Many individuals are turning to massage therapy: In 2022, 11.1% of people reported visiting a massage therapist in the past year. According to a 2025 report from the American Massage Therapy Association (AMTA), the top reasons individuals seek massages are health and wellness (e.g., soreness/stiffness/spasm, chronic pain) and mental health (e.g., relaxation and stress reduction).
The growing demand for massage therapy can be a boon to business, but therapists should not lose sight of potential liabilities. These include allegations of failing to detect injuries, sexual misconduct, and providing services outside their scope of practice.
Fortunately, massage therapists can take several steps to reduce the risk of legal action from clients. Risk reduction starts with conducting a thorough client intake and continues with monitoring for red flags during treatment. Proper referrals and detailed policies and procedures round out liability prevention strategies. Adhering to best practices and documenting thoroughly underlie all these strategies.
Conduct a thorough intake
A thorough intake helps the massage therapist understand the client’s needs and expectations, which is essential for establishing a positive relationship.
In addition to general information such as name, address, email, and phone number, the intake form should collect data on health history across the major body systems, including cardiovascular, musculoskeletal, neurological, respiratory, reproductive, and skin. The AMTA offers a free intake form that can be downloaded. In addition to body systems, the form has spaces for other key items such as diabetes, cancer, depression, and fibromyalgia.
Data from the form and conversation between therapist and client should answer the following questions:
- Why are you seeking massage therapy?
- Are you under a doctor’s care or taking medications?
- Do you have any medical conditions (e.g., high blood pressure, diabetes)?
- Are there areas you would like to avoid or focus on?
- Are there any areas of pain?
- What are your energy levels like?
- When was your last massage, and how did it go?
- What would make this massage a success for you?
When reviewing medications, therapists should note any that may interfere with pain perception. If pain sensation is diminished, the therapist could inadvertently cause injury. In addition, anticoagulants and antiplatelets medications can make the client more susceptible to bruising.
The therapist should review the form, discuss any concerns, and then develop a treatment plan in collaboration with the client. The plan can be included in the intake form or in a separate document.
Be sure the client signs the intake form (and the treatment plan if it is a separate document) to acknowledge their understanding. The form should include a waiver that clearly outlines the client’s responsibilities (such as informing the therapist if they are experiencing pain during a session).
Retain signed forms in a secure physical area or secure digital file to protect privacy.
Watch for red flags
Massage therapists should be cognizant of verbal and/or nonverbal cues, also known as red flags, that may indicate a client is dissatisfied with treatment. Not all clients will speak up with their concerns, so changes in behavior, such as significantly less detailed responses to questions, should prompt further assessment. In these situations, it is best to explore by sharing observations and asking open-ended questions, such as, “You seem quieter today than usual. What’s on your mind?” By dealing with issues promptly, therapists may avoid future liability.
In addition, therapists should be alert to signs that the client is experiencing discomfort, such as unexpected movement, which could indicate an injury. Again, clients may fail to speak up, thinking the pain is an expected part of the treatment.
Massage therapists also need to watch for red flags to ensure their own safety. They should be wary of clients who make inappropriate comments, request same-day home visits without a referral, and share emotional issues that go beyond massage therapy. Therapists should trust their instincts and decline sessions if they are concerned. One resource is Respect Massage (respectmassage.com), which aims to “educate and empower massage therapists so they can easily spot, deter, and escape from clients that are looking for happy endings or ‘extras.’”
Refer when needed
Massage therapists are committed to helping their clients feel better, so it can be tempting to go beyond their scope of practice by suggesting medical diagnoses or using techniques they are not trained in. Therapists should resist these temptations, which can put clients at risk and lead to liability claims against the therapist. For example, providing a technique the therapist is not trained in could cause patient injury and result in a claim.
Instead, therapists should refer the client to a healthcare provider, so they receive the care they need. If appropriate, offer to speak with the provider to describe the treatments provided to date.
Develop policies and procedures
Both solo and group massage therapy practices need to have detailed policies and procedures in place. Policies and procedures needed in any setting include client intake, infection prevention, standards for delivering care, equipment maintenance, communication standards, and employee training and expectations. It is also helpful to have a checklist to assess for possible liability risks, for instance, ensuring that intake forms include a complete history.
Standardization through policies and procedures promotes effective communication and consistent practice, thereby reducing liability risk.
Follow best practices
Massage therapists should follow best practices when delivering care to reduce liability risks. For example, proper draping (exposing only what is necessary and securing the drape to avoid slippage) and clearly explaining techniques before starting helps to defent against charges of inappropriate touching. Therapists should provide privacy for clients when removing and donning their clothes, and be specific about what needs to be removed and what is at the client's discretion. Therapists should also ask permission before touching areas of the body such as the buttocks.
Another example of best practices is following infection prevention standards to avoid transmission of illness and skin conditions.
Therapists need to document thoroughly (sidebar). One tool that can be used at the intake stage and after each session is the SOAP note: Subjective (client symptoms), Objective (clinical observations, Assessment (client evaluation), and Plan (treatment recommendation). SOAP notes help document the client’s progress and may also be useful when communicating with insurance companies. The AMTA offers a free SOAP note form that can be downloaded.
Finally, massage therapists should adhere to ethical guidelines such as those set by the Associated Bodywork & Massage Professionals.
Despite following best practices, a massage therapist can be on the receiving end of liability claims. Therefore, they should have liability insurance and notify their insurance provider immediately upon receiving a claim notice.
Reducing liability risk
Massage therapists provide valuable services to their clients. To ensure they can continue to provide these services, therapists need to take steps to reduce their risk of liability. These steps not only protect the therapists themselves but also safeguard the clients they serve.
Lynn Pierce, FNP-C
Senior Risk Management Consultant with HPSO
Sidebar #1
Reducing liability through documentation
The adage “If it wasn’t documented, it wasn’t done” is a powerful reminder: Documentation is a powerful tool massage therapists can use to defend themselves against client legal action. Here are examples of key areas for documentation:
- Intake forms
- Liability waivers
- Dates of sessions
- Services performed
- Treatment notes
- Communications, including verbal discussions, texts, and emails
- Client education (the AMTA has free handouts for clients that may be helpful)
- Changes in client’s mental or physical status
- Referrals to other providers.
In addition, clients should sign all forms.
References
American Massage Therapy Association. Massage therapy industry fact sheet. 2025. https://www.amtamassage.org/publications/massage-industry-fact-sheet/
American Massage Therapy Association. Client intake form. n.d. https://www.amtamassage.org/resources/forms-templates/client-intake-form/
American Massage Therapy Association. Free SOAP note. n.d. https://www.amtamassage.org/resources/forms-templates/soap-notes/
Associated Bodywork & Massage Professionals. ABMP’s code of ethics for massage therapists. n.d. https://www.abmp.com/abmp-code-ethics
Benjamin BE. Keeping clients safe, part 2: How to avoid violating client boundaries. Massage and Body Work. 2021. https://www.abmp.com/massage-and-bodywork-magazine/keeping-clients-safe-part-2-how-avoid-violating-client-boundaries
Benjamin BE. Keeping clients safe, part 1: How to avoid client injuries. Massage and Body Work. 2021. https://www.abmp.com/massage-and-bodywork-magazine/keeping-clients-safe-part-1-how-avoid-client-injuries
Levin J, Bradshaw M. Prevalence and determinants of massage therapy use in the U.S.: Findings from the 2022 National Health Interview Survey. Explore. 2024;20(6):103015