There is a particular kind of announcement that has echoed through the massage therapy profession for a quarter century. It goes something like this: *An organization is creating standards of practice.* It arrives with the language of milestones. It promises consistency, professionalism, and public protection. And it is almost always presented as if it were happening for the first time.
The most recent version came from the American Massage Therapy Association (AMTA) in 20251, which announced — with understandable pride — that it is developing national standards of practice for the profession. It’s a worthy goal. It’s also worth pausing to ask a simple question before we celebrate: *Haven’t we done this before?*
AMTA also just announced this at their National Convention happening as I write:
And…what is taking so long. The committee to create the Standards of Practice was created in 20232.
The honest answer is yes. Repeatedly. The history is worth walking through, because it tells us something important about where the profession actually stands — and it lets each of us decide for ourselves what to make of the timing.
First, what a standard of practice actually is…I wrote about it previously this year.
It helps to be precise, because the phrase gets used loosely. A standard of practice is a formal, documented statement of what competent practitioners are expected to know, do, and refrain from doing. It defines scope, sets minimum competencies, and establishes what a competent session requires — assessment, documentation, referral, and the rest.
That is different from a code of ethics. A code of ethics tells you *how to behave* — honesty, confidentiality, avoiding exploitation. A standard of practice tells you *what competent clinical work looks like*. Many professions publish both, and the two get confused constantly. Holding onto that distinction turns out to be the key to reading the history clearly, because much of what our profession has labeled “standards of practice” over the years has actually been conduct and ethics material wearing a clinical name.
With that in mind, here’s the historical record on how long the profession has been talking on standards of practice..
The timeline
2000–2001 — NCBTMB issues its first Standards of Practice.** On October 23, 2000, the National Certification Board for Therapeutic Massage & Bodywork released a document it described as a “consumer bill of rights.” It built on the NCBTMB Code of Ethics and covered six areas: professionalism, legal and ethical requirements, confidentiality, business practices, roles and boundaries, and prevention of sexual misconduct. Every one of those six is a *conduct* domain. The profession’s first national “Standards of Practice,” in other words, was largely an ethics-and-behavior document. That’s not a criticism of its intent — it did real work protecting the public — but it’s worth naming for what it was.
NCBTMB Standards of Practice (2000), reported in *Massage Today*, Jan. 2001. https://web.archive.org/web/20060521162405/http://www.massagetoday.com/archives/2001/01/05.html
2005 — AMTA publishes Practice Standards.** AMTA maintained its own practice standards document, designed to be used alongside its Code of Ethics. (This version is no longer on AMTA’s current website, though it survives on archive.org.) So by the mid-2000s, the two largest national organizations each had a standards document in circulation.
AMTA Practice Standards (2005, archived). https://web.archive.org/web/20051026064110/http://www.amtamassage.org/news/032505.html
2010 — Researchers study whether standards actually affect practice.** Fortune and Gillespie published a pilot study in the *International Journal of Therapeutic Massage & Bodywork* examining how practice standards shaped therapists’ real-world work experience — an early, thoughtful attempt to ask whether these documents changed anything on the table. Fortune, L.D. & Gillespie, E. (2010). *IJTMB* 3(3):5–11. https://doi.org/10.3822/ijtmb.v3i3.73
2013 — ELAP builds the foundation.** The Entry-Level Analysis Project, a 21-month research effort produced through the Coalition of National Massage Therapy Organizations — with AMTA as a participant — defined entry-level competencies for the profession. This was arguably the closest the field has ever come to the foundational competency framework a real national standard needs to be built on. But then it was never adopted. AMTA, which helped create it, later stated it does not support part of it. That single fact is worth sitting with.
While AMTA continues to support the general content of the ELAP report, we have never endorsed or supported the 625-hour recommendation. ( My sources have been deleted but I know they said it.)
Entry-Level Analysis Project (ELAP), 2013. http://www.elapmassage.org/
2017 — NCBTMB revises its Standards of Practice.** The current NCBTMB version, ratified September 15, 2017, updated and expanded the 2000 document. It covers the right ethical territory. It is not, however, a clinical practice standard in the fuller professional sense — it doesn’t define what conditions massage treats, what assessment is required before treatment, or what documentation a clinical session demands. https://ncbtmb.org/standards-of-practice/
2023 — AMTA quietly begins again.
AMTA established its Healthcare Advocacy & Research Committee (HARC) to support government relations in the clinical and integrative care environment. According to the AMTA-Kentucky chapter’s own Government Relations report, the seven-member committee had “only begun the work of reviewing the Standards of Practice for the Massage Therapy profession to determine what, if any, changes may need to be made,” describing it as a slow, deliberate process. So the current effort actually started internally in 2023 — reported at the chapter level in 2024 — well before any national fanfare.
AMTA-KY *In Touch*, Fall 2024, Government Relations Report (Ann Boone, LMT). https://myemail.constantcontact.com/Your-Communicator-2024-IN-TOUCH-AMTA-KY-Fall-Newsletter.html?soid=1101698969607&aid=1PPgAwCKNaw
August 2024 — The VA steps in.** The Department of Veterans Affairs published a Federal Register Notice of Request for Information on developing a national Massage Therapist Standard of Practice — one that carries federal *preemption* authority over conflicting state requirements. A federal agency, in other words, began writing a legally enforceable definition of what a massage therapist is. AMTA and FSMTB both submitted formal responses during the comment period.
VA Notice of Request for Information, Federal Register, 89 FR 62868 (Aug. 1, 2024). https://www.federalregister.gov/documents/2024/08/01/2024-16944/notice-of-request-for-information-on-the-department-of-veterans-affairs-massage-therapist-standard
2025 — AMTA announces its national standards project.** AMTA filed a federal notice that it is developing new national standards of practice, and announced the effort publicly on its website on August 15, 2025.
AMTA RFI response to the VA. https://downloads.regulations.gov/VA-2024-VACO-0001-0560/attachment_1.pdf
2026 — Two processes, running in parallel.** Today, two national standards-of-practice efforts are underway at the same time — one by the VA, one by AMTA — with no public explanation of how they relate. And neither has published the underlying practice framework their standard would be derived from.
What the record shows — and what it doesn’t
Lay the timeline out and a pattern emerges on its own.
The profession has produced documents titled “Standards of Practice” going back to 2000. It has had *two* national organizations maintaining such documents for the better part of two decades. It built a genuine competency foundation in 2013 — and set it down. And now, in 2025, its largest association is announcing the creation of standards of practice as though the ground were fresh.
AMTA claims3:
Throughout this process, we will actively engage with coalition partners, industry leaders, allied organizations, and our members to ensure every perspective is heard and valued. Stay tuned for more information.
Have any other organizations been contacted?
But they are doing that without having a practice framework in place!
Shouldn’t a Practice Framework come first?
Which raises a question the profession rarely asks out loud: shouldn’t a practice framework come first? A framework answers the foundational questions — what is massage therapy’s domain, what problems doest address, what is the clinical process from assessment through outcomes, what are the core values beneath the work?
A strong professional identity is built on a unified vision, shaped by core values and ethical principles that guide practice standards and decision-making responsibilities in client care. A recognized professional identity influences how the massage therapy profession is perceived and how therapists see themselves within it. Establishing a professional identity enhances confidence and deepens the sense of belonging in the massage therapy field.
Professional identity is dependent on two factors:
A definition of the profession
A professional practice framework
Defining Massage Shaping Professional Identity By Sandy Fritz
A standard of practice can’t help but answer those same questions; it just answers them implicitly, through whatever assumptions the drafters happen to carry. Build the standard without an explicit, profession-owned framework underneath it, and the standard quietly becomes the framework by default — authored under deadline pressure rather than deliberate consensus, and then everything else in the profession gets aligned to a foundation no one actually chose.
That’s what makes the current moment worth watching closely. Neither the VA nor AMTA has published a practice framework that its forthcoming standard is derived from. AMTA’s own 2023 statement lists “Create Standards of Practice” as a goal, with no mention of the framework that would give those standards their shape. Maybe that framework exists internally and simply hasn’t been shared. Maybe it doesn’t. Either way, it seems fair for working therapists to ask — before the documents are written, rather than after — what foundation they’re being built on.
How has this affected the profession historically?
The historical lack of unified standards within the massage therapy profession created massive hurdles for practitioners, schools, and regulators alike, particularly in the realm of state-level licensing and professional legitimacy.
1. The Patchwork of Local Regulations and the “Adult Entertainment” Stigma
Because there were no statewide or nationwide standards of practice, regulation was left entirely up to individual states, local counties and municipalities. This created a fragmented regulatory patchwork. In regions with no state laws, local municipal leaders frequently governed massage therapists under local ordinances designed to regulate adult entertainment or control illicit activities.
2. Education Gaps and the Scope of Practice Conflict
Up until the 1980s, only nine states regulated massage therapy. Even as state-level licensing began to rise in the 1990s and 2000s, there was no baseline educational standard or defined scope of practice agreed upon by the broader industry.
The AMTA established its own internal educational requirements (eventually a 500-hour minimum) and standards of practice, but these only applied to AMTA members. In 2005, the AMTA Board formally recognized that the wider profession still lacked baseline education standards, an articulated body of knowledge, and a comprehensive scope of practice. Without these, the industry could not even agree on foundational terminology—such as how to define “medical massage” without triggering restrictive, premature regulations by state boards.
3. The Portability Crisis and Competing Exams
The absence of a centralized, uniform standard severely restricted “portability”—the ability of therapists to legally practice when they relocated to another state. Because educational standards and licensing laws varied so wildly from state to state, a therapist licensed in one jurisdiction often faced a mountain of bureaucratic red tape, delays, or was forced to complete entirely new training to practice elsewhere.
Initially, the National Certification Exam (NCE) administered by the NCBTMB (which AMTA originally helped create and seed) was used as a standard for licensing. This was again putting the cart before the horse.
However, the creation of competing exams and the launch of the Massage & Bodywork Licensing Examination (MBLEx) by the FSMTB in 2005 created deep divisions. The AMTA ultimately shifted its support to the MBLEx in 2009 to champion a single, uniform exam that state regulatory boards could accept to facilitate true cross-state portability.
4. Collaborative Initiatives to Unify the Profession
To resolve these deep-seated complications, the industry had to slowly build unified frameworks from scratch:
The MTBOK Initiative (2008–2011): AMTA, ABMP, FSMTB, MTF, and NCBTMB joined forces to steward the Massage Therapy Body of Knowledge (MTBOK) to map out competencies and establish a unified baseline.
The Entry Level Analysis Project (ELAP) (2012): A coalition of seven national massage organizations initiated ELAP to map out precise entry-level knowledge and skills, recommending a baseline of 625 hours of education to ensure safe, competent practice nationwide.
We did that, but these projects were left collecting dust…without a practice framework.
The lack of unified standards was never neutral — it shaped the profession in ways still felt today. Because every state wrote its own scope, education hours, and licensing exam, a therapist licensed in one state has long faced real barriers moving to another. The discrepancies among massage laws are precisely why professional mobility stayed so limited. Without an agreed baseline for what a competent graduate must know, schools taught wildly different content at wildly different hour counts, and licensing boards had no shared yardstick for an unfamiliar transcript.
When hospitals and insurers asked the question every payer eventually asks — is there a recognized standard defining what this profession does and how competence is verified? — massage has no single, adopted answer, while nursing, physical therapy, and medicine did. That gap is a large part of why the profession has spent decades knocking on the door of healthcare integration and reimbursement without being fully let in.
Now what?
https://www.amtamassage.org/about/news/standards-of-practice/
Healthcare Advocacy & Research Committee (HARC) https://myemail.constantcontact.com/Your-Communicator-2024-IN-TOUCH-AMTA-KY-Fall-Newsletter.html?soid=1101698969607&aid=1PPgAwCKNaw
https://www.amtamassage.org/about/news/standards-of-practice/
