed for Massage Therapists with the basic level of training and certification. It is to be used in conjunction with the CMMOTA Standards of Practice for Massage Therapist and/or Spa Therapists and the CMMOTA Code of Ethics for quality assurance in the practice of Massage Therapy. The authors of this document recognize the overlapping roles between Massage Therapists and other Complementary Health Practitioners and therefore have included a partial list of activities restricted under the various pieces of legislation which govern health professions in the jurisdictions which CMMOTA Full Massage Therapist or Associate Massage Therapist or Student Massage Therapist members are authorized to practice.

This scope of practice statement creates public awareness in the choice of a suitable health care provider for their massage therapy care needs. It also assists Massage Therapists to distinguish between modalities that lie within their scope of practice and those which do not.

This document does not apply to Spa Therapist members, whose Scope of Practice is a separate association document, and covers practice by Spa Therapist members within regulated jurisdictions within Canada in which CMMOTA Spa Therapists are authorized to practice.

This document does not apply to Registered Massage Therapists (RMT), whose Scope of Practice is established and governed by their respective legislated professional College within a regulated Province or Territory of Canada.

Purpose

The purpose of this Scope of Practice document is to:

Provide a summary of authorized professional activities for Canadian Massage and Manual Osteopathic Therapist Association (CMMOTA) members registered as massage therapists with the Association;

Provide new and prospective graduates of Massage Therapy programs entry-to-practice margins;

Set a framework upon which CMMOTA Massage Therapist Members can maintain their identity as professionals;

Encourage sound-logic and evidence-based approaches to guide care provided by a CMMOTA Massage Therapist member;

Provide CMMOTA Massage Therapist members a benchmark to maintain good standing with the Association and the Health Insurance Industry;

Provide CMMOTA a parameter by which to initiate a complaints investigation process and implement a disciplinary action where applicable.

Acknowledgements

Special thanks to the Federation of Massage Therapy Regulatory Authorities of Canada for the 2016 Entry‐to‐Practice Inter-Jurisdictional Practice Competencies and Performance Indicators for Massage Therapists which defines the practice competencies expected for Full Massage Therapists at their entrance into practice.

Liability Statement

In addition to this document, Massage Therapist Members are accountable to work in a manner that is consistent to all applicable pieces of Federal, Provincial and Municipal legislation, Association Bylaws, Association Policies and Procedures, Standards of Practice, and Code of Ethics documents.

GLOSSARY

Capable Scope: the sum knowledge surrounding the treatment or potential treatments for which the therapist has received sufficient training in to allow them to practice the techniques necessary for safe and effective treatment of a physical condition of a client, and has adequate professional liability insurance coverage for the same.

Client: The person receiving Massage Treatment from a qualified Massage Therapist.

Massage Therapist: An individual that has graduated from an approved and licensed massage therapy program and has become a Full Massage Therapist member, or is in the second year of an approved and licensed massage therapy program and has become an Associate Massage Therapist member, or is in approved and licensed massage therapy program and has become a Student Massage Therapist member of the Canadian Massage and Manual Osteopathic Therapist Association (CMMOTA).

Massage Treatment: This is the therapeutic intervention provided by a qualified Full Massage Therapist, or Massage Therapist in training (Associate Massage Therapist or Student Massage Therapist).

Registered Massage Therapist: An individual that is a member in good standing of the legislated College of Massage Therapy within a Regulated Province or Territory in Canada.

Restricted Activity: An action that is legally impermissible and/or unethical and/or immoral and/or unauthorized for the Massage Therapist to perform on a client due to inadequate training/skills/education and certification.

Scope: The assessment, treatment and prevention of soft tissue physical dysfunction, injury, and pain, using skills and techniques acquired through the entry-level modalities in which the Massage Therapist is trained to competently perform during their massage therapy program training and certified to perform after graduation, or additional modalities in which the Massage Therapist has received advanced training that has been recognized as sufficient training to practice the advanced modality by their professional liability insurance provider in accordance with Section 4 of Appendix 19 – Modalities List for Massage Therapists.


Summary of Scope of Practice

From a physiological perspective, this is what is permissible for CMMOTA Massage Therapist members:

• Massage Therapy Modalities as outlined in Appendix 19: Modalities List for Massage Therapists for which the therapist has received adequate recognized training in, and has professional liability insurance coverage in place to practice.

• Client education for self-care or home-care. For example:

Suggesting that an office worker with low back pain get up and move around periodically throughout their workday; or

Suggesting self-care techniques which may help stretch or strengthen areas of concern; or

Educating clients of factors influencing their pain, for better understanding and further take steps toward self-care.

Full Massage Therapist members may also teach, mentor, or employ and/or supervise other members of the profession or those training to enter the profession, or conduct research in the techniques and/or practice of massage therapy in accordance with the training and certification they have received and which they have professional liability insurance coverage for.

Summary of Restricted Activities

This scope of practice restricts CMMOTA Massage Therapist members from performing the following activities:

1. Prescribing/administering medications.

2. Providing diagnoses.

3. Puncture of the dermis.

4. Performing all forms of psychotherapy, mental health counselling, or spiritual counselling.

5. Resetting or attempting to treat a broken bone or joint.

6. Performing any other restricted activities as defined in applicable provincial legislation in the jurisdiction in which the therapist practices. (see end note 1.)

7. Performing modalities which are not approved or defined as Massage Therapy in accordance with Appendix 19: Modalities List for Massage Therapists and billing them as Massage Therapy.

8. Performing modalities included in Appendix 19: Modalities List for Massage Therapists without having adequate training recognized and insured through their professional liability insurance coverage provider.

9. Providing advice on areas outside of the scope of massage therapy including but not limited to client’s mental, social, financial, or nutritional health except ONLY in the form of a referral and ONLY when requested by the client.

10. Inserting body parts or equipment into the anus, vagina, or urethra

11. Massage of the nipple, areola, penis, testicles, vulva, or perinium.

12. Initiation or pursuit of personal romantic relationship(s) with client(s) within twelve months of the last treatment with the therapist.


SCOPE OF PRACTICE

1. Client Interaction

Scope

The Massage Therapist:

• Communicates professionally with the client

• Applies principles of beneficence and non-maleficence when working with clients

• Respects the client’s right to refuse treatment

• Treats all clients fairly and impartially

• Maintains privacy and confidentiality of client information in accordance with provincial and federal legislation

• Provides the client with all the options pertaining to the treatment session, including the potential benefits and side effects

• Invites the client to attend treatment sessions

• Creates an environment where confidentiality can be maintained for the client to fully disclose their health history

• Seeks informed consent from the client before performing any activity within this scope of practice document

• Seeks written informed consent for treatment of any sensitive areas (as defined in the CMMOTA Treatment of Sensitive Areas Policy) before preforming any activity within this scope of practice document

• When required by law reports to relevant authority, or encourages reporting, when there is evidence and admission of abuse on a client in accordance with CMMOTA’s Duty to Report Policy

• Reasonably charges the client for services rendered

• Retains the right to refuse to provide treatment if safety of the client and/or the therapist is perceived to be compromised

• Discloses to the client their level of training/certification and licensure

• Prohibits animals from entering a treatment space except where the animal is a certified or licensed service animal.

Restricted Activities

The Massage Therapist shall not:

1. Refer to themselves as any other protected title under any provincial or federal legislation in the jurisdiction in which they are practicing; or

2. Encourage, initiate, or maintain a sexually intimate relationship with an existing client; except when legally married or in a common law relationship; or

3. Encourage, initiate, or maintain a sexually intimate relationship with a former client within a twelve-month period following the end of the therapeutic relationship; or

4. Encourage, initiate, or maintain behavior of non-therapeutic nature; or

5. Misrepresent their qualifications to members of the public.

Termination or Refusal of Treatment

The Massage Therapist may refuse or terminate treatment where:

1. The therapist believes that the condition of the client requires treatment that is beyond the therapist’s capable scope; or

2. The Safety of the client is perceived to be compromised; or

3. The Safety of the therapist is perceived to be compromised; or

4. Sexual harassment has been perceived to occur before or during a treatment session; or

5. The client refuses to follow proper draping procedures; or

6. The client refuses to pay for treatment or for previously missed or cancelled appointments.

Where treatment has been refused or terminated the therapist must document within the client’s treatment chart the date of the refusal of treatment, the reason, or reasons why the treatment was stopped or refused in detail.

Where there have been serious breaches of professional boundaries by a client, which include sexual harassment in the form of inappropriate physical contact or sexually suggestive behaviour or sexually suggest remarks or requests for sexual services, the therapist is encouraged to document such within the treatment chart, and to report the incident to their supervisor, employer, clinic owner, the Association, and the respective police authority within the jurisdiction where the incident took place.

2. Technical Skills

Scope

The Massage Therapist,

• Performs physical assessments and re-evaluations on clients as per the CMMOTA Standards of Practice for Massage Therapists and Spa Therapists document

• Partners with the client to develop an appropriate treatment plan

• Implements treatment techniques as outlined in the CMMOTA Standards of Practice for Massage Therapists and Spa Therapists document and the Inter-Jurisdictional Practice Competencies and Performance Indicator for Entry-to-Practice Massage Therapists and as outlined in CMMOTA’s Appendix 19: Modalities List for Massage Therapists for which the therapist has adequate recognized training in and carries adequate professional liability insurance coverage for.

• Effectively manages time in the workplace

• Provides a progress report when requested

• Refers the client out to more experienced professionals when the complexity of the client care exceeds their expertise or when there is a high risk of a negative outcome in response to a therapeutic intervention or whenever is suitable

Restricted Activities

The Massage Therapist shall not:

1. Perform any activity restricted in any Health Professions Act or other applicable legislation which governs the profession in the jurisdiction in which they are practicing;

2. Perform treatment on a client without seeking and obtaining informed consent;

3. Perform treatment on a sensitive area on a client without seeking and obtaining informed written consent;

4. Perform a therapeutic intervention to intentionally harm the client;

5. Perform High Velocity Low Amplitude Thrusts on a client;

6. Diagnose a condition presented by a client and/or suggest that a therapeutic intervention can provide a cure for a disease or syndrome;

7. Issue a requisition to a client for a diagnostic test;

8. Perform a technique on a client without having the skill, education, training and certification;

9. Perform a technique on a client without having adequate professional liability insurance coverage for use of the technique;

10. Puncture the dermis of the client in the course of treatment;

11. Perform intra-anal, intra-penile and/or intra-vaginal treatments on a client;

12. Perform massage of the nipple, areola, penis, testicles, vulva, or perinium.

3. Research

Scope

The Massage Therapist,

• Performs research activities within the limits provided by CMMOTA’s Standards of Practice for Massage Therapists and Spa Therapists, Code of Ethics, and Massage Therapist Scope of Practice documents

• Employs ethical, morally sound, and lawful methods of recruiting participants

• Seeks and obtains informed consent from every participant in the study

• Accurately reports/documents the findings and any other data relevant to the research

• Avoids plagiarism

• Cites referenced sources accurately and comprehensively

Restricted Activities

The Massage Therapist shall not perform any unethical and/or illegal research methods.

4. Teaching and Mentorship

Scope

The Massage Therapist:

• May teach as a continuing education provider when they show evidence of competence in Massage Therapy Skills

• May teach as an educator for a massage therapy program when they meet the Educator requirements as listed by the relevant employment organization or in absence of that, the requirements provided by the Provincial Ministry of Private Vocational Training/ Advanced Education Department in the jurisdiction in which they are providing instruction.

• May mentor other massage therapists or spa therapists within the boundaries of CMMOTA’s Standards of Practice for Massage Therapists and Spa Therapists, Massage Therapist Scope of Practice, and Code of Ethics documents

• Shall only teach modalities and techniques that are within scope for massage therapists unless the educator has adequate certification through an association that governs the out-of-scope modality that is being taught.

• Shall only teach massage modalities and techniques that fall within the scope of practice for the professional designation of the trainee.

Restricted Activities

The Massage Therapist:

• Shall not teach and/or mentor student therapists in activities outside of their training, qualifications, skills, and certifications.

• Shall not teach modalities and techniques to Massage Therapists or those training to become Massage Therapists that are not within scope of practice for the profession unless the course material content and course advertising clearly state that the modalities and techniques being taught are out of scope of practice for Massage Therapists.

• Shall not teach massage therapy modalities and techniques to a trainee that fall outside of the scope of practice of a professional designation of the trainee unless such training is provided as part of a recognized massage training program.

5. Leadership and Resource Management

Scope

The Massage Therapist:

• Performs cost-benefit analyses of their health care business and service to clients

• Applies quality assurance and quality control measures in the provision of services to the client including but not limited to therapeutic interventions and administrative tasks

• Monitors resource provision to clients

• Fairly allocates resources such as time, finances and intellectual wealth to clients and staff

• Prioritizes and budgets for task completion

Restricted Activities

The Massage Therapist shall:

1. Comply with any Provincial and Federal Government legislations, Human Rights Commissions and Labor laws regarding health and safety and employment standards;

2. Provide a workplace free of verbal or conduct harassment or discrimination due to disability, sexual orientation, gender, race, religion, country of origin, ethnic descent, family, appearance, color, age, criminal history, medical history, marital status etc.

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End Notes

1. List of applicable provincial legislation for restricted activities:

Alberta – Health Professions Act Section 1.3 – https://kings-printer.alberta.ca/1266.cfm?page=H07.cfm&leg_type=Acts&isbncln=9780779848430

Manitoba – The Regulated Health Professions Act Part 4 – https://www.canlii.org/en/mb/laws/stat/ccsm-c-r117/latest/attachment/r117.pdf

Northwest Territories – Health and Social Services Professions Act Section 7.2 – https://www.justice.gov.nt.ca/en/files/legislation/health-and-social-services-professions/health.and.social.services.professions.a.pdf

Nova Scotia – no list of restricted activities, rather activities of health professionals registered in the province are “permitted” – Regulated Health Professions Act – https://nslegislature.ca/sites/default/files/legc/statutes/regulated%20health%20professions.pdf

Nunavut – no list found.

Quebec – Medical Act Section 31 and 43 – https://www.legisquebec.gouv.qc.ca/en/document/cs/M-9?langCont=en#ga:l_vii-h1

Saskatchewan – no blanket list of restricted activities, as they do not have umbrella legislation. The individual health professions acts, or college scope of practice documents sometimes address restricted activities or advanced activities which require additional training.

Yukon – Health Professions Act Sections 3 and 6 – https://laws.yukon.ca/cms/images/LEGISLATION/acts/hepr.pdf

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