Doctor’s Orders: Getting “Permission” for Massage Therapy

How many times have you heard another massage therapist say something like, “Well, I got the doctor’s permission, so I…” after which she launches into a story about choosing to ignore this issue or that contraindication or choosing not to ask that question or make this adjustment, all because they had a doctor’s note?

Too many massage therapists assume that a doctor’s note or an official prescription for massage means that they don’t have to consult their training, conduct a thorough intake or, in extreme cases, take responsibility for what happens in their treatment room. Still others proudly announce, “I won’t work with an oncology client without a doctor’s note.”

The concept of physician endorsement in our work is complicated. There is an unexamined assumption around the perceived need to have “a doctor’s note”, whether in the hospital setting or in private practice.  We take a doctor’s note or order or prescription as a green light to forget what we have learned about how to work safely or we decide that our training alone is not enough to qualify us to work with such a person.

Don’t get me wrong. Endorsement of our work by physicians is a good thing. Each time it happens, the door to a larger conversation opens. When we and our patients and clients ask for written “permission” from a physician, however, it is important to recognize it more as a tool of relationship cultivation than of clinical significance. It’s an opportunity for education and dialogue. It puts massage therapy top of mind, if only for a split second. It says to clients, patients and therapists, “Massage is good.”

What it doesn’t say is:
“Massage is safe. Full speed ahead.”

When a doctor provides a patient with written “permission” to receive massage, it is just that; permission to receive massage. Any massage.  In most cases, it is not a bulleted list of the myriad concerns that our training and experience as massage therapists tell us we need to take into consideration. It is not permission for us to check our brains and accountability at the door.

As healthcare continues to distill itself into increasingly smaller bits of specialization, massage therapy is following suit. There are fewer and fewer massage therapists who simply do “massage” anymore. We do CST, AIS, SCS, MLD or OrthoBionomy…or we are “oncology massage therapists”. The list goes on. This trend will not make it any easier for doctors to understand how we are working with their patients. I am not advocating that we abandon the trend for specialization (that’s another topic altogether). I’m suggesting that it places a larger burden on us to educate other health professionals about exactly what we do.

It is no more fair for us to expect a physician to understand the specifics of massage therapy than it is for a physician to assume that a massage therapist understands how to do open heart surgery. The truth is that most physicians, when they sign or write an order for massage therapy, are saying, “It can’t hurt.”

You and I know differently.

The next time you receive a note from a physician giving your client or patient permission for massage, remember that we owe it to the people we touch to work as safely and responsibly as we know how…no matter who gives us the “all clear”.

**Please keep in mind that some facilities require a physician’s order or prescription. This post is not intended to suggest that you stop adhering to that requirement; simply think about what it does and doesn’t mean to have a doctor’s endorsement.

Practice building tip:

Doctors and massage therapists have the same goal: to make people feel better. We can highlight this commonality while also raising massage therapy to a new level. Start putting those doctors’ notes, prescriptions and orders to good use. Ask your client if he/she minds if you send the doctor a write-up about the session, explaining the adjustments you made to ensure safety. Or simply call the physician or send a note of appreciation with a business card and a brochure about what you do and how you do it.  Keep it short, simple and consistent. You can (and should!) send the same note and information to the same physician or practice each time you work with one of his/her patients…and don’t be attached to results. You’ll make a big impression on some physicians and none at all on others, but if we all start doing this, the momentum will build and the way will open for us to serve more people in a bigger way and to participate in healthcare.

Lauren Muser Cates
Founder/Owner, Lighthold Massage Therapy & End of Life Care

Lauren is a featured presenter in our November 19 webinar. In 2003, massage therapy found Lauren Cates like a needle in a haystack. She had never had a massage before she went to massage school. If you had told her 10 years ago that she would be making her living providing massage for people with cancer and traveling the United States teaching others how to do it, too she would have laughed in your face…politely, of course. She served, from 2005-2009 as the Clinical Supervisor for Hospital/Oncology Massage at The Teal Center at Virginia Hospital Center in Arlington, VA and since 2010 has been president of the Society for Oncology Massage ( Lauren has an active private practice in addition to her duties providing and supervising massage for medically complicated, oncology and end of life patients at both Virginia Hospital Center and Children’s National Medical Center  with a non-profit organization she co-founded in 2010, called Healwell. She has participated in adult and pediatric oncology massage research, including writing practical protocols and she co-teaches a 9-day in-hospital training course for massage therapists that provides a unique opportunity to work directly with inpatients in the ICU, oncology and acute rehabilitation units. Lauren blogs at where this blog first appeared and is reprinted here with permission.