Issue link: https://www.massageandbodyworkdigital.com/i/68178
SCOPE OF PRACTICE WHAT IS SCOPE OF PRACTICE? Scope of practice is a phrase used by licensing boards or certifying bodies for various professions that defines the procedures, actions, and processes that are permitted for a licensed individual. A board's purpose is to ensure qualified individuals practice in a safe and effective manner, according to local, state, or national laws. Public protection is the board's primary concern.1 In medical or health professions, a qualified professional has been trained in the physiological effects, indications, contraindications, and proper application of a technique or skill. Typically, this is confirmed through educational guidelines, licensing examination(s), and/or a competency evaluation. The board ensures that these qualifications have been met. In the field of massage therapy, the scope of practice varies from state to state. For example, in New York, "The practice of the profession of massage therapy is defined as engaging in applying a scientific system of activity to the muscular structure of the human body by means of stroking, kneading, tapping, and vibrating with the hands or vibrators for the purpose of improving muscle tone and circulation."2 Ohio identifies massage therapy as "the treatment of disorders of the human body by the manipulation of soft tissue through the systematic external application of massage techniques, including touch, stroking, friction, vibration, percussion, kneading, stretching, compression, and joint movements within the normal physiologic range of motion; and adjunctive thereto, the external application of water, heat, cold, topical preparations, and mechanical devices."3 Texas describes massage therapy as "the manipulation of soft tissue by hand or through a mechanical or electrical apparatus for the purpose of body massage and includes effleurage (stroking), petrissage 58 massage & bodywork september/october 2009 Massage Therapy Body of Knowledge Representatives from six of the profession's key organizations, including Associated Bodywork & Massage Professionals, have banded together to create the Massage Therapy Body of Knowledge (MTBOK). This stewardship group's primary responsibility is to "develop and adopt across the massage therapy profession a living resource of competencies, standards, and values that inform and guide the domains of practice, licensure, certification, education, accreditation, and research." Participants believe that a "well- articulated body of knowledge will help to drive the recognition and growth of massage therapy" through education standards, teaching qualifications, and regulatory requirements. To learn more, visit www.mtbok.org. (kneading), tapotement (percussion), compression, vibration, friction, nerve strokes, and Swedish gymnastics."4 Among state laws, common themes emerge with regard to the scope of practice for massage therapy: (1) massage therapy involves the manipulation of soft tissue; (2) this soft-tissue manipulation should have a specific therapeutic intent or purpose. Beyond these two major points, legislative and professional discrepancy begins. TERMINOLOGY Terminology, excluded forms of soft-tissue therapy, exemptions, and other issues about scope of practice warrant great debate among legislators, lobbyists, massage practitioners, and other healthcare providers. Legislators are motivated to protect the public, streamline processes, and minimize complaints. Massage practitioners want to protect their profession and ensure the greatest possible freedom to practice their craft. Other healthcare providers want to protect their own profession from infringement by other disciplines. One of the greatest areas of confusion for massage practitioners is terminology. Massage practitioners need to develop a vocabulary that the medical field can adopt. Terms that draw frequent fire are range of motion, joint mobilization, therapeutic exercise, neuromuscular reeducation, and manual therapy. Other professions may try to limit the scope of practice of massage therapists by writing a definition that restricts treatment of illness or injury or by including language that specifically excludes particular techniques such as those listed above. RANGE OF MOTION Range of motion as a technique involves moving a joint through its normal, physiological motions. The direction and degree of movement possible varies between joints and is usually described as flexion, extension, abduction,