By Sue Shekut, Owner, Working Well Massage, Licensed Massage Therapist, Certified Wellness Coach, ACSM Personal Trainer
Recently, I had a reader post a questions about an earlier post I had written regarding massage and chiropractic issues in Illinois. While trying to answer her questions, I found out much more about the legislation that governs the use of unlicensed personnel to perform massage in chiropractic offices. I thought it might be useful to others if I wrote it out in a post versus burying it in a comment, so read on…
In my mind, having a non massage therapist receptionist perform a massage, whether or not the chiropractor is in the same office, is unethical, even if it were legal in Illinois. However, there other stipulations that restrict the use of a receptionist and office manager from performing massage in a chiropractic office. And specifically, in Illinois, unlicensed people may not practice massage on new patients outside the office setting even if the chiropractor is present.
Let me give another example of how this law can be broken and how unlicensed, untrained people can be giving massages out in public. Last fall, I volunteered at a charity event performing massage with the understanding that my company would be the only massage providers at this event. I bought signs for our booth (which set me back quite a bit), contracted with a massage therapist to work the event with me (because I don’t expect other massage therapists to work for free to promote my business) and made it to the event to locate our booth. And what did I find? A chiropractor was setting up massage chairs in our booth and had a young lady in tow to help him give massages. I was uncomfortable with having people I don’t know giving massages under my company’s banner, but at that point the event had already started. So we welcomed the chiropractor and his staff person and got to know them better.
We had spoken to the chiropractor about our frustrations with the law regarding chiropractors hiring unlicensed people to perform massage. I asked the young lady if she was a licensed massage therapist and she said “No.” My fellow massage therapist and I were shocked and concerned that she would be giving massages in our booth. The young lady said “Well, I’ve been in enough locker rooms and have seen people get massage to know what I am doing.” With that as her rationale for being able to provide massage, and the chiropractor mumbling something about his other massage therapist not being available that day, she started massaging people. Soon she was massaging children under 18 years old. Granted, the chiropractor was standing right next to her the entire time. But would you want your kids or loved ones to be given a massage by someone who’s main claim to her abilities was seeing other people get massages in a rehab room? I wouldn’t. Was the chiropractor violating the law? Yes. Was she? Yes, as well. And if she hurt someone or even gave them a bad massage, it was my name on the banner people would associate her with. I did not know then that they were not obeying the law. Now that I know I would have handled the situation differently.
So if you are hosting a charity event or getting a massage at such an event, make sure you ask if the massage therapist is licensed, especially if they are part of a chiropractor’s booth. I have to wonder too if a chiropractor is using unlicensed people illegally to give massages, could I trust him or her in other areas of my care?
I pasted the relevant text of the relevant law below. Note that although the text says physicians, chiropractors are included as physicians in this act. My clarifications are given in brackets.
(225 ILCS 60/54.2)
(Section scheduled to be repealed on November 30, 2011)
Sec. 54.2. Physician delegation of authority. [Which also includes chiropractors]
(a) Nothing in this Act shall be construed to limit the delegation of patient care tasks or duties by a physician, to a licensed practical nurse, a registered professional nurse, or other licensed person practicing within the scope of his or her individual licensing Act. Delegation by a physician licensed to practice medicine in all its branches to physician assistants or advanced practice nurses is also addressed in Section 54.5 of this Act. No physician may delegate any patient care task or duty that is statutorily or by rule mandated to be performed by a physician.
(b) In an office or practice setting[so only in the office, not at health fairs or at charity events to market the practice] and within a physician‑patient relationship, [which means, within the context of an existing patient/physician relationship, not to market new clients] a physician may delegate patient care tasks or duties to an unlicensed person who possesses appropriate training and experience provided a health care professional [which in this case would either be training by the chiropractor OR licensed massage therapist], who is practicing within the scope of such licensed professional’s individual licensing Act, is on site to provide assistance [so the licensed massage therapist must be on site to provide assistance unless the chiropractor is trained to give massages].
(c) Any such patient care task or duty delegated to a licensed or unlicensed person must be within the scope of practice, education, training, or experience of the delegating physician and within the context of a physician‑patient relationship. [Again, the massage given must be within the scope of practice of the chiropractor/and or licensed massage therapist on site AND must be within an existing physician-patient relationships, not for marketing purposes or for new patients]
(d) Nothing in this Section shall be construed to affect referrals for professional services required by law.
(e) The Department shall have the authority to promulgate rules concerning a physician’s delegation, including but not limited to, the use of light emitting devices for patient care or treatment.
(Source: P.A. 96‑618, eff. 1‑1‑10.)
The link to the final law is here.
Working Well Resources' Blog 
[…] Clarifying Legal Issues for Massage and chiropractic in Illinois (workingwellresources.com) […]
In Illinois, what is the law regarding massage therapist and hand tools? What is the law regarding acupuncturist and what tools are under there scope of practice?
Michael,
Thanks for your questions! You can find the answers to your questions in the state’s website. For a link to specific info about the Massage Therapy Licensing Act, go to http://www.idfpr.com/dpr/who/masst.asp.
As far as specific info on using tools, here is what I found in the Massage Licensing Act: These [massage] techniques may be applied by a licensed massage therapist with or without the aid of lubricants, salt or herbal preparations, hydromassage, thermal massage, or a massage device that mimics or enhances the actions possible by human hands. ” (Can you do cupping with the human hand?)
Also note that Section 25 Exemptions states that: “(g) Practitioners of Asian bodywork approaches are exempt from this Act if they are members of the American Organization of Bodywork Therapies of Asia as certified practitioners or if they are approved by an Asian bodywork organization based on a minimum level of training, demonstration of competency, and adherence to ethical standards set by their governing body. ” So if cupping or other tools are used and training is obtained form the Asian bodywork school approved by an Asian bodywork organization, then it seems there are no restrictions in using cupping or other Asian bodywork tools. It seems only Licensed Massage Therapists cannot use tools such as cupping in our work.
Rules for acupuncturists are here: http://ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1290&ChapAct=225%26nbsp%3BILCS%26nbsp%3B2%2F&ChapterID=24&ChapterName=PROFESSIONS+AND+OCCUPATIONS&ActName=Acupuncture+Practice+Act.
The only tools I see mentioned in this Act are needles. See: Sec. 10. Definitions. As used in this Act:
“Acupuncture” means the evaluation or treatment of persons affected through a method of stimulation of a certain point or points on or immediately below the surface of the body by the insertion of pre‑sterilized, single‑use, disposable needles, unless medically contraindicated, with or without the application of heat, electronic stimulation, or manual pressure to prevent or modify the perception of pain, to normalize physiological functions, or for the treatment of certain diseases or dysfunctions of the body and includes activities referenced in Section 15 of this Act for which a written referral is not required. Acupuncture does not include radiology, electrosurgery, chiropractic technique, physical therapy, naprapathic technique, use or prescribing of any drugs, medications, herbal preparations, nutritional supplements, serums, or vaccines, or determination of a differential diagnosis.
Interestingly, neither Act mentions cupping specifically nor Acupressure except for the exemption of practitioners of Asian bodywork from the Massage Therapy Act. In effect, this means that practitioners of Asian bodywork like Shiatsu, Tui Na and Jin Shin Do have no restrictions on their practice, are not considered massage therapists nor acupuncturists, and can do whatever they want and claim whatever they want without any legal restriction. Does this protect the public from harm? Perhaps not. But it does give those with Asian bodywork credentials a lot of freedom and flexibility in practicing in Illinois. Much more so than those of us trained in Western massage modalities! Enjoy that freedom while it lasts. 🙂
Sue
[…] Michael A Hughes, an Asian bodyworker in Chicago, posed some questions to me in my other blog, WorkingWellResources, asking “In Illinois, what is the law regarding massage therapist and hand tools? What is the […]
good
This article is quite old, so I am wondering if the law is still in place? I’m trying to figure out if I can work or not. I am from and licensed in Iowa, and because of the issues with the state of Illinois, I guess I am looking at 12-18 months before I get my license. The Chiropractor that I currently work for (I am just doing paperwork and marketing) is telling me that I can work under his license. Because this is illegal in Iowa, it makes me feel horribly uncomfortable and the info on the AMTA website says I cannot work for him. I need clarification though, because he hired me to give massage, and I am afraid I’m not going to have a job at all. Could you tell me if the law is current and what I can and cannot do. Though honestly I don’t feel right working without my license.
Shannah,
I can’t give you legal advice. To the best of my knowledge, this law is still in place. However, I am not sure why AMTA says you cannot work under your chiropractors license. It may for for ethical reasons. Your best bet is to speak to your local AMTA rep or AMTA national if you are an AMTA member and find out specifically what they know. Or better yet, call the state of Illinois Department of Professional and Financial Regulation for the best advice. Check out their webpage on the Massage Therapy act here: http://www.idfpr.com/profs/info/MassageTherapy.asp And I doubt it will take 12-18 months for you to get an IL Massage therapy license. If you submit your paperwork and have a valid MT license in Iowa, you should be able to get an IL MT license in a few months. Good luck!
Sue
Can a licensed chiropractor employ a licensed/insured massage therapist out of his rented office space in a commercial building that is situated in a B3 zone (City of Chicago / which does not allow massage therapy). The massage therapy given in the office is two fold. One massage is physician patient related.and the other massage service provided is non physician patient related and designed to recruit new patients for massage only. and to create residual income because his perception is there is more money doing this than for performing chiropractic services. My concern is if this is a violation of the law for the chiropractor and the therapist employed and is it necessary to have a special use license. This service is being billed under the name of the chiropractic office but marketed under a separate name which involves wording for marketing purposes specifically for massage. Is this a violation and what can be done? Can the owner of the building be held liable for the chiropractors activity?
Hi Michele,
Thank you for reading and commenting on my blog!
I am not clear on what you are asking. If you are asking if a chiropractor can hire someone to give massages under their license, then I believe they can. I don’t think massage establishment zoning ordinances apply for what the city considers medical offices. I also don’t think I have the legal expertise to advise you clearly. If you are trying to operate within the scope of the law and Chicago zoning ordinance, I recommend you approach the city directly with your questions. They have a lovely business department full of helpful people.
Good luck and let me know what you find out!
Thank you, Sue