CranioSacral Therapy Outlawed in Mississippi?

By Cliff Korn, BS, LMT, NCTMB and Rebecca J. Razo

Mississippi law governing massage therapy prohibits therapists from engaging in the "manipulation or adjustment of osseous tissue," and it appears that the Mississippi State Board of Massage Therapy (MSBMT) has lumped CranioSacral Therapy (CST) into this definition as a prohibited massage therapy practice.

Massage Today first learned of the situation from Mississippi therapist Brenda Eiland, NCTMB, RMT.

"I didn't get a straight answer," she said. Instead, she received an e-mail from Limbaugh stating, "Our law does not permit the movement of osseous tissue" [emphasis ours].³ Unsatisfied with the response, Eiland contacted the Mississippi attorney general's office for a clearer explanation, wherein she received a response from Leyser Hayes, the special assistant attorney general representing the MSBMT. He stated: "Mississippi Law does not permit the movement of osseous tissue [CranioSacral Therapy has been defined by the board to involve this movement] ... Section 73-67-7 (h) Miss. Code Ann. (1972) as amended ... defines what massage means for purposes of the practice of same in Mississippi."⁴

Mississippi law §73-67-7(h) provides the following definition of massage:

" 'Massage' means touch, stroking, kneading, stretching, friction, percussion and vibration, and includes holding, positioning, causing movement of the soft tissues and applying manual touch and pressure to the body (excluding an osseous tissue manipulation or adjustment). 'Therapy' means action aimed at achieving or increasing health and wellness. 'Massage therapy' means the profession in which the practitioner applies massage techniques with the intent of positively affecting the health and well-being of the client, and may adjunctively (i) apply allied modalities, heat, cold water and topical preparations not classified as prescription drugs, (ii) use hand held tools or devices designed as t-bars or knobbies, and (iii) instruct self-care and stress management. 'Manual' means by use of hand or body."⁵

Subsequent inquiries by Eiland and Massage Today to the MSBMT about the practice of CST were referred to the new Mississippi "Scope of Practice" rule, which was mailed to Mississippi therapists in September.

Generally, scope-of-practice statements outline permissible practices for legally operating massage therapists. Mississippi's scope of practice, however, only states what cannot be performed legally. The new scope of practice says:

"The Scope of Practice of massage therapy in Mississippi Law §73-67-7 (h) clearly excludes an osseous tissue manipulation or adjustment [emphasis ours]. The Board recognizes that certain course work, which may include an osseous tissue manipulation or adjustment, may be required to pass National testing such as NCETMB or NCCAOM, however these courses must be taught in a manner where massage therapists who practice in Mississippi understand that procedures specific to the manipulation or adjustment of osseous tissue are being taught in theory only and for the sole purpose of passing such exams. To practice such procedures in Mississippi is in violation of §73-67, as well as other laws in Mississippi, which govern the scope of practice for other professionals. CEU courses which include an osseous tissue manipulation or adjustment will not be approved for renewal of Registration. Please refer to our Web site for a complete list of Mississippi Approved Continuing Education Providers and Programs at www.msbmt.state.ms.us."⁶

Massage Today Editor Cliff Korn contacted the Mississippi Attorney General's Office and the executive director of the MSBMT: "Osseous tissue manipulation or adjustment are typically terms referring to chiropractic or osteopathic high-velocity, low-amplitude (HVLA) thrusts or techniques," Mr. Korn said in a letter. "Is it the interpretation of the board that 'manipulation or adjustment' is synonymous with 'movement'? I noticed in your listing of continuing education providers that all of John Barnes' myofascial release seminars were approved, and CranioSacral Therapy is an integral part of his teachings. Please ... confirm or deny the legality of a trained CranioSacral therapist to practice under the Mississippi Professional Massage Therapy Act," he added.⁷

In its response to Korn, the MSBMT stated the "Attorney general's office does not speak for the board of massage therapy. The Mississippi State Board of Massage Therapy speaks through its minutes." Again, Korn was referred to the Mississippi scope of practice rule.⁸

In a final attempt at clarification, Massage Today asked the MSBMT if the attorney general's office was incorrect in stating that "movement" of osseous tissue is illegal.9 In a written response, MSBMT President Lynn Cox stated: "The board has not interpreted any particular modality as the manipulation or adjustment of osseous tissue, but rather, reiterated in its statement on scope of practice that any technique that manipulates or adjusts osseous tissue is in violation of the law that governs massage therapists, as well as laws that govern other professionals. If the board ruled that one couldn't do CranioSacral, the name would probably be changed to SacralCranio, wouldn't it? The law has not changed. Massage therapists in Mississippi are prevented from the manipulation or adjustment of osseous tissue, regardless of one's 'expert' training."¹⁰

But according to Eiland, Cox's statement is untrue: "They have indeed signaled out a modality, as proved by the e-mail from [Hayes] and a message for me [from Limbaugh, stating] 'you cannot practice CranioSacral work as a massage therapist in Mississippi.' "¹¹

Still, the MSBMT has yet to define the terms "manipulation" or "adjustment." In a letter to the MSBMT, Dr. John Upledger, Massage Today columnist, stated, "CranioSacral Therapy does not incorporate any techniques that involve direct osseous manipulation, mobilization or adjustments. Instead, practitioners focus on releasing restrictions in the soft-tissue, fascia and musculature that surround and protect the brain and spinal cord. How can I be so sure? Because I developed CranioSacral Therapy and coined the name... ."¹²

Despite repeated requests, the fact remains that the MSBMT has continued to be vague in responding to questions related to the practice of CST in Mississippi. It remains unclear if the MSBMT is defining the terms "manipulation" and "adjustment" to mean HVLA thrusts - or something more. Look for updates of this situation in future issues of Massage Today.

References

1. E-mail to Massage Today from Brenda Eiland. Sept. 16, 2003
2. Letter to Milne Institute from MSBMT. July 21, 2003.
3. E-mail to Brenda Eiland from MSBMT Executive Director Beverly Limbaugh. Aug. 11, 2003.
4. E-mail to Brenda Eiland from Special Assistant to the Mississippi Attorney General representing the MSBMT. Sept. 5, 2003.
5. Mississippi Code of 1972 (as amended) [§73-67-7(h)]. www.mscode.com/free/statutes/73/067/0007.htm.
6. Mississippi Scope of Practice of massage therapy. www.msbmt.state.ms.us/msbmt/msbmt.nsf/
   8B8E4E18A105080B86256DA4005271E7/$file/scope+of+practice+for+
   web-site.doc.
7. Letter from Massage Today Editor Cliff Korn to the Mississippi State Attorney General's Office and Beverly Limbaugh, executive director, MSBMT.
8. E-mail from Beverly Limbaugh to Cliff Korn.
9. E-mail from Cliff Korn to Beverly Limbaugh.
10. E-mail from MSBMT President Lynn Cox to Cliff Korn.
11. Phone conversation with Brenda Eiland. October 3, 2003.
12. Letter from Dr. John Upledger to the MSBMT.

Former editor of Massage Today, Cliff is owner of Windham Health Center Neuromuscular Therapy LLC. He is nationally certified in therapeutic massage & bodywork and is licensed as a massage therapist by the states of New Hampshire and Florida. Cliff is a member of the International Association of Healthcare Practitioners; a professional member and past president of the New Hampshire chapter of the American Massage Therapy Association; a certified member of the Associated Bodywork & Massage Professionals, Inc.; and a past chairman of the board of directors of the National Certification Board for Therapeutic Massage & Bodywork.