Rescinding CMTO’s Complementary Modalities and Modalities Outside of Scope Policies

Winter 2020

On November 24, 2020, Council rescinded two policies – 1) the Complementary Modalities policy, and 2) Modalities Considered to be Outside the Scope of Practice policy.

Rescinding these policies reflects CMTO’s continued commitment to regulatory modernization and an outcomes-based approach to policies and guidance. These policies contained lists used to indicate modalities that fell outside of the Scope of Practice of Massage Therapy and specified which of those modalities may be used within a Massage Therapy treatment plan.

Some of the concerns with the policies are that they:

  • quickly became out of date;
  • could not include all possible modalities or reflect all the names/terms used for those modalities;
  • were highly prescriptive;
  • limited RMTs’ use of their professional judgement;
  • potentially restricted the use of new modalities not yet added;
  • were not necessarily evidence-informed in their categorization; and
  • were tied to the Continuing Education Units (CEUs) that no longer align with STRiVE.

Moving away from a list-based format provides the Massage Therapy profession with more latitude to use professional judgement to determine what is or is not in scope (as opposed to needing to consult a prescriptive list).

How can RMTs determine whether a specific modality is Massage Therapy?  (e.g., ultrasound)

Regulated health professions (RHPs) in Ontario are defined by their Scope of Practice, Standards of Practice, Code of Ethics, and other practice guidance instead of the modalities, techniques or tools they use. This allows different RHPs to use the same or similar therapeutic interventions within each of their professional contexts and have those interventions be considered that specific type of therapy. This approach also provides room for the incorporation of new interventions, use of professional judgement, and application of knowledge, experience, and skill to the application of these interventions.

The use of modalities by RMTs should be considered through this ‘contextual’ lens. For example, when an RMT provides therapeutic ultrasound within the Scope of Practice of Massage Therapy, following the Standards and Practice, Code of Ethics, and as part of a Massage Therapy treatment plan, this modality is Massage Therapy. While if the same modality is provided by a Physiotherapist within their Scope of Practice and treatment plan, it is Physiotherapy. In other words, it is not the name or “type” of modality that dictates how the intervention is classified; instead, it is the intended outcome and context for the provision of that intervention.

Going forward, RMTs will want to use the Scope of Practice, Standards of Practice, Code of Ethics, and other practice guidance and evidence-informed resources to provide the framework to decide whether a modality, technique or tool is suitable to incorporate into Massage Therapy. CMTO’s Practice Specialist is here to help with any questions or concerns that arise.

For example, RMTs should consider questions like:

  • Scope of Practice: Does this modality involve the manipulation of soft tissue or joints? Is the aim of the use of this modality to develop, maintain, rehabilitate or augment physical dysfunction or relieve pain?
  • Standard of Practice: Can I comprehensively obtain informed consent from clients for this modality (e.g. can I explain the risks, benefits, side-effects, etc., to clients sufficiently for them to make an informed decision)? Can I satisfy all the requirements of the Standards of Practice when providing this modality? Can I assess the health outcomes of the use of this modality? Can I appropriately limit the risk of disease transmission using this modality? Is this modality being provided within a Massage Therapy treatment plan?
  • Code of Ethics: Do I have the training and skills needed to safely provide this modality? Is the use of this modality in the client’s best interest?
  • Evidence-Informed Practice: Is there evidence to support the use of this modality for this client and their health needs? What is the likely mechanism of action for this modality and does it align with Scope of Practice?

Modalities provided within the Scope of Practice of Massage Therapy would be billed as Massage Therapy treatment. Modalities that do not fall within Massage Therapy Scope of Practice cannot be billed as Massage Therapy treatment.

CMTO has published helpful information to support RMTs in making these decisions in the ‘Modalities’ section of our Practice Advice webpage.  We will continue to work on developing additional practice resources and tools to support RMTs decision making in this area.

Questions about the practice of Massage Therapy can be directed to CMTO’s Practice Specialist at

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