Many massage therapists receive only the most cursory education when it comes to professional referral. Generally, somewhere in the course of a professional ethics class we will be taught that we need to refer our clients to the appropriate healthcare professional when their needs go beyond our scope of practice. We are taught the limits of our scope, but given a vague catch all along the lines that anything beyond that should be sent to someone else, and when in doubt that someone else should be a doctor.
However, there is a lot more to know than just those couple sentences. Is scope of practice the only reason to refer out? By referring out, aren’t we just admitting to the client that we can’t help them? From a business point of view, aren’t we simply sending our paying clients away? Sadly, answering these questions is something that most of us have to learn by trial and error over years of experience. I have been fortunate enough in my career to work closely with a physical therapy practice, even helping to manage multiple clinics for a year and a half. In the course of that time I feel I have learned some valuable aspects to professional referral that I can share with my fellow massage therapists.
There are many reasons that a massage therapist would and should refer out to a physical therapist. From a health and wellness perspective, massage therapy and physical therapy can complement each other very well. In the simplest sense, we address soft tissue restriction and tension. Much of what we do is aimed at correcting one side of muscle imbalance: the tight or shortened side. However, our ability to impact the lengthened side of a muscle imbalance is limited. Muscles that are weak, atrophied or uncoordinated need exercise and strengthening, which falls directly under the traditional purview of a physical therapist.
At some point, most every massage therapist reaches a point with a few clients where progress stagnates or plateaus. In those cases, referral to another healthcare professional gives the client new treatment options, and—at the very least—demonstrates that you are dedicated to helping them get better whatever that may take. Sometimes we may suspect that a client has arthritis, bursitis or other conditions, but of course, we do not make diagnosis. Well, physical therapists are qualified to make such diagnosis and seeing a PT may be cheaper or easier than getting an appointment with a doctor.
Massage therapy and physical therapy are also naturally complementary because massage therapy tends to be a form of ongoing or wellness care, whereas physical therapy tends to be episodic. That means that typically physical therapists will see a patient for a delineated period of time for one condition known as an episode of care. Actually, most insurance specifically refuses to pay a physical therapist for maintenance or ongoing care. Once the patient has achieved certain functional goals, their episode of care is declared completed. A natural course of treatment for someone seeing a PT and an MT would be to see the physical therapist for specific, acute problems and then return to the massage therapist for ongoing care and maintenance.
For example, I had a client whom I saw regularly for low back and shoulder pain. The shoulder pain was stubborn and persistent. We would regularly work through the soft tissue, but he frequently complained of lingering pain in the joint itself. I referred him to the physical therapist for which I was working, who diagnosed him with a torn labrum and sent him to an orthopedic surgeon. The surgeon confirmed the tear with an MRI and performed a surgical repair. After the surgery, the client underwent several months of physical therapy on the repaired shoulder. During that time I also saw him to address his back pain and other complaints, because those were not part of the episode of care and therefore not covered by insurance. When the client completed his physical therapy, he returned to me for ongoing work on the affected shoulder and on the opposite arm that had been compensating during his recovery.
The client saw benefit because he was able to receive multiple forms of therapy. The fact that the physical therapist and I worked together cemented our mutual authority for the client and fostered an ongoing professional relationship between us. To this day we will occasionally refer clients back and forth when needed: a win-win-win. Hopefully, I’ve given you a sense for why to refer to a physical therapist and how the referral benefits both the massage therapist and physical therapist. In later articles we’ll discuss how to go about establishing a network of referral sources and how to make the referral.