Structural Integration in the United States in 2013

Author
Translator
Pages: 91-103
Year: 2013
IASI - International Association for Structural Integration

IASI Yearbook 2013

Volume: 2013

Milree Keeling, R.N., M.S., BCSITM, happily practices KMI Structural Integration in central Massachusetts, where she practiced as a nurse-midwife for over 20 years. She is the secretary to the Board of Directors of the IASI, and chair of its Law and Legislation Committee. In 2011, the MA Nurse Practice Act was revised to remove physician supervision of nurse-midwifery practice; Milree led the decade-long legislative effort.

Abstract

Structural integrators must commonly comply with massage therapy licensing and regulations to practice in the United States.

This article summarizes regulations in the 50 states and District of Columbia and includes a summary of those states that exempt structural integration (SI) from massage licensure, those that do not require massage licensure to practice SI, and the one that specifically licenses SI. Regulation in other nations varies widely, and an international review would be welcomed.

Structural integration (SI) practice emerged in the United States (US) as a unique bodywork discipline in the 1960s and 1970s. At the same time, the first well-organized effort for state licensure of massage therapy was active across the country. Licensure authorizes only qualified individuals to engage in practice, and sanctions those who practice without authorization. Despite the efforts of some SI practitioners to seek exemption from massage licensure, a considerable majority of states required massage licensure for the practice of touch and bodywork therapies by 2000. The professionalization of SI since the early 1990s resulted in coordinated efforts to seek exemption or appropriate regulation wherever licensure laws have been proposed or opened for revision.

The primary purpose of licensure is protection of the public from unsafe, unprepared, or unethical practitioners. Standards for education and for safe, ethical practice and operation of professional facilities are common inclusions in licensure laws and regulations. States also license professions to provide exclusive title protection for practitioners and to maintain professional registries.

Licensure as a massage therapist is not required for the practice of structural integration in 17 states (33%), and the practice is named as exempt from massage licensure in 9 (20%) of those states in which massage is licensed. New Hampshire is the only state in which SI is specifically licensed (Table 1). In 28 of the 34 states which require massage licensure for SI, basic education programs must be accredited by a national accrediting organization or achieve massage board approval through a process approaching or equivalent to the scope and cost of accreditation (Table 2). Eleven of these 34 states require more than 500 hours of basic massage education (Table 3), and most states specify how programs must allocate required clock-hours to specific topics. Many, but not all, SI practitioners are also massage therapists. However, because massage education and/or licensure is not consistently required for admission to SI education programs, and few SI programs are also considered massage education programs, many SI practitioners are ineligible for licensure in most states that require it.

Table 1

States in which structural integration does not require a massage license:

Because massage and bodywork are not licensed (7)

Alaska   California

Kansas  Minnesota

Oklahoma Vermont Wyoming

Because structural integration is licensed as SI (1)

New Hampshire

Because structural integration is exempt from massage licensure (9)

Colorado Georgia

Idaho    Illinois

Maine   Massachusetts

Montana New Mexico

The purpose of this review is to inform practitioners, educators, and SI leaders about the current legal status of the profession in the US. It addresses only the 50 states and the District  of Columbia (DC). Regulation in other nations varies widely, and an international review would be welcomed. This review was compiled from state statutes, code, and regulations at the end of 2012 and includes: relevant definitional statements from law and regulations (rules) in each state; the various license types each state requires; educational and competency examination requirements; and specific barriers for SI practitioners.

Each state regulates professions in a unique way, and there is little coordination among states in how licensing laws and regulations are written. However, most states try to streamline the licensure process somewhat for practitioners who are licensed in another state by including a reciprocity process; this means that licensure in another state partially meets their requirements for licensure.

This review reveals a fragmented approach to licensure of SI and massage, and duplicative certification and accreditation processes within massage itself. Practitioners and educators are challenged by a wide range of requirements that are confusing at best. At worst, they severely limit practice portability between states and expansion.

The following acronyms and abbreviations are commonly used.

  1. ABTE of NCCAOM: Asian Bodywork Therapy Examination of the National Certification Commission of Acupuncture and Oriental Medicine
  2. AMTA: American Massage Therapy Association
  3. CBSI: Certification Board of Structural Integration
  4. CE: continuing education
  5. CESI: Certification Examination for Structural Integration
  6. COMTA: Commission on Massage Therapy Accreditation
  7. FSMTB: Federation of State Massage Therapy Boards
  8. IASI: International Association of Structural Integrators
  9. MBLEx: Massage & Bodywork Licensing Examination
  10. NBCA: National Board Certification Association
  11. NCBTMB: National Certification Board for

Therapeutic Massage & Bodywork 12.NCCA: National Commission for Certifying

Agencies

  1. NCETMB: National Certification Examination for Therapeutic Massage and Bodywork
  2. USDOE: United States Department of Education of access to an adequate supply of qualified SI practitioners for the population.

Table 2

States in which SI is licensed as massage which have accreditation-equivalent requirements for education programs (28)

Alabama              Arizona

Arkansas             Connecticut District of Columbia              Florida Indiana  Kentucky

Louisiana             Maryland

Mississippi          Missouri

Nevada                New Jersey

New York            North Carolina

North Dakota    Ohio

Oregon Pennsylvania

Rhode Island     South Dakota

Tennessee         Texas

Utah      Virginia

Washington       West Virginia

Alabama

Issues for SI practitioners:

SI is considered a practice of massage therapy. School approval is similar in detail and scope to accreditation. The board may grant only the specific licenses that are outlined in statute.

Definitions:

Massage therapy is the profession in which the practitioner applies massage techniques and related touch therapy modalities with the intention of positively affecting the health and well-being of the client.

Licenses Granted/Required:

Licensed Massage Therapist, Licensed Massage Therapist Instructor, Qualified Massage Establishment.

Education and Exams:

  1. 650 hours at board-approved school; the board approves examinations.
  2. NCETMB plus oral or practical exam.

Table 3

States requiring more than 500 hours of basic education for licensure (11)

Alabama              Arizona

Hawaii  Kentucky

Mississippi          Nebraska

New York            North Dakota

Ohio      Pennsylvania Utah

  1. The board may allow nationally accredited exam created ‚Äúby an independent company.‚ÄĚ
  2. The board approves schools.

Alaska

No state regulation of massage or bodywork

Arizona

Issues for SI practitioners:

SI is considered the practice of massage therapy. Only accredited schools may qualify for educational requirements.

Definitions:

  1. Bodywork therapy means massage therapy.
  2. Massage therapy means the following that are undertaken to increase wellness, relaxation, stress reduction, pain relief and postural improvement or provide general or specific therapeutic benefits:

?             The manual application of compression, stretch, vibration, or mobilization of the organs and tissues beneath the dermis, including the components of the                    musculoskeletal system, peripheral vessels of the circulatory system, and fascia, when applied primarily to parts of the body other than the hands, feet, and head.

?             The manual application of compression, stretch, vibration, or mobilization using the forearms, elbows, knees, or feet or handheld mechanical or electrical devices.

Licenses Granted/Required: Licensed Massage Therapist. Education and Exams:

  1. 700 hours from accredited, board-approved

school.

  1. The board approves schools.
  2. The board may approve nationally-administered exams. 4. MBLEx or NCETMB, unless graduated from state-accredited school.

Arkansas

Issues for SI practitioners:

SI is considered the practice of massage therapy. CE must be board-approved, and the requirements are detailed and onerous. School licensure is similar in detail and scope to accreditation. The board may grant only the specific licenses that are outlined in the statute.

Definitions:

Regulations define massage as the practice of all massage therapy techniques and procedures including all phases of massage and bodywork for the purposes of relaxation, stress reduction, pain relief, injury prevention, injury repair, postural improvement, and/or health enhancement; including any hands-on bodywork techniques and procedures rising to the level of the techniques and procedures intended to be regulated under this chapter and not covered under specific licensing laws of other boards.

Licenses Granted/Required:

Licensed Massage Therapist; can be upgraded to Master Massage Therapist or Massage Therapy Instructor; the Board licenses schools.

Education and Exams:

  1. 500 hours; plus 250 hours professional practice for either upgrade.
  2. MBLEx or state exam required.
  3. The board determines exams.
  4. The board approves CE courses. California

Issues for SI practitioners:

The law creates language to build on for a mandatory licensure law. Until 1000 SI practitioners are licensed in CA, SI is not eligible for a seat on the council.

Definitions:

  1. Massage therapist, bodyworker, bodywork therapist, or massage and bodywork therapist, means a person who is certified by the California Massage Therapy Council.
  2. The terms massage and bodywork shall have the same meaning.

Licenses Granted/Required:

?             Voluntary certification, no mandatory licensure

?             CA Massage Therapy Certification Council functions as a board without licensure powers

?             Certified Massage Therapist (CMT).

?             Certified Massage Practitioner (CMP) Рuntil 2015.

?             Schools are voluntarily registered.

Education and Exams:

  1. CMT: 500 hours from registered schools plus NCETMB.
  2. CMP: 250 hours from registered schools.
  3. The council approves exams.

Colorado

Specific exemption from massage licensure for structural integration practices such as Rolfing¬ģ and Hellerwork¬ģ.

Connecticut

Issues for SI practitioners:

SI is considered the practice of massage therapy. Schools must be nationally accredited for approval. Definitions:

Massage therapy means the systematic and scientific manipulation and treatment of the soft tissues of the body, by use of pressure, friction, stroking, percussion, kneading, or vibration by manual or mechanical means, range of motion, and nonspecific stretching.

Licenses Granted/Required: Licensed Massage Therapist. Education and Exams:

  1. 500 hours directly supervised at accredited schools.
  2. NCETMB.
  3. The board approves schools.

Delaware

Issues for SI practitioners:

SI is considered the practice of massage therapy, but the exams required don’t test for SI bodywork, which is a distinct category in the rules.

Definitions:

  1. No person shall engage in the practice of massage and bodywork therapy or hold himself or herself out to the public in this state as being qualified to practice massage and bodywork therapy; or use in connection with that person’s name, or otherwise assume or use, any title or description conveying or tending to convey the impression that the person is qualified to practice massage and bodywork therapy, unless such person has been duly licensed or certified.

 

  1. Hellerwork and Rolfing are specifically named as bodywork.

Licenses Granted/Required:

Licensed Massage Therapist, Certified Massage Therapist, and the board may have authority to grant additional licenses.

Education and Exams:

  1. Licensed Massage Therapist: 500 hours.
  2. Certified Massage Therapist: 300 hours.
  3. NCETMB, MBLEx.
  4. The board approves schools and may approve national exams.
  5. The board approves CE courses in two categories: core and elective.

District of Columbia

Issues for SI practitioners:

SI is considered the practice of massage therapy. CE for re-licensure must be board approved  and the requirements are detailed and onerous. School approval requires COMTA or USDOE accreditation, or state (any state) licensure.

Definitions:

A massage therapist, or any person so authorized under the act, to perform massage therapy may perform therapeutic maneuvers in which the practitioner applies massage techniques, including use of the hand or limb, by applying touch and pressure to the human body. Massage techniques include, but are not limited to: Rolfing, neuromuscular therapy, Shiatsu or acupressure, trigger point massage, Trager¬ģ, Tui na, reflexology, Thai massage, deep tissue massage, myofascial release, lymphatic drainage, craniosacral therapy, polarity, Reiki, Swedish massage, and therapeutic touch.

Licenses Granted/Required:

Licensed Massage Therapist, Massage Therapy Apprentice, and the Board may have authority to grant additional licenses.

Education and Exams:

  1. 500 hours.
  2. NCETMB or other NCCA- or FSMTB- certified [sic] exam.
  3. CE approval by board, detailed criteria.

Florida

Issues for SI practitioners:

SI is considered the practice of massage therapy. Schools must be licensed by the state and school accreditation is required. Licensure examinations must also be available in Spanish.

Definitions:

Massage means the manipulation of the soft tissues of the human body with the hand, foot, arm, or elbow, whether or not such manipulation is aided by hydrotherapy, including colonic irrigation, or thermal therapy; any electrical or mechanical device; or the application to the human body of a chemical or herbal preparation.

Licenses Granted/Required: Licensed Massage Therapist, Massage Establishment.

Education and Exams:

  1. 500 hours in licensed school (any state).
  2. NCETMB, MBLEx.

Georgia

Issues for SI practitioners:

None, if IASI member or membership eligible.

Definitions:

A person who uses touch and movement education to effect change in the structure of the body while engaged in the practice of structural integration, provided that he or she is a member of, or whose training would qualify for membership in, the International Association of Structural Integrators and provided that his or her services are not designated or implied to be massage or massage therapy, is exempt from massage licensure.

Hawaii

Issues for SI practitioners:

SI is considered the practice of massage therapy. Schools must be licensed by the state or approved by the USDOE, AMTA, or the Rolf Institute¬ģ.

Definitions:

  1. Massage, massage therapy, and Hawaiian massage, commonly known as lomilomi, means any method of treatment of the superficial soft parts of the body, consisting of rubbing, stroking, tapotement, pressing, shaking, or kneading with the hands, feet, elbow, or arms.
  2. A licensee may advertise as being able to perform the type of massage known as Rolfing if the licensee has received basic Rolfing training in classes sponsored by the Rolf Institute and been certified as a Rolfer‚ĄĘ and given membership in the Institute.

 

Licenses Granted/Required:

Licensed Massage Therapist, Massage Therapy Apprentice, and Massage Establishment Education and Exams:

  1. 570 defined hours.
  2. State exam, administered quarterly.

Idaho

Specific exemption from massage licensure for SI practitioners.

Illinois

Issues for SI practitioners:

Requires approval by an SI governing body (undefined).

Definitions:

Practitioners of certain service-marked bodywork approaches that do involve intentional soft tissue manipulation, including but not limited to Rolfing, Trager Approach, polarity therapy, and Ortho- Bionomy¬ģ, are exempt from (massage licensure) if they are approved by their governing body based on a minimum level of training, demonstration of competency, and adherence to ethical standards.

Indiana

Issues for SI practitioners:

It is unclear whether limited definition of massage includes SI. Schools must be state-regulated and accredited.

Definitions:

Massage therapy means the application of massage techniques on the human body and includes: the use of touch, pressure, percussion, kneading, movement, positioning, nonspecific stretching, stretching within the normal anatomical range of movement, and holding, with or without the use of massage devices that mimic or enhance manual measures.

Licenses Granted/Required:

Certifications for massage therapy, as determined by the board.

Education and Exams:

  1. 500 hours at state-regulated and accredited school.
  2. MBLEx, NCETMB, NBCA Massage Therapy Certification Examination Iowa

Issues for SI practitioners:

Bodywork, and probably SI, is practice of massage therapy. The definition is unclear regarding inclusion, but the opportunity for waiver from rules exists.

Definitions:

Massage therapy means performance for compensation of massage, myotherapy, massotherapy, bodywork, bodywork therapy, or therapeutic massage, including: hydrotherapy, superficial hot and cold applications, vibration and topical applications, or other therapy which involves manipulation of the muscle and connective tissue of the body excluding osseous tissue, to treat the muscle tonus system for the purpose of enhancing health, muscle relaxation, increasing range of motion, reducing stress, relieving pain, or improving circulation.

Licenses Granted/Required: Licensed Massage Therapist. Education and exams:

  1. 500 hours at board-approved school.
  2. MBLEx, NCETMB.
  3. Board approves exams.

Kansas

No state regulation of massage or bodywork.

Kentucky

Issues for SI practitioners:

SI is considered the practice of massage. The state approves all schools using extensive criteria and a process similar to accreditation.

Definitions:

The practice of massage therapy means the application, by a massage therapist licensed by the board, of a system of structured touch, pressure, movement, and holding to the soft tissues of the human body with the intent to enhance or restore the health and well-being of the client.

Licenses Granted/Required:

Licensed Massage Therapist.

Education and Exams:

  1. 600 hours from state-approved school.
  2. MBLEx, NCETMB, Ohio and New York state exams.
  3. Board approves exams; CESI meets published criteria.

Louisiana

Issues for SI practitioners:

SI is considered the practice of massage therapy. Requirements for certification as an instructor are specific and onerous. Since CBSI is not NCCA accredited, the CESI is ineligible for board approval.

Definitions:

  1. Massage therapy means the manipulation of soft tissue for the purpose of maintaining good health and establishing and maintaining good physical condition. The term shall include effleurage (stroking), petrissage (kneading), tapotement (percussion), compression, vibration, friction, (active/passive range of motion), Shiatsu, and acupressure, either by hand, forearm, elbow, foot, or with mechanical appliances for the purpose of body massage.
  2. Equivalent terms for massage therapy are massage, therapeutic massage, massage technology, Shiatsu, body work, or any derivation of those terms.

Licenses Granted/Required:

Licensed Massage Therapist, Registration and Certification of Massage Establishments, Certification for Massage Instructors.

Education and Exams:

  1. 500 hours.
  2. MBLEx, NCETMB, ABTE of NCCAOM, plus required oral state exam.
  3. The board approves exams from an NCCA- accredited agency.
  4. The board approves CE providers.

Maine

Definitions:

The activities and services of individuals who practice other forms of tissue work exclusive of massage therapy, such as Rolfing, Trager, reflexology, Shiatsu, Reiki and polarity, if those practitioners do not use the title massage therapist or massage practitioner… are exempt from massage therapy licensure Maryland

Issues for SI practitioners:

SI is considered the practice of massage therapy. Education programs need to be accredited, and CE programs must be board-approved 90 days in advance to apply to license renewal.

Definitions:

Massage therapy means the use of manual techniques on soft tissues of the human body including effleurage (stroking), petrissage (kneading), tapotement (tapping), stretching, compression, vibration, and friction, with or without the aid of heat, limited to hot packs and heating pads, cold water, or non-legend topical applications, for the purpose of improving circulation, enhancing muscle relaxation, relieving muscular pain, reducing stress, or promoting health and well-being.

Licenses Granted/Required: Licensed Massage Therapist. Education and Exams:

  1. 500 hours from USDOE-accredited program.
  2. ABTE of NCCAOM, NCETMB, plus required Maryland Massage Therapy Jurisprudence Examination.
  3. The board may approve other exams.
  4. The board approves all CE courses (NCBTMB courses automatically qualify).

Massachusetts

SI is named as exempt from massage licensure by statute.

Michigan

SI is named as exempt from massage licensure by statute.

Minnesota

No state-level regulation of massage or bodywork.

Mississippi

Issues for SI practitioners:

SI is considered the practice of massage therapy. Education programs must be accredited. If CBSI were certified by a nationally accredited organization recognized by the board, then board-certified SI practitioners would be exempted from licensure.

Definitions:

  1. From rules: Massage means touch, stroking, kneading, stretching, friction, percussion and vibration, and includes holding, positioning, causing movement of the soft tissues and applying manual touch and pressure to the body (excluding an osseous tissue manipulation or adjustment). Therapy means action aimed at achieving or increasing health and wellness.

 

Massage therapy means the profession in which the practitioner applies massage techniques with the intent of positively affecting the health and well-being of the client

  1. From statute: Other allied modalities that are certified by a nationally accredited organization recognized by the board are exempt from massage licensure.

Licenses Granted/Required: Licensed Massage Therapist, Massage Establishments.

Education and Exams:

  1. 600 hours from COMTA-accredited (or equivalent) program.
  2. Very specific (to massage practice) hourly and content requirements inappropriate for SI, including: infrared heat and hydrotherapy, history of massage, 50 1-hour supervised massages.
  3. MBLEx, NCETMB, ABTE of NCCAOM; plus required state law examination.
  4. Board may approve other nationally accredited exams.
  5. Board regulates schools with very specific requirements similar to accreditation
  6. Board approves CE programs and instructors.

Missouri

Issues for SI practitioners:

SI is considered the practice of massage therapy. Only a Licensed Massage Therapist may use the term bodywork. Students must be licensed, and schools must be accredited.

Definitions:

Massage therapy, a health care profession which involves the treatment of the body’s tonus system through the scientific or skillful touching, rubbing, pressing, or other movements of the soft tissues of the body with the hands, forearms, elbows, or feet, or with the aid of mechanical apparatus, for relaxation, therapeutic, remedial or health maintenance purposes to enhance the mental and physical well- being of the client.

Licenses Granted/Required:

Licensed Massage Therapist, Licensed Massage Therapist Student, Massage Business License, and Board Certified Mentor.

Education and Exams:

  1. 500 hours in state-approved, regionally- or nationally-accredited school, or 500 hours apprenticeship with board-approved certified mentor.
  2. MBLEx, NCETMB, ABTE of NCCAOM, NBCA Massage Therapy Certification Examination
  3. The board may approve statistically valid exams.

Montana

SI is named as exempt from massage licensure by statute.

Nebraska

Issues for SI practitioners:

SI is considered a holistic therapy according to regulations, and thus requires massage license. Definitions:

Massage therapy means the physical, mechanical, or electrical manipulation of soft tissue for the therapeutic purposes of enhancing muscle relaxation, reducing stress, improving circulation, or instilling a greater sense of well-being and may include the use of oil, salt glows, heat lamps, and hydrotherapy.

Licenses Granted/Required: Licensed Massage Therapist. Education and Exams:

  1. 1000 hours within nine months in class setting,

including 100 hours of hydrotherapy.

  1. MBLEx, NCETMB.
  2. The board approves exams.

Nevada

Issues for SI practitioners:

SI is considered the practice of massage therapy. Statutory language would require CBSI to be accredited to approve CESI. Education programs that are not licensed or accredited must be approved by the board.

Definitions:

Massage therapy means the application of a system of pressure to the muscular structure and soft tissues of the human body for therapeutic purposes, including, without limitation: effleurage, petrissage, tapotement, compressions, vibration, friction, and movements applied manually with or without superficial heat, cold, water, or lubricants for the purpose of maintaining good health and establishing and maintaining good physical condition.

Licenses Granted/Required:

Licensed Massage Therapist,Massage Establishments.

Education and Exams:

  1. 500 hours.
  2. MBLEx, NCETMB.
  3. The board may approve exams from an NCCA- accredited board [sic].

New Hampshire

Issues for SI practitioners:

Certification by IASI or the Rolf Institute required. No reciprocity options by law.

Definitions:

From statute: The general court, to protect the health, safety, and welfare of the people of the state of New Hampshire, establishes a regulatory program for licensure of reflexologists, structural integrators, and Asian bodywork therapists. The general court recognizes that there are different and specific bodywork professions, and this chapter provides for licensure to differentiate those professions that have attained maturity through established history and  the creation of credible professional associations and training.

Licenses Granted/Required: Bodywork (required to practice SI). Education and Exams:

  1. No specific education requirement named.
  2. Structural integrators must hold current certification from IASI [sic] or the Rolf Institute.

New Jersey

Issues for SI practitioners:

SI is considered the practice of massage therapy and only Licensed Massage Therapists may use term bodywork. Schools must be accredited or state-approved.

Definitions:

Massage and bodywork therapies or massage and bodywork means systems of activity of structured touch which include, but are not limited to, holding, applying pressure, positioning, and mobilizing soft tissue of the body by manual technique and use of visual, kinesthetic, auditory, and palpating skills to assess the body for purposes of applying therapeutic massage and bodywork principles. Massage and bodywork therapy practices are designed to affect the soft tissue of the body, including practices of structured touch of the soft tissues that affect energy fields of the body, for the purpose of promoting and maintaining the health and well-being of the client.

Licenses Granted/Required:

Licensed Massage Therapist, and the Board registers employers.

Education and Exams:

  1. 500 hours at a state-approved or accredited school.
  2. MBLEx, NCETMB, ABTE of NCCAOM.
  3. The board approves exams.
  4. The board approves CE providers.

New Mexico

Issues for SI practitioners:

Requirements for licensure for SI practitioners who are not Rolf-certified is not addressed in statute and rules.

Definitions:

Rolfing Structural Integration exempt by statute.

New York

Issues for SI practitioners:

SI is considered the practice of massage therapy; schools must be state-approved or demonstrate equivalent program; education program and exam must test western and oriental massage; CE technique demonstrations in classes may only be done by New York Licensed Massage Therapist.

Reciprocity is only allowed between states with equivalent hours and exam, and applicant must have two years’ experience in practice.

Definitions:

The practice of the profession of massage therapy is defined as engaging in applying a scientific system of activity to the muscular structure of the human body by means of stroking, kneading, tapping, and vibrating with the hands or vibrators for the purpose of improving muscle tone and circulation.

Licenses Granted/Required: Licensed Massage Therapist. Education and Exams:

  1. 1000 hours, including western and oriental massage.
  2. NY State Massage Therapy Exam; the board may approve other exams.
  3. The board registers education programs and determines equivalence for out-of-state programs.
  4. The board approves CE sponsors who must be organizations; $900 fee for 3 years.

North Carolina

Issues for SI practitioners:

SI is considered the practice of massage therapy. The school approval process is similar to accreditation, and expensive. Applicants must complete a program at a board-approved or licensed school, or provide proof that their school is exempt from a requirement for licensure in its state of jurisdiction.

Definitions:

Massage and bodywork therapy are systems of activity applied to the soft tissues of the human body for therapeutic, educational, or relaxation purposes. The application may include: pressure, friction, stroking, rocking, kneading, percussion, or passive or active stretching within the normal anatomical range of movement…. A person holds out himself or herself to others as a massage and bodywork therapist when the person adopts or uses any title or description including massage therapist, bodywork therapist, masseur, masseuse, massagist, somatic practitioner, body therapist, structural integrator, or any derivation of those terms that implies this practice.

Licenses Granted/Required:

Licensed Massage and Bodywork Therapist; the board regulates establishments.

Education and Exams:

  1. 500 hours at a board-approved or licensed school.
  2. MBLEx, NCETMB.
  3. The board approves exams.
  4. The board approves CE providers.

North Dakota

Issues for SI practitioners:

SI is considered the practice of massage therapy. Schools must have a liaison to the board and meet curricular requirements to be approved.

Definitions:

Massage means the scientific and systematic manipulation of the soft tissues of the human body through any manual or mechanical means… for the purpose of promoting, maintaining, and restoring the health and well-being of the client.

Licenses Granted/Required: Licensed Massage Therapist. Education and Exams:

  1. 750 hours at accredited or state-approved school.
  2. MBLEx, NCETMB
  3. The board approves exams.
  4. CE must be pre-approved by the board for licensure renewal.

Ohio

Issues for SI practitioners:

SI is considered the practice of massage therapy and licensure is by the Board of Medicine as a limited practice of medicine. Schools must be licensed or board-approved, and the MBLEx is the only acceptable exam. There is no license reciprocity process.

Definitions:

Massage is the treatment of disorders of the  human body by the manipulation of soft tissue through the systematic external application of massage techniques including touch, stroking, friction, vibration, percussion, kneading, stretching, compression, and joint movements within the normal physiologic range of motion.

Licenses Granted/Required: Licensed Massage Therapist. Education and Exams:

  1. 750 hours over at least nine months at a state-approved school.
  2. MBLEx is currently the only accepted exam.
  3. Board may approve other exams.
  4. Federal Bureau of Investigation background check required.
  5. No CE requirements.

Oklahoma

No state regulation of massage or bodywork.

Oregon

Issues for SI practitioners:

SI is considered the practice of massage therapy and schools must be approved by the state board. The CESI can be taken for licensure if the practitioner has graduated from a state-approved school.

Definitions:

  1. From statute: Massage or massage therapy means the use on the human body of pressure, friction, stroking, tapping, or kneading; vibration or stretching by manual or mechanical means or gymnastics, with or without appliances such as vibrators, infrared heat, sun lamps, and external baths; and with or without lubricants such as salts, powders, liquids, or creams for the purpose of, but not limited to, maintaining good health and establishing and maintaining good physical condition.
  2. From rules: Bodywork means the use on the human body, for the purpose of, but not limited to, maintaining good health and establishing and maintaining good physical condition of: pressure, friction, stroking, tapping, kneading, vibration, or stretching by manual or mechanical means or gymnastics; appliances, tools or devices; topical preparations; or hot and cold applications.
  3. From rules: Exempt practice if the practitioner holds an active certification from a national

or international professional organization or credentialing agency that:

?     Requires a minimum level of training specific to their discipline, demonstration of competence and adherence to an approved scope of practice and ethical standards;

?     Maintains disciplinary procedures to ensure adherence to the requirements of the organization or agency.

Licenses Granted/Required: Licensed Massage Therapist. Education and Exams:

  1. 500 hours at licensed, accredited, or board-

certified school or program.

  1. MBLEx, NCETMB, CESI, plus required state practical exam.

Pennsylvania

Issues for SI practitioners:

SI is considered the practice of massage therapy and only a Licensed Massage Therapist may use term bodywork. Schools must be accredited or state-approved.

Definitions:

The application of a system of structured touch, pressure, movement, holding, and treatment of the soft tissue manifestations of the human body in which the primary intent is to enhance the health and well-being of the client without limitation, except as provided in this act.

Licenses Granted/Required: Licensed Massage Therapist. Education and Exams:

  1. 600 hours in-class supervised instruction.
  2. MBLEx, NCETMB; tests must be given by professional testing organization.
  3. The board approves CE providers, faculty, and courses.

Rhode Island

Issues for SI practitioners:

SI is considered the practice of massage therapy. Option is provided for licensure reciprocity if applicant graduated from an accredited or licensed school.

Definitions:

The practice of massage means engaging in applying a scientific system of activity to the muscular structure of the human body by means of stroking, kneading, tapping, and vibrating with the hands or vibrators for the purpose of improving muscle tone and circulation.

Licenses Granted/Required: Licensed Massage Therapist. Education and Exams:

  1. 500 hours at a COMTA-accredited (or equivalent) school.
  2. NCETMB.

South Carolina

Issues for SI practitioners:

SI is considered the practice of massage therapy. Schools must be state-approved.

Definitions:

  1. Massage/bodywork therapy means the application of a system of structured touch of the superficial tissues of the human body with the hand, foot, arm, or elbow with or without aid by hydrotherapy, thermal therapy, massage devices, human hands, or the application of herbal preparations for therapeutic, relaxation, or educational purposes.
  2. A person who advertises as a massage/bodywork therapist when a person uses or adopts any title or description, including but not limited to massage practitioner, massage therapist, manual therapist, muscle therapist, massotherapist, myotherapist, bodywork therapist, body therapist, masseur, masseuse, massagist, or any other derivation of these terms implying the practice of massage/bodywork therapy.

Licenses Granted/Required: Licensed Massage Therapist. Education:

  1. 500 hours at a state-approved school
  2. MBLEx, NCETMB.
  3. The board may approve exams.
  4. The board approves CE providers.

South Dakota

Issues for SI practitioners:

SI is considered the practice of massage therapy and only a Licensed Massage Therapist may use term bodywork. Schools must be accredited or state-approved.

Definitions:

Massage: the systematic mobilization of the soft tissues of the body through the application of hands or devices for the purposes of therapy, relaxation, or education through means which include: pressure, friction, stroking, rocking, kneading, percussion, compression, or stretching.

Licenses Granted/Required: Licensed Massage Therapist. Education:

  1. 500 hours at a licensed or accredited school.
  2. MBLEx, NCETMB, NBCA Massage Therapy Certification Examination.
  3. The board approves exams.

Tennessee

Issues for SI practitioners:

SI is considered the practice of massage therapy and only a Licensed Massage Therapist may use term bodywork. Schools must be accredited or state-approved. There are very specific content requirements for CE hours. Reciprocity is only available if an applicant has equivalent education or five years’ experience and NCBTMB certification for five years.

Definitions:

Massage/bodywork/somatic: the manipulation of the soft tissues of the body with the intention of positively affecting the health and well-being of the client.

Licenses Granted/Required: Licensed Massage Therapist, Massage Establishments.

Education and Exams:

  1. 500 hours at a state-approved or accredited school.
  2. MBLEx, NCETMB, ABTE of NCCAOM.
  3. The board approves exams.
  4. The board approves CE providers

Texas

Issues for SI practitioners:

SI is considered the practice of massage therapy. Schools must be licensed or state-approved and requirements are detailed and onerous.

Definitions:

  1. The manipulation of soft tissue by hand or through a mechanical or electrical apparatus for the purpose of body massage.
  2. Massage therapy is a health care service when the massage is for therapeutic purposes.
  3. A person may not for compensation perform or offer to perform any service with a purported health benefit that involves physical contact with a client unless the person holds a massage or other license.

Licenses Granted/Required:

Licensed Massage Therapist, Massage Establishment, Massage School, Massage Instructor. The Board may issue distinct licenses for alternative providers but has not yet written rules to do so.

Education and Exams:

  1. 500 hours at a state-approved or licensed school.
  2. MBLEx, NCETMB, plus required Texas Jurisprudence Exam.
  3. The board approves exams and CE providers.

Utah

Issues for SI practitioners:

SI is considered the practice of massage therapy and only a Licensed Massage Therapist may use the term bodywork. Schools must be accredited or state-approved.

Definitions:

The practice of massage therapy means:

(a)  the examination, assessment, and evaluation of the soft tissue structures of the body for the purpose of devising a treatment plan to promote homeostasis;

(b)  the systematic manual or mechanical manipulation of the soft tissue of the body for the purpose of: promoting the therapeutic health and well-being of a client; enhancing the circulation of the blood and lymph; relaxing and lengthening muscles; relieving pain; restoring metabolic balance; achieving homeostasis; or other purposes;

(c)  the use of the hands or a mechanical or electrical apparatus;

(d)  the use of rehabilitative procedures involving the soft tissue of the body;

(e)  range of motion or movements without spinal adjustment;

(f ) oil rubs, heat lamps, salt glows, hot and cold packs, or tub, shower, steam, and cabinet baths;

(g)  manual traction and stretching exercise;

(h)  correction of muscular distortion by treatment of the soft tissues of the body;

(i)   counseling, education, and other advisory services to reduce the incidence and severity of physical disability, movement dysfunction, and pain;

(j)   similar or related activities and modality techniques;

Licenses Granted/Required:

Licensed Massage Therapist, Massage Therapy Apprentice, and the board registers Massage Employers.

Education and Exams:

  1. 600 hours at a state-registered or nationally- accredited school.
  2. MBLEx, NCETMB.
  3. The board approves CE providers.

Vermont

Vermont has officially declined to regulate massage or bodywork.

Virginia

Issues for SI practitioners:

SI is considered the practice of massage therapy and only a Licensed Massage Therapist may use term bodywork. Schools must be state-approved.

Definitions:

Massage therapy means the treatment of soft tissues for therapeutic purposes by the application of massage and bodywork techniques based on the manipulation or application of pressure to the muscular structure or soft tissues of the human body.

Licenses Granted/Required: Licensed Massage Therapist. Education and Exams:

  1. 500 hours at a state-approved school (any state).
  2. MBLEx, NCETMB.
  3. The board approves exams.

Washington

Issues for SI practitioners:

SI is considered the practice of massage therapy. Schools must be accredited or state-approved through a detailed process similar to accreditation. Definitions:

  1. Massage and massage therapy mean a health care service involving the external manipulation or pressure of soft tissue for therapeutic purposes. Massage therapy includes techniques such as tapping, compressions, friction, Swedish gymnastics or movements, gliding, kneading, shaking, and fascial or connective tissue stretching, with or without the aids of superficial heat, cold, water, lubricants, or salts.
  2. Intraoral massage means the manipulation or pressure of soft tissue inside the mouth or oral cavity for therapeutic purposes.

Licenses Granted/Required:

Licensed Massage Practitioner, endorsement for intraoral massage.

Education and Exams:

  1. 500 hours at a state-approved school (accreditation or equivalent required).
  2. MBLEx, NCETMB, plus required practical exam.
  3. The board approves exams.
  4. The board approves schools.

West Virginia

Issues for SI practitioners:

SI is considered the practice of massage therapy. Schools must be accredited or state-approved. Definitions:

Massage therapy means a health care service which is a scientific and skillful manipulation of soft tissue for therapeutic or remedial purposes, specifically for improving muscle tone, circulation, promoting health and physical well-being. Massage therapy includes massage, myotherapy, massotherapy, bodywork, bodywork therapy, or therapeutic massage including hydrotherapy, superficial hot and cold applications, vibration and topical applications or other therapies which involve manipulation of the muscle and connective tissue of the body, for the purpose of enhancing health, reducing stress, improving circulation, aiding muscle relaxation, increasing range of motion, or relieving neuromuscular pain.

Licenses Granted/Required: Licensed Massage Therapist. Education and Exams:

  1. 500 hours at a board-approved/licensed school.
  2. MBLEx, NCETMB.
  3. The board approves exams.

Wisconsin

SI is exempt from massage licensure by statute, and practitioners may use the terms bodyworker and bodywork therapist.

Wyoming

No state regulation of massage or bodywork.

Conclusion

All errors and omissions are my responsibility.

I welcome your corrections and feedback about your experience in your state. The IASI Law and Legislation Committee works to support access to SI practitioners in all jurisdictions, and would welcome any interested IASI members to join us. If you would like to discuss regulation of practice in your state, or join the committee, please contact me at iasimilree@ gmail.com.

 

Structural Integration in the United States in 2013

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