Click each of the questions below to be taken to the answer:
Cosmetology Overlaps: body wraps, scrubs, facials, and paraffin.
The Massage Therapy Board is in the process of sending a letter to the Cosmetology Board that outlines the Board’s positions concerning these issues. It appears that the position of the Massage Board is that body wraps, exfoliating scrubs, facial massage and paraffin is within the scope of massage therapy. We’ll update you once we learn more.
The BLMTB Board’s position: There are overlaps of practice with many professions. In the case of cosmetologists, they’ve asserted that all of these practices are for beautification purposes. Massage Therapists claim that these practices have health benefits, and are not merely used for beautification. This issue is at the center of the conflict between our two professions.
It is the opinion of the BLMTB Board that massage therapists should not claim any beautifying effects and that statutory language be used to clarify what these procedures do. [Including the language: These procedures are] “primarily intended to enhance or restore health and well-being by promoting pain relief, stress reduction, and relaxation.”
The Massage Therapy Board at its June 22 meeting included the terms “facial massage” and “exfoliating scrubs” in the letter to the cosmetologists as being part of the massage therapy scope of practice.
The BLMTB Board agrees that massage therapists should avoid using the term “facial” and use the term “facial massage” instead. This differentiates how each profession performs “facials” and avoids confusion.
This brings us to the next issue: use of the term “exfoliation.” Our definition of scope of practice includes the phrase “the external application of water, heat, cold, lubricants, salts, skin brushing, or other topical preparations not classified as prescription drugs”. As written, this definition includes the use of exfoliating agents (salts, skin brushing, and other topical preparations such as sugar and muds). Therefore, Massage Therapists should be able to use the term “exfoliation” to describe what these treatments do.
In short, the BLMTB Board’s position is body wraps, exfoliating scrubs, facial massage and paraffin all are part of the scope of massage therapy when performed to enhance the health and well-being of the individual.
The BLMTB Board’s position:
There are overlaps of practice with many professions. In the case of cosmetologists, as long as they claim only to perform these tasks for beautification purposes, they are not encroaching on the practice of massage therapy. If they claim health benefits for any of these modalities, then they are encroaching upon the practice of massage therapy. Since these modalities that beautify also have health benefits, they are encroaching on the practice of massage therapy and should no longer be able to perform these practices.
The above statements are made to make a point: for far too long, the cosmetologists have been claiming that anything that beautifies belongs only to them, even if the procedure has health benefits and the intention is to bring about health and not specifically to beautify. This is a false choice as much of what brings about health has the side benefit of beautifying. However, we recognize that to keep the peace, massage therapists should not claim any beautifying effects. Our intention is to bring about health and well-being, so let’s stick to those descriptions.
There was also discussion at the April 27, 2010 Board meeting concerning the terms “exfoliation” and “facial” and how we should avoid using them. The BLMTB Board does not agree. The cosmetologists do not “own” either term, and their usage should not be confined to cosmetology practice. However to differentiate how we each perform “facials,” massage therapists should always use the term “facial massage” and avoid using the term “facial” by itself. Unfortunately, the cosmetologists themselves have muddied the waters on this issue by
- not defining “facial” either in the statutes or in the rules and
- claiming as part of the teaching or practice of barbering 37-31-101.(9) (d) “giving facial or scalp massages, including treatment with oils, creams, lotions, or other preparations applied by hand or mechanical appliance.”
As far as the term “exfoliation” goes, yes, it is defined in their rules ("Exfoliation" means the sloughing off of nonliving (dead) skin cells by very superficial and noninvasive means) but this is a very generic definition, with no “intention” attached. And just because it is defined by them, does not mean that it is owned by them. Massage Therapists should be able to use the term “exfoliation” to describe what scrubs do.
This brings us to what the practice of massage therapy includes:
body wraps, scrubs, and paraffin all are considered to be part of our scope. Read the trade journals, they agree. Here’s why: our definition of scope of practice includes the phrase “the external application of water, heat, cold, lubricants, salts, skin brushing, or other topical preparations not classified as prescription drugs”.
Body wraps are applied with the hands and are a means of delivering a variety of topical preparations and could be considered a topical preparation in and of itself.
Scrubs consist of salts and/or other topical preparations
Paraffin is a topical preparation.
In short, the BLMTB Board’s position is body wraps, scrubs and paraffin all are part of the scope of massage therapy when performed to enhance the health and well-being of the individual.
Excerpt from the April 27, 2010 Board Meeting Minutes:
“The Board began discussion of a question from [name] asking if massage therapists are able to perform body wraps and scrubs. There seems to be a distinction as to the purpose for the applications of wraps, paraffin wax, and scrubs as to whether they are for beautification purposes or for the therapeutic purpose of restoration of health and well-being by promoting pain relief, stress reduction and relaxation. The members directed staff to draft a letter to the Board of Barbers and Cosmetologists stating the Board of Massage Therapy’s position on these areas for review at the next Board of Massage Therapy Board meeting. The persons posing these questions will be notified that the Board is continuing to address their issues”.
Excerpt from the June 22, 2010 Board Meeting Minutes:
“The draft letter to the Board of Barbers and Cosmetology (BAR/COS) was discussed and wording was suggested concerning exfoliation and facial massage. It is hoped that the BAR/COS Board would address this letter at its July 19, 2010 meeting. Motion: Stacy Baird moved to send the letter to the Board of Barbers and Cosmetology as discussed. Dr. Soloway seconded. Motion Carried.”
Applicable Statutes:
37-33-403. Definitions.
(4) (a) (i) "Massage therapy" when provided by a massage therapist means the application of a system of structured touch, pressure, positioning, or holding to soft tissues of the body, Swedish massage, effleurage, petrissage, tapotement, percussion, friction, vibration, compression, passive and active stretching or movement within the normal anatomical range of motion, the external application of water, heat, cold, lubricants, salts, skin brushing, or other topical preparations not classified as prescription drugs, providing information for self-care stress management, and the determination of whether massage is contraindicated and whether referral to another health care practitioner is recommended.
(ii) The techniques described in subsection (4)(a)(i) must be applied by the massage therapist through the use of hands, forearms, elbows, knees, or feet or through the use of hand-held tools that mimic or support the action of the hands and are primarily intended to enhance or restore health and well-being by promoting pain relief, stress reduction, and relaxation.
(b) The term does not include providing examinations for the purpose of diagnosis, providing treatments that are outside the scope of massage therapy, attempts to adjust, manipulate, or mobilize any articulations of the body or spine by the use of high-velocity, low-amplitude thrusting force, exercise, exercise instruction or prescription, or the use of tape when applied to restrict joint movement, manual or mechanical traction when applied to the spine or extremities for the purposes of joint mobilization or manipulation, injection therapy, laser therapy, microwave diathermy, electrical stimulation, ultrasound, iontophoresis, or phonophoresis.
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Is breast massage legal? Do I need a separate consent form to perform it?
At this time the Board’s answers are Yes and no. The Board has already developed a rule concerning Unprofessional Conduct that concerns sexual contact. If the work is not done for sexual purposes, then it is ok. Also, the Board discussed that while they are not going to require a separate consent at this time, members seemed to think it was a good idea for practitioners to use them so there is no question as to the intent or the purpose of the breast massage.
Excerpt from the April 27, 2010 Board Meeting Minutes:
“[name] submitted a question on whether breast massage is illegal in Montana and asked if written permission is needed from the client. The Board responded that breast massage is not illegal as long as it does not violate unprofessional conduct regulations and it responded that no separate consent form is required at this time. Board members commented that licensees may want to use a consent form so there is no question as to the intent or the purpose of the breast massage.”
Applicable Rules:
=========== Reference Rule No. as they are adopted ==========
NEW RULE II UNPROFESSIONAL CONDUCT (1) The following conduct is unprofessional conduct justifying disciplinary action against a licensee:
(c) engaging in or soliciting sexual contact or sexual intercourse, as those terms are defined in 45-2-101, MCA, with a client, when such act or solicitation is related to the practice of massage therapy;
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Do I need to have a consent form before performing any massage?
At this time the Board’s answer is no.
When developing the Unprofessional Conduct rules, such a consent form was in an early draft, but did not become a rule. In omitting it, the Board determined it was not necessary. The Board reaffirmed this at the April 27 meeting. CONFIRM THIS….
This doesn’t mean that you shouldn’t use one. It simply means that the decision is left to the individual practitioner to determine for themselves whether or not to use one rather than require everyone to.
Excerpt from February 22, 2010 Massage Therapy Rules Committee meeting:
“Motion: Michael Eayrs moved to strike 1(t). Susan Carlson seconded. Motion Carried.”
Note: the original text of 1(t) was “(t) failing to obtain informed consent from a client or a client's representative prior to providing any therapeutic intervention;”
In striking the item, the Board chose not to adopt this as a rule.
The Recommendations of the Rules committee were passed in the Board meeting later that same day: “Motion: Dr. Soloway moved to accept the Unprofessional Conduct Rule, Continuing Education Rule, and the lapsed but not revived rule as passed in the Rules Committee today. Deb Kimmet seconded. Motion Carried.”
Excerpt from the April 27, 2010 Board Meeting Minutes:
“The Board responded to [name] that there is no requirement for insurance or signed consent forms for treatment.“
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Is animal massage part of the scope of massage therapy in Montana?
There is nothing in the statutes regulating animal massage. [BLMTB Board Note: There is nothing in the statutes making animal massage illegal either. In the past, animal massage therapists – one school - ran into difficulties with the veterinary board by using the word “health” in their promotional information. It is suggested to avoid such claims.]
Excerpt from the April 27, 2010 Board Meeting Minutes:
“[name] asked if animal massage was addressed in the new law. The Board’s response is that animal massage is not currently regulated under the massage therapy statutes. Board Counsel will send a response.”
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Is a practitioner limited to only the things listed in the law?
No.
During the rule-making process, the Board decided that it is not unprofessional conduct for a person to do something outside of the scope of massage therapy. They did this by refusing to adopt a rule stating that it would be. There are just too many massage therapists with “dual professions” – they do more than just massage (yoga, personal training, etc.). Where the Board has jurisdiction is if someone does something that is within the scope of massage therapy, and they aren’t trained to do it, or harm someone.
Something else to keep in mind: if you are doing something that is not within the scope of massage therapy, make sure that you are also not violating other professions’ statutes. If you do, there is nothing to stop them from pursuing action against you, and being licensed in massage therapy will not protect you.
BLMTB Board Opinion: The Board determines whether an action is within the scope of massage therapy or not. If it is not, the Board really has no jurisdiction over the individual, other than to ensure that the individual is not purporting to practice massage therapy while doing something outside of the scope. If that’s the case, and the person is blurring the lines, the Board could take jurisdiction.
We encourage individuals to make it clear to their clients when they are practicing massage therapy and when they are not.
For example: aromatherapy. If the oil is put in lotion, it is part of the practice of massage therapy. If it is diffused into the air, it is not. Strengthening exercises are not within the scope of massage therapy. While these are not the only examples, it is your responsibility to know the scope of practice.
The scope of practice for massage therapy is as follows:
(4) (a) (i) "Massage therapy" when provided by a massage therapist means the application of a system of structured touch, pressure, positioning, or holding to soft tissues of the body, Swedish massage, effleurage, petrissage, tapotement, percussion, friction, vibration, compression, passive and active stretching or movement within the normal anatomical range of motion, the external application of water, heat, cold, lubricants, salts, skin brushing, or other topical preparations not classified as prescription drugs, providing information for self-care stress management, and the determination of whether massage is contraindicated and whether referral to another health care practitioner is recommended.
(ii) The techniques described in subsection (4)(a)(i) must be applied by the massage therapist through the use of hands, forearms, elbows, knees, or feet or through the use of hand-held tools that mimic or support the action of the hands and are primarily intended to enhance or restore health and well-being by promoting pain relief, stress reduction, and relaxation.
(b) The term does not include providing examinations for the purpose of diagnosis, providing treatments that are outside the scope of massage therapy, attempts to adjust, manipulate, or mobilize any articulations of the body or spine by the use of high-velocity, low-amplitude thrusting force, exercise, exercise instruction or prescription, or the use of tape when applied to restrict joint movement, manual or mechanical traction when applied to the spine or extremities for the purposes of joint mobilization or manipulation, injection therapy, laser therapy, microwave diathermy, electrical stimulation, ultrasound, iontophoresis, or phonophoresis.
Applicable Statutes:
37-33-403. Definitions(4) (a) (i) "Massage therapy"
(b) The term does not include ... providing treatments that are outside the scope of massage therapy,
Excerpt from February 22, 2010 Massage Therapy Rules Committee meeting:
“Motion: Grace Bowman moved to have 1(f) read "accepting and performing massage therapy responsibilities which the licensee knows or has reason to know that he or she is not competent to perform." Stacy Baird seconded, Motion Carried.”
The Recommendations of the Rules committee were passed in the Board meeting later that same day:
“Motion: Dr. Soloway moved to accept the Unprofessional Conduct Rule, Continuing Education Rule, and the lapsed but not revived rule as passed in the Rules Committee today. Deb Kimmet seconded. Motion Carried.”
Note: The final version adopted above was very different than the original draft that would have prohibited practice outside of the scope of massage therapy. The original draft read: “(f) performing services outside of the licensee's area of training, expertise, competence, or scope of practice or licensure;” The Board, by not adopting the original draft, was affirming that massage therapists often practice multiple professions.
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