CE INSTITUTE LLC BLOG

Have you ever wondered where spa’s come from?  Who thought of this concept?  When? How? Why?  Modern day spas today are most closely related to ancient Greek practices with an eventual Roman evolution of bath houses from thousands of years ago.  Our earliest known spa use is tainted by muddled history stories, with whatever evidence feels strongest for one to follow or believe. 

In ancient Greek and Roman times, bath houses were frequented amongst multiple classes of society. While the wealthiest may have had a private bath within their own home, they would still frequent the public bath houses as a way of life. They were places for recreational, health and social activities, in addition to the most obvious use of bathing for personal hygiene and sanitation.  

Detoxifying and Vasoconstriction with a Cold Plunge and Contrast Baths at the Spa

Did you know that Roman bath houses had different baths, usually at different levels and with different temperatures? Public bath houses could be heated with fire under the floors, and cold baths or cold plunges would usually be the lowest level of the bath house, where they are dug deep into the ground to preserve a chilly temperature.  

So, while today, cold plunges are all the rage as it can vasoconstrict soft tissues which helps eliminate waste products held within the body in an ultimate detoxification, it’s likely this cold plunge process started in Roman public bath houses, with its multi-temperature baths which would also known as contrast baths. An ancient Roman bath house is where these multi-temperature baths were collected and housed or used together in one establishment.

Muscular Soft Tissue Healing, Recouperation and Vasodilation at the Spa

Today’s modern day spas will offer a variety of bodywork and massage services that will manually increase circulation whether it’s pressing the soft tissue to create an ischemic effect, then releasing the soft tissue which will in turn produce a resurgence of blood and nutrients to the affected area.  This increases circulation and all the riches of newly oxygenated blood to an area for increased cellular metabolism and healing.  By contrast in ancient Roman bath houses, participants would exercise in a yard or dedicated area to sport to increase their circulation.  

We have gone one step further today by creating machinery and electrical devices to increase circulation within the spa business.  This is anything between pressotherapy garments that even hospitals use, with air pressurized balloons gently squeezing the soft tissue then releasing it, which will help increase cardiovascular circulation as well as help prevent blood clots if an individual is sedentary.  We also have massage chairs that we can sit in to help increase circulation with pressing and releasing soft tissues, as well as hand held devices and much more.

Do Any Ancient Spa Establishments Still Exist?

Yes, many old bath houses which might also be known as the world’s first spas still exist, although most fell into a period of disrepair until being rehabilitated or repaired for mostly tourism attractions today. For example, it’s the Musee de Cluny at 28 rue Du Sommerard, 75005 Paris, France which is the ancient Roman spa that is mostly pictured throughout this article. 

Today’s modern Paris Museum which is called the Mussee de Cluny was built on an approximate 2,000 year old ancient Roman bath house which was actively used for approximately 200 years. The museum’s curators suggest that any Roman city conquered was fairly worthless without a set of Roman baths, and in this particular area, there were three of them.  The bath house we have pictured throughout this article at the Musee de Cluny was the center of the area’s social activity, where people came to relax, exercise, have their hair cut and read.  Some ancient Roman baths had a public library. That’s fairly similar to what is practiced today, where magazines and travel books are shared common fare in a modern day’s spa reception area.

The Musee de Cluny’s ancient Roman bath or spa was split into three different levels.  This included an area deep underground, where hydraulics and drainage were routed.  

The ground floor entrance was an open exercise area.  This ground level area consists of both indoor and outdoor rooms with more rooms above.  

The museum curators suggest that bathers would start at the bath house with a hot bath, which was also called the caldarium. Then bathers would move onto the warm baths with tepid water in a tepidarium.  The last place the bathers would go in their spa ritual would be the frigidarium which is also known as the cold room.  

The Archaeological Crypt from the Ile de la Cité, just in front of Notre Dame Church, has another ancient Roman Bath in ruins available for public display with the purchase of a ticket, similar to how one would view the Musee de Cluny.  The crypt's Roman bath was believed to have been in use until the 4th century. Below shows a map of how this 2nd Roman Bath was configured. 

The following video without narration shows the Roman bath ruins that were buried for centuries and recently unearthed between 1965 and 1970 at the Archaeological Crypt from the Ile de la Cité.  The map showing above is flipped or in reverse to what will be shown on the video below, so the video starts at the left of the unearthed baths and starts with the entrance, then leads to the frigidarium, them moves on to the tepidarium and ultimately ends in caldarium.  

There are many other spas or bathing houses throughout the world that still remain, some in better conditions than others with one of the most popular being “Bath” in Somerset England, where many have gone throughout time to “take the waters.” And pictured below is a peasant spa in Yugoslavia where public bathing and cupping was practiced for health around the 1900s.

The oldest spa in the world may be in Pakistan which is dated back to 2500 BC, approximately 4,500 years ago.  But the truth is, we may never know where the oldest spa originated given volcanic eruption, time and dust has covered most of the earth’s surface as well as the loss of areas due to sea erosion and more.  What we do believe is that the ritual of spa is a centuries old practice that has evolved into a wonderful modern day marvel that continues to restore health through the ages.

By: Selena Belisle, Founder/Instructor, CE Institute LLC. The images included in this article are stock photos and not from the spa itself because they prohibited photos to protect client privacy.

The following information is a professional evaluation conducted of an add-on facial service provided in London's hotel spa luxury market.  It is our hope in sharing this one-time experience that both practitioners and business owners can learn how to maximize operations with add-on services, such as this mini facial appointment example: 

From a business perspective, providing add-on services should not just be about scheduling extra services for extra income. That would be an extremely narrow view of such a wonderful business opportunity.  Add-on services also diversify a practitioner’s work, sometimes exposing practitioners to new clients. Other times you might expose clients to new products that are used during the add-on.  Clients may be exposed to a mini-service with the add-on, and then upgrade or rebook for the full service as well.  So, there is a LOT  potential to be had with an add-on service, but it’s up to each individual spa or massage establishment business to offer or maximize it.

Most establishments enjoy an approximate 100% mark-up on spa products.  They might pay $20 for a product and then retail it to customers for $40.  Retailing products is a wonderful method to increase income without much effort.  Providing add-on facial services to massage and bodywork appointments is a wonderful way to increase income both through added service, potential service upgrades and rebooks, and with retail potential income as well.   Of courses massage therapists and bodyworks should not provide esthetic or facial services without proper training and licensure.

What we have found is there are some who provide add-ons like the service I had at this establishment, the YĀTRĀ Urban Spa at Montcalm Royal London House. But the potential of this extra business is minimized when extended services or retail are not offered with it.  Service providers should be compensated approximately 10% of the sale price on average with retail sales, so it is in their financial interest as well to provide retail sales suggestions with their services.  Plus, massage therapists, estheticians and other personnel are usually paid a commission of each service, so it’s in the practitioner's best interest to suggest to upgrade to longer and greater services when they have the time to do so, to continue to maximize their income while at work.

Regardless of all of this added business potential, this was my personal experience at this London spa with my Radiance Lift add-on. 

The Radiance Lift add-on was advertised as a "kombucha-infushed sheet mask" and showed a picture of a face and facial sheet next to the service description. Applying these facial sheets only takes a minute or two at most to apply. I was curious what the spa would do for the remaining 14-minutes of this appointment so I booked it! The service provider will usually just pull a sheet from an enclosed source and place it over the client’s face, to their comfort level.  Almost anyone can place a facial sheet over their own face, but regardless of applies it, allergies or other contraindications such as skin burn, rash, etc. must be considered first.  This is why the practitioner must be properly trained to provide this service.

To my pleasant surprise, no facial sheet was offered, but a mini facial was provided instead.  I didn’t ask why they didn’t provide the facial sheet as advertised and prepaid for.  The entire spa service provided was not a great experience, and I did not want to add to the negativity by asking or pointing out that what they were providing was different than what I had scheduled.  In reality, I was thrilled to receive the mini facial instead of the facial sheet application that I had already paid for. 

If the massage therapist who provided the mini facial performed a skin analysis, she did so silently, without questions, so her analysis was incomplete at best. The reason why you want to ask questions if I do have some red tones in my skin, and if I had exfoliated that morning, then a service provider would not want to provide a double cleanse or exfoliation within a few hours a later.  That could result in a medical error with skin burn or other soft tissue damage. Her mini facial was provided in the following order:

She started with a facial cleanse which was wonderful and then ended with wiping the cleanser away with a cold towel while standing on the side of the table which was awful.  The spa establishment was unaware and not prepared for the facial add-on which I had scheduled and prepaid the day before this appointment, so I’m not sure if their hot towel cabi or hot water was broken; however, cleanser should be removed with a  warm to hot towel to open the skin’s pore for a greater cleansing effect when wiping the skin.

She repeated a second cleanse followed by another awful wipe with a cold towel.

This was followed by a wonderful facial massage, when she later told me was a facial oil when I had asked her what it was after the service had concluded. A third cold towel wipe of this facial oil was used with poorest skill level of all.  After wiping my entire face, the towel was not adjusted so the dirty area of the towel that had just wiped my face was now applied to wipe over my eyes. As a trained and licensed esthetics instructor myself, this disgusted me and made my eye area feel dirtier than when the facial service started.

In professional spa services, a new towel should be used after every step as well.  In this service, I’m not sure if she used a new towel with every wipe, but it did not feel like it.

Toner was applied next with what felt like some form of cotton, in a manner that could have been improved.  At least I think it was toner.  I would have to guess because she did not tell me what she was using nor doing, and I did not ask her so that I could evaluate her service as she provides it, instead of possibly making her nervous with questions or giving suggestions on how to improve the service through questions, etc.  The contact between the cotton and skin was firmer than necessary, and the order to which the cotton was applied to the skin was erratic.  She moved between my cheeks to the forehead to the chin and other areas in a nonsensical order that I have never felt before and simply felt like a misapplication. A more standard application of cotton to the face would be working upwards, downwards or laterally, with working upwards the regularly preferred method with facial services.

I believe the therapist finished with dabbing moisturizer on my face.  The beautiful massage strokes she used with the cleanses and facial oil were gone, and a rougher quick spread of product across my face was applied instead which was an extremely unpleasant finish after the cold towels and inappropriate use of cotton.

This practitioner provides incredible massage strokes and has beautiful hands. She would likely benefit from another practitioner emulating what it feels like to have a cold towel, too much pressure with cotton and a rough moisturizer application on her own face, so that she could learn from this and know from feeling it that those steps can be seriously improved.  However, in the end, human services are usually a personal preference, and what I enjoy, another may dislike and vice versa.  However, after decades of education, personal practice, employment, employing others and teaching these types of services, I believe I have a reasonable opinion of what the general population likes or expects with this type of service, and these are my opinions.

I do not know if this spa establishment offers retail skin care products.  I did not see any publicly available in a very small and sparce reception area of one of the nicer hotels in London.  If the spa does not provide retail, then they are missing added potential business income in addition to not providing the best service of all to a client.  With facial services in particular, we would want a client to be able to continue with appropriate facial cleansers, exfoliators, moisturizers and other specialized requirements for ongoing skin improvement and glow. If a client purchases a retail product that is only available at your establishment, and if they like the product because its providing results, then the client may have to return to your establishment for more product when they run out, which could result in additional scheduled services upon their return with other greater business opportunities.

We do not recommend substituting services without a client’s knowledge or consent, like what happened with this service at this establishment.  Every business, as some point, will usually run out of supplies.  Sometimes manufacturers discontinue products and there also can be supply shortages, shipping issues and other problems.  The reason why it’s important to gain the clients’ consent prior to altering their service regardless of the reason is a provider may complete an altered service, and then the client has the right to request the service they paid for, which means you could provide an alternative service without payment if consent was not acquired beforehand.  It is our opinion that clients do not have to pay for services that were provided but not scheduled.  We believe substituting services without a client’s consent, whether it’s prepaid or charged after the fact, could be seen as a fraud upon the client, which is usually illegal, or criminal is US based practices.  So, I believe the massage therapist ran the risk of providing this mini facial service for free, if I had requested the paid Radiance life appointment I had scheduled afterwards.

I do not enjoy writing critical reviews that point out poor skill level and execution; however, it is written for our students and other practitioners to learn from, because we often do not see constructive criticisms like this in writing.  We wrote this analysis here solely for our school’s teaching purposes where our students can hopefully learn from this experience and use it to improve their own services.

By: Selena Belisle, Founder/Instructor, CE Institute LLC

We are utilizing stock images in this article to help define regular facials and mini facials; however, many of the images do not depict appropriate eye protection.  When cleansing, exfoliating, masking, etc., the client should have cotton eye pads over the eyes to help prevent skin care products from entering or harming the eyes.

A mini facial is usually an abbreviated service of a regular full facial.  It might only include a few steps of a full facial service to:

• Save time and provide a shorter service when greater time for the full service is not available
• Provide a more economical service option to the client
• Use as a paid advertising option to get clients on the table with hopes they will upgrade to the full service once they start to experience the steps
• Provide as an alternative service is a client is contraindicated or cannot have the full facial service, such as:
  • when a practitioner is fully booked and the client is running tardy
  • the client cannot receive certain aspects of full facial service such as they had:
    • a recent exfoliation
    • facial radiation oncology treatment
    • other contraindications

Full facial services are usually between 50-60 minutes long, with luxurious or specialty facials reserved for 80-90 minute services.

Full Facial Services Usually Include Any Combination or Multiplication of the Following Steps:

1. Professional Skin Analysis Including Oral Intake & Questions
2. Cleansing, including manual, brush, machinery and other methods.
3. Exfoliating, including manual/mechanical, chemical, machinery and other methods.
4. Toning, including spritzing, wiping, atomizer
5. Steaming, and other steps and applications to open pore for deeper cleansing
6. Extractions, including manual extractions and using tools to provide a deeper cleaning of the skins pores
7. Electrical applications for various purposes
8. Machinery applications for various purposes
9. Masking
10. Massaging
11. Serum applications of many different varieties and uses.
12. Eye cream applications
13. Moisturizing
14. SPF application for daytime appointments
15. Steps may be deleted or added upon at a service provider of establishment's discretion

Facials with greater steps or additional products including tools and machinery than what is listed above might qualify as a specialty facial instead of what’s considered to be a normal or regular facial service.

Mini-facials can be provided in a multitude of different methods or steps which can  include any of the following:

1. Cleanse
2. Tone
3. Moisturize

1. Double Cleanse
2. Tone
3. Moisturize

1. Cleanse
2. Tone
3. Massage
4. Moisturize

1. Double Cleanse
2. Tone
3. Massage
4. Moisturize

The Following Alterations Could Made to the Suggested Mini Facial Routines Above

• A facial masque could be substituted for the massage.
• An exfoliation or exfoliating cleanse can be substituted for the 2^nd cleanse instead of a double cleanse. 
• Serums, eye moisturizer and machinery services that are quickly applied can be added as well.

All facial services regardless of length should always be subject to a professional skin analysis to ensure:

• appropriate products are used
• avoid allergens  
• accommodate precautions
• learn of contraindications
• meet client goals

Mini facials can be executed somewhere between a 10-to-30-minute service, depending on how many tasks are performed.  We believe a decent mini facial would take approximately 20 to 30 minutes for the best efficacy and experience. Regardless of how long you offer your mini facial for, the time should be advertised similar to massage therapy appointments, so that a client is not upset if they feel the service should have been longer than what was provided.  It’s difficult to start a mini-facial over again after the client has already been moisturized. We want to avoid negative experiences as service providers, nevermind the waste of moisturizer or products when identical steps must be repeated to correct a problem.

Licensed service providers including estheticians should develop a working relationship with a professional skin care brand where they can develop reliable use and application of known products, and then retail those products for at home use and continued client benefit.

I sought a walk-in foot reflexology appointment at an eastern influenced Reflexology establishment in Paris.  Upon entering, one of the first things I saw or realized was that it was the cleanest, most sleek or professional in appearance when compared to our similar establishments in ANY country. They provided open services which allowed a greater amount of clients to be served than an establishment that has set up private treatment rooms instead.

I was seeking to analyze various eastern modalities practiced in European cities and this experience did not disappoint.  By its own standard of eastern Tuina practice, it was likely the best reflexology asian fusion appointment I have ever experienced which I found in a small establishment in the southside of Paris.

They had a variety of appointments available which included both Reflexology and Tuina, with a small retail area on shelves. The different appointments, time-lengths and combinations provided busy tourists and walk-ins appropriate options to select or more importantly upgrade into longer services.  So they have maximized their business opportunities with the available space, which was good to see the excellent forethought in this establishment. I speak a little bit of Chinese from my time studying at the Beijing Massage Hospital in China, so I engaged the women in Chinese and they were pleasantly surprised to hear my attempt at their language as an American tourist in Paris. All of the women appeared to be extremely well trained Tuina practitioners of Chinese descent. This was my opinion from viewing their methodical hands-on application which was continued effortlessly and without missing a beat regardless if they were directly looking at their work, or the walk-in patrons.  Their speed, thoroughness, anatomical foot movement with joint mobilization and other professional anomalies exposed their expertise.

The practitioners gaze up from their work as new potential patrons walk-in on the busy streets of Paris, to welcome them and encourage them to enter for service.  In most Tuina establishments, client privacy or speaking to others while providing open services is normal, despite it not being or feeling the most professional when providing a one-on-one medical or massage service, especially to a client who is used to more discreet western practices.

At first, I attempted to book a 60 minute service which would include 30 minutes foot reflexology and 30 minutes tuina. The Tuina was defined or explained as body massage on their service menu with pricing.  I was told they had availability for my appointment and they asked me to sit in one of the relaxing chairs next to other customers, and then I waited for a period of time while the providers continued to work on other clients who had arrived and started service before me.  Pictured below is what I would consider a relaxing chair or lounge chair which further reclines for client comfort.  Relaxing chairs allows access points to a client from three different positions for massage therapists, reflexologists and other service providers:

1. Providers can sit in front of the client to work the feet and lower extremities.
2. Providers can sit to the sides of the client to work their hands and upper extremities.
3. Providers can sit or stand in back of the client to work the head, neck and upper torso.

After sitting for a considerable period of time waiting, I told them I had another appointment and would only be able to do the 30-minute reflexology due to time constraints, and the woman who appeared to be running the front desk then went and got a bucket of tepid water lined with clear plastic for a foot soak and placed my feet in it.  This plastic should be replaced between clients for sanitation reasons.

When I put my feet in the soak for my 30-minute appointment, I wondered how much of my 30-minute appointment was going to be spent in the soak after already sitting there for so long.  However, the manager immediately proceeded to the back of my chair and started a dry facial tuina application.  After putting my feet in the soak she had then left to go wash her hands, so I thought I was going to be left there sitting again as I had watched some of my staff treat clients. Instead, I was very happy to see that my time in the soak would be spent with an upper body massage.  The manager started with facial massage in clearing my 3rd eye and worked her way superiorly to apply quick pressure and stimulation on various meridians throughout my scalp, around my ears and continued posteriorly and inferiorly to my cervicals.  She used extreme pressure through my masseter and buccinator muscles, all through touch and feel given she was standing behind me and could not see what she was touching from behind the chair.  She continued to use the bony landmarks of my face to start and finish different strokes while my feet were in the soak. She then turned my head to one side and then the other, as she applied grasping techniques from my upper to my mid-back, reaching between my soft tissue and the chair as she worked superiorly to inferiorly down my erector spinae muscles.  It was all completely wonderful, and a real bonus to a 30-minute reflexology session.

Once she finished with my upper body massage and foot soak, she removed the bucket of water and sat in front of me. She then applied baby oil to one lower extremity and foot.  While Tuina or reflexology would usually be applied without a massage medium in China, baby oil is typically used in establishments outside of China for its excellent glide, including on the palms of hands and soles of feet, plus its inexpensiveness.  My provider's initial application of her reflexology felt like I was going to receive Tuina on my feet instead of a reflexology application; however, when she started manipulating around my toes with excessive pressure, I asked her to use less pressure and she then said she was working around my ear reflex points, so that helped me realize and differentiate that she was truly practicing reflexology with what felt like some sort of Tuina influence.  The following are some notes of this foot reflexology session from an obvious Tuina expert practitioner:

1. There was no care working around broken toe joints.  I have several broken toes and some of the joints have started to fuse with the fractures; however, this therapist manipulated those long-time broken joints with force and without hesitation which made me nervous; however, no harm was done, and it does seem like my toes feel and move a little bit better with this manipulation too. In American application, if we manipulated similarly and accidentally damaged or broke a toe joint with such force, we'd likely be sued and find ourselves as a defendant in court.

2. She worked one foot at a time and didn't wrap the second foot while working on the first or vice versa.  The other providers in the establishment did, which was good practice and what we teach here at our school.  I believe the manager working on me might have been a bit out of practice with client comforts, and performed the appointment herself when all of her other staff were busy, and I had already waited an excessive period of time for my appointment to begin.

3. The practitioner used excessive pressure where it felt like a 10 VAS Score.  I repeatedly asked her to use less pressure, which was sometimes followed for about 10-30 seconds before excessive pressures resumed. In America, it is considered unethical to ignore a client's request or direction for legitimate therapeutic service, and could also have greater consequences if a client is injured after not appropriately adjusting to a customer's request.

4. After approximately 10-minutes instead of the foot reflexology session on just one foot, I started feeling euphoric.  It felt like channels of energy within my body were awakened with good spirits.  It's hard to put it into words beyond simply stating that I overall felt better health, despite the excessive pressure being applied to my feet which was quite painful. It is typical in western or any application to feel better during reflexology, massage or other bodywork during and after service.

5. Approximately 25-minutes into my 30-minute reflexology session I felt an overwhelming feeling of nausea.  I have taught and practiced reflexology for decades, and while I had never personally experienced this feeling despite receiving hundreds of reflexology sessions myself, I did have my first experience with it during this appointment and it was overwhelming.  It is possible that I could have felt nauseous with or without the reflexology application and we'll never know otherwise.  It's so irregular amongst recipients that it's hard to say nausea could be a reflexology side-effect, and while it is rare, it has been repeatedly reported throughout the years.  I simply allowed the reflexology to continue and the feeling eventually subsided.  In an western reflexology application, I might continue the reflexology for a few minutes similarly.  If a client starts to rapidly deteriorate during reflexology, I would immediately stop and seek appropriate medical attention.  But in this case here, the nausea became an afterthought that I had forgotten about once I stood up, until I wrote this article. I never mentioned my feelings of nausea to the practitioner due to our language barrier, and I was more focussed on trying to help her understand my need for less pressure, nevermind the new feeling of nausea!

6. During the reflexology application, I couldn't help but notice the poor ergonomics of hand, finger and knuckle use, which includes pressing into soft tissues which puts excessive pressures on a practitioner's joints.  Unfortunately this is mostly unavoidable during reflexology practice, unless you use a tool which we also do not feel is appropriate.  Foot reflexology application is not appropriate work for any practitioner who is experiencing pain, arthritis or other medical deterioration of joints of the hand, regardless of your training, practice or background.

7. On a more positive note, the practitioner did move my foot around in many to many different angles with her continuous application.  I personally usually just leave a foot in its normal anatomical position and work around the foot as it lays.  After viewing this methodical alteration of foot positions, I may start new reflexology routines here at the school in which more vigorous repositioning of the foot for different access is applied.

8. In this reflexology application, the practitioner worked the lower extremities in addition to the feet which we feel is acceptable and good practice when the provider has time.  The most important focus would be spending the majority of the appointment time stimulating the reflex points though, which this practitioner did.

9. This reflexology application was laser precise, thorough and fast.  I thought I worked quickly and recommended students to not exceed the speed of my application; however this practitioner was even faster than I am with her stimulation of points which is surprising.  I had doubted true reflexology's effectiveness when points are merely quickly passed over with stimulation versus purposely applied with greater intention and time. This quickness and speed seemed effective by this extremely experienced reflexologist.

10. Her foot reflexology application was similar to what we teach in regards to the different areas and thoroughness of the foot which receives various strokes and stimulation.  While the speed remained quite fast throughout, she did use simultaneous and alternating strokes similar to how we apply reflexology with both hands over an individual foot.  Even the knuckles are used singularly for stimulation and simultaneously, similarly to how we teach to apply our foot reflexology lung press here at the school.

11. The reflexology application included pinching, pushing, striking, rubbing, pressing and other soft tissue stimulation applications. There was practically no gliding which we teach to help relax a client, with the exception of a very fast application of gliding strokes which almost amounts to friction, when she used the heel of the palm over the lateral dorsum of the foot.

12. Probably because baby oil had been applied, she finished her service on each lower extremity by taking the paper towel from under my foot and using it as a barrier to massage my lower leg and foot with various compressions which felt quite nice. These compressions with the paper towel allowed most of the oily residue to be removed. When she removed the paper towel from underneath my feet which was placed there for likely sanitation reasons, it left my feet directly on a red towel.  I am concerned about the reuse of these red hand towels from one client to the next.  Linens such as these with direct client contact should be laundered between clients and not reused.

13. While we do love utilizing relaxing chairs and offering open services which maximizes establishment service provider space, in this particular case the setup hyperextends the client’s knees (seen in the picture above) which we do not feel is good practice, and in some cases, could leave a client’s knees feeling worse than when they started. I am only 5’4”, and every client who was taller than me suffered the same joint hyperextension. This can easily be adjusted by properly bolstering the knees with some type of support such as a professional bolster, pillow or rolled towel.

14. The 30-minute reflexology session was completed with very significant and hard striking tapotement, where practitioners raised their hands high in the area and then struck the lower extremities, in addition to using force with their strikes, including pounding the calcaneus of the sole of the foot with their fists.

When I stood, the first thing I noticed was how light I felt. It felt like I had lost 50 pounds! There was a certain lightness in my feet where my legs didn't feel heavy, which was an unusual feeling after spending so much time walking through Paris, seeking places like this one. Any feeling of nausea had dissipated and was forgotten.  The next morning, I did have some soft tissue soreness in some areas of the feet, where they had likely been overworked with too much pressure, however I would not call it significant pain.  My feet still felt great but the obvious feeling of lightness no longer remained.

What was nice to experience in Paris with this European influence on reflexology service provided with eastern influence was slightly better sanitation and visual esthetics than what is normally found in some of these foot reflexology establishments. I had a tuina massage in London that was so unsanitary and professional that I was not able to write about the experience without being overly critical.  For example, one of my legs was bolstered with a roll of toilet paper.  In writing professional evaluations and reviews of the massage and bodywork services, we want to review good examples and provide learning experiences to avoid poor examples as well for overall business and career improvement.

In conclusion, there are a lot of similarities and some stark differences with foot reflexology applications between western and eastern practitioners.  In the end, both application styles are effective.  It is my opinion that western reflexology applications are taught to be more sanitary, professional and discreet while eastern applications may result with more immediate noticeable effectiveness.  Now if we could only merge the two together while avoiding legal liabilities, we'd likely have the most effective and therapeutic service of all. 

This establishment, the providers and its location are purposely not disclosed to protect their privacy.  While we would recommend services there given the quality when compared to the rest of their unique class, the intention of this article is to provide an analysis for learning and improving our own individual practice, with no other ulterior motive or purpose.

This is professional evaluation of the 15-minute 20 pound (that’s $27 US at the time of service in 2025) Radiance Scrub add-on service that was offered with my 60 minute massage at the YĀTRĀ Urban Spa at Montcalm Royal London House. This is merely a professional opinion of a one-time experience at this establishment.

The massage therapist was assigned to perform both add-ons I had prepaid for with my massage therapy appointment.  There was some serious disorganization at the spa because apparently no one was aware that I had added and prepaid for these services the day before (DON’T).  After I added my massage appointment and appointment time to schedule on this establishment’s website, I was then given the option to schedule some add-ons with it (DO’s). There were around 5 different add-ons to choose from(DO’s), and there was not much to any description of what the service would be.  All of the add-ons were 15 minutes and 20 pound each (DO’s), and you were able to add more than one as well (DO’s). It is great business for both the spa and customers to offer add-ons (DO’s).

I chose the Radiance Scrub as an add-on which I assumed was a full body scrub given its 15-minute advertised application.  I had to guess what it would be, because there was no description of the service on their website (DON’T)and no contact information on the spa’s website pages (DON’T).  I believe a 15-minute scrub application wouldn’t be appropriate for the back or decollete because both areas would be raw after 15 minutes. While 15 minutes for a full body scrub is quick, it is perfectly doable. They do advertise a 15-minute foot scrub because if it was only an arms or legs scrub, then it would say arms or legs seeing they defined the foot scrub.  I tried to ask the practitioner twice if the scrub I paid for was a full body service, and she appeared puzzled and seemed to say yes, but I wasn’t really sure of what I would be receiving.

I had two prepaid add-ons with my massage (DO’s), and she chose to prioritize the scrub add-on over the facial add-on.

When the therapist asked me to return to the same room we had just left for the massage, she asked me to disrobe and lie face up on the massage table (DON’T).  I asked her if she wanted me to do that right now because she was standing far from the door and gave no indication that she would leave, and she responded, yes now.  So I took off my robe in front of her which left me naked, and then crawled naked in front of her onto the massage table into supinated position.  She placed a bath towel to cover my private areas, then began the scrub on my anterior legs.

The scrub application itself was poor.  The massage therapist used slow strokes with fairly firm pressure and it was fairly dry (DON’T).  To improve this body scrub application, a therapist could use slightly more scrub product, add a little bit of water to give the product better glide over the skin, and quicken her strokes with very little pressure. Scrubs in almost any area should be applied with quick light strokes to lift the outer layers of the epidermis in an attempt to remove dead skin and exfoliate the body.  

After the therapist finished with my legs, which she was able to complete on both anterior and posterior sides with flexing my knee on the table and reaching under for the posterior leg as well (DO’s), she moved onto my arms.

The scrub application to my arms was equal to my legs.  She was able to complete scrub the 360 degree surface of my arms while in supine position (DO’s); however, she used similar slow firm massage strokes with the scrub which was not enjoyable.  Here's an example of providing a full body scrub with steam to enhance the experience. This video visually demonstrates an appropriate application speed of light scrub strokes:

Then the therapist asked that I roll over onto my stomach in pronated position.  This was slightly unpleasant with the scrub application on the anterior side of my body.  We would recommend that if a practitioner can scrub 360 degrees around the arms and legs, then to have the client sit up on the table and swing their legs over the side so that the back can be scrubbed in a 15-minute full body application. Clients should be provided a towel or sheet to cover their anterior body while sitting, leaving their back exposed. This massage therapist chose to apply the body scrub similar to a massage appointment instead (DON’T), and started scrubbing my posterior legs once I turned over into pronated position.

My calves were scrubbed with the same slow firm strokes as her massage (DON’T); however, this therapist seemed to become more alert when scrubbing my hamstrings.  My upper posterior thigh scrub had quicker strokes and the pressure lightened (DO’s), so I was happy to feel like the therapist was remembering that scrubbing is supposed to be light and quick, and hoped she would continue that type of appropriate application to my back.  She did not.  After finishing with the legs, she undraped my back and continued the same slow firm strokes on my back with the scrub product, similar to how she applied it on my anterior body (DON’T).

Because this scrub was only 15-minutes and left on my body so that I could shower it off (DO’s), I would recommend the spa to provide waterproof slippers.  For my several hundred dollar spa treatment that included a massage with two add-ons, they provided me an ill-fitting robe and cloth slippers which are not appropriate with hydrotherapy services (DON’T).  We would consider a 15-minute scrub a partial hydrotherapy service because the client is going to have to shower it off, hence using water to complete the appointment by showering off the scrub (DO’s).

It is also appropriate with water soluble scrub such as salt or sugar, for the therapist to wet the scrub until it’s dissolves and then wipe the residue from the client’s body instead of requesting that they shower it off.  Regardless of the type of scrub application, the scrub must be removed to provide an appropriate and effective spa service (DO’s).

After she finished with my full body scrub, the practitioner moved on to provide my facial add-on.  This is ill-advised because she left me on the table slightly wet with the tacky feeling of the scrub on my body while performing the facial (DON’T). When providing a spa scrub that must be showered off in combination with a facial, the facial should be performed first and the scrub second.  For the 15-minute scrub, we would recommend scrubbing anterior and posterior arms and legs while in the supinated position, and then have the client sit-up and swing their legs over the side of the table to finish the scrub on the back, and then leave the treatment room so that the client can put a robe on or shower in privacy, if the shower being used is in the treatment room.

Images of the spa and staff are purposely not named or pictured in this evaluated due to the constructive analysis, and to protect their privacy. The pictures on this article are stock photos from other establishments. This was a poor experience at this spa and we are not trying to amplify the fact here beyond providing this information as  a teaching example of do’s and don’ts. This evaluation here is purely written from an educational standpoint of what to do or not do during a massage therapy appointment.  This is a personal opinion and experience to as learning and teaching opportunities to improve overall massage therapy industry practice and spa operations. This is an extremely fair and accurate description of what was experienced .  To claim it was better would be a false representation.

I scheduled an Indian Head Massage and Foot Reflexology appointment at the Calmer Clinic in London’s Dolphin Square.  This health clinic offers multiple holistic approaches for optimal wellbeing. There is an impressive array of healthcare services provided which include: Acupuncture, Coaching, Counselling, Osteopathy, Physiotherapy, Massage, Nutritional Therapy, Reflexology, Reiki and possibly more. It is an extremely well-rounded holistic establishment.

I went to the clinic first to inquire about the services and met a very pleasant Dolphin Square resident who was working in reception. She gave an extremely favorable review of this service and encouraged me to text the practitioner to schedule it. I texted the practitioner and her first available appointment was scheduled approximately a week later.

I arrived at my appointment and was greeted by the provider herself.  She was pleasant, professional and confident.  She brought me into a private treatment room and conducted a thorough health intake which included reviewing present disease, treatment goals, potential contraindications and more.  Once the intake was concluded, she had me sit in a chair without arms to start the Indian Head Massage first.  She placed a paper towel roll over the chair to increase sanitation measures and washed her hands before she began and after the session concluded as well.  Washing her hands after service concluded was important, despite still needing to provide a second service on me (foot reflexology).  The reason why a practitioner should wash hands between services like this is because she needed to setup the reflexology treatment area, and one would not want to touch equipment immediately after working on a client to prevent cross contamination.

She started and concluded the Indian Head Massage service with deep breathing exercises and reiki holds.  I sat still in the chair and she stood behind both me and the chair to execute the hands-on service, as pictured below:

After the introductory work, she started massage techniques with beautiful fingertip plus heel or palm of the hand friction techniques on the upper back through clothing, followed by deeper friction techniques, particularly around the shoulder blades which feels wonderful for almost any American.  Working through the trapezius around the levator scapulae and rhomboids are one of the top requested areas to work on in massage therapy practice, and that’s where she started which felt wonderful. She was fairly precise in following the strict protocol of Indian Head Massage which has specific orders of manipulation for therapeutic benefit.  She even included manual techniques that are similar to regular massage tapotement which were fairly intense.  She warned me of their intensity prior to beginning the striking technique.  Close to a minute into this technique, I told her that I would prefer to move onto something else and she happily obliged with complete understanding.

The service continually progressed up the cervical area and through the scalp, head and face with a wonderful combination of soft tissue manipulative strokes that were skillfully applied to each area.  It felt incredible and I never wanted her to stop!  I thought I would be uncomfortable sitting in a chair without arms, but there was some ritual feeling with the precise execution that made it feel more comfortable than I could have ever imagined. My guess is if the service is not properly executed, then a customer may not feel entirely comfortable in that chair for half an hour while the massage therapist gently moves about in many different motions and directions.

At the end of service, I felt relaxed and relieved.  There was a significant reduction in stress and pleasant euphoric feeling.  I would rate the hands-on application 5 stars and the clinical environment 4.5 stars.  While this authentic massage treatment was provided in a clinic, the chair for me to sit on was placed close but not exact to the middle of the room, and I kind of felt like I could have enjoyed it more if I had been seated in front of something visual, to close my eyes to as a lasting relaxing thought.  To me, plopping a chair in any place and providing service does work, especially when you’re as skilled as this practitioner, but environment matters, and the environmental execution of this appointment can be improved.

Regardless of the clinical environment, I would repeat this appointment over and over again on a weekly basis if I was local.  It was wonderful, incredible and everything special that it should be with any well-trained practitioner like this one.

This is a professional evaluation of what turned out to be a very poor experience at the YĀTRĀ Urban Spa at Montcalm Royal London House. This is merely a professional opinion of a one-time experience at this establishment.

This was supposed to be a several hundred dollar prepaid massage therapy and spa appointment with add-ons at an upscale spa in London. I arrived without a minute to spare to my 11 am appointment that I had prescheduled and paid 100% for in advance, on their website.  I emailed the spa shortly prior to my arrival to tell them that I was on my way, but uber was arriving later than their guaranteed 10:30 am arrival time.  I first tried to call the hotel where the spa was hopefully located, but the phone number on the hotel website was not configured correct for an international call and obstructing an international call on my cell phone from the U.S. The address and phone number of the spa was not listed anywhere on their spa website pages; however, you could access the spa website pages through the London hotel website, so I used the London Hotel's info as contact information for the spa.

When I arrived at the spa, I was greeted by staff that were not overly friendly. They told me to sit in their waiting area despite my appointment time was already starting when I was supposed to be on the table! Then a front desk staff member brought me a client intake form which I had already filled out half an hour earlier in my uber, on my ride over.  I told them I had already filled out their online intake form and then they took their written intake form away. 

I then asked the front desk staff if they wanted me to change into a robe or anything, and they said yes and told me to wait again.  I stood waiting for a robe, shocked that they seemed so unprepared for my arrival, which was now overlapping the time I should be on the table receiving my prepaid services.  When I asked what was going on with the robe after waiting an excessive period of time for it, one staff member went into another room where the other staff member went, and then a robe with a towel and slippers were then handed to me.  I was then told to go to the lady’s locker room to change and that there would be lockers available for my items.

I went to the bathroom first before changing.  I could only wash my hands with water because their single soap dispenser at the sink was empty.  I also had to go to a second toilet stall because the first toilet stall seat was stained with urine. After using the bathroom, I removed my clothing at the lockers and put on the most ill-fitting robe I have ever worn in my life.  The robe’s waffle weave material was of standard/good quality, but the robe was above my knees while the sleeves were almost a full foot past my wrists, and the front was barely covering me.  If I bent over in it, I was going to put on a good show!

I returned to the reception area, and someone told me to follow them into a room. When I entered the room, I saw dirty filth on the floor at the entrance way with electrical cords that anyone could easily trip over next to the entrance (screenshot below).  I was not warned about the electric cords and luckily saw them when I was examining the filthy floor.  Below is the only picture I took at the spa given the email notification I received after this business secured my payment. It said photos were not allowed to respect guest privacy.  I feel this photo is not invading guest privacy which is the only reason provided for their no photo notice after nonrefundable payment was collected.

The person I followed into the room did not ask or address me by name, nor provided their name or their function in the spa.  They instructed me to lie face down on the massage table and to cover myself with a towel.  It appeared they had professional spa tables with a hole cut out for the face during pronated position. The table draping was all perfectly coordinated matching brown color.  I asked the woman’s name who led me into the room, and if they were my service provider?  She told me she was going to provide my massage and her name.  I then asked her what my appointment would entail, given I was super interested in their 5-element theory services.  She then responded it was an aromatherapy appointment.  So, I asked her, what type of aromatherapy, and does she know which essential oils are being used for which element?  She responded I was going to receive zest massage oil and it was for fire (although she cited a different element before correcting herself to fire). It was then that I realized this was going to be a simple preblended oil massage, and there was no true 5-element theory being practiced here.

I pulled the towel back on the massage table as she had asked me to get onto the table in pronated position.  She then immediately took the towel from my hand and placed it back over the table sheet that was covering the entire table, with a small hole in it for my face.  When I realized that she wanted to leave that small towel over the entire table sheet to keep the table sheet covered or clean, I realized there was no sanitary barrier provided for between my face and the table sheet hole.  So, I told her I wasn’t comfortable placing my face on the table sheet if it wasn’t clean, and she responded to not worry about it because they change it once a day. I had an 11 am appointment, so I started to wonder how many clients’ faces had already breathed into that terry towel table sheet fabric before asking me to place my face directly in it too.

I then told her I really was not comfortable placing my face on the table sheet because it seemed unsanitary, so she rephrased and responded: I mean we change it after every client. Unfortunately, that’s not what she had initially said, and those are extremely expensive table sheets.  Without telling her, I realized those table sheets could run around $100+ each. I personally doubted they were being laundered and replaced with frequency between every client, because that would seriously deteriorate the table sheet’s life use, not to mention they’re extremely bulky, and I couldn’t see where they would store such bulky items to replace between every client. Without saying so, I believed her first statement was true, and the table sheets were not to normal sanitary standards if a client is breathing on them without replaceable barriers, and if that draping is only replaced on a daily basis.

She then started folding a towel to create a better barrier between my face and the terry towel facial hole of the table sheet.  Knowing that bacteria or viruses such as COVID-19 could have already contaminated the massage table sheet, I told her I was simply going to place the towel over the hole and turn my head to the side instead of place my face in the hole.  This would be much less comfortable for me, but I felt that it was better than possibly getting sick with COVID or other infectious disease.  She accepted this and left the room so I could get onto the table.   When she returned to the room, she asked if I wanted the table heated and I responded yes.  I heard a bunch of beeping which sounded like she was increasing the table temperature with a heating apparatus; however, no additional heat was ever felt. I believe their table heating apparatus was broken. She never checked in about temperature again throughout the entire massage therapy appointment.

The massage therapist’s initial contact through the towel was divine.  It was firm, confident and complete. She moved with ease over the towel with compressions prior to undraping my back to start the massage. The initial aromatherapy oil application was average and then a superior back massage followed.  My ankles were not properly bolstered while lying in a pronated flat position, so I asked if she could provide bolstering for my ankles and she did. It seemed like they had setup the table for massage with a rolled up hand towel near the ankle area which provided less than 2” of ankle bolstering prior to mounting of the table, which is not effective nor acceptable practice.

After fulfilling my ankle bolster request, she continued her back massage with superior strokes that were an excellent speed for the pressure.  She had a good variety of strokes that went from small to large, light, medium and firm pressure, fingertips, full hands, heel of the hand, palms and forearms.  It was all good with the exception that she occasionally dropped to a one-handed massage which still felt excellent.  While most therapists would maintain 2-handed contact through the massage, her 1-handed work was of such high quality that you don’t really miss the 2^nd hand lack of contact. We simply believe that 2-handed contact should be maintained at all times during massage therapy practice, although if someone was to occasionally use 1-hand instead of two for full body massage therapy, we would say this was a perfect example of where that practice could be acceptable given how complete and incredible it felt.

During my back massage, the massage therapist lifted my arms that were lying on the table next to my body, and she hung them over the sides of the massage table with my elbows flexed at a 90-degree angle.  This was acceptable, until she started performing shoulder depression techniques.  Hanging my arms over the sides of the table elevated the super vertebral border of my scapula which repeatedly made bone-on-bone contact with her knuckles during her shoulder, upper back and cervical massage, which was uncomfortable.

Her posterior leg massage was wonderful.  She undraped both legs and worked on them simultaneously.  Her strokes included superior travelling lateral lower extremity massage strokes immediately followed by inferior travelling medial lower extremity strokes.  So, it was an outside inside circle of massage throughout the lower extremities leaving them feeling quite complete.  She then continued on to perform more posterior leg massage, one leg at time to complete the pronated work. The therapist appropriately redraped each area after completing the local massage.

When she finished pronated massage, she excessively tapped my shoulder despite myself being wide awake and asked me to turn over.  She left the towel flat on my back without adjusting this draping out of the way for me to move, which was awkward.  I began to turn over to supinated position, and she then quickly grabbed the towel and lifted it so I could turn more easily. She did not move the ankle bolster before she asked me to roll over either. This left the bolster in the wrong place when I rolled over into supinated position, so I had to ask her to move the bolster into an appropriate position underneath my knees so that I could be comfortable on the massage table.

Once I turned over into supinated position, she then performed similar bilateral work to the anterior lower extremities with her continued superior massage therapy strokes and contact. She performed foot massage while working the legs. She continued her massage to my upper extremities which was unremarkable when compared to the application in other areas of the body.  She finished her massage with my head neck and shoulders with continued high-quality massage.

When performing full body massage therapy sessions, especially when a client is wearing footwear that exposes their feet to the elements, such as flip flops or sandals, we would prefer to see a therapist working on the feet last or wash their hands prior to working around the face after touching the feet. This was not done in this appointment.

During the entire massage, the service provider did not check in with me about her massage pressure, areas to work on, music or temperature.  The table temperature she stated was going to increase at the beginning of the massage was never felt, and she never checked in about that adjustment either. I did not ask for adjustments for any of these measures beyond appropriate table covering and massage bolstering.

The massage therapist unfortunately suffered from halitosis, aka bad breath.  In addition to the offending odor, I suffer from an allicin allergy, and I detected what smelled like hints of garlic which made me feel slightly sick during the massage, especially during the supinated upper body work when her airway was closest to my olfactory senses. 

When my massage was finished, I could hear her washing her hands in the treatment room sink. I was then asked to get up and put my robe on and exit the treatment room.  She then asked if I liked the appointment.  It felt more like she was seeking praise rather than anything else.  If I had wanted more or less pressure, alternative music or anything different, then it was too late to make that accommodation.

I did have other services scheduled at the spa, so I put my robe on and went to the front desk to inquire about what I should do to receive the two other services I had scheduled.  The front desk staff member seemed shocked at my question and told me to have a seat in the waiting area, again. I sat, waited and watched commotion between the front desk staff and therapist who had just performed my appointment.  Several minutes later the therapist who had just completed my massage asked me to follow her back into the treatment room to perform the other scheduled services. It should be noted that this establishment had me pay for all services including the add-ons in advance, but seemed unaware that I had scheduled them, never mind the fact that I had already paid for them too.

My massage and add-on appointments were performed in a couple’s room where they were two tables with plentiful room for both. The spa itself is in the basement of the hotel and is of standard quality or layout for the potential of an upscale experience.

After my massage and add-on services were completed, I was able to enjoy the establishment’s hydrotherapy offerings including the pool and hot tub that is available for both male and female guests. Both the pool and hot tub were perfect temperatures at this establishment.  I also continued my hydrotherapy experience by showering in the lady’s locker room where there was:

• Excellent shower pressure.
• Perfect water temperature.
• Aromatherapy shower gel, shampoo and conditioner provided.
• Ceiling mounted waterfall shower and handheld shower handle available.

I also tried to go to the bathroom again a few hours after my arrival, only to find that the earlier stained toilet seat still remained. I had mentioned that the soap dispenser was empty to front desk staff once I had changed into my robe prior to my massage appointment.  The hand soap dispenser was successfully refilled and usable.

To conclude this experience evaluation, this spa has many qualities to become a superior establishment. To improve its quality, our recommendations would be:

An overhaul of the spa website, including:

• Eliminate pre-tipping payments for services that haven’t been provided. It is not appropriate to charge a customer for tips aka as service charges prior to the appointment, especially if the client misses the appointment and is not able to receive the service due to illness, traffic issues, etc.
• Include appropriate contact information including street address and phone number without international digits included on the spa website.
• Publish the spa’s business policies somewhere clearly visible and accessible on the spa website.

Better therapist education including:

• How to properly explain appointments to clients prior to providing them (this is also required from a safety perspective).
• How to verbally check-in with a client during an appointment to ensure the recipient is comfortable and make appropriate adjustments as needed for continued enjoyment.
• How to properly bolster and drape supinated and pronated massage clients.
• Review the client’s health history on the intake form prior to service.

Improve front desk operations:

• Be prepared for client arrival, especially for clients who are running behind (directing customers to sit and wait during their massage appointment time is unacceptable).
• Coordinate proper execution of paid services to guests amongst staff.
• Polish the guest welcoming experience.

Sanitation and safety measures that could be improved include:

• Clean the floors and remove all visible stained/filth.
• Cover exposed electric cords on floors where a client could trip.
• More regular checking and cleaning of the guests’ bathrooms or overall establishment.
• Ensure tables, equipment and supplies are all being properly sanitized.
• Ensure table draping is being properly replaced with clean draping materials between clients.
• Install more user friendly or cost-effective table and customer draping materials, if it is not reasonable to properly change the current table sheets between every client.
• Continually provide  appropriate sanitation products, such as ensuring hand soap containers are not empty.
• Provide personal hygiene education to staff, including topics such as halitosis and hand washing requirements.

Improve spa experience:

• Do not provide uneducated services publicly.  If the staff or business is uninterested in learning about a  service to provide it, then it reflects badly on the business, especially when an educated customer is not provided proper service similar to what was experienced here. It’s probably best to cancel services with apologies due to staff or supply shortages when they cannot be properly provided rather than provide bad experiences like this one.
• Provide a better cancellation policy.  A 7-day cancellation notice requirement without refund is excessively exploitive, punitive, and also subjects the staff and establishment to infectious disease without a more reasonable policy for sick customers.
• Provide teas, snacks and other common offerings for customers to enjoy when they have paid hundreds of dollars for services and will be spending a decent amount of time at the establishment.
• Wall hangings, pictures or art (of ANY value that include purchases at discount retailers) could visually enhance and improve this basement spa’s appearance. The physical space itself is acceptable but could be visually improved with little expense and effort.

How did I get to this unfortunate experience?

I chose to book a 60 Minute 155-pound Elemental Journey Fire Massage at this spa after seeing the hotel rated #1 on Trip Advisor. This massage alone equals $210 US with the exchange rate, plus they add a mandatory tip in addition to schedule the appointment. This establishment has really nice pictures on their website, and their 5-element theory services peaked my interest, so it looked like it would be a great experience!  Especially after that #1 online rating!  What could go wrong?

I booked the appointment online and the first thing their website did after I selected which service to schedule was it asked me for a tip (In London, they call their tips “service charges” which I believe is different from how the US defines service charges).  I hadn’t finished scheduling the service yet and their system was already asking me to prepay a tip for it!  How am I supposed to tip someone without seeing, feeling or knowing the service quality? That is a rhetorical question.  The answer is you cannot tip someone in advance, and it is poor business practice to expect  this when the customer has not experienced the service to provide the appropriate tip amount for it.  Tips should almost always reflect the level of service provided. And in some countries, tips are automatically included in the service price, so it would not be appropriate to tip even more than the tip that is already included in the price with average service.  At this spa, they provided three different percentages for service charges on their website before I could finalize scheduling an appointment with them, so I selected the service charge option in the middle of the three, hoping it would be appropriate.   I felt I could always tip more if I felt it was appropriate to do so after the service.

After I was forced to navigate through online tipping before ever seeing the spa, meeting the staff or receiving the service, I was then given the option to schedule add-ons. So, this went from a poor experience to an excellent one!  Then I saw all of their options and prices which were extremely affordable, so I’m thinking awesome, great, terrific!  I absolutely love this!  That’s great business for both the spa and customers to offer add-ons. I forgot all about that sour upfront tipping experience! I added-on a Radiance Scrub which I assumed was a full body scrub given its 15-minute advertised application.  Afterall a 15-minute scrub application wouldn’t be appropriate for the back or decollete because it would be raw after 15 minutes, and if it was only arms or legs, then it should say arms or legs.  They do advertise a 15-minute foot scrub so through obvious deduction, I assumed it was the full body.

I also added what was listed as a “Radiant Lift” to my massage appointment, which was advertised as a kombucha-infused sheet mask for the face. It takes less than 30 seconds to apply a facial sheet, so my curiosity was peaked about what they would do for the other 14-minutes of the appointment. In my past establishments and in our current school here at CE Institute LLC in Miami, Florida, we would provide scalp, hand, and or foot massage while a client is “masking”.  Seeing I was in another country at a high-end establishment, I was looking forward to seeing their methods and comparing them to ours.

Both radiance add-ons (scrub and lift) were advertised for 20 pounds and 15 minutes each.  That’s a bargain folks!  It’s also wonderful marketing focused to boost business income, keeping the practitioner busy with diversified work and possibly land even greater sales if the customer purchases retail products from the add-on services.

Their website then forced me to pay in-full, 100% in advance for all of the appointments without showing a cancellation policy for the payment!  I was happy to provide my charge card to hold or deposit the appointment.  I was even happy to provide my credit card for possible tardy or no-show charges.  So all that excitement over the add-on services was turned sour again when I was asked to tip in advance, and now I’m being forced to pay in-full to schedule it all.  It felt like I was on a rollercoaster booking this appointment.  There were lots of exciting opportunities to enjoy here, but their business practices at offering them were appalling.  So, I paid in-full, 100% in advance, and then started searching for an exact address on the spa website to navigate transportation and learn what time I should leave to allow plenty of time to arrive and check out their business.  I had looked up where the hotel was prior to scheduling and knew it was close to where I was located.  But I also know that some hotel associated spas could be across the street or in a separate building, so I wanted the exact street address to enter on my cell phone for an uber.  There was no published street address in the spa’s confirmation emails after my full payment, nor was this listed on the spa website.  This was a roller coaster experience for sure, of highs and lows, of what are we doing here? Did I just pay hundreds of dollars to an online scam masquerading as a luxury spa? Or does this place really exist?

Then when I read their confirmation email, I wanted to immediately cancel the appointment because it said that pictures were not allowed in the establishment for guest privacy.  I was perturbed  again, this time for  a different reason.  I wasn’t provided their spa policies in advance, prior to requiring me to pay and tip first with a nonrefundable several hundred dollar charge. I can’t find their spa business policies listed on any of the spa’s website pages. I felt this was really bad business but then I realized, I’m visiting for an experience, and we all learn from good AND bad experiences.  So, while I was still intrigued to see what they were doing with their 5-element massage plus add-ons, I thought, even if this was a bad experience, it’s something I could share from a teaching perspective to help others learn from it, including myself.  And even if I had wanted to cancel, there was no phone number to call for immediate action, and it was nonrefundable, so while I could email them, I deferred to my latter decision to allow this experience to happen whether it was good, bad or average.

Greater images plus the staff are purposely not named or pictured in this professional evaluation due to the constructive analysis, and to protect their privacy.  This evaluation here is purely written from an educational standpoint of what to do or not do during a massage therapy appointment.  This is a personal opinion and experience to as learning and teaching opportunities to improve overall massage therapy industry practice and spa operations. This is an extremely fair and accurate description of what was experienced .  To claim it was better would be a false representation.

Does anyone know what's pictured here below in this article? Or why that picture would be shown when discussing the root cause of a problem?

That is a water pump that was installed and made available for public service to London's population from over 200 years ago.  Today, it's now walled off with an iron fence, but well preserved as part of London's history.

Do you know why an image like that from London's history is significant to the definition of root cause? It's because 40 years after that pump's installation, there was a significant cholera outbreak in a consolidated area of London; and, only one doctor was able to zero in on the source that created this rapid disease outbreak. That doctor started documenting all of the cholera illnesses and deaths on a map, and found that they circled around one of these types of public London water pumps. 

England's Thames is one of the most popular rivers in the world. It was the lifeblood of England, where settlers could easily move up and down the country, and accept traders and other goods over this easily transportable body of water.  Then the Thames River became England's toilet. Before modern day plumbing was created, toilets were installed along the Thame's where residents relieved themselves, then the Thames would wash the sewage away. That was until the population grew so great, that the Thames became a literal cesspool, and that grisly sewage leaked into London's water supply. One of London's water wells/pumps became particularly contaminated to the point that it was responsible for the severe cholera outbreak of 1864.  Once the infected well was identified and it's pump handle was removed, there was a significant decline in cholera cases.

So what does that have to do with neuromuscular therapy which is also known as NMT? 

Neuromuscular therapy (NMT) attempts to discover the root cause of whatever reason placed a client in front of a practitioner.  Some clients seek massage therapy for back pain, insomnia, ambulatory issues, stress or other medical disorder.  So when a client shows up to the office and receives a general Swedish massage, would they feel better?  Probably? Definitely? We would say or claim almost anyone would feel better after a regular full body massage.  But would a regular body massage provide long lasting relief from headaches? Or back pain?  Or postural issues? The answer is no.  Regular body massage usually provides temporary relief, which is why we have neuromuscular therapy for practitioners who want to dig a little deeper to that root cause of an issue.

We will compare this to London's 1864 cholera outbreak. Could doctors provide laudanum or other medical treatment while a client was dying of cholera to ease their suffering? Sure they could. But would that really help them? Of course not. According to the Mayo Clinic, over 50% of individuals infected with cholera will die if not properly treated with today’s advance in medicine.  It's the same with body massage.  We're providing a temporary relief, but that may not address the root cause or causation of the medical issue for why the client sought treatment in the first place.  We must find the root cause of any issue to provide significant treatment to a client seeking relief.

In neuromuscular therapy, our job is to:

• ask questions
• assess posture
• measure leg lengths to look for anomalies
• visually inspect foot care and wear
• relieve trigger points
• determine if a client has lost range of motion
• elongate shortened soft tissue aka increase range of motion (ROM) with massage therapy, bodywork and stretching techniques 
• much MUCH more....

Neuromuscular therapists are looking for what could be causing the issue where a client is seeking relief.  Sometimes the issue is easy, such as your client is an athlete who just ran a marathon, and all of the strenuous exertion has made them seek pain relief.  If we only had clients that were all as easy as this scenario.

Some of our clients are seeking massage therapy because modern medicine has failed them. They have some type of pain or disorder that several doctors have already missed or dismissed, and the client is still seeking answers, and is now sitting in front of you. Neuromuscular therapists are investigators. Our job is to look for a root cause of whatever the client suffers from, and then:

• provide skillful soft tissue manipulation as needed
• provide recommendations within their scope of practice, such as: your shoulder would probably feel better if you didn't carry that twenty pound purse on it all day
• provide referrals to other medical professionals as needed (i.e. From looking at your feet and then the wear pattern on your shoes, you might benefit from some orthotics. Let’s have you meet with a podiatrist to see what they think, while I simultaneously try to increase your circulation to your lower leg cramps and relax some of soft tissue restrictions.) and much MUCH more....

Here's an example of seeking a root cause with a client who is experiencing headaches with unilateral neck pain.  If you observe them turning their head every time you speak, ask them if they hear better in the ear that they are turning towards you. If yes, refer them to an audiologist for a hearing check.  If their hearing is properly restored, perhaps they'll stop constantly turning their neck to one side which might be causing that unilateral cervical pain with headache. Once you've relieved their trigger points, released soft tissue restrictions, restored range of motion or whatever else is obtainable, you will likely have addressed that client's root cause of their medical problem as well as provided some much needed relief.

When a medical issue such as chronic or worsening headaches with increasing cervical pain is presented to a doctor, they might order tests to rule out a fatal obvious problem such as blood clots. They could order MRIs, cat scans, or other life threatening potential causes, but do you think a doctor takes the time to really evaluate a client today? Most do not have the time to sit and have a meaningful conversation with a client, asking questions and watching or evaluating different soft tissue ailments, or the client’s overall body mechanics in general. That’s where a neuromuscular therapist can help.  It is our job to evaluate the client’s body mechanics and more, to try to get to the root cause of their issue and address it.

Now some might think NMT practitioners will have less clients because they resolve a root cause to the point that a client may no longer need to see them, but that's just not the case. That’s because people love to talk.  When someone shares that a therapist relieved pain that four different doctors couldn't, just get ready for massive referrals and more medical problems to present themselves with new clients at your pain relief establishment!

In today's hands-on therapeutic practices, we want to continue the work that was extraordinarily defined with this example of a cholera outbreak over 200 years ago. We need to get to the root cause or causation of medical problems to really help our clients with a more holistic approach. While most medical practice today is transactional, where one issue is treated which could cause four more issues, we want to be different.  Let's treat the root cause of medical issues with neuromuscular therapy to help our clients even more.