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Acupuncture and massage on injury logs

Summary A safety professional asked whether back cumulative trauma was an illness or injury and when acupuncture or massage made a case recordable. OSHA classified back cases as injuries, treated acupuncture as medical treatment, and treated massage or reflexology as medical treatment on a second or later medical visit. OSHA archives the letter and warns it may no longer represent current policy.
Document
Federal opinion letter
Agency
Occupational Safety and Health Administration (OSHA)
Document number
1993-10-28-0
Date issued
October 28, 1993
Status
Archived by the agency
OSHA labels this an archive document and warns that it may no longer represent current policy.
Status last verified October 9, 2026

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OSHA labels this an archive document and warns that it may no longer represent current policy. It may no longer reflect the agency's current position. Treat this page as historical context, not current guidance, and verify current law before relying on anything here.
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NOTICE: This is an OSHA Archive Document, and may no longer represent OSHA Policy. It is presented here as historical content, for research and review purposes only.

October 28, 1993

David F. Coble, MS, CSP
Vice President, Safety ELB
[Recipient address omitted]
Dear Mr. Coble:

Thank you for your letter dated September 27, requesting an interpretation of several OSHA injury and illness recordkeeping issues. I will respond by first repeating each question then addressing it. Whenever possible I will reference the Recordkeeping Guidelines for Occupational Injuries and Illnesses by stating the page and Q&A numbers.

Q1 If a doctor diagnoses "cumulative trauma of the back", is this an illness or an injury?

A1 Back cases should always be classified as injuries and are recordable if they meet the injury criteria. This generalization was made to keep the recordkeeping determinations as simple and equitable as possible (page 38, Q&A D-4).

Q2 At what point does acupuncture and massage treatment become recordable?

A2 Any treatment of acupuncture is to be considered medical treatment for OSHA injury and illness recordkeeping purposes. It is generally performed to relieve the discomfort associated with painful disorders, requires a high degree of skill since it involves piercing specific peripheral nerves, and cannot be performed by a lay person.

For OSHA injury and illness recordkeeping purposes, massage therapy is evaluated as a form of physical therapy. Physical therapies are considered medical treatment only when they are administered on a second or subsequent visit to medical personnel (page 43, Guidelines).

Q3 At what point does a treatment called "reflexology" become recordable?

A3 For OSHA injury and illness recordkeeping purposes, reflexology, defined as a form of massage therapy to the feet, is considered medical treatment when performed during a second or subsequent visit to medical personnel.

I hope you find this information useful. If you have any further questions, please contact us at Area Code (202) 219-6463.

Sincerely,
Bob Whitmore
Chief
Division of Recordkeeping Requirements

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