Let There Be Light - for Massage Therapists

Does using Low Intensity Lasers (LILT) in a Massage Therapy practice in B.C. fall within our scope of practice? This question has been posed many times during my use of LILT for the last 4 years. The short answer - yes!
I had the nod from our College (CMT), then president Doug Fairweather, in 2007, after  making a presentation to the Board defending my use of LILT. Although my presentation was a lengthy one, with Power Point and all, I will extrapolate and present to you my letter to the board.

Novemeber 11, 2007

Dear Ms. Rigby,

Re: Continuing Education and Professional Development (CE/PE)

Enclosed please find my submission for CE/PD accreditation for a Meditech seminar and more recently a conference held in Toronto for Low Intensity Laser Therapy in the Treatment of Athletic Injuries.
It is my understanding that recently Mike Berger, RMT was refused credits for this because “these courses are outside our profession’s currently applicable scope of practice.” With all due respect to the Quality Management Committee, I wish to dispute this decision and request that these hours be credited.
Under the current Health Profession Act – Massage Therapists Regulation under the heading Definitions – “massage therapy means the kneading, rubbing or massaging of the human body, whether with or without steam baths, vapour baths, fume baths, electric light baths or other appliances, and hydrotherapy …” Clearly by this definition electric light baths are acceptable under our scope of practice. The definition continues – “…or any similar method taught in schools of massage …”. I draw your attention to a course outline taken from the Okanogan Valley College of Massage Therapy, an accredited school. Under the heading Term 2: Hydrotherapy/Spa: “You will be introduced to actinotherapy. Actinotherapy is defined as the use of "rays of light" for therapeutic benefit. This brief course presents the theory of ultraviolet and infrared light and their application in a massage therapist’s practice.” Clearly light, ultraviolet to infrared is taught as a therapeutic tool to be used in a Massage Therapy practice.
I am aware of the report by George K. Bryce, Hazardous Energy Reserved Act for Physical Therapists – Implications for Massage Therapists and Other Health Professions. As far as I can find, these recommendations have not been implemented.
However, having said all this, let us draw our attention to the word “Laser” which could  be the issue.  The word “Laser” has a superior marketing appeal because of its cool, interesting and mysterious nature. It conjures up the images of Star Wars, Laser light shows, and medical surgeries performed with this light.
Therapies currently available for the treatment and stimulation of soft tissue repair include the application of light and forms of phototherapy that utilizes the electromagnetic spectrum in and beyond the visible range. Used in addition to best clinical practice in the management of soft tissue injuries, there is considerable evidence that phototherapy can help improve tissue repair. The main types of phototherapy are Lasers and LED’s (light emitting diodes).
Electromagnetic radiation in the form of photons delivered in either laser or non-laser form has been applied to wounds as a means of stimulating healing for over 30 years. The technique is now referred to as phototherapy, photon therapy or as photobiomodulation, the use of photons to modulate biological activity.
The Meditech International Inc. group provides seminars and workshops covering the therapeutic values of light and the application in a clinical setting. Unfortunately, the word “Laser” is used in its marketing and certification course, however a closer look at the contents and the use of Laser in the course amount to less than 10%. The major source of light used, discussed and recommended in their workshops is administered by LED’s. This is based on countless research papers presented through the entire course.
LED’s produce light consisting of those wavelengths both in the visible spectrum and that in the infrared spectrum, as that of sunlight, halogen lights, light bulbs or infrared heat lamps. Exposer to the red light and/or infrared spectrum can stimulate the healing of chronic wounds (Mester et al 1985) and acute wounds (Dyson & Young 1986). It is also important to note the classification standard governing the safety of electric modalities. LED’s used and recommended for therapeutic value are Class 1 – “This class is eye-safe under all operating conditions”, under the US. Food and Drug Administration (FDA) and Health Canada.
Lasers, however, unlike light from non-laser sources, produce a light are coherent, that is, in phase, the troughs and peaks of the waves coinciding in time and space. Also the light from lasers is collimated, i.e. it’s rays are non-divergent.
As a former educator of post graduate Neuromuscular Therapy (St. John Method) of 15 years, I taught, discussed, and/or demonstrated intra-oral, intra-nasal, intra-rectal and intra-vaginal methods of treatment for musculoskeletal conditions. I am aware that in the province of BC, some of these methods may be beyond our scope of practice. However full credits were given even though a part of the lecture and workshop may have been beyond our scope of practice for this province but remained part of the course content as it was applicable in other provinces or states. As with the Meditech seminars and certification, some therapies may be beyond our scope of practice in this province, do not overlook the overall course content of actinotherapy.
In conclusion, I strongly disagree with the Quality Management Committee decision that the use of light does not fall within our scope of practice, as laid out by the Health Professional Act, and as taught in our BC Colleges. I’m also adamant that if workshops such as Hot Rock Therapy (research?) and other such workshops be included for CEC, surely a workshop that provides up-to-date scientific research on the physiological effects of administrating low level light to tissue and cells would also be recognized for it’s therapeutic value in a clinical setting.
I feel it’s important the Board recognize that the potential of technology, and collaborating with scientists advances our therapy as Massage Therapists, yet does not take away or diminish our sense of touch and the power of healing.  Consequently, furthering ourselves within our scope of practice, or for that matter, understanding therapies that are available outside our scope should be encouraged by our College and Board. This can only enhance our ability to direct our patients to the best available treatments to meet their needs. As a result, we obtain further acceptance by the mainstream medical community and public alike, that we are well-informed, educated and capable practitioners.
In Health,
Peter J. Roach, RMT