CE INSTITUTE LLC BLOG

• Four Seasons Hotel George V, Paris: https://www.fourseasons.com/paris/spa/
• Ritz Paris: https://www.ritzparis.com/hotel/paris/ritz-club-spa
• Claridge's Spa, London, England (pictured below): https://www.claridges.co.uk/spa/

Would you like to learn more about the practice of neuromuscular therapy?  Have you ever heard of neuromuscular therapy?  Neuromuscular therapy also known as NMT is hands-on soft tissue manipulation that helps properly align and improve function of the human body. While there are additional benefits, some NMT applications include client evaluations and much more.  Here’s and example:

Kyphoscoliosis is a combination of two different medical conditions that create a three-dimensional deformity of the human vertebral spine:

1. Kyphosis is an excessive forward or anterior curvature in the upper thoracic spine.
2. Scoliosis is an excessive lateral or sideways curvature of the spine, which would always affects multiple areas of the spine.

In neuromuscular therapy appointments, clients should complete a written client intake form or health history prior to hands-on bodywork. The client’s goals for their treatment should also be included during this client intake period, with reasonable goals set and mutually agreed.

After a provider has the client’s medical diagnoses in writing, they should then evaluate a client’s posture amongst other evaluation techniques to provide proper hands-on neuromuscular therapy treatment.  Hopefully, if you ever see an individual similar to the one pictured here, they would already have a kyphoscoliosis diagnosis so that a provider could easily communicate with the client about their medical condition. 

When a practitioner is not qualified to create a diagnosis within their licensed scope of practice, then they would not be able to diagnose or tell this individual that they have kyphoscoliosis. Instead, someone such as a massage therapist (LMT), physical therapist assistant (PTA) and others who cannot legally diagnose medical conditions would need to make a medical referral to a doctor for a proper diagnosis, if or when the client is unaware of their medical condition.

Kyphoscoliosis (or any spinal deformity) becomes easier to treat once a medical diagnosis has been made.  While working various spinal deformities are covered in our neuromuscular therapy courses, we are showing this example here for one obvious reason.  Do you see the shoulder bag on this individual’s depressed shoulder?  If you had a kyphoscoliosis client like this, which shoulder would you recommend they carry their shoulder bag?

The answer is this kyphoscoliosis client should be carrying their shoulder bag on their elevated left shoulder. Their left shoulder is elevated while their right shoulder is depressed.  That creates a lateral curvature of spine which is known as scoliosis, and almost always results with uneven shoulders and/or pelvis. Your goal would be to try to even the two sides of the vertebral spine to bring them anatomically level to one another.  So, while hands-on techniques such as myofascial release, trigger point therapy, deep tissue bodywork or massage therapy could help improve a client’s anatomical position, it would be difficult to maintain any improvements if a kyphoscoliosis individual spends their days walking around like this.

This is why it is critical in neuromuscular therapy appointments to review the client’s activities of daily living, workplace ergonomics, everyday lifestyle habits and more.  This can help you determine if they are doing something that could be harmful to their progress after they leave your treatment room.  Then practitioners can address harmful activities to help prevent a client’s continued digression.  Otherwise, a client might not feel that your therapy is effective or helpful when they do not achieve desired results.

Attempting to correct long term spinal deformities is extremely difficult. It is practically impossible to achieve structural improvement in cases such as structural scoliosis.  Functional scoliosis would prove easier to treat. Each individual and spinal deformity would have a different degree of difficulty or possibility.  A client’s activity outside of your treatment is just as important as the therapy provided inside of it.

If a client with a vertebral spinal deformity is in pain, then pain relief would be an obvious treatment goal.  However, treating the root cause of the pain would create longer lasting results which is why in this case here, we would want to try to even the shoulders into normal anatomical position, if or when possible. This could take years without 100% success.  In this individual’s case, we would consider any postural improvement to be a success and continued digression a possible failure.  Keep in mind that it is difficult in neuromuscular therapy treatments to determine when there is failure because the treatment could have slowed or minimized the client’s digression, and it would be hard to tell otherwise.  One indicator of success versus failure would be if a client terminated their neuromuscular therapy and then rapidly digressed worse than what was happening during treatment, then you’d both know your past treatment(s) were quite successful.

When providing neuromuscular therapy, if we learned our client was walking around with a shoulder bag on their depressed shoulder, we would want to immediately suggest to swap the bag onto their elevated left shoulder, or to not carry anything on their uneven shoulders at all.  We would educate the client that hanging weight on their depressed shoulder could create further depression and deformity, and work against shared treatment goals in neuromuscular therapy.  Although we do need to be a bit careful when making these recommendations because of our licensed scope of practice.  If the client wants greater lifestyle direction beyond a few tips, practitioners such as LMTs and non-autonomous nurses and the like should refer the client to the proper professional who can address any lifestyle improvements to be made as part of their licensed scope of practice.  There are specialty practices that can provide this educated direction.

We hope this visual and written explanation helps define what neuromuscular therapy practice could be for you, beyond the hands-on work itself.  To learn more as a licensed healthcare practitioner who is capable of performing evaluations and soft tissue manipulation, please visit and register for our neuromuscular therapy training at:  https://ceinstitute.com/collections/neuromuscular

How does your massage appointments compare to one of the most well known, upscale brands in the world?  See our Harrods experience below to compare for yourself:

Scheduling a massage appointment at Harrods was quite easy. I physically went to the spa to schedule and to see their facilities. They did not have a printed price list available. Instead, they had a QR Code that I could look up on my cell phone or they could show me the services and prices on their computer. I chose to book a 50-minute Aromatherapy Massage because it was only 10 pounds more than the regular massage price at one hundred twenty pounds in the year 2025. The attendant who scheduled my massage was very kind and patient. She additionally scheduled a salon appointment directly after my massage. She also wrote out an appointment card so that I could remember the appointment date and time. She underlined their phone number to contact in case I had to reschedule or cancel, and she took a 50% deposit on my credit card to hold the appointment.

I showed up two days later for my scheduled appointment and arrived thirty minutes prior to my appointment start time. Check-in for the appointment was standard and easy. I was directed to a small sitting area to wait for my therapist. The therapist pleasantly greeted me early with a smile and brought me to a treatment room with an electric massage table, chairs and waxing equipment. It was a little disappointing to see that the massage table had a hole in it for the face instead of a separate face crest to support the head and neck in pronated position. The therapist had me fill out a health intake form in the treatment room and asked if I wanted water. I accepted the water, and she brought me a bottle and cup while I was filling out my intake form. I wrote that I was seeking a relaxation massage, and the therapist stated she was going to choose the aromatherapy for me, although it was a little difficult to understand what she was saying because of her thick accent.  I asked her which aromatherapy oil she was going to choose from amongst her 4 preblended choices, and she said it would be rose oil for relaxation, which I accepted.

She then asked me to undress to my knickers and get onto the massage table face down. I undressed to my bottom underwear and covered myself with the extra-large bath sheet towel.  Surprisingly, I found the hole in the table where my head was acceptably comfortable when compared to other tables with holes for face rests. The therapist then re-entered the room and turned on the faucet and ran the water for a maximum of three seconds before it stopped.  She started her service shortly after that with hot towels on my pronated feet.  She then proceeded to provide gentle compressions from my feet to my upper back which included the back of legs, hips and full back.  She then performed a little bit of scalp work and some acupressure as well on my posterior cervical area. She proceeded to undrape my back for massage while I laid flat on the table, so I then asked her if she would please bolster my ankles for lower back support.  She quickly agreed and then physically left the treatment room, closing the door behind her to obtain a bolster.  Unfortunately, she was not prepared to properly provide essential bolstering throughout my massage appointment when she had to leave the room to obtain this vital massage accessory.

She re-entered the room within a short period of time, bolstered my ankles, asked if it felt okay, and then proceeded to my back massage.  The back massage initially felt like she was following or clearing meridian lines instead of Swedish massage.  After working both sides of my vertebral spine, she then proceeded into gentle and general massage work, including the traditional effleurage and petrissage Swedish massage therapy.  She checked in about the pressure of her massage almost 15 minutes into the session, and it was good.  The therapist performed very nice posterior cervical massage while I was pronated to finish the back massage.

The treatment room was extremely warm (at least 80 degrees Fahrenheit if not warmer), so during my back massage I asked her to expose my feet and lower legs to make it a little cooler, and she willingly and quickly obliged.

She then proceeded to undrape one posterior leg, then the other as she massaged each leg individually.  All of the work was good with light to moderate pressure as requested.  She draped the large bath sheet by tucking it into the side of my underwear to securely expose each posterior leg.  She then removed my ankle bolster as she prepared herself for supinated massage.

The therapist then lifted the bath sheet into the air, completely exposing me while asking me to roll over into a supinated position.  I rolled over and she placed the towel over my anterior body and a pillow under my head which was comfortable.  She then exposed one anterior leg and started her massage without bolstering my lower extremities again.  I asked her to place a knee bolster under my knees, and she again obliged, appropriately using the same bolster that had already been removed from under my ankles while I was in pronated position.

After each individual leg massage which was appropriately undraped then draped again, she massaged each arm, hand and fingers appropriately. Some of her "strongest" or "best" massage was then executed through the decollete and cervical area while pronated.  She finished the appointment strongly with a nice scalp massage.  Facial massage was not offered nor provided during this 50-minute aromatherapy massage appointment.  When she finished the appointment, she told me I could keep the bottle of water that she left on the sink counter and proceeded to leave the room.  She ended the massage pleasantly but before she closed the door behind her, I stopped her and asked if she could please wipe the oil off the soles of my feet given, I was wearing sandals without socks, and did not want to slip and slide in them post-massage. The therapist again complied and used a hot towel to remove the oil.

Overall, I would rate this 50-minutes aromatherapy massage appointment at Harrods 3.8 stars out of 5 stars.  It was a good massage but there is a significant rating reduction from 5 stars due to the lack of automatic bolstering, which could leave a client feeling less comfortable after their massage appointment than when they started.  The human spine is curved and physically stressed on a flat surface without appropriate knee and ankle bolstering while lying flat in both prone and supine position. The multi-purpose treatment room was not properly stocked when the therapist had to leave it during the service to obtain an essential massage bolster. The deduction from 5 stars continues for leaving heated wax pots uncovered during an aromatherapy massage because the wax odor overpowered the aromatherapy and cognitive olfactory senses. Significant deduction was created further when the provider applied oil to the soles of the feet and did not automatically remove it which creates a safety hazard for a massage establishment and client. The front desk staff, massage therapist and physical contact of the massage provider itself was very good and could easily receive five stars.

MASSAGE FACILITIES

The facilities upon arrival were clean, professional, almost sterile but very modern and beautiful.  I received the massage in an interior room with no window.  The bathroom was extremely clean upon my arrival and fairly filthy when I was leaving the facilities several hours later, after my massage and salon appointment when my services were concluded.  When I was leaving, one of the toilet stalls had a cone in the middle of it to prevent the overflowing water situation from being used or perhaps worsening.  There was trash on the floors in the bathroom which looked like it was not being properly maintained.  The handicap toilet stall appeared to have a hand soap dispenser on both sides of the sink which provides brilliant access to individuals with mobility issues. It also had a high toilet and low sink which is most appropriate and accommodating for handicapped individuals.  I did not see a shower, bath or extra facilities that are usually standard in an upscale spa or massage establishment. I did not change into a robe, and both dressed and undressed in the multi-purpose treatment room.

The front desk to schedule, check-in and check-out for the massage session was clean and fully staffed with pleasant and knowledgeable employees. The sitting area prior to the massage was void of complimentary magazines or reading material, snacks or beverages. There was a small food menu in the waiting area that was left out in the open without instructions. The menu required additional payment for their various offerings, and it was unclear how to exercise it.  It seems fairly awkward that a client would order a sandwich or salad from their massage therapist, which is the only person I saw or spoke to once I was seated in the waiting area.

Recommended changes for the facilities would be:

1. Have massage or bodywork recipients fill out their health intake form in the waiting area instead of inside of an overheated treatment room while sitting next to open wax pots with an unpleasant aroma. 
2. Cover the wax pots in the multi-purpose treatment room. This could reduce the temperature of the overheated room, keep the wax itself more sanitary and diminish some of the unpleasant aroma that the wax creates in that small treatment room.
3. Keep appropriate equipment and accessories in any room where they could be required.
4. Add complimentary snacks, beverages and reading material to the waiting area to create an upscale experience which is expected of Harrods' reputation. The extremely well staffed front desk could certainly attend to the sitting area with these added amenities to keep it upscale, tidy and organized.
5. Provide an appropriate tipping chart for service providers given English standards are different from American and perhaps other countries as well. In London's tourist district where Harrods is located, most of the surrounding businesses include a service charge but apparently Harrods did not.  Without a chart or recommendation, it's awkward and difficult to ascertain what would be appropriate or offensive.
6. Add separate face rests to massage tables for increased cervical or head support and comfort, instead of using tables with a hole cut out for breathing space and pronated position.  While it did not appear there was physical space in the multi-purpose treatment room to add length to the massage table with an added face rest, it would have been best to provide my aromatherapy service in one of the many empty treatment rooms that appeared to be available, especially if they were larger, had face rests and appropriate massage equipment or accessories to provide the session uninterrupted.
7. We do not recommend adding robe service or shower facilities to the appointment which would likely increase the cost of providing or paying for it.

HARRODS MASSAGE APPOINTMENT PROS:

• Caring compassionate contact by the service provider.
• Friendly and accommodating practitioner.
• Provided slightly greater time than the 50-minute advertised appointment.
• Hot towels were available and used with the massage service.
• The massage appointment was very reasonably priced when compared to other local massage establishments, and with the Harrods' name or brand behind the service.

HARRODS MASSAGE APPOINTMENT CONS

• Unpleasant aroma of uncovered wax pots overpowered the smell of the aromatherapy oil and appointment, and likely contributed to the overheating of the room.
• Large bath towel/sheel (instead of "regular"/larger sheet) draping created overexposure while turning from pronated to supinated position.
• Appropriate bolstering was not automatically performed nor readily available/prepared within the treatment room.
• Used oil to perform hand and foot massage.  Massage lotion or cream would be preferred for massage application in these areas.
• Did not automatically remove oil from soles of feet prior to table dismount which creates liability risk if/when client slips and falls.
• Facial massage was not included nor addressed by the service provider.
• Hand washing should be more thorough if the massage therapist's only hand wash prior to the appointment was the 3 second rinse that I physically heard.

Many pathogens including harmful parasites can be microscopic, meaning they are not visible to the naked eye. If your client suggests they have a new unknown itch or rash, it’s always safest to have them see a doctor prior to potentially spreading a harmful infection.  Working on a client with an unknown rash or itch is too big of a risk, given the practitioner could acquire the infection themselves and/or spread it onto other clients.  Even if a practitioner wears gloves, that is not good enough, because parasites or other harmful pathogens could spread into your treatment area causing further infection later on down the road.

Different parasites commonly harbor in different areas of the human body depending on which type of infection is present.  Some integumentary or skin infections may be more prevalent between the fingers while others may harbor in areas of where clothing meets the skin, such as underwear, shirt or pant lines.  Other infections might show a “line” of parasitic infection on human skin, such as what is pictured in this article on the individual's posterior lower leg. 

It is critical to conduct a proper and thorough client intake process before a client disrobes or infects your treatment space.  This would include devising your own written client health intake form for the modalities that you offer or practice.  Most liability insurance companies provide general client health intake forms for free to their customers, and then a practitioner can determine if that form makes sense for their practice, or if it should be modified for their own practical needs with legal counsel or other options. Once the client has filled out their intake form, practitioners should take notes of each treatment provided to ensure the client’s goals are being met for overall quality and improvement measures.  Upon each new client appointment, practitioners should then ask the client if there’s anything new since their last visit, and that is when a practitioner should be notified if a client has a new itch or rash.

If the client does not disclose a new rash or itch (that developed for an unknown reason) until they are on the treatment table, it is probably best to immediately terminate the session until a medical diagnosis is determined that it was not caused by something that could be contagious.  While that may seem inconvenient, continuing the session with a possible contagion puts everyone at higher risk and is ill-advised.

It is also important to prohibit clients from bringing their own linens, cushions and other fabric type items into your work space, given they can be difficult to sanitize and can also harbor harmful pathogens beyond our clients themselves.

CE Institute LLC has extensive hands-on home study courses for licensed health care providers to learn hands-on modalities from the comfort of your own home, at your own pace.  Login 24/7/365 until your course access expires to make training convenient and easy!  Please click the play button on the video below to see more:

One of the best ways to add and maintain loyal customers within your spa or massage business is to offer a membership program that provides exclusive benefits to people who pay a monthly or annual fee. Your business will continue to operate as usual for regular customers while your membership program generates a new source of income.

A membership program offers multiple products and customized experiences to your customers. This makes good business sense because when people have more options they will buy more. By making certain products and experiences exclusive to one segment of your clientele— your members—you will build customer loyalty while maximizing profitability.

People want to feel like they belong. They want to feel special. Your members will experience more services, products and support than when they were nonmembers. A membership program provides a sense of belonging while offering authentic benefits to members.

This is the purpose of a membership program: to increase customer loyalty and business revenue, while the customer benefits from enhanced care.

Management should be thinking of business tips to increase service values, business revenue and brand loyalty, all by offering a membership program. (While you are getting ready to launch your membership program, these ideas can be provided within your regular business model as benefits that are upsold to regular customers.) Making sure benefits are truly special will incentivize customers to join your membership program.

All of your guests should feel pampered; otherwise, you won’t attract or retain enough regular clients—nor enough potential customers to join your membership program—so the benefits you provide should stand above and beyond standard items offered to all customers, to justify becoming a member.

Build a Membership Program

Building a membership program is not a one-size-fits-all experience. Determining which benefits you will offer will be entirely customized to each business’s capability, staff skill levels and licensed capabilities, space limitations and budget.

All businesses should capitalize on any perceived benefits they can offer to their customers. Therefore, one goal of your membership program is to use and maximize what you already have in order to generate added value.

A membership program is an opportunity for a business to highlight its specialties, whether onsite perks, retail or massage-tools investments, exclusive treatment spaces or appointments, or such staff competencies as chair massage, reflexology, aromatherapy and mini treatments that could be included in standard business, or treatments that are only available for special clientele.

To determine if a membership model is a good fit for your business, you can engage in beta testing by asking some of your most loyal customers to trial a membership program for free or at a reduced price. If the program is a success, those customers could be offered a founding-member reduced rate to join your membership program. If the beta test is deemed unsuccessful, this presents you with the opportunity to make changes to the program.

You can start with one level of membership as a trial. When the membership program begins to grow, additional tiers of membership benefits could be offered along with an increasing tiered price-point. 

This is how this works, as one example: A member at tier one receives five basic benefits for $20 per month while a member at tier two receives five basic benefits plus five enhanced benefits for $35 per month.

Once existing business practices and services are recognized and translated into member benefits, then owners and management can get creative and think about additional benefits that can be added to the membership program. In evaluating how to add benefits, it is important to review past successes and leading business models.

To learn more, please register for live business training at our school where you share in questions and answers with a live instructor at:  https://ceinstitute.com/

How a business charges for membership will be entirely up to ownership and/or management. There are many unique factors that must be evaluated, and there is no one national business model that fits all practices.

It is not within the scope of this, or any, article to tell someone how much they should charge for membership because this charge—as with any service or product you sell—is determined by each unique marketplace, treatment space, and staff abilities. There is no one correct formula that can be applied across all healthcare, massage and/or spa establishments. Expecting someone to determine your business’s price points and benefits without an evaluation would be like asking an appraiser to price a home without looking at the home or marketplace!

The author of this article does not offer or sell any type of business marketplace evaluations; in fact, we recommend owners evaluate their own business rather than hire someone to conduct an evaluation because a business owner—you— will understand your own business, marketplace and customer base best, more so than any expert who would have to do copious amounts of research to learn the same.

Different marketplaces and skill levels will command different price points. Some business markets are seasonal, some are saturated, and some are void of competition. The evaluation criteria are endless and must be considered for accurate business direction, especially with business offerings and price points.

As many as 95% of new start-ups do not make it past their first five years of business. Many times those failures are due to poor planning and improper evaluation of the business’s unique abilities and situation.

Also, a successful business model cannot always be copied and applied to a different or new business with hopes of similar success. Each business and marketplace will have its own unique criteria to consider when determining operations.

That Said, Consider These Pricing Models

That said, things to take into consideration when setting your membership pricing, as well as the member-only special fees for services and products you set, include competition pricing in your locality, as well as customer-perceived value for the services and products that will be included in the membership.

Customers should feel like they’re getting something extra when they’re paying extra, and it will be up to the business ledger and customer feedback to determine when an appropriate balance has been achieved.

 The Price-Per-Session Model

One option to consider is the price-per-session model for a membership program. This is the model national massage franchises use.

This is how it works: You charge a certain price for a one-time appointment. For the customer who commits to receiving a set number of sessions per month as a benefit of your membership program, each per-session price is lower than the usual price.

For example, if a member pays $100 for a monthly membership that allows them to pay up-front for three massage sessions to be used within one month at a cost per session of $125 instead of the usual $150, they save $75 per month. Additional perks and benefits of membership will more than make up for the additional $25 paid for a monthly membership fee.

This model incentivizes a customer to join your membership program, which provides a reliable stream of income for your business, while the customer enjoys a discounted rate and benefits from regular body-care sessions.

The Annual Pricing Model

Consider providing a discount if a customer pays for membership for a year in advance versus paying a monthly membership fee.

Some customers might look at an annual membership payment as an excellent way to support your business while also saving money. A 15% savings is an appropriate amount for this discount.

This is how it works: Let’s say your membership program costs $75 per month. That equals $900 per year. 15% off $900 is $135, so a member who pays for an entire year of membership benefits upfront pays just $765.

To learn more, please register for live business training at our school where you share in questions and answers with a live instructor at:  https://ceinstitute.com/

VIP parties are a way to build on the feeling of belonging and specialness a membership program provides, or to simply recognize valued clients. Your party could be exclusive to VIPs or members plus their friends and family, to show others how good membership feels. Or you could host a party for all of your customers, with an employee on-site to sign up new members, and a separate area dedicated to a members-only lounge featuring free 10-minute chair massages or foot reflexology sessions, door prizes and catered snacks.

Use these types of events to recognize your valued customers, promote a membership program, gift certificates and mini-sessions, sell products at a special discount, and introduce guests to services they might not have booked before.

Consider holding a members-only party centered around retail products, such as a make-your-own hand scrub event or an educational event on how to properly use a motorized body brush—and then sell retail items members can take home.

Another type of event is to allow a vendor to host a demonstration for your members to gain exposure and sales while you profit from renting space to the vendor and members benefit from learning something they can use, such as the use of a new product, self-massage or meditation.

 For any type of event held in your business, post an employee at the door to have all attendees sign a waiver allowing photos and video of them to be taken at the event and posted on social media. Use your social media channels to show the world how you appreciate your customers and members. Social media is a great way to increase business exposure with minimal effort and expense.

To learn more, please register for live business training at our school where you share in questions and answers with a live instructor at:  https://ceinstitute.com/