integrative care team

As massage therapists, we have all heard a phrase along the lines of, “When in doubt, refer out.” On the face of it, this seems like a logical rule to follow, one which seems to be for our protection and the well-being of our clients.

However, if we dig a bit deeper, we see that this simple phrase can create much of the isolation we experience as massage therapists. Scope of practice is one reason for this.


Misunderstood Scope of Practice?

One reason massage therapists tend to get stuck in isolation is the area of scope of practice. We either become so fearful of not wanting to exceed our scope that we refer clients out to other practitioners never to see them again, or we are so fearful of losing our clients that we never refer and hope for the best.

The referral model is still present in much of the health care field today: Each practitioner in the chain is isolated, working in the silo of his or her specialty. The client or patient is defined not by the whole person, but by the disease, injury or issue presented.

Often in the referral model, the client is not given enough information and must rely on the expertise of the practitioner to decide what the best course of treatment might be. This is one reason the practitioner must be completely clear on his or her scope of practice.


create a network

Create a Network

In our many years of experience as massage therapists and educators, we have discovered that the best way to protect ourselves both from working in isolation and exceeding scope of practice is through creating an interdisciplinary network of health care practitioners to collaborate in the care of each client. Not only is the client’s well-being talked about in a more comprehensive, holistic manner; but each practitioner on the team gains awareness of each others’ type of knowledge and skills, leading to continued improvement in decision-making.

This model springs to life when working within a sports medicine team in the care of professional or Olympic athletes. Whether discussing recovery from a current injury or illness, or the prevention of future injury, a medical doctor discusses best care with a physical therapist, athletic trainer, chiropractor, acupuncturist, psychologist, nutritionist, massage therapist, and possibly more specialists to discover the truly best course of treatment for an individual athlete.

Ideas and philosophies are shared among practitioners and treatment paths are debated, until all agree on the approach and goals best suited to the individual.

So, how can we as massage therapists begin opening the conversation to collaborate with other health care professionals? One false notion is that we must work in close proximity with other health care professionals in an office space, like a wellness center.

Unfortunately, this does not always present us with the best model. More often than not, wellness centers are still a variety of practitioners working within their individual specialties behind the closed door with a client.

Again, we are looking at a referral model instead of true collaboration. For collaboration to work, those doors need to open and, instead of a referral from massage therapist to acupuncturist and the acupuncturist to the physical therapist, those practitioners need to discuss best practices for care of the whole individual. Ideally, this discussion will happen with the client becoming a partner in her own health care decisions.

One of our best resources to begin building a collaborative network is actually our clients. Who are the doctors, dentists, chiropractors, acupuncturists they trust? Who are the other practitioners they have been to in order to receive care for a particular condition? Open lines of communication by learning from clients.

As long as this is done appropriately, we will gain the trust of our clients and the trust of the health care community as we increase the safety of working with our clients.


collaborate to stay in scope of practice

True Collaboration

In our many years of experience working in collaboration with other practitioners in sports medicine and hospital settings, we realized that most of the skills needed for true collaboration can be gained through proper education and experience:

Educating ourselves in the laws of HIPAA so that we can properly share client information; understanding our skill sets within the parameters of stages of healing from injury and surgery; incorporating knowledge of medications and side effects as we strategize a session; knowing truly effective clinical skills of assessment and differential diagnosis; and becoming confident in the vernacular of medical treatment teams.

Recently, there has been much research on the subject of integrative medicine and how massage therapy can best find its place in an integrative model. The delivery of health care is changing to achieve a triple aim of better health care, better patient/client outcomes, and lower overall costs. To achieve this, new integrative and collaborative models of health care delivery are being developed.

The American Massage Therapy Association utilizes the definition of integrative medicine as provided by the Consortium of Academic Health Centers for Integrative Medicine: “Integrative medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and client, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, health care professionals and disciplines to achieve optimal health and healing.”

Of utmost importance here to becoming a true collaborator in the health care community, we need to be committed to continuing our education, to building clinical skills and vocabulary, which will enable us to become an effective part of an integrative health care team.

In our Advanced Neuromuscular Therapy Program at the National Holistic Institute, the primary goal of this 450 hours of continuing education is to prepare therapists for a career in collaborative, integrative health care. We draw from our years of experience of working in sports medicine and hospitals, of building private practices in collaboration with other health care professionals from doctors to chiropractors to orthodontists to psychiatrists, in order to offer education in skills specific to working collaboratively.

We provide a deep and thorough education of Functional Anatomy and Orthopedic Pain and Injury Assessment, utilizing the H.O.P.R.S. (History, Observation, Palpation, Range of Motion tests, and Special tests) format. We understand differential diagnosis and pharmacology, and how to navigate HIPAA laws as we move into a collaborative model of client care.

We understand how to strategize care and modify sessions with a client based on a large variety of factors, including stage of healing and therapies applied by other medical professionals from athletic trainers to physical therapists to medical doctors.

The client is always first and foremost a partner in healing, helping us make decisions regarding what path a strategy should take as we clearly identify both short- and long-term goals for treatment.

We thoroughly take session notes in a S.O.A.P. (Subjective, Objective, re-Assessment, Plan) format. These comprehensive session notes are of a quality and organization that can be shared and used by other health care professionals who collaborate in client care.


get off the sidelines

Get Off the Sidelines

As integrative and collaborative approaches to health care become more widespread, it is our responsibility as massage therapists to continue educating ourselves so that we can continue to become effective members of these health care teams.

Working on the sidelines in isolation can no longer be acceptable if we are committed to making our clients’ wellness needs the priority.


About the Authors

Cynthia RibeiroCynthia Ribeiro, B.C.T.M.B., has a degree in physical education, studied surgical nursing and graduated from two massage school programs. She founded the Western Institute of Neuromuscular Massage Therapy, and was appointed honorary clinical professor at the University of California-Irvine Medical School in 2003. Currently, she is Advanced Neuromuscular Therapy Program developer and co-manager, and instructor at the National Holistic Institute. She is a past president of the American Massage Therapy Association.

Kirsten D. StaleyKirsten Staley, B.C.T.M.B., has degrees in psychology and sociology. She has been a massage therapist for more than 12 years and has received over 1,000 hours of continuing education combined in neuromuscular therapy and hospital-based massage. She has been a massage and neuromuscular therapy instructor for more than 10 years, and is currently co-manager and instructor of the Advanced Neuromuscular Therapy Program at National Holistic Institute.