Medical Practice vs. Massage Practice

From the Author

I have a habit of occasionally revisiting old Facebook discussions, comments, and posts. Today's writing was inspired by a post I made back in March 2025, where I shared a rather sad story. Upon rereading that discussion and reflecting on the reactions it sparked, I felt compelled to analyze the entire conversation more deeply.

The tone of the discussion was, in my view, somewhat alarming. It reminded me how important it is for us, as massage therapists (MTs), to clearly understand who we are, to respect our professional role, and to stay grounded in our ethical and legal responsibilities.

Yes, it’s true—massage therapists can sometimes make mistakes. We can occasionally cross the boundaries of our scope of practice or act negligently. Of course, we must strive to avoid such errors. We cannot afford to be negligent in any form, including—but not limited to—crossing the scope of practice. However, when comparing our potential missteps to those that can occur in medical practice, massage therapy remains relatively safe and benign.

In the medical field, there is a legally accepted framework that allows for a certain level of risk and even error. For instance, it's completely legal and routine for a doctor to prescribe a powerful medication and then say, “Let’s try it and see—if you develop side effects, we’ll stop it and try something else.” This approach is considered normal and acceptable medical practice, even though the side effects of these medications can sometimes trigger new health issues.

I do not mean to generalize. Some medical doctors are very responsible and passionate about their work. Others are more focused on protecting themselves from potential malpractice claims. The system, unfortunately, often incentivizes defensive medicine rather than careful, patient-centered care.

Massage therapists, on the other hand, are spared from the responsibility of prescribing medications—not because we are morally superior, but because the very nature of our practice is inherently safer. We work with the body using non-invasive methods, and our outcomes, both positive and negative, typically carry much lower risk.

That said, part of our professional confidence must come from understanding that we carry our own set of responsibilities—just like medical doctors carry theirs. For example, if a physician refers a patient for massage and we believe their prescription or specific instructions are partially or completely inappropriate, we are not obligated to follow them blindly. We have a duty to apply our professional judgment.

We are professionals, and we must think, act, and conduct ourselves as such—always within the legal scope of our practice, but never with a diminished sense of responsibility.

In the conclusion of this article, I will outline in detail the essential differences between Medical Practice vs. Massage Practice.

Below is the original Facebook post that led to this reflection.

Very sad story .Approximately 15 years ago, I treated a 25-year-old male for a lower back disorder. At that time, he was already a very successful businessman. Over the years, he has come to my office multiple times for various sports-related injuries affecting different regions of his body. Each time, I was able to treat him successfully with good outcomes.

Two weeks ago, his wife called me urgently, requesting an emergency appointment due to severe neck and upper back pain radiating to his upper extremity. It was heartbreaking to see this once energetic young man in such distress. Three years ago, he had suffered a stroke, and it was difficult to process the sad reality of seeing someone so young, strong, and athletic in this condition sitting in wheelchair. He was convinced that the Covid vaccine booster injection was the cause.

Regardless, I provided treatment, and he experienced relief. A second session further reinforced the positive results, and his prognosis was excellent. However, I later received a call from him canceling his next treatment. As I always do in such situations, I asked how he was feeling. He responded, “I feel better, but I’m at my doctor’s office for an appointment I scheduled a week ago.”

The doctor had reviewed his MRI results and instructed him to stop massage therapy, instead scheduling him for an emergency epidural injection, believing the MRI findings indicated a dangerous condition.

I requested to speak with the doctor, but my patient said, “Tell me what you have to say, and I’ll forward it to him.” Instead, I chose a different approach. I told my patient, “I will send you a text, and you must ensure the doctor reads it before proceeding with the epidural.”

Here is what I wrote:

"Dear Doctor, I am not an MD, but I can understand medical conditions when reading impressions. There is no spinal cord edema or any indication suggesting an urgent need for an epidural injection. Moreover, I have provided two treatments following a medical massage protocol for muscular syndrome (ASM syndrome), and both were successful. I strongly urge you to reconsider the epidural injection. Additionally, I must remind you that the patient is on a high dosage of Plavix. He must be taken off this medication before any epidural procedure, as proceeding now would constitute malpractice."

To my surprise, the doctor called me almost immediately—furious and threatening. I remained calm and replied, “If you perform an epidural injection now, you will be committing malpractice. And please, do not raise your voice at me.”

His final words were, “If you were an MD, I would tell you to read the latest data on the subject. But you’re not, so stop confusing the patient.”

Dear friends, what can I say? A very sad story. The unnecessary epidural injection led to hemorrhagic complications and an emergency hospitalization. I just remembered to check in and see how my patient was doing. Just off the phone. His wife told me he is still in the hospital, having suffered another stroke.

We must pray for him. I told her she must sue this doctor—he should not be practicing medicine. This was all completely unnecessary. Unfortunately, no logical argument I made could convince my patient otherwise. In the end, the doctor's authority prevailed, with devastating consequences.

Dear followers. Rereading my post again, analyzing everything including what I wrote to this so-called over proud MD, feel no regret, but hundred percent positive I did right thing. Any good reasonable Dr., Would think, would ask patient, really Medical Massage helped you and you feel better? Would check reflexes, would say let’s try using medical massage. Again I was reading impression from MRI report, nothing suggest compromised spinal cord, requesting him to look again at MRI report. It wasn’t urgent to perform epidural injection, hospital stripped him from privilege, and yes he committed malpractice, by not considering temporary stopping Plavix. Possible he will lose his license to practice medicine. Everything I wrote to him was supported by medical committee, and my text to him was used by this committee. And I was praised by numerous members of committee by doing the right thing , writing my text to Dr.

As a professional massage practitioner, I didn’t cross borders of my scope of practice by writing to him and most important, I have provided qualified treatments for ASM syndrome, and succeeded. And most likely would sustain results treating this muscular syndrome As an a massage therapist, I have successfully provided 1000s protocols for muscular syndromes. The main point of this writing is the reaction of my colleagues. Below is the first post I received:”

sorry dude,.. but that was not your place,.... when i read what you wrote i was thinking,.. well "thats gonna piss him off" regardless of what we have learned,... the MD is the higher authority,.. and you really are dancing on a knife's edge with practicing med w/o a license - keep in mind its not that I disagree with your treatment or your opinion but questioning a physician (right or wrong) is this climate is dangerous to your license.”

My Goodness—This Was Written by a Massage Therapist?
On what authority is he speaking? The authority to destroy a life?

Because I wrote a message to the doctor, I was “dancing on a knife’s edge”? Was I practicing medicine without a license?
And this statement: “Questioning a physician—right or wrong—in this climate is dangerous to your license”?
Really?

Even more troubling were the multiple responses from fellow massage therapists agreeing with the physician who committed malpractice—who severely harmed a patient. Not one word of sympathy for the patient.

That’s why I decided to write this clarification: “Medical Practice vs. Massage Practice.”

Understanding the Difference

Let’s start by defining medical practice:

“Medical practice” refers to licensed professionals—physicians, nurse practitioners (NPs), and physician assistants (PAs)—who establish diagnoses, offer medical advice, perform procedures (including surgical ones), manage rehabilitation and treatment of various illnesses and injuries, and engage in preventive care.

Now let’s define massage practice, but first by clarifying what is outside our scope:

• We cannot prescribe medication.
• We cannot advise patients to stop taking prescribed medication.
• However, we can encourage patients to consult with their physician regarding side effects or concerns about medications.

For example, not long ago I treated a patient with a lower back issue who had been prescribed 1200 mg of ibuprofen. During the initial evaluation, she mentioned stomach pain and dark-colored blood in her stool. I asked clarifying questions, then insisted she speak to her prescribing doctor immediately. She did, and it turned out to be critical. That’s how we should operate—within scope, yet responsibly engaged.

In another case, a patient came in for lower back pain. On palpation, I didn’t feel it was musculoskeletal. I declined treatment and referred him back to the physician. In one unforgettable instance, I was nearly certain a patient had peritonitis. I instructed him to go to the emergency room and informed his referring doctor of my decision. Later, the doctor told me the patient’s appendix had ruptured on the operating table. During my evaluation, the patient didn’t have the typical localized pain—only vague lower back discomfort. That is the power of careful clinical reasoning, even within massage therapy.

We are professionals. And within our scope, it is perfectly appropriate to act responsibly, including writing to a doctor—as I did in my Facebook post.

Defining Massage Practice

Massage therapy includes, but is not limited to:

• Performing initial evaluations, focusing on the condition of soft tissue
• Identifying fascial and muscular tension and reducing it
• Locating and deactivating trigger points using ischemic compression
• Managing lymphedema and accelerating venous and lymphatic drainage
• Enhancing arterial blood supply
• Performing detoxification massage
• Managing stress through targeted massage techniques
• Decompressing the spine
• Preventing and treating stress-related conditions, such as:
• Tension headaches
• Essential hypertension (in some cases, effectively managed through massage)
• Providing post-event sports massage
• Preventing and treating delayed onset muscle soreness (DOMS)
• Treating sports-related injuries
• Complementing medical treatments by reducing medication dependence
• And much more...

If you’re interested, please visit my blog by clicking the link below, where I further explain massage therapy’s clinical use.

https://www.medicalmassage-edu.com/blog/

Dear colleagues:
If you disagree with anything I’ve defined or stated here, please feel free to share your thoughts. Professional dialogue is welcome—and essential. But if you agree, then I hope it strengthens your pride in our profession. In serious discussions like the one I’ve addressed, let’s offer professional insight—not blind support for medical authority when it goes unchallenged.

Let’s express ourselves—agreement or disagreement. What matters is that we act as professionals with informed opinions.

Conclusion

To advance our profession—both in theory and in clinical skill—we must recognize that massage therapy is its own science, especially when applied clinically. Within our defined scope, we can often help people effectively and with fewer side effects than conventional medical treatments.

This is not about competition between professions. I am a strong advocate of true integrative medicine—medicine where professionals from all disciplines contribute their strengths, with mutual respect and clearly defined responsibilities.

If you haven’t read my articles on these topics, I highly recommend taking the time to do so. It may reshape your understanding of the true power of massage therapy—and reinforce not only the legitimate authority of physicians, but also our own.

https://www.medicalmassage-edu.com/blog/medical-massage-prevention-ospinal-fusions-other-orthopedic-surgeries.htm

With respect and determination,
Boris