Massage Therapy Journal Summer 2026

54 • Massage Therapy Journal

AMTA Continuing Education

Ethical Scope of Practice Concerns in Clients with RA Ethical scope of practice governs every interaction between a massage therapist and a client. When a client has been diagnosed with an incurable, progressive disease such as RA, that causes constant pain and the potential for disfigurement, maintaining ethical scope of practice can become more challenging and boundary issues often arise. Massage therapists can find it easy to deeply empathize and over-identify with a client who has RA, perhaps creating conditions where breaches of accepted scope of practice feel natural and even kind. Prevent Scope of Practice Breaches Massage therapists tend to be compassionate, caring people, which can sometimes lead to stretching or breaking accepted scope of practice for client-practitioner conduct. Certain situations may facilitate failure to adhere to these breaches. For example when the practitioner is: • New to the profession and uncertain about appropriate boundaries • Working without day-to-day or on-site supervision or mentorship • Unwilling to adhere to ethical scope of practice for clients who fulfill the practitioner’s own emotional needs, such as for admiration, gratitude, and self-esteem based on the opinions of others. Scope of practice breaches occur and carry the potential for risk or harm to a client when the massage therapist is not licensed in an additional specialty, but continues to offer suggestions like the following: • Shares opinions with clients about certain foods or nutritional supplements, but is not a nutritional consultant or dietician • Offers suggestions to clients about the types of exercise or demonstrates certain exercises without being an athletic trainer or exercise physiologist • Gives clients advice about their mental health or includes mental health “exercises” as part of the massage but is not a mental health care provider

In their 2021 article, Madeline R. Vann, MPH, and Beth Levine noted that: “According to research published in the October–December 2015 issue of Complementary Therapy in Clinical Practice , study participants reported relief from pain and stiffness after four once-a-week moderate-pressure massages on arms affected by rheumatoid arthritis, supplemented with daily self-massage at home. They also reported having a stronger grip and a greater range of motion than those who were given only a light-touch massage.” 69 Earlier research published in the same journal found that massage had similar benefits for RA pain in the hands and also reported that the combination of weekly massage therapy and daily self-massage led to improved mood and better sleep. Yet another study, published in the November 2019 issue of Chronic Pain and Management , established that “moderate massage of the hips also reduced pain and sleep disturbances.” 69

Ruth Werner describes the benefits of massage therapy for clients with RA this way: “Massage can be effective for pain, stress and muscle tension. All of these benefits can be specifically applied for RA patients, especially between episodes of flare.” 70

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