The Future of Massage Therapy

These are some strange times we are living in. In the weeks that have followed the lock down in the province I have been riding an emotional roller coaster. Recently, the dominating emotion is grief. 

Grief for the world of massage therapy. Everything about the way we practiced is now gone, at least for now……

My industry is at a turning point, not only in how we provide treatment, but also determining if it is safe. When we return to practice it will be a completely different experience for both therapist and client.

Currently, our regulatory college, the CMTO is working with other health regulators, and the Government of Ontario, to evaluate our operations and systems to develop guidelines to ensure we can provide safe care once we are allowed to reopen. This will include dramatic changes in sanitation and hygiene protocols as well as the implementation of stringent screening guidelines. While the CMTO has not officially issued our new standards of practice, below are some guidelines that other provinces have put in place for therapists returning to work in the coming weeks. Ontario will likely follow suit on some, if not all of these guidelines.

What Will a Massage During COVID-19 Be Like?

• PPE: Your RMT will be fashioning PPE in the form of a mask, gloves, safety glasses, apron/smock or shirt that will be changed between every treatment. Clients will be required to wear a mask during the entire visit in the clinic.
• Less appointment availability: RMT’s will need to invest more time between clients to properly sanitize our spaces and stagger appointment times with other therapists in the clinc. In addition, some provinces are recommending therapists treat a maximum of 4 clients per day (half of normal volume for some).
• One Set Appointment Duration: Some provinces are recommending only offering 60 minute treatments as it is easier for clinics with multiple therapists to stagger appointments.
• Payment/Intake Forms: These things will become contactless. Online intake forms and tap debit/credit will become the new norm.
• Screening before every treatment for COVID-19 symptoms with temperature check upon arrival.
• No more waiting in the reception area, you will likely be asked to wait in your car until 5 minutes before your appointment time.
• Treatment rooms may feel sparse and sterile due to removal of fabric furniture and anything else that cannot be wiped clean.
• Waivers:  With this unprecedented time, many professional liability providers are unable to give assurance that policies will cover litigation / claims arising from unintentionally spreading the COVID-19 virus via our clinic, or serious health consequences as a result of dislodging blood clots. To protect themselves, many RMT’s will likely require waivers to be signed pre-treatment.

 
Is Massage Safe Right Now?

There is always an element of risk when receiving any treatment, and massage therapy is no exception. A global pandemic with a new virus has undoubtedly added another layer of complexity when determining the level of risk involved. Since COVID-19 is unprecedented, the information surrounding it is fluid and we are learning new things about it every day. Some of what we are discovering combined with what we already know is giving rise to concerns about the safety of massage during this pandemic.

Emerging Contraindications: There is mounting evidence linking blood clots and COVID-19. These mysterious blood clots can occur even when no other signs and symptoms are present. This is particularly relevant to massage therapy because this is one of the more serious contraindications to treatment (Rattray, F. Ludwig, L. Clinical Massage Therapy. Talus Incorporated, 2000). We put direct pressure on the tissues and blood vessels in the normal course of our work, which has the potential to dislodge a blood clot causing serious health consequences for the client. This can include a pulmonary embolism, or stroke. Unfortunately, some COVID-19 patients present with stroke as their first sign, meaning we cannot properly screen for this danger in the same way we do for other health issues. 

Even though I would like to think of these scenarios as unlikely and happening in far away hot spots like New York, it’s not. An RMT within my professional association in Ontario contracted COVID-19 from one of her clients in March. She then passed it on to two others, all of them developing blood clots. One of them having serious complications as a result. This hit close enough to home to give me pause that it could be a very real possibility of returning to practice.

Hierarchy of controls: 
 
This is a system used to minimize or eliminate exposure to hazards. Under this framework, physical distancing is ranked most effective for minimizing the spread of COVID-19. Given the close contact our job requires, maintaining the recommended 6.5ft distance between client and therapist is impossible. It places both therapist and client at an increased risk for acquiring and transmitting the virus. Depending on the treatment length, we are in close contact in a small treatment room for 30min-90min. Our only safeguard is PPE, which is ranked as the least effective for reducing exposure.

So is it Safe or Not?

I can tell you when you receive a massage going forward, it will be “as safe as possible” meaning the therapist will do all that they can to prevent the spread of COVID-19 by implementing the guidelines put forth by our regulatory college. Unfortunately, the safety of getting a massage during this pandemic needs to be based on more than just increasing sanitation protocols and wearing PPE. It also needs to be about further investigating and considering the blood clots that are showing up in asymptomatic individuals. All things considered, at this point we cannot as an industry definitively say there is not an increased risk to receiving a massage treatment during this time.

What’s Next?………..

As we sit in limbo, massage therapists are taking stock and evaluating the level of risk associated with the return to practice. Some may be worried about their health, or spreading the virus to a family member, or client that may be high risk, or immunocompromised. Other’s may be concerned about that availability of PPE, or the emerging evidence about blood clots. Some may be considering the financial ramifications of operating at half the volume with increased overhead to be able to operate safetly, or a combination of all of the above. There are therapists that are being proactive and are getting prepared to safety open their doors when we are given the green light. Each therapist will view the level of risk differently for their personal and professional situation. As well, every therapists’ timeline to return to practice will vary . We are all navigating unchartered territory.

In the coming weeks/months (once massage therapy is phased into the reopening of the province) you will likely see massage therapists open their doors, some close their doors, while others change careers, or go inactive.
 

As for me, I will be reopening my practice…………When?……….I’m not sure……..

While I wait for word from our government and regulatory body I will be doing my own risk-assessment through continuing to review research and new information as it comes to light. I am eager to get back to doing what I love and helping my clients feel better. However, I must carefully examine whether the benefits of returning to practice once permitted outweigh the personal and professional risks.
 

I truly hope to see you on the massage table soon!!