Massage therapists often use pressure to manipulate soft tissues to alleviate pain and tension. With the medical implications of this type of work, regulations are upheld through licensing, certification, and registration in the U.S. and Canada.

Generally, a license is issued by the government and a certification is distributed by a private institution. Andn so, there are legal differences between a licensed massage therapists (LMT) and a certified massage therapist (CMT).

What does a massage therapy license do?

Being a LMT shows that you have obtained the required knowledge set by the local bureaucracy to safely practice massage on the general public. 

Although only 44 out of 50 states in the U.S. require a therapist to be licensed, LMTs are able to move more freely from state to state while retaining their position and/or practice since most states require similar prerequisites.

Most massage requirements include enrollment in an accredited general massage school and a passing score on the Massage and Bodywork Licensing Exam (MBLex)

The MBLex is a test that bodyworkers only need to pass once and their score can be searched by any massage or licensing board. This exam ensures competency in seven different areas: 

  • anatomy and physiology
  • kinesiology
  • pathologies
  • benefits and outcomes of massage therapy
  • client assessment
  • ethics and law
  • guidelines for professional practice.

What does a massage certification do? 

There are several types of massage certifications. You can receive a one in a specific modality, but there are also state level certifications.

A state certification often has fewer restrictions on background prerequisites for those who can perform massage. These often include aspects like a minimum age or general education.

Most states will require a specified amount of massage education hours from an accredited school. However some massage certifications are elective courses to further their knowledge in a modality or learn to work with a specific clientele.

For example, sports teams who employ massage therapists to look after their players, but they may require any therapist that applies to be certified in advanced neuromuscular therapy or rehabilitation. 

When working for a dental practice, you may be required to have training that applies specifically to those with jaw and mouth disorders or cleft palate.

massage therapy practice

Massage therapists, physiotherapists, and occupational therapists practice in Walt Fritz’s MFR class in Los Angeles, Calif. on August 5, 2017. (Photo by Nick Ng.)

So what’s the difference between a LMT and CMT?

A LMT is a therapist who has met government requirements of a territory to practice massage. They will likely have a diploma from an accredited massage school and have passed the MBLex. 

Accredited programs can be found in traditional community colleges, but there’s also a wide range of vocational schools. 

However, not all are accredited, so it’s important to make sure whatever program you enroll in is accredited.

A certified massage therapist (CMT) is one who has met the requirements of a private agency

California is one of the states without a requirement for licensing, but most counties require practicing massage therapists to be certified by the California Massage Therapy Council (CAMTC)

Despite not offering a government license, California is the third in the Burden of Licensing Requirements, following Hawaii and Nevada.

[Related: What’s the Difference Between an Independent Contractor and Employee in Massage Therapy?]

Which states do not require a massage license or certification?

In Kansas, Minnesota, Vermont and Wyoming, there are no state regulations for massage therapists. 

Minnesota and Wyoming have no state wide regulations for massage, nor do they have government or private organizations to oversee massage therapists who practice within their boundaries. Each of these states leave the regulation of massage up to individual counties.

In Kansas, practicing massage therapists must pass the MBLeX, but there’s no required documentation issued by the state. 

Vermont has no listed requirements and the purview of massage therapists is deferred to the Vermont Secretary of State, according to Massage Insurance Plus, an independent massage liability company.

lmt vs cmt in US states

Map of U.S. states where licensure is required. (Image by Nick Ng, via

What’s the difference between a RMT and a LMT?

The most obvious difference between registered massage therapists (RMTs) and LMTs is that registration— like certification—is also regulated by a non-governmental entity, but that’s where the similarity with certification ends.

In Canada, RMTs are federally regulated in some provinces and have a fairly universal standards of practice, which can vary among provinces. While many of these standards are common practice in many massage establishments in the U.S., they are formal bylaws in Canada.

Even though the RMT profession is overseen by its College of Massage, the Ministry of Health in each regulated province has the authority to review and make certain changes to the College’s regulations. 

RMTs have a similar scope of practice as LMTs in the U.S. and is defined by CMTO as “the assessment of the soft tissue and joints of the body and the treatment and prevention of physical dysfunction and pain of the soft tissue and joints by manipulation to develop, maintain, rehabilitate or augment physical function, or relieve pain.”

The biggest difference is that massage is universally regulated as a healthcare profession in Canada, which is something many therapists have been pushing for in the U.S. 

Massage therapy is currently regulated as a health care profession in five provinces,” said Bodhi Haraldsson, who is a RMT at PainPro in Surrey, B.C., and a former vice president of the Registered Massage Therapy of British Columbia (RMTBC). 

RMTs are held to stricter requirements than LMTs. Schooling in the U.S. is usually categorized in hours with the requirements ranging from zero in unlicensed states to 1,000 hours in Nebraska and New York

Haraldsson explained that in Canada, training is measured by months and requirements range from 18 to 36 months, or 2200 to 3000 hours. RMTs are not required to complete a specified number of hours, but all accredited programs will cover subjects like pathology, manual therapy, exercises, and home care prescriptions far more in depth than in schools in the U.S.

Just like in the U.S., other countries have their own set of requirements for massage and bodyworkers. In Canada, RMTs must meet the requirements of the province in which they intend to work.

Each province has its own College of Massage Therapists from which massage is regulated, and all practicing massage therapists must register with the college in their respective area:

  • British Columbia: CMTBC
  • Ontario: CMTO 
  • New Brunswick: CMTNB
  • Newfoundland and Labrador: CMTNL

Although these provinces do hold varying requirements, they all feed into the same general establishment allowing for similar requisites. 

Massage Continuing education

massage therapists taking a workshop CEUs

Jamie Johnston (RMT) and Marie Zahn (LMT) at Cory Blickenstaff’s “edge work” workshop in Victoria, BC., Oct. 2016. (Photo by Nick Ng)

Much like teachers, doctors, and other occupations with constantly evolving practices, massage therapists are often required to show proof of continuing their education. 

Continuing education courses are usually broken down into units (CEUs), and for those who wish to maintain their credentials, it’s often mandatory for them to complete a certain amount of CEUs within a defined period of time.

These are enforced either by the state or county; however, insurance companies like the one offered by the American Massage Therapy Association (AMTA) will compel the completion of CEUs in order for massage therapists to maintain their liability insurance, but some employers may require additional certifications to perform specific massages.

Requirements for continuing education vary just as widely as the legal requirements for licensing and certification. There’s no black and white answer because these variations are subject to state or territory.

Disclaimer: None of the organizations and companies mentioned are affiliated with Massage & Fitness.

Lindsay Jones massage therapist
Lindsay Jones, LMT
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Lindsay is a licensed massage therapist and a mother of three, who specializes in rehabilitation with emphasis on prenatal and postnatal care.

After graduating from the National Holistic Institute in San Jose, Calif., she went on to study how pain affects the body and how it can be alleviated during the constant changes of pregnancy and early motherhood.

In her free time, Lindsay has a deep love of all forms of art from storytelling and music to sewing and painting.