Know Your Boundaries

By Cindy Williams
[Classroom to Client ]

When I first heard the term scope of practice in 2010, I was 10 years into my career as a massage therapist. Ten years! Even then, to be honest, I wasn’t sure what it meant. Sometimes you don’t know what you don’t know. I attributed my lack of knowledge to attending school in the late 1990s when educational standards in our profession were not as structured as they are now, and terms such as scope of practice were not presented and defined in many entry-level programs. The reason might have been that many states, including the one I had been trained and was practicing in, did not yet have legislation in place to outline laws and regulations or require licensure of massage therapists.

Recently, the topic of scope of practice came up again when I was contacted by two colleagues, both massage therapists, who sought new employment opportunities after COVID-19 greatly impacted their private practices. Both were concerned about techniques they were being asked to perform in chiropractic clinics. I realized that even with a clear definition of scope of practice, practitioners of all experience levels might still be unsure what does and does not fall within their scope—or even where to find the information they need when in doubt.

So, what should you do if you find yourself in a place of uncertainty?

Start with your state board

If you practice in a state that is regulated, you can go online to your state’s massage therapy board website and view the current laws and regulations, or simply give them a call. A complete list of massage therapy boards is available at

In 2014, the Federation of State Massage Therapy Boards (FSMTB) drafted the Model Massage Therapy Practice Act that defines and applies general guidelines to scope of practice ( In Section 104, the document states that the “practice of Massage Therapy means the manual application of a system of structured touch to the soft tissues of the human body, including but not limited to: (1) Assessment, evaluation, or treatment; (2) Pressure, friction, stroking, rocking, gliding, kneading, percussion, or vibration; (3) Active or passive stretching of the body within the normal anatomical range of movement; (4) Use of manual methods or mechanical or electrical devices or tools that mimic or enhance the action of human hands; (5) Use of topical applications such as lubricants, scrubs, or herbal preparations; (6) Use of hot or cold applications; (7) Use of hydrotherapy; and (8) Client education.”1 Still, there is room for question in some cases.

Apply critical thinking

The most important consideration is why we have a scope of practice in the first place. The answer is easy: to protect the public (our clients) from harm. When you keep clients’ safety at the forefront, you are less likely to perform a technique you feel apprehensive about. Following are simple questions you can ask yourself when deciding what techniques are within your scope of practice:

• Have you been formally trained to perform the technique?

• Do you have a certificate of completion or transcripts to prove your training?

• Does the technique involve using manual touch or devices that mimic the use of hands to apply touch to the body for therapeutic value?

Ask, “Am I Covered?”

Even with board guidelines and the use of critical thinking, there are gray areas when it comes to scope of practice—even some seemingly appropriate applications might not be covered by your liability insurance policy. For example, applying stretches within normal range of motion might appear to be acceptable, but not all insurance policies cover it. Also, your policy might not cover the use of some topical applications, especially if they are homemade or contain ingredients that aren’t legal in your state.

Also, in some cases, client education has limits. Can you recommend at-home exercises? Your policy might cover some but not all. A call to your insurance provider is definitely in order before proceeding with making these suggestions.

Do the legwork

This article, as well as other articles on massage therapy scope of practice, cannot give you black-and-white answers. The goal, rather, is to guide you to where to find the answers.

Today, the majority of states have legislation in place. Since each state has its own laws and regulations (and believe me when I say they are ALL different),  you will need to do the legwork to ensure you are keeping your clients safe and performing only those techniques that are legally allowed (as well as covered by your liability insurance) in your state.

While it might seem easier to assume nothing will go wrong, your license is on the line, not to mention your client’s well-being. Massage therapy continues to evolve, so let’s work together to stay involved, informed, educated, and current, while upholding professional standards we can all be proud of.


1. Federation of State Massage Therapy Boards, “Model Massage Therapy Practice Act” (Overland Park: FSMTB, 2014): 10–11.

Since 2000, Cindy Williams, LMT, has been actively involved in the massage profession as a practitioner, school administrator, instructor, curriculum developer, and mentor. She maintains a private practice as a massage and yoga instructor. Contact her at