Guidelines for Best Practice: Updated January 21, 2025
Preface
The Canadian Massage and Manual Osteopathic Therapists Association (CMMOTA) defines massage therapy in practice, as the assessment, treatment and prevention of joint and soft tissue physical dysfunction, injury, and pain, using manual and electro therapeutic modalities, soft tissue manipulation and mobilization. Massage therapy is a clinically oriented healthcare profession that can assist in alleviating pain and discomfort associated with repetitive strains, persistent chronic pain conditions, muscular overuse, and many other musculoskeletal dysfunctions arising from a variety of stressors utilizing both therapeutic and relaxation techniques to provide a therapeutic outcome. Entry level techniques are specified in the Inter-Jurisdictional Practice Competencies and Performance Indicators for Massage Therapists at Entry-to-Practice (September 2016) (see end note 1) document. Additional modalities which require advanced training may be incorporated into a therapists practice when approved by the Association in conjunction with the professional liability insurance provider. The intention of therapy must be to improve and restore the body back to health.
All health care practitioners have Practice Standards to guide their actions, procedures, and interventions. These guidelines will allow service-users to trust that regardless of the individual therapist they see, they will be treated to a certain standard. Just as physiotherapists, nurses, or surgeons are trusted to work under similar guidelines to their peers, the same will apply to all CMMOTA Members with respect to Massage Therapy.
Philosophy Statement
All Massage Therapists and Spa Therapists registered under CMMOTA are required to read and uphold the Massage Therapists Pledge as outlined by the Canadian Council of Massage Therapy Schools as well as the CMMOTA Code of Ethics.
All CMMOTA members must, “First of all, do no harm”, and strive to treat in such a way that provides a therapeutic benefit to the client.
All CMMOTA Members must understand that their behavior reflects not only on the Canadian Massage and Manual Osteopathic Therapists Association, but also the entire massage industry. It is therefore of utmost importance to review these Practice Standards and seek training where there is a lacking skill.
Where a CMMOTA member becomes aware that another member of the association is or has breached the Standards of Practice for their profession, they are encouraged to file a formal complaint with the Association related to the alleged professional misconduct. More information on this process can be found on the CMMOTA website, or by contacting the office at info@cmmota.com
Practice Statement:
In clinical practice, CMMOTA Massage Therapists and Spa Therapists are expected to:
i. Perform detailed interviews of the client’s history within the Massage Therapy Scope of Practice;
ii. Physically assess the client’s body with the intent of developing an appropriate treatment plan;
iii. Apply treatment techniques and modalities solely intended to achieve a therapeutic outcome and/or be prophylactic towards the maintenance of overall health in the client;
iv. Provide referrals and collaborate with other healthcare practitioners to achieve wellness in the client;
v. Recommend home-rehabilitative care to clients to augment their recovery;
vi. Engage in self-development including but not limited to research activities, mentorship and continued education.
Modalities
Massage Therapists are to refer to Appendix 19 of the CMMOTA Policy and Procedure Handbook which provides a list of insurable Modalities approved by CMMOTA. Spa Therapists are to refer to Appendix 42 of the CMMOTA Policy and Procedure Handbook which provides a list of insurable modalities approved by CMMOTA.
Purpose for Standards of Practice
Since Massage Therapy is currently not regulated in Alberta, Saskatchewan, Manitoba, Nova Scotia, Quebec, Yukon, Nunavut, and the Northwest Territories, The Canadian Massage and Manual Osteopathic Therapists Association (CMMOTA) has thereby adopted these Standards as a governance document for all its Massage Therapists Members who reside or practice in an unregulated province or territory. These Standards of Practice are also applicable to CMMOTA Spa Therapists registered with CMMOTA in the regulated provinces of British Columbia, Ontario, and Prince Edward Island.
The purpose of these Standards is to:
Provide best practice guidelines for CMMOTA members and provide a point of reference for research and development;
Provide new and prospective graduates of Massage Therapy entry-to-practice markers for self-evaluation;
Provide existing CMMOTA Massage Therapists and Spa Therapists professional indicators to maintain;
Provide the general public with standards to expect from their therapist;
Provide CMMOTA a parameter by which to initiate a complaints investigations process and implement a disciplinary action where applicable.
Acknowledgements
Special thanks to the Canadian Council for Massage Therapy Schools for provision of the Massage Therapists Pledge and 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.
Liability Statement
In addition to these standards, all CMMOTA Massage Therapists and Spa Therapists are accountable to all applicable pieces of Canadian legislation, CMMOTA Bylaws, CMMOTA Policy and Procedures, Scope of Practice, and Code of Ethics documents.
Special mention is given to the following Acts:
A. Personal Information Protection and Electronic Documents Act, 2000
B. Alberta’s Personal Information Protection Act (PIPA) that became law on January 1, 2004
C. Freedom of Information Act (FOIP)
Glossary
Assessment: An educated evaluation of a client’s condition and physical basis for their symptoms in order to determine a course of treatment. (see end note 2)
Indication: An indication is a term used to describe the reason when or why the technique or competency is to be applied. (see end note 3) It encompasses but not limited to past, current, foreseeable health conditions and client inquiries.
Competency: An activity that the Massage Therapist or Spa Therapist is to perform as it pertains to the indication. (see end note 4)
Re-evaluation: A physical assessment of the client that happens immediately after the application of a technique or intervention on affected tissue.
Sensitive areas: Areas of the body including the chest, breast tissue, groin region, gluteal region and abdominal region considered private areas by the general public.
Standard: A standard is a description of a minimum level of performance one is required to demonstrate in the achievement of the competency.
The Quality Assurance Standard is described, followed by its benefits and any safety precautions/ contraindications that may be applicable.
Capacity: The ability of a client to understand treatment information, potential risks and reasonably foreseeable consequences giving or withholding consent to Massage Therapy Treatments.
Capable Client: A client who has mental capacity. Individuals seeking Massage Therapy Services are deemed capable unless the CMMOTA Massage Therapist or Spa Therapist has reason to believe otherwise. Situations where capacity might be questioned include evidence of confused or delusional thinking, or perceived alcohol or drug impairment, or the client’s inability to make a clear treatment choice, or a lack of ability to communicate.
Guidelines for the Provision of Information to Incapable Clients
The therapist must tell the incapable client that a substitute decision maker will assist the client in understanding the proposed treatment and inform that person of the reason for the use of the substitute decision maker. If the client disagrees with the finding of incapacity, they must be informed of their right to go to the Consent and Capacity Review Board to have the decision overturned.
The therapist must involve the incapable client, to the extent possible, in discussion with the substitute decision-maker.
If the client disagrees with the need for a substitute decision-maker because of the finding of incapacity, or disagrees with the involvement of the present substitute, the member must advise the client of his/her options. These include finding another decision maker of the same or senior rank that is more acceptable to the client, and/or exercising his/her right to apply to the Consent and Capacity Review Board. Members are expected to assist clients in exercising their rights. If the therapist feels unable to do this, he/she should seek direction from the Association or contact an advocacy agency to provide advice to the client.
Substitute Decision Makers
Substitute Decision Makers (SDM) are individuals who make treatment decisions for individuals who are not capable of making them independently. In most cases, the individual will be a family member. The SDM is expected to act in the client’s best interests and to make decisions that are consistent with the client’s last known wishes.
The Health Care Consent Act sets out a hierarchy of substitute decision makers:
• an official guardian appointed by the courts;
• an attorney for personal care;
• a representative appointed by the Consent and Capacity Review Board to act for the client;
• a spouse, partner or relative in the following order:
o Spouse or partner;
o Child if 16 years or older or the custodial parent;
o Parent who has a right of access;
o Brother or sister; or any other relative.
In most cases, the therapist will speak with the client and/or family members to determine the highest-ranking individual to make treatment decisions for the client.
Summary Overview of Procedural Standards
Pre-Treatment Procedures
The Massage Therapist or Spa Therapist,
a. Performs a proper introduction: including but not limited to therapist name and qualification.
b. Performs a health-intake assessment which can include but not limited to interview, gait, postural analysis, palpation, motion, neurological and appropriate tests.
c. With consent, requests and reviews relevant health records from the client and from their medical team.
d. Records information pertinent to the client and treatment.
e. Communicates to the client treatment goals.
f. Clearly communicates to the client how treatment will be performed, how to position themselves on the table, proper draping procedures, and areas to be exposed during treatment.
g. Records informed consent for general treatment.
h. Records informed written consent for treatment of sensitive areas including the chest, breast tissue, inner thigh, gluteal, and groin. (Only perform breast and groin massage if proper training has been obtained.)
i. Ensures window coverings are in place prior to client changing/dressing/start of treatment.
j. Steps out of the room if client is to undress.
k. Washes hands for a minimum of 20 seconds with hot running soapy water before treatment of the client.
l. Knocks before entering the treatment room and wait for permission to gain access.
During Treatment
The Massage Therapist or Spa Therapist,
a. Communicates their clinical intention and changes of intention throughout the treatment with the client.
b. Always keeps some lighting on within the treatment space during the treatment.
c. Maintains proper draping procedures, only exposing the areas to be treated, while maintaining coverage of the client’s breasts, genitalia, and gluteal cleft.
d. Applies techniques, modalities and remedial interventions to which approved training and/or certification has been received within the CMMOTA definition of Massage Therapy and in accordance with Appendix 19: Modalities List for Massage Therapists.
e. Applies all forms of listening skills.
f. Avoids contact with anything other than the client’s tissue and treatment equipment.
g. Communicates to the client when the treatment session has ended.
Post Treatment Procedures
The Massage Therapist or Spa Therapist,
a. If client is undressed, steps out of the room to allow client privacy to dress.
b. Washes hands for 20 seconds with hot running soapy water and washes the lotion, cream, or gel container.
c. Reassesses the client where applicable.
d. Provides self-care to the client where applicable.
e. Cleans all modality/intervention/treatment equipment as specified by manufacturers/peer-established standards and/or current literature.
f. Receives direct payment from the client where applicable and provides the client with a receipt for services rendered, and/or obtains Health Insurance coverage information in a manner consistent with the health insurance companies requirements and submits a claim only for treatment services rendered by the therapist for adjudication and payment by the insurance company either directly to the provider or reimbursement directly to the client.
g. Bids the client good-bye and reminds them of the next appointment.
h. Completes treatment notes in a timely manner and stores them in a secure place.
Summary Overview of Professionalism Standards
Pre-Treatment Procedures
The Massage Therapist or Spa Therapist,
a. Provides their name, designation and intention during first-time introductions. (For example, “Hello, my name is John Smith, I am a spa therapist and will be providing your treatment today, please follow me.”)
b. Uses a private space where confidentiality can be maintained for the health-intake interview and physical assessment.
c. Gains informed consent from the client prior to start of treatment. (Ask clients to initial or sign the consent document(s) if necessary.)
d. Communicates mainly within the boundaries of massage therapy and scope of practice.
e. Explains billing and ‘no-show’ procedures.
f. Explains therapy time allocation.
During Treatment
The Massage Therapist or Spa Therapist,
a. Covers windows and turns off electronic devices that have the capability to visually record the treatment session.
b. Refrains from using in-ear devices which would restrict their ability to hear or interact with the client, including but not limited to ear buds connected to another electronic device or noise cancelling ear plugs.
c. Touches the client with therapeutic intent only.
d. Communicates strictly within the boundaries of massage therapy.
e. Gains verbal consent from the client when approaching areas deemed sensitive by the public.
f. Works within the specified and agreed upon timeframe.
g. Demonstrates a hygienic routine during treatment. (For example, avoid hand contact with other personal body parts and avoid skin contact with equipment not sanitized.)
h. Communicates to the client the start and end of the treatment session.
Post Treatment Procedures
The Massage Therapist or Spa Therapist,
a. Reassesses or inquires of client’s physiological state post session.
b. Bills under the name of the therapist that performed that treatment and NO ONE ELSE.
c. Where applicable, provides the client with a receipt containing the name of the therapist for that session, registration details (Association and Number), the location, date and duration of session, amount owed and paid by client in accordance with the applicable CMMOTA receipting policy for their professional designation.
d. Provides a reminder (written or otherwise) of next treatment sessions.
e. Allows enough time to clean and prepare for the next client.
f. Legibly documents all treatment information for that session and any incidences where applicable in accordance with the CMMOTA Client Records, Charting, and Treatment Notes Policy.
Ongoing Professional Procedures
The Massage Therapist or Spa Therapist,
a. Publicly displays licensing, registration and certifications as much as possible.
b. Maintains collegial working relationships.
c. Maintains work-related conversations in the presence and hearing of clients.
d. Ensures data protection and confidentiality measures are being continually applied to client records.
e. Ensures that all equipment is cleaned and maintained on a regular basis. A written record of all repair and maintenance activities must be kept.
f. Demonstrates professional development by taking relevant courses.
g. Provides or participates in mentorship programs.
h. Reads and follows Association Bylaws and Policies.
STANDARDS OF PRACTICE
1. COMMUNICATION AND CLIENT INTERACTION
Client Interview
Indication:
First time client, returning client, current client in need of treatment for an acute event and any other applicable time.
Competency:
Perform a comprehensive client interview within the time allocated.
Standard:
Quality Assurance
A detailed client interview must be taken to validate treatment, identify potential causes of the chief complaint, compensatory factors and concerns that may limit or inhibit treatment effects or create an adverse effect post treatment.
This client interview may augment a client intake form.
How to:
The Massage Therapist or Spa Therapist,
• Uses both closed and open-ended questions to learn the following information from the client:
o Past and current health status including but not limited to:
Trauma
Allergens
Confirmed Diagnoses
Undefined symptoms
Surgeries
Infections
Autoimmune reactions
Exercise, Diet and Activities of Daily Living
o Reasons for seeking treatment
o Previous interventions for any health issue including but not limited to:
Medications
Supplements
Exercise and Diet
Primary Health Care Practitioner recommendations
Alternative Health Practitioner Approaches
Results of attempted interventions
o Personal health goals including but not limited to:
Short and Long-term goals
Treatment session goals
• Applies active-listening skills to interpret non-verbal cues from the client
• With consent from client, legibly records all the information learned and stores it securely where it is easily accessible for future appointments with the respective client.
Benefit
• Builds trust between the client and therapist
• Allows for the development of an appropriate treatment plan
• Limits negative reactions to treatment due to undisclosed relevant health information
Safety/Contraindication
• Physical, emotional or psychological distress limiting accurate responses from the client
• Inadequate time for both the therapist and client
In these cases, the client interview should be deferred to a different time.
Informed Consent
Indication:
Before the application of any procedure or technique to new, returning, or existing clients and any other applicable time when informed consent is necessary.
Competency:
Receive evidence of informed consent prior to the application of techniques. Ensures that the client knows that they may revoke their consent at any time.
Standard:
Quality Assurance
There must be documented evidence of informed consent received from the client to proceed with treatments from a Massage Therapist or Spa Therapist. Treatment of Sensitive areas (refer to glossary) must receive written informed consent prior to delivery of treatment in accordance with CMMOTA’s Treatment of Sensitive Areas Policy. Further, the therapist must inform the client that consent may be revoked at any time.
How to:
The Massage Therapist or Spa Therapist,
• Describes the technique to the client
• Describes where the technique will be performed
• Describes how the technique will be performed
• Explains the benefits of using the technique
• Describes potential side effects or risks associated with the use of the technique
• Asks if the client is willing to go through the procedure
• Informs the client that consent may be revoked at any time
• Documents the client’s response in the treatment record
• Has the client fill out and sign a treatment of sensitive areas form when applicable
• Stores the information securely for future reference
Benefit
• Builds trust between the client and therapist
• Allows for the development of an appropriate treatment plan
Safety/ Contraindication
• Incapable clients: Caregiver or guardian consent is sought
• Physical, emotional, or psychological distress limiting accurate responses from the client
• Inadequate time for both the therapist and client
Treatment should be deferred to a later date until informed consent from the client can be granted.
2. SAFETY
Infection Control
Indication:
When initiating touch of therapeutic intent, between clients, within a therapeutic space, when there is known contamination and/or potential cross-contamination pre and post treatment and during treatment and any other applicable time when infection control measures should be implemented. (see end notes 5 and 6)
Competency:
Habitual hygienic practice
Standard:
Quality Assurance
There must be a verbal/written infection control policy and procedures on-site.
How to:
The Massage Therapist or Spa Therapist,
• Defers or refuses treatment when the therapist is ill
• Defers or refuses treatment when the therapist has a diagnosed communicable disease for which no protective barrier might prevent transmission of the disease
• Showers and wears clean clothing
• Washes their hands for at least 20 seconds pre and post contact with clients
• Cleans the treatment equipment after every use as per manufacturer or health and safety standards
• Disinfects all surfaces that have come into contact with known or unknown pathogens
• Within the best of their ability, prevents cross-contamination from themselves to their client
• Organizes and cleans the general and treatment spaces
• Completes an incident report and informs clients when a communicable disease may have been present within the environment and may potentially affect them
• Washes and disinfects contaminated linen separately from other laundry
• Follows guidelines as laid out by Alberta Health Services regarding animals in clinic space entitled “Animals in Health Care: Best Practices Recommendations”: https://www.albertahealthservices.ca/assets/healthinfo/ipc/if-hp-ipc-animals-hcf.pdf
Benefit
• Limits the spread of disease
Safety
• Protective clothing and gloves should be worn when handling corrosive cleaning supplies
• Protective clothing, gloves, and/or masks should be worn when working with clients with communicable diseases
• Protective clothing, gloves, and/or masks must be worn where they would provide a suitable protective barrier to prevent transmission of a communicable disease from the therapist to the client
Physical Assessments
Indication:
Physical Assessments are indicated for all clients seeking Massage Therapy to resolve signs and symptoms.
Competency:
Perform a comprehensive physical assessment making note of all relevant observations.
Standard:
Quality Assurance
Informed consent must be obtained from the client for the therapist to proceed with any physical assessment and findings must be accurately documented in the client record for future reference.
How to:
The Therapist,
• Notifies the clients ahead of time of the scheduling of a physical assessment, duration and associated costs of the assessment
• Schedules ample time and limits foreseeable interruptions during the client’s physical assessment
• Notifies the client of the benefits and possible side-effects that may be experienced following the physical assessment
• Receives informed consent from the client to proceed with the physical assessment
• Applies investigative procedures within the therapist’s scope of practice to the body including but not limited to:
o Postural and gait analysis
o Active, Passive, Resisted and Fatigue Range of Motion Tests
o Palpation
o Nerve Testing
o Special Orthopedic Tests (see end note 7)
• Documents the objective findings legibly
• Communicates all assessment findings to the client
Benefit
• Reveals known and unknown health imbalances in the client
• Ensures relevance of treatment plans
• Creates a benchmark for progress, reassessments and discharging the client
• Rules out conditions that need a referral to other health practitioners or diagnostic imaging
Safety/Precaution
• Conditions or contraindications that would cause the client to experience an adverse reaction following application of the investigative procedures
Pre and Post Treatment Procedures
Indication:
Whenever a client attends a treatment session
Competence:
Perform pre and post treatment procedures in a timely manner
Standard:
Quality Assurance
There must be an established procedure that extends to infection control, wellness checks, note-taking, communications, billing, scheduling and any other activities relating to the client before and/or after a treatment session. (see end notes 8, 9, 10 ,11)
Pre-Treatment procedure
How to:
The Massage Therapist or Spa Therapist,
• Ensures the treatment room is hygienically prepared for the incoming client
• Ensures that equipment and supplies have been properly maintained and disinfected
• Ensures that treatment environment is private, secure and safe for the client
• Acknowledges and greets the incoming client
• Shows the client into treatment room
• Seeks pertinent information regarding the current and past appointments where applicable
• Physically assesses the client
• Communicates the sessions goals
• Steps out of the room if the client must change or undress
• Knocks on the door and waits for a response to regain re-entry into the treatment room
• Clearly instructs the client on how to position themselves for the start of treatment and how to initiate proper draping requirements
Post-Treatment procedure
How to:
The Massage Therapist or Spa Therapist,
• Communicates the end of the treatment session to the client
• Re-evaluates the client to record if session goals were achieved
• Sets next session goals where applicable
• Selects and demonstrates home rehabilitative exercises where applicable
• Bills and reschedules client where applicable
• Shows client out and bids goodbye
• Washes hands and cleans treatment space
• Documents all relevant information pertaining to that treatment session (Please refer to Charting)
Benefit
• Maintains consistency between appointments
Safety/Precaution
• Similar safety/precautions or augment as required when working with special populations
• Augment as required when dealing with communicable diseases
Treatment Plans
Indication:
For every client seeking massage for rehabilitation, that has completed a physical assessment and has consented to beginning treatments or any other situation to which a treatment plan is requested.
Competency:
Develop a customized treatment plan for each client.
Standard:
Quality Assurance
The treatment plan must cover as many areas as pertains to the physical assessment findings.
How to:
The Massage Therapist or Spa Therapist,
• Asks their client their goals and devises a short-term and long-term goals-list that encompasses a positive therapeutic outcome for the client
• Develops the treatment plan from information from the interview and assessment findings
• Estimates, documents and honestly communicates to the client the length of time on average that it takes to achieve the agreed upon treatment goals
• Documents and communicates to the client the estimated number of treatments
• Documents and communicates to the client the frequency of appointments
• Documents and communicates to the client the expected duration of each session
• Determines and communicates to the client areas of focus, techniques and additional modality therapies to be used during the named appointments
• Recommends appropriate home rehabilitation activities to the client
• Schedules dates/times of reassessment
• Determines and communicates to the client prospective dates to be discharged from treatments (see end notes 12, 13, 14, 15)
Benefit
• Effectively manages the client’s health
• Ensures efficacy of treatment or redirection when there is no change in symptoms
Charting
Indication:
For every client that has received any form of massage service including but not limited to assessments, treatments, recommendations, referrals and advice or when documentation is required such as in incident reports, progress reports and/or discharge reports.
Competency:
Accurately and comprehensively documents therapist-client encounters for a paid or voluntary service offered.
Standard:
Quality Assurance
Treatment notes must contain: the name of the client, date of service, type of service, techniques/recommendations applied or offered, duration of session, names or initials or signature of the therapist and any other relevant information to the Massage Therapy Session.
How to:
The Massage Therapist or Spa Therapist,
• Organizes client information in any of the note-taking formats such as:
o OPPQRST (Onset, Provocative, Palliative, Quality, Radiation, Site, Timing) of pain and Treatment plan
o SOAP (Subjective, Objective, Application/Assessment/ Diagnosis, Plan)
o APIE (Assessment, Plan, Implementation, Evaluation)
o CARE (Client Condition, Action taken, Response, Evaluation)
o PPALM (Purpose of Session, Pain, Allergies and Skin Conditions, Lifestyle and Vocation, Medical and Surgical Information) and Treatment Plan (see end notes 16, 17, 18)
• Records client information as specified in the format chosen
• Ensures that treatment notes are completed in a timely manner and in accordance with CMMOTA’s Client Records, Charting and Treatment Notes Policy.
• Includes the client’s name, treatment date, time, and duration of session in the notes
• Records the treatment intervention in a manner that would allow it to be duplicated in future sessions
• Includes a key in the client’s chart for any abbreviations used in the notes whether common or not
Benefit
• Easy retrieval of client files for Insurance Claims, Litigation, Workers Compensation Boards and other Health Care Practitioners
• Eliminates therapists stress and time wastage in the provision and review of old records by Third Parties
• Prevents inaccurate modifications when files are requested at a later date
Record Keeping
Indication:
For all client records including but not limited to client charts, incident reports, progress reports and/or discharge reports, insurance claims, legal documentation and diagnostic reports if kept separate from client charts.
Competency:
Storage and maintenance of client information as required by provincial and federal regulations.
Standard:
Quality Assurance
Records must be stored in a safe and secure environment to ensure physical integrity, logical integrity, and confidentiality. There should be evidence that reasonable steps have been taken to protect the records from theft, loss, unauthorized use or disclosure, copying, modification and/or unauthorized disposal.
How to:
The Massage Therapist or Spa Therapist,
• Stores client charts in a clean, safe, secure and dry place.
• Stores the record in a secure room or locked filing cabinet away from the public to ensure client confidentiality
• Backs ups electronic records on a regular basis with the back-up copies stored in a secure, locked location
• Transfers and disposes off files in a secure manner and in accordance with any other requirements that may arise
• Accesses electronic records in a manner that maintains confidentiality of the client’s personal information
• Releases the client chart or client’s personal information only if express written consent from the client is received (Preferably signed consent)
• May or may not charge a fee for the release of the client chart in accordance with CMMOTA’s Client Records, Charting and Treatment Notes Policy.
• Respects the FOIP and PIPEDA Legislation with respect to the release of client information (Refer to the Liability Section at the beginning of the document)
• Keeps clients’ charts in accordance with CMMOTA’s Client Records Charting and Treatment Note Policy.
Benefit
• Easy retrieval of client files for Insurance Claims, Litigation, Workers Compensation Boards and other Health Care Practitioners
• Eliminates therapists stress and time wastage in the provision and review of old records by Third Parties
3. SKILLS
Draping
Indication:
For client treatments performed on skin where applicable, and through draping where appropriate.
Competency:
Able to expose an area of treatment and securely drape all other areas not receiving treatment at the time. Knowledgeable about sensitive areas, and areas which must remain draped during treatment.
Standard:
Quality Assurance
When used, the drape stays in place securely for the intended time and purpose.
How to:
The Massage Therapist or Spa Therapist,
• Communicates intent to the client and receives informed consent before undraping client
• Handles the drape firmly when transitioning through different treatment areas
• Requests verbal consent when undraping areas of the body deemed as sensitive
• Maintains draping coverage of the client’s breasts, genitalia, and gluteal cleft at all times
• Never works under the drapes
• Exposes the area to be treated and re-drapes the area after treatment
• Keeps all areas not receiving treatment draped unless client requests otherwise
• Keeps all sensitive areas draped when not being treated regardless of client request to do otherwise.
Benefit
• Communicates, establishes, and maintains a professional boundary in the therapeutic relationship.
Safety
• None
Soft-tissue Techniques and Modalities
Indication:
Conditions and/or structural and/or functional limitations created and maintained by soft-tissue imbalances.
Competency:
Able to identify the different types of soft-tissue, normal tissue texture and pathological signs embedded in the soft tissue.
Standard:
Quality Assurance
Soft tissue must be adequately warmed up before the application of the technique.
How to:
The Massage Therapist or Spa Therapist,
• Receives informed consent from the client prior to the initiation of the soft-tissue technique
• Applies the five principles of Massage Therapy:
o General to Specific to General
o Superficial tissue to deep then back to superficial
o Proximal to Distal then back to Proximal
o Peripheral to Central to Peripheral
o Treats the antagonist where applicable (see end notes 19, 20)
• Applies the appropriate technique for the tissue-type in question
• Stops treatment when there is evidence of tissue response
• Where applicable, applies hydrotherapy techniques and any approved additional modalities to facilitate soft-tissue recovery
• Avoids known local contraindications to soft-tissue techniques or modifies the techniques where appropriate
Benefit
• Strong positive therapeutic effect for the client
Safety
• Avoid treatment when known contraindications to the techniques are suspected or exist in the client
Home Rehabilitation Activities
Indication:
Where recovery and treatment intervention are enhanced by the client performing rehabilitative activities outside of the therapeutic environment.
Competency:
Recommend and demonstrate appropriate client self-care for the recovery of the condition or body system in question.
Standard:
Quality Assurance
Home rehabilitation activities must be specified with frequency, intensity and duration and be re-evaluated after a designated period for correct application and efficacy.
How to:
The Massage Therapist or Spa Therapist,
• Recommends client self-care at the appropriate stage of treatment
• Provides or recommends the tools to facilitate the activity
• Demonstrates the activity to the client
• Requests the client to demonstrate the shown activity back to the therapist
• Modifies rehabilitation activities to prevent further damage of compromised tissue
• Documents the self-care activity suggested to the client
• Appoints a re-evaluation date
• If applicable, appoints a date to discontinue the rehabilitation activity
Benefit
• Shorten recovery time
• Enhance a positive therapeutic outcome for the client
Safety
• Avoid recommendation where known contraindications to the rehabilitative position exist in the client
Treatment of Special Populations
Indication:
Clients legally or medically deemed as vulnerable and for whom Massage Therapy treatment plans, space and protocols must be modified to accommodate the vulnerability aspect. Examples include but are not limited to: pregnancy, infants, children, elderly, medical disabilities, terminal illness.(see end note 21)
Competency:
Able to modify physical assessments, treatment positions and techniques yet ensure a therapeutic response in the affected tissue.
Standard:
Quality Assurance
Proper training and/or certification must be obtained for the treatment of conditions specific to special populations.
How to:
The Massage Therapist or Spa Therapist,
• Easily identifies conditions specific to a special population
• Treats conditions within special populations for which they are trained
• Readily modifies and adapts treatment procedures and plans for special population clients
Benefit
• Ensures maximum therapeutic benefit to the client
Safety
• All safety precautions and contraindications when working with special populations apply
a) Pediatric Client Treatment Guidelines
Indication:
These guidelines are indicated for clients below the age of majority in the jurisdiction in which the treatment is taking place or older than 12 months presenting with a symptom that can be treated within the Massage Therapy Scope of Practice. (see end note 22)
Competency:
Able to modify physical assessments, duration of sessions, treatment positions and techniques to ensure a positive therapeutic response in the affected tissue.
Standard:
Quality Assurance
Proper training and/or certification must be obtained for the treatment of conditions in the Pediatric Population.
How to:
The Massage Therapist or Spa Therapist,
• Easily identifies whether the condition presented is specific to the pediatric population
• Always encourages parental/guardian supervision when working with the pediatric especially if it is the client’s first treatment
• Thoroughly outlines areas of treatment, draping procedures and the client’s/parent’s/guardian’s right to terminate the treatment session
• Helps the pediatric client understand what is to be expected during the treatment
• Determines capacity of the pediatric client and if deems incapable, defers informed consent to the parent/guardian
• Treats conditions within special populations for which they are trained
• Readily modifies and adapts treatment procedures and plans for the pediatric client
Benefit
• Ensures maximum therapeutic benefit to the client
Safety
• All safety precautions and contraindications when working with special populations apply
• Unless otherwise prescribed, pediatric treatments are recommended not to exceed 30-45 minutes
b) Geriatric Client Treatment Guidelines
Indication:
These guidelines are indicated for clients over the age of 70 years presenting with a symptom/s that can be treated within the Massage Therapy Scope of Practice. (see end note 23)
Competency:
Able to modify physical assessments, duration of session, treatment positions and techniques to ensure a positive and not injurious physiological response in the affected tissue.
Standard:
Quality Assurance
Proper training and/or certification must be obtained for the treatment of conditions in the Geriatric Population. Treatment plans must take into consideration physical, psychological and socioeconomic factors affecting the client. (see end note 24)
How to:
The Massage Therapist or Spa Therapist,
• Easily identifies whether the condition presented is specific to the geriatric population
• Establishes whether client is frail and inactive to avoid rigorous brisk techniques such as extreme spinal mobilizations (see end note 25)
• Establishes integrity of client’s skin to avoid aggressive shearing techniques (see end note 26)
• Thoroughly outlines areas of treatment, draping procedures and the client’s right to terminate the treatment session
• Helps the geriatric client understand what is to be expected during the treatment
• Determines capacity of the geriatric client and if deems incapable, defers informed consent to the caregiver or medical supervisory personnel
• Treats conditions within the special population for which they are trained
• Readily modifies and adapts treatment procedures and plans for the geriatric client
• Schedules ample time for the client’s preparatory, transition and actual treatment time
Benefit
• Ensures maximum therapeutic benefit to the client
Safety
• All safety precautions and contraindications when working with special populations apply
c) Clients with Impairments Treatment Guidelines
Indication:
These guidelines are indicated for clients with impairments such as but not limited to visual, hearing, speech, mobility, self-care and cognitive. (see end note 27)
Competency:
Able to modify physical assessments, duration of sessions, treatment positions, techniques and space to ensure a safe environment for clients with impairments.
Standard:
Quality Assurance
Basic training and/or certification covers treatment modifications for clients with impairments.
How to:
The Massage Therapist or Spa Therapist,
• Thoroughly outlines areas of treatment, draping procedures and the client’s right to terminate the treatment session
• Helps the medically impaired client understand what is to be expected during the treatment
• Determines capacity of the client and if deems incapable, defers informed consent to a caregiver or the medical supervision team
• Treats conditions within the special population for which they are trained
• Readily modifies and adapts treatment procedures and plans for the client
• Schedules ample time for the client’s preparatory, transition and actual treatment time
Benefit
• Ensures maximum therapeutic benefit to the client
Safety
• All safety precautions and contraindications when working with special populations apply
4. PROFESSIONALISM
Professional Boundaries
Indication:
At all times within the therapeutic setting.
Competency:
Maintain professionalism at all times in the therapeutic setting including but not limited to conversation, demeanor, time management, client interview, treatment, personal appearance and appearance of the therapeutic environment. (see end notes 28, 29)
Standard:
Quality Assurance
Professional boundaries must exist in the therapeutic relationship and communicated to the client where applicable. The therapist must not engage in communication or activities that cross the client’s physical, mental and emotional boundaries.
How to:
The Massage Therapist or Spa Therapist,
• Dresses appropriately for a therapeutic setting
• Maintains professional conversations in the workplace
• Creates and maintains spatial and physical boundaries as relates to non-therapeutic touch
• Communicates clearly and seeks informed consent from the client before performing a technique that is in the client’s personal space
• Is aware of transference and counter-transference red flags for appropriate action
• Documents legibly and accurately as per work-place policies when breaches of professional boundaries occur
• Reports serious breaches of professional boundaries to the appropriate authority
Benefits
• Educates service-users on what to expect in Massage Therapist’s or Spa Therapist’s work setting
• Minimizes professional misconduct in the workplace
• Limits client complaints about professional misconduct
Safety/Precaution
• Implement extra policies when working with minors, clients with developmental disabilities or other health disabilities and where the primary language and mode of communication is not understood by the therapist and/or client
Dual Designations
Indication:
Dual designation status is indicated when the therapist has more than one Canadian-recognized training and certification, licensing and/or registration applicable to the same client.
Competency:
Perform within the scope of practice of each designation safely as per training and certification.
Standard:
Quality Assurance
The Massage Therapist or Spa Therapist must show evidence of actively preventing confusion that may arise from any overlap of the various designations in clinical practice.
How to:
The Massage Therapist or Spa Therapist,
• Publicly displays and makes readily available training completion documents
• Performs techniques learned with the scope of practice of each designation
• Develops a clear policy for communication to clients and interested parties when one designation is used over another
• Creates separate appointments for clients seeking one or the other designation
• Creates a separate billing system for clients seeking one or the other designation
• Provides the client with an accurate billing receipt with the appropriate registration information for the service received
• Maintains a distinct documentation format and/or record system for each designation
• Reports to the relevant authority when there is use of a dual designation with fraudulent intent
Benefit
• Guards against fraud
• Provides clarity to third party inquirers such as insurance companies and legal teams
Referrals and Professional Collaborations
Indication:
If conditions and/or physical assessment findings warrant intervention that falls outside of the capable scope of the massage therapist/spa therapist or where the health of the client fails to improve under the supervision of the massage therapist/spa therapist or where additional self-care measures beyond the therapists ability to provide instruction in such measures is warranted, or in any other situation where referral to and/or professional collaboration with other health care practitioners or providers in the care of the client applies.(see end notes 30, 31)
Competency:
Recognition of the CMMOTA’s Massage Therapist Scope of Practice or Spa Therapist Scope of Practice, the capacity of the therapist to provide effective treatment within their scope, and awareness of the restricted activities under any federal or provincial legislation.
Standard:
Quality Assurance
If applicable, referrals and involvement of a multi-disciplinary health team in the care of the client must be recommended to the client in a timely manner.
How to:
The Massage Therapist or Spa Therapist,
• Communicates to the client the need for other professional involvement in the management of their health
• Within scope of practice, recommends experts that may participate in the client’s recovery process
• Provides a progress report for the client to approach the recommended expert with
• With consent from the client, seeks a progress report from the recommended expert after an agreed upon time has elapsed
• Regarding medical and/or recreational Cannabis, and other related cannabinoid products, the therapist is to direct referrals only to the client’s primary physician.
Benefit
• Strong positive therapeutic outcome for the client
Conflict of Interest
Indication:
When the therapist stands to gain in more ways than outlined in the therapeutic relationship.
Competency:
Be able to identify, mitigate and declare a conflict of interest where it exists or is suspected in the Massage Therapy environment.
Standard:
Quality Assurance
There must be a declaration of a conflict of interest and reasonable effort applied by the therapist to mitigate it in the work setting.
How to:
The Massage Therapist or Spa Therapist,
• Acts within the confines of the therapeutic relationship
• Accurately declares imminent conflicts of interest to client and parties involved
Benefit
• Maintains trust in the therapeutic relationship
• Maintains trust in the work environment
Self-development
Indication:
For maintenance of professional registrations and licensing in Massage Therapy and to evolve as the industry and practice evolves.
Competency:
Recognize limitations of current practice and skills.
Standard:
Quality Assurance
There must be evidence of periodic investment in relevant professional development.
The Massage Therapist or Spa Therapist,
• Regularly performs an introspective audit of their training, skills, current professional experience and work environment
• Regularly perform an analysis of memorable events in their work history; both positive and negative
• Actively pursues ways to overcome obstacles around their professional growth
• Periodically attends CMMOTA approved workshops or other continuing education relevant to Massage Therapy
• Takes on tutelage opportunities to better themselves and/or for the purpose of developing massage or spa therapists
Benefit:
• Improves service provision to new and existing clients
Safety:
• Avoid if potentially burnt out. Focus on regaining balance before additional self-development
____________________________________________________________
END NOTES
1. Federation of Massage Therapy Regulatory Authorities of Canada. 2016. Inter-Jurisdictional Practice Competencies and Performance Indicators for Massage Therapists at Entry-to-Practice.
2. Rattray, F. and L. Ludwig. 2000. Clinical Massage Therapy, Understanding, Assessing and Treating over 70 Conditions. Talus Incorporated, Toronto.
3. Rattray, F. and L. Ludwig. 2000. Clinical Massage Therapy, Understanding, Assessing and Treating over 70 Conditions. Talus Incorporated, Toronto.
4. Rattray, F. and L. Ludwig. 2000. Clinical Massage Therapy, Understanding, Assessing and Treating over 70 Conditions. Talus Incorporated, Toronto.
5. College and Association of Registered Nurses of Alberta. 2013. Practice Standards for Regulated Members. http://www.nurses.ab.ca/docs/default-source/document-library/standards/practice-standards-for-regulated-members.pdf?sfvrsn=d4893bb4_8 Accessed April, 17th 2019.
6. World Health Organization. 2011. Core components for infection prevention and control programmes. Assessment tools for IPC programmes.pg 11.
7. Rattray, F. and L. Ludwig. 2000. Clinical Massage Therapy, Understanding, Assessing and Treating over 70 Conditions. Talus Incorporated, Toronto.
8. Federation of Massage Therapy Regulatory Authorities of Canada. 2016. Inter-Jurisdictional Practice Competencies and Performance Indicators for Massage Therapists at Entry-to-Practice.
9. Rattray, F. and L. Ludwig. 2000. Clinical Massage Therapy, Understanding, Assessing and Treating over 70 Conditions. Talus Incorporated, Toronto.
10. College and Association of Registered Nurses of Alberta. 2013. Practice Standards for Regulated Members. http://www.nurses.ab.ca/docs/default-source/document-library/standards/practice-standards-for-regulated-members.pdf?sfvrsn=d4893bb4_8 Accessed April, 17th 2019.
11. World Health Organization. 2011. Core components for infection prevention and control programmes. Assessment tools for IPC programmes.pg 11.
12. Federation of Massage Therapy Regulatory Authorities of Canada. 2016. Inter-Jurisdictional Practice Competencies and Performance Indicators for Massage Therapists at Entry-to-Practice.
13. Rattray, F. and L. Ludwig. 2000. Clinical Massage Therapy, Understanding, Assessing and Treating over 70 Conditions. Talus Incorporated, Toronto.
14. College and Association of Registered Nurses of Alberta. 2013. Practice Standards for Regulated Members. http://www.nurses.ab.ca/docs/default-source/document-library/standards/practice-standards-for-regulated-members.pdf?sfvrsn=d4893bb4_8 Accessed April, 17th 2019.
15. World Health Organization. 2011. Core components for infection prevention and control programmes. Assessment tools for IPC programmes.pg 11.
16. Rattray, F. and L. Ludwig. 2000. Clinical Massage Therapy, Understanding, Assessing and Treating over 70 Conditions. Talus Incorporated, Toronto.
17. Canadian Patient Safety Institute. 2009. Enhancing Patient Safety Across the Health Professions. (1): 1-56
18. Salvo, S. 2016. Massage Therapy, Principles and Practice, 5th Edition. Elsevier, St. Louis.
19. Federation of Massage Therapy Regulatory Authorities of Canada. 2016. Inter-Jurisdictional Practice Competencies and Performance Indicators for Massage Therapists at Entry-to-Practice.
20. Rattray, F. and L. Ludwig. 2000. Clinical Massage Therapy, Understanding, Assessing and Treating over 70 Conditions. Talus Incorporated, Toronto.
21. World Health Organization. 2011. Core components for infection prevention and control programmes. Assessment tools for IPC programmes.pg 11.
22. Canadian Patient Safety Institute. 2009. Enhancing Patient Safety Across the Health Professions. (1): 1-56
23. Canadian Patient Safety Institute. 2009. Enhancing Patient Safety Across the Health Professions. (1): 1-56
24. Canadian Patient Safety Institute. 2009. Enhancing Patient Safety Across the Health Professions. (1): 1-56
25. Canadian Patient Safety Institute. 2009. Enhancing Patient Safety Across the Health Professions. (1): 1-56
26. Canadian Patient Safety Institute. 2009. Enhancing Patient Safety Across the Health Professions. (1): 1-56
27. Canadian Patient Safety Institute. 2009. Enhancing Patient Safety Across the Health Professions. (1): 1-56
28. World Health Organization. 2011. Core components for infection prevention and control programmes. Assessment tools for IPC programmes.pg 11.
29. Canadian Patient Safety Institute. 2009. Enhancing Patient Safety Across the Health Professions. (1): 1-56
30. Salvo, S. 2016. Massage Therapy, Principles and Practice, 5th Edition. Elsevier, St. Louis.
31. Canadian Interprofessional Health Collaborative. 2010. A National Interprofessional Competency Framework. Pg.15
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