A graphic chart with the words massage business safety in the middle, and circles with phrases around the edge: maintain your credential; choose insurance wisely; work within scope of practice; engage in proper hygienic habits; and maintain your professional reputation

Some aspects of running a massage practice—choosing décor, creating session room ambiance and crafting a menu of services—are fun and exciting, but they should not eclipse the practical aspects of running a business.

For a massage therapist, these include finding a proper location, pricing your services correctly, and ensuring the safety of you and your clientele.

Elements of ensuring the safety of you and your clientele include maintaining a credential, choosing the best liability insurance, working within scope of practice, engaging in proper hygienic habits, and maintaining your professional reputation through ethical decision-making. We’ll explore each of those elements here.

Massage Business Safety: Your Credential

1. Maintain your credential. Licensing is fundamental to one’s ability to operate a business. Each local municipality has unique provisions regarding obtaining a business license. Contact your local city hall or view your city’s municipal website to learn how to earn your business license in your respective city. (Social media is not the ideal place to inquire about local business license provisions.) Usually a separate license is needed for retail sales, so you will need to obtain such a license if you wish to sell products.

Consider that names of licenses may vary greatly nationwide. In Arizona, the license allowing retail sales is called the Transactions Privilege Tax license. In Colorado, this same license is called the Sales Tax License. In Florida, this same license is called the Sales Tax Permit. There can be different levels of tax licensing and privilege depending on the state, so be sure to thoroughly absorb information before committing to license acquisition.

Obtaining one’s license to perform massage in your state or municipality is fundamental to your practice. Massage therapists are required to hold a state license to practice in 46 states as well as Puerto Rico, the District of Columbia and the US Virgin Islands. (Visit massagemag.com/laws for more in-depth regulatory information and to contact your state board of massage.)

This license allows you to legally practice in your respective state. For those living in the states that do not license massage therapists—Wyoming, Kansas, Vermont and Minnesota—there are still city and municipality laws that may govern your massage practice.

There are local police forces monitoring unlawful massage practices. Often, these forces are small with few resources, as other serious criminal offenses will demand community resources. The ability to police ourselves as an industry is key to protecting the effectiveness of state licensure as a means of protecting the general public in our industry. I encourage you to report any therapist you know of who is practicing massage therapy without the required city or state licensure.

Massage Business Safety: Your Insurance

2. Choose insurance wisely. Holding liability and general liability insurance is as fundamental as effleurage in a classic massage session. General liability insurance is often referred to as malpractice insurance and covers claims asserting malpractice leading to injury in a massage setting outside your usual location, whereas liability insurance covers claims within your usual location. In the massage industry, coverage of at least $1,000,000 per claim and $3,000,000 aggregate is baseline standard, with some insurance providers exceeding these totals. (Visit massageliabilityinsurancegroup.com/comparison-grid to view a comparison of many types of liability insurance policies available to massage therapists and bodywork professionals.)

Author, educator and business expert Cherie Sohnen-Moe outlines many types of insurance massage therapists may consider in her book, Business Mastery:

• Small business: A canopy term for business losses of all varieties.

• Fire and theft: Covers business-related equipment, supplies and documents.

• Product: Covers products created, produced and distributed by your business.

• Business interruption: Ensures some income in case of insurable temporary closure of your business.

• Personal disability: Provides a safety net in case you cannot work due to an unfortunate circumstance health-wise.

• Partnership: Protects you from litigation stemming from your partner’s actions or negligence.

Massage Business Safety: Your Scope of Practice

3. Work within scope of practice. Scope of practice is defined as the provisions and parameters of work allowed to a profession by government agencies. Understanding the scope of practice as defined by your respective state will ensure you are working legally. Contact your local or state massage board to obtain accurate information regarding if a modality is allowed in your area.

Adhering to scope of practice may seem like common sense, but there are situations where scope of practice may be in question. For example, in the state of Arkansas colonic or any form of internal hydration is clearly stated as “not included in the scope of massage therapy practice” within their state board rules and regulations.

If a massage therapist were to also become a colon hydrotherapist, this person would need to make sure massage and colon hydrotherapy are not performed within the same therapeutic session, ensuring clear delineation of services.

Scope of practice concerns may arise when continuing education instructors from out of state present certain techniques in classes that may not be allowed in all states. One interesting example is the controversial case of providing breast massage, which laws in several states, including Washington and Arizona, allow, with stipulations being met in conjunction with this work.

A teacher from Washington could decide to travel to Illinois and present a breast massage class, yet students of this class licensed in Illinois could not legally perform what they learned in class, as breast massage is not allowed in the same context as Washington state. (This example illustrates how being intimately familiar with your particular legal scope of practice will help guide your continuing education choices as well as protect your practice.)

If a practice, procedure or modality is not clearly written into a state’s scope of practice statements, the proper course of action is to contact the state board to obtain their official stance on if said practice, procedure or modality is allowed. Do not assume a practice, procedure or modality falls within a state’s scope of practice without seeing verbiage clearly stated in state rules or definitions.

Massage Business Safety: Your Cleanliness

4. Engage in proper hygienic habits. There are many guidelines to follow in protecting your practice, one of which is keeping your massage space impeccable with hygienic care. These steps will ensure universal precautions are met and ensure hygienic care is being given in one’s practice of massage.

[Read “17 CDC Safety & Sanitation Guidelines for Massage Therapists Considering Re-Opening a Practice”]

• Keep all walking surfaces free of debris, wires and moisture. This will help you and your clients avoid unnecessary slip-and-fall accidents.

• Have available in your space these supplies to clean, disinfect and sanitize your massage space: gloves, leak-proof plastic bags, a soiled-linen receptacle, paper towels, cleaning alcohol, disinfectant spray, all-purpose cleaner, spray bottles, antimicrobial soap, chlorine bleach, broom, mop and garbage can. These often-overlooked items are significantly important to ensure your practice space projects cleanliness.

• Thoroughly wash your hands and forearms up to the elbows with a healthy lather of soap for 30 seconds with very warm water before every session, after every session and even during a session, such as after massaging feet, if need be.

• Groom your hands and nails properly, ensuring no hangnails, through which bacteria can easily enter the body.

• Remember the distinction between sanitation (simply washing a surface with soap and water) and disinfection (destroying pathogens with bleach or alcohol solutions). Sanitizing one’s massage space is not enough to ensure hygienic care. Consider how much time you will need daily, weekly and monthly to disinfect your massage space.

• Sterilization methods, which include boiling objects for 20 minutes, will ensure complete destruction of pathogens. Consider if your equipment can withstand such methods.

• Have a first aid kit available that includes such standard items as non-latex gloves, bandages, cold compresses, antiseptic wash, scissors, tweezers, antibiotic ointments, hand sanitizer, alcohol wipes and adhesive tape.

• Make sure your clients provide an emergency contact on their initial intake form. Be sure to know whom to call depending upon their emergency (i.e., for a seizure patient, should 911 or the emergency contact be called first?)

• Check your massage table, sheets and towels for tears, stains and indications of uncleanliness. Remember that linen stock from laundry services may occasionally include an unclean bundle.

Massage Business Safety: Your Professional Reputation

5. Maintain your professional reputation. Reputation is paramount in our industry. Protecting one’s massage practice also involves making choices from a space of integrity and honesty. When faced with ethical dilemmas or client conflicts, consider these key questions:

. When faced with ethical dilemmas or client conflicts, consider these key questions:

• Does the action keep the focus on the safety and well-being of the client?

• Are you remaining in your scope of practice?

• Are you being respectful of the power imbalance or transference effect? Are you using this power imbalance to your own benefit?

• Does the action create a dual relationship and make therapeutic boundaries less clear?

• Does the action remain within the original contract with your client? Are you honoring the agreed-upon treatment plan?

• Does the action create a safer environment for the client?

• Could the action lead to future breakdowns of the therapeutic relationship?

Answering these questions will help a massage therapist make an ethical choice and protect the reputation and integrity of their business.

Do No Harm

One final note: Consider the Hippocratic Oath, which contains two main features: the duty to do good whenever possible and the duty to do no harm. Although massage therapy graduates do not state this oath, there is a societal assumption that all health care practitioners, massage therapists included, are servicing clients from this mental framework.

The Hippocratic Oath sums up the therapeutic relationship. As long as massage therapists follow the guidelines provided here—and provide as much positive support and assistance to clients whenever possible while conducting themselves with ethical behaviors, actions and manners that do not create harm—the role of the massage therapist will continue to flourish in the health care industry.

Jimmy Gialelis

Jimmy Gialelis, LMT, BCTMB, is owner of Advanced Massage Arts & Education (advancedmassagece.com) in Tempe, Arizona. He is a National Certification Board for Therapeutic Massage & Bodywork-approved provider of continuing education, and teaches “Professional Ethics for LMTs” and many other CE classes. He is a regular contributor to MASSAGE Magazine, and his articles include “To Succeed in Today’s Massage Market, You Can’t Make These 3 Mistakes” and “These 5 Keys Will Unlock the Door to Massage Session Re-Bookings.”