COVID-19

Les MTA qui administrent des soins devraient se référer au document Pandémie de COVID-19 – directives de l’Ordre sur la pratique de la massothérapie. Ce guide a été préparé à partir de l’information et des ressources fournies par le ministère de la Santé et Santé publique de l’Ontario, en collaboration avec d’autres organismes de réglementation des soins de santé.

Updated June 11, 2021

The College of Massage Therapists of Ontario (CMTO) continues to monitor the COVID-19 pandemic and we will be updating this page as information becomes available. We acknowledge this has been a challenging time for healthcare professionals and the healthcare system, and we thank Registered Massage Therapists (RMTs) for their commitment to keeping their clients and communities safe and healthy. The safety of the public, including RMTs, remains our top priority.

Current situation and guidance

RMTs are permitted to practise provided they follow:

FAQs for RMTs

Masking and personal protective equipment (PPE)
Infection, prevention and control (IPAC)
Client/RMT screening and potential exposure
Providing treatment
General

Masking and personal protective equipment (PPE)

What type of mask should I wear while providing treatment and how often should my mask be changed? 

At a minimum, RMTs must wear a surgical/procedure mask approved for medical use. There are three classifications of surgical/procedure masks under American Society for Testing and Materials (ASTM) International Standards (Level 1, 2 and 3). Approved surgical/procedure masks of all levels and number of layers are acceptable for use by RMTs.

CMTO cannot approve specific masks or brands of masks. For more information on surgical/procedure masks, please refer to Government of Canada’s COVID-19 medical masks and respirators: Information for health professionals.

It is best practice for an RMT to change their mask after every client, and masks must be changed whenever wet, damaged or soiled. Please wash your hands before and after touching, adjusting, putting on or removing a mask.

You may also choose to take droplet and contact precautions to limit the risk of COVID-19, which includes wearing:

  • Surgical/procedure mask;
  • Isolation gown;
  • Gloves; and
  • Eye protection (goggles or face shield).

CMTO strongly recommends that RMTs wear eye protection (e.g., goggles or face shield), in addition to all required Infection Prevention and Control (IPAC) measures in CMTO’s COVID-19 Pandemic – Practice Guidance for Massage Therapists. CMTO wants to reiterate this strong recommendation because in some cases, local public health units may be determining whether an RMT needs to isolate for 14 days (after unknowingly being exposed to COVID-19 by a client) on whether eye protection was used.

What if a client refuses to wear a mask? 

If the client refuses to wear a mask, you may refuse to treat the client at that time. If you decide not to treat, you should have a discussion with the client about the risks and why you are not providing treatment. This discussion must be documented in the client health record. Learn more about assessing risk.

You may need to make modifications to accommodate the clients’ ability to safely and comfortably wear masks throughout treatment. If a client cannot wear a mask (e.g., due to a health condition), please use your professional judgement to assess the risk of providing treatment.

For more information on the proper use of PPE in healthcare, please see Public Heath Ontario’s Infection Prevention and Control Fundamentals.

Infection, prevention and control

Do I need to complete any specific training related to the pandemic?

Before practising during the COVID-19 pandemic, RMTs must complete the free online Public Health Ontario training listed below. RMTs are not required to submit proof of completion to CMTO, but they should keep the completion certificates in their own records.

Here are a few tips if you are having technical issues: 

  • The online learning platform is compatible with Internet Explorer and Chrome. Modules will not work properly in Firefox or Safari browsers.
  • The Public Health Ontario modules are to be completed in real time through their online learning platform. You cannot download the modules.
  • The modules are media heavy. Clearing your browser cache before completing each course will help things run smoothly.
  • Refer to Public Health Ontario’s Online Learning Requirements to get your computer ready for the best learning experience.
  • Refer to Public Health Ontario’s FAQs and How Do I Guide for additional support.

What do I need to know about ventilation in my practice space?

The Ministry of Health has not issued requirements regarding ventilation practices for healthcare providers that would directly apply to RMTs. For this reason, CMTO has not created any specific ventilation or air filtration requirements.

RMTs who want to learn more about ventilation or air filtration should view the following resources:

RMTs may choose to take additional precautions regarding ventilation and/or air filtration at their discretion or in response to their own risk assessment of their practice setting.

Do I need to clean and disinfect pillows after each use? Can I just change the pillowcase/cover? 

RMTs must wash and dry all linens, blankets and pillows used in treatment in the highest heat possible after every client.

If the pillow is made of, or covered entirely by, a plastic or otherwise non-porous material, it must be cleaned and disinfected between clients using products approved by Health Canada.

If both the pillow and pillowcase/cover are made of porous materials (like cotton, polyester, rayon, viscose or linen), both the pillow and pillowcase/cover must be cleaned and disinfected after every client.

Items that cannot be cleaned and disinfected after every client should be removed from the treatment room.

Client/RMT screening and potential exposure

My client has a chronic or pre-existing health condition, and the symptoms of their condition (e.g. headache) are listed in the Ministry of Health’s COVID-19 Patient Screening Guidance. Does this mean I can’t treat them? 

If a client responds “no” to every item on the patient screening guidance document, with the exception of responding “yes” to a symptom in Q4 (e.g., headache), the RMT needs to clarify with the client whether the symptom is related to a chronic or pre-existing health issue. If the client indicates the symptom is related to a chronic or pre-existing health issue, and the symptom is not new or worsening, the client is considered to screen negative for COVID-19 and the RMT can proceed with treatment.

If the symptom cannot be explained by a chronic or pre-existing health issue, and/or the symptom is new or worsening, the client is considered to screen positive for risk of COVID-19. The RMT must defer treatment and encourage the client to self-isolate and complete the Ministry of Health’s online self-assessment tool.

All client screening must be documented in the client health record.

A client tested positive for COVID-19. When can I provide in-person treatment to this client?

RMTs cannot provide treatment until the client has been cleared, or their case is considered resolved by their local public health unit. Clients can provide confirmation verbally or in written form.

I may have been exposed to COVID-19, what should I do? Can I still practise?

Please complete the Ministry of Health’s online assessment tool and follow any instructions provided, which may include direction to self-isolate for a specified period, contact your local public health unit, and/or obtain a COVID-19 test. If you are symptomatic or have had known or suspected exposure to a confirmed COVID-19 case, you cannot practise until you have received clearance to do so. If you have travelled outside of Ontario, either domestically or internationally, follow any advice imposed on returning travellers to Ontario, including requirements for self-isolation, before returning to practice.

Do I need to notify clients about potential contact with suspected or confirmed cases of COVID-19 in my practice?

The answer to this may vary depending on the public health unit (PHU). RMTs should work with their local PHU and are reminded to keep a log of anyone entering the practice setting for contact tracing purposes. If there are any confirmed cases of COVID-19 in a provider, staff, client or visitor of the practice, the RMT should report it to their local PHU and follow their directions.

Providing treatment

Are there treatment techniques, skills or modalities that are higher risk and may require additional PPE?

Your risk assessment before any client interaction must include an assessment of the risks posed of using any modality, technique or tool that you would like to apply in the treatment. Learn more about assessing risk.

Certain techniques or modalities may present a higher risk of transmission or exposure to COVID-19, even if the client and/or RMT is vaccinated against COVID-19. You must determine whether it is appropriate to use these techniques/modalities given the increased risk of COVID-19 transmission/exposure. Some potential areas of risk may include:

  • Techniques requiring direct contact with areas close to the client’s mouth, nose, eyes or ears.
  • Techniques that cause prolonged vibration, such as tapotement, as this may loosen phlegm or mucus leading to an increased risk of coughing.
  • Techniques that require removing or adjusting the client’s mask, such as intraoral massage. This increases the risk of exposure to respiratory droplets and can increase the risk of coughing.
  • Hydrotherapy, due to the use of the equipment and/or the increased risk of exposure to fluids that may be contaminated.

If you determine a higher risk treatment should be provided, you must wear eye protection (face shield or goggles), in addition to a surgical/procedure mask. You must also determine whether additional PPE, beyond the mask and eye protection, is warranted, such as a gown and/or full contact/droplet protection, as outlined in Public Health Ontario’s Routine Practices and Additional Precautions in All Health Care Settings (Appendix B) on pages 57-58. 

In the case of intraoral treatment, RMTs must wear, at minimum, a surgical/procedural mask, eye protection (face shield or goggles) and gloves.

For more information on the proper use of PPE in healthcare, please see Public Heath Ontario’s Infection Prevention and Control Fundamentals.

Do I still need to sign my receipts? Can I provide them electronically?

RMTs are required to sign receipts according to the CMTO Policy for Receipts. This can be done by hand or electronically.

Are there any additional considerations for record keeping? 

In addition to the routine requirements for record keeping, RMTs must record the following:

  • a general infection prevention and control record/log for the practice,
  • a notation of COVID-19 infection precautions taken for each client in the client health record, including:
    • screening dates, outcomes and related decisions;
    • PPE used during treatment;
    • modifications to treatment; and
    • details of infection prevention and control measures used to prepare for, during, and after each treatment.
  • a roster of all people entering the space for contact tracing purposes.

Documentation should be kept for 10 years.

Are there any aspects of Massage Therapy I can provide virtually?

Offering Massage Therapy virtually has several complexities that will need to be considered and should only be used in very few and unique situations.

Some examples of these rare situations in which virtual treatment may be permissible include:

  • When an RMT may need to provide guidance for client self-care; or,
  • When an RMT would like to complete an intake process for a new client before the client’s first visit. 

If providing a service virtually, the RMT must be transparent in all documentation, including billing invoices, that the services were provided remotely and whether only a partial assessment/treatment was performed (i.e., it does not constitute a full session of Massage Therapy and cannot be billed as such). RMTs must advise their clients that virtual practice may not be covered by their insurance provider as Massage Therapy.

Before using any platform, ensure that the platform is confidential and secure and meets the requirements of the Personal Health Information Protection Act, 2014. You must obtain the consent required under the Health Care Consent Act, 1996 and CMTO’s written consent requirements for treating (or viewing) sensitive areas (if applicable). In addition, all applicable legislative and CMTO requirements would still need to be adhered to, such as maintaining client health records.

What happens if an RMT is found to be practising contrary to government directives or CMTO guidance?

CMTO expects RMTs to comply with government and public health directives to prevent and control the spread of COVID-19. RMTs who are found to be practising contrary to guidance may face serious consequences, including investigation by CMTO, penalties levied under government legislation, or civil liability in court.

If you have concerns, please contact the Professional Conduct Department at professionalconduct@cmto.com or call 416-489-2626/1-800-465-1933 extension 4149.

CMTO is receiving questions from RMTs and the public, and will continue to track and promptly respond to them. For more information, please contact CMTO’s Practice Specialist at practicespecialist@cmto.com or by phone at 416-489-2626/1-800-465-1933 extension 4124. 

General

What about my income? What financial relief is available to me?

The following resources are available for information about economic relief: 

Additional Resources for RMTs

Along with CMTO’s COVID-19 Pandemic – Practice Guidance for Massage Therapists (Pandémie de COVID-19 – directives de l’Ordre sur la pratique de la massothérapie), RMTs should access the following websites for the most current information and guidance:

RMTs are required to follow infection prevention practices at all times, in all practice settings.

Resources for Infection Prevention and Control (IPAC):

Mental Health Resources

Other Resources

For questions about this information, please contact CMTO’s Practice Specialist at practicespecialist@cmto.com or by phone at 416-489-2626/1-800-465-1933 extension 4124.

COVID-19 Resources for Clients

If you are looking for information about COVID-19 and Massage Therapy, including what to expect at your next appointment, please review our client resource.

If you have questions or concerns about COVID-19 and Massage Therapy, please contact CMTO’s Practice Specialist at practicespecialist@cmto.com or by phone at 416-489-2626/1-800-465-1933 extension 4124.

You can access the following websites for the current and reliable information about COVID-19:

Vaccination Information

Vaccination Information

Healthcare professionals in Ontario, including RMTs, have been identified as a priority group for the COVID-19 vaccine. Getting the COVID-19 vaccine helps protect you, your clients and the greater community. All available vaccines are rigorously tested and deemed to be safe and effective prior to use across Ontario. 

For more information, please see the following resources:

General Information and Vaccine Safety

Vaccine Rollout and Eligibility

For Healthcare Providers

COVID-19 Vaccine FAQs

Is it mandatory for RMTs to get the COVID-19 vaccine?

Vaccination is not mandatory, but CMTO encourages Massage Therapists (RMTs/MTs) to be vaccinated. You can find more information about booking a vaccine on the Ontario Government’s COVID-19 vaccine booking page

How can RMTs get a COVID-19 vaccine? What about my second dose?

If you have not yet been vaccinated, you can visit How to book a COVID-19 vaccine appointment or your local public health unit’s (PHU) website to find out how to get the COVID-19 vaccine.

The Ontario Government has announced that it would accelerate second doses for people who already received their first dose. The timing of your second dose will depend on when you received your first dose, which vaccine you received (i.e., Pfizer, Moderna or AstraZeneca), supply and/or your age. Learn about getting your second dose.

Can workplaces require COVID-19 vaccination?

CMTO cannot comment on an employer’s vaccination policies and cannot provide advice to RMTs about their obligation to employers. RMTs can consider seeking legal advice or contacting the Registered Massage Therapists’ Association of Ontario (RMTAO) about adhering to workplace health and safety policies, including policies about vaccination.

If a client asks whether/when I have been vaccinated, do I have to tell them?

COVID-19 vaccination is an important topic of conversation in healthcare settings and may come up as part of discussions with clients. However, COVID-19 vaccination status is personal health information and RMTs are not required to disclose their personal health information to clients. If you wish to share your immunization status you are permitted to do that.  

Can I ask a client if they have been vaccinated?

Asking clients about their vaccination status is not part of pre-treatment COVID screening, but may be part of collecting a client’s health history information.

RMTs can request information about vaccination and immunization as a part of collecting or updating health history information to ensure safe and ethical Massage Therapy treatment. Clients may disclose their recent vaccination independently or when updating health history regarding use of medications.

MOH’s COVID-19 Patient Screening Guidance does not include questions about vaccination status, and this should not be asked as part of active screening.

If a client has been partially or fully vaccinated, do I still have to follow all COVID-19 practice guidance?

Yes. At this time, regardless of whether you and/or the client have been partially or fully vaccinated, you must practise in accordance with CMTO’s COVID-19 Pandemic – Practice Guidance for Massage Therapists (e.g., masking, infection prevention and control).

Can I treat clients who screen positive for COVID-19 but have been vaccinated?

If a client has been vaccinated but screens positive for symptoms of COVID-19, you cannot provide in-person treatment at that time. If a client screens positive, you must instruct them to contact their primary care provider, use the Self-Assessment Tool, or contact Telehealth Ontario for guidance about whether or not to obtain a COVID-19 test and/or self-isolate.

RMTs should not provide in-person treatment to clients who screen as positive until at least 14 days after the client has been symptom-free, or until the client has been cleared by a primary care practitioner or local public health unit professional.

At this time, MOH has not issued any guidance specific to treating people who are partially or fully vaccinated. CMTO will continue to monitor for evolving guidance as it becomes available.

If clients ask me if they should be vaccinated for COVID-19 or about specific vaccines, what should I tell them?

As health professionals, CMTO encourages RMTs to support the Government of Ontario’s evidence-informed vaccination campaign. While discussing the COVID-19 vaccine in detail or providing advice about types of vaccines is not within the Scope of Practice for Massage Therapy, RMTs are encouraged to help counter vaccine hesitancy. RMTs can refer clients to their primary healthcare provider or to MOH’s COVID-19 vaccines page for information.  

RMTs have a professional responsibility to provide safe, ethical and evidence-informed treatment. This includes not promoting anti-vaccination sentiments or misinformation that contradicts scientific evidence. Publicly communicating information (e.g. in-person or online) that is contrary to scientific evidence could result in inquiries or action by CMTO.

Do I need to modify treatment if a client has recently been vaccinated?

Treating clients who have recently been vaccinated depends on the specific details of each case (e.g., how soon the client arrives for treatment following the vaccination and/or the client’s reaction to the vaccine).

Considerations include whether the client is experiencing any side effects from receiving the vaccine at the time of the appointment, including whether the side effects are local or generalized, and whether they could be considered common or uncommon. Please refer to MOH’s About COVID-19 Vaccines document for more information on reactions to vaccines (pg. 3 and 4).

RMTs would also consider whether the vaccine injection site has healed. If the injection site has not fully healed, the RMT would avoid direct treatment of the area in accordance with Standard of Practice 15.

With these considerations in mind, RMTs determine whether it is safe to proceed with assessment and treatment, or if modifications or postponing treatment are necessary. In any case where an RMT is concerned with a client’s experience of uncommon or acute reactions and/or side effects, the RMT should refer the client to a primary care practitioner, Telehealth Ontario, or emergency care.

Workforce Matching Portal

Ontario is seeking those with experience in providing healthcare to help provincial efforts to prevent and control the spread of COVID-19.

The Ministry of Health is looking for:

  • healthcare providers who may be working part-time and want to and are able to increase their work hours;
  • former healthcare providers who are retired and are prepared to return to employment; or
  • anyone who is inactive with their regulatory college or registered but not currently employed.

If you are interested, please register with Ontario’s Health Workforce Matching Portal.

Archive of Communications to RMTs

May 21, 2021 – COVID-19: New Government Announcements

May 13, 2021 – Ontario Extends Stay-at-Home Order (no direct impact on RMTs’ practice)

April 21, 2021 – COVID-19 Update

April 16, 2021 – COVID-19 Update

April 7, 2021 – COVID-19 Update

April 1, 2021 – COVID-19 Update

February 25, 2021 – COVID-19 Update

February 2, 2021 – COVID-19 Update

January 12, 2021 – COVID-19 Update

December 21, 2020 – COVID-19 Update

December 11, 2020 – COVID-19 Update

November 20, 2020 – COVID-19 Update

October 2, 2020 – COVID-19 Update

August 14, 2020 – Updated COVID-19 Practice Guidance and FAQs

July 10, 2020 – New Resource and Updated Frequently Asked Questions (FAQs) Registered Massage Therapist (RMT) Resource

June 26, 2020 – Recording Now Available: Infection Prevention and Control for Regulated Health Professionals 

June 18, 2020 – Client Resource and Screening Guidance

June 11, 2020 – Upcoming Webinar – COVID-19 Infection Prevention and Control for Regulated Health Professionals

May 29, 2020 – Update: Gradual Restart of Services 

May 19, 2020 – Closure of Non-Essential Business Extended and Practice Guidance for RMTs

May 19, 2020 – Closure of all Non-Essential Businesses – Order extended until May 29, 2020 

May 6, 2020 – Closure of Non-Essential Business Extended until May 19, 2020

May 1, 2020 – Preparing for a Future Return to Practice

April 23, 2020 – Closure of Non-Essential Business Extended until May 6, 2020

April 17, 2020 – COVID-19: Non-Essential Business Closure Extended to April 23

April 8, 2020 – A Message from the President and Registrar

March 25, 2020 – COVID-19 Update: Massage Therapists Cannot Practice – Massage Therapy is Not Emergency Care

March 23, 2020 – COVID-19 Update – Premier’s Announcement, Ministry of Health Healthcare Provider Recruitment and new CMTO COVID-19 webpage

March 20, 2020 – COVID-19 Update – Directive from Chief Medical Officer and FAQs for RMTs

March 17, 2020 – College of Massage Therapists of Ontario Providing Services Remotely

March 16, 2020 – COVID-19 Updated Guidance

February 26, 2020 – Update from Ministry of Health on COVID-19 – Updated March 13, 2020

January 31, 2020 – Update from Ministry of Health on Coronavirus

January 27, 2020 – Coronavirus Update for RMTs