CE INSTITUTE LLC BLOG

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. 

Before looking into the spa, I went to Claridge's Hotel and enjoyed breakfast in their dining area (near the hotel entrance), prior to going downstairs to view and book in the spa. Claridge's is supposed to be known for their world class service, and my excellent experience at breakfast confirmed that feeling.

I took the elevator down to the basement to get to the spa.  When I exited the elevator, the first thing I saw was this amazing visual art, pictured below.  You have to walk towards it to enter the spa reception area.

After going around the corner, the receptionist greated me with a smile and asked if she could help. I told her I was interested in booking some services, and that I own a school that teaches CE hours to massage therapist, cosmetologist and other licensees, and she responded that she was happy to hear that I was personally visiting them.  She asked if I wanted a tour which I accepted, and then she proceeded to show me their swimming pool area which she said could be used for two hours if a 90-minute spa service was booked. 

She then brought me back to reception where we started reviewing the different spa services they had to offer.  Her first and strongest recommendation was for their Bamboo & Silk Ritual which is £330 pounds in 2025, and what she called their "signature service." On the Claridge's website, the service is described as a "total mind and body immersion".  It's advertised to provide the following over their 90-minute appointment:

• a welcoming foot ceremony
• a nurturing silk facial
• a trilogy of body and hand massage techniques
• an invigorating bamboo body massage
• seasonal herbs within hot oil-infused poultices
• a deep hand massage

After we decided I would schedule their signature Bamboo & Silk Ritual appointment for the following day, she asked for my details such as name, phone, email, etc. I handed her a business card and she said I would need to finish the appointment electronically to hold it.  That means they wanted my credit card.  So I told her I would wait to receive their email to enter my credit card details, given I was in a foreign country and wanted to make sure my credit card worked on their electronic platform.

The establishment is littered with private sitting areas, so she asked if I would like to have a seat while she setup the appointment and I accepted.  She asked if I wanted some water while I waited which I also accepted (pictured above.) Water was served in a thick quality plastic cup which is standard for pool area beverages, or for areas where clients are barefoot so that they do not injure themselves if a drinking glass were to break on tile, marble or hard floors in the massage, spa or ammenities spaces. I received their email on my phone to finish entering my credit card data to hold the appointment and I completed it there in the sitting area. She then requested that I show two hours prior to my appointment so that I could enjoy their ammenities first, which I did.

I arrived well before my service was supposed to start to smiling women at reception. They checked me in and then showed me back to the ladies locker room that included a cold shower room, steam, sauna and there were large cubicles with regular showers, sink and toilet, as if it’s your own private bathroom with door. 

Pictured next is their private cubby bathroom area:

This is their steam room:

And their sauna:

With cold shower. It is setup similar to a Roman waterfall shower that can be adjusted for hot or cold: 

All of those water and bath amenities pictured above are in the ladies locker room.  The ladies lockers are pictured next and stocked with a one size fits everyone bathrobe, flip flops and towel:

She asked if I wanted any tea, nuts or fruit and I gladly accepted. The tea was in a paper cup for the same reason they use plastic drinking cups. The nuts were delivered in a sealed bag which is excellent for sanitation or clients in the area with a nut allergy.  The bag of nuts also had dried fruit, and it was labelled with allergens in bold print too which was extremely conscientious of the facility. 

Most spas would have some type of bowl with nuts and a dispenser which are not self-contained, have sanitation issues, and are a risk to those who have allergies too. So this is an excellent job and effort on behalf of this spa and massage establishment.

On a side note, London overall seems more sensitive about allergens than the United States.  In restaurants, they ask if you have allergies, and then they even ask about cross contamination if you’re food order doesn’t contain your allergen, they want to make sure you’re okay if the allergen was stored in the same cupboard or refrigerator with what you ordered, given some cannot have cross contamination without serious consequences including death.  One restaurant, The Albert in downtown London even had me sign on their tablet about my allergy.

The lockers were fairly standard for an upscale spa, but there wasn’t a second privacy door or corner to the ladies locker room, so anyone standing just outside the ladies locker room could see directly into anyone changing directly in front of their locker which is fairly common practice.  You had to use the bathroom cubbies for privacy from outside male guests.

I changed into my bathing suit, used the pool and relaxed at the one of the pool cabanas where both regular and lemon water with more fresh fruit was provided. 

Towels are plentiful with extra amenities and well appoined touches provided. The spa has made excellent use of common area space for seating:

I then showered prior to my appointment and enjoyed their aromatherapy body wash, shampoo and conditioner.  It was a perfect heavenly aromatic blend of rose, petitgrain and clove essential oils. You can view the aromatherapy products standarly provided to the right of the shower in the pic below:

My appointment then started on time with a very kind and well-groomed practitioner. She reviewed medical conditions with me before we started and had me sign her tablet that the medical intake was complete. 

My signature service was supposed to start with a footbath, but I told her I had just showered and she saw that I had used the pool, so she gave me the option to have the foot bath first, or start on the table, and I opted for the table to receive more table time. She did have the foot bath set up and ready to go if I had opted to use it, pictured below. The foot bath was a large copper bowl with still water, and essence to the side to choose or use.

The therapist then explained the order of my treatment which would include massage, poultice treatment, bamboo massage and then a quick facial.

The treatment room and entire spa is beautiful with simplistic yet elegant blush beige tones. The massage or bodywork table had a hole in it for the face rest which was okay but not great.  The opening felt fairly small so I asked for an additional towel so that the upholstery seam was not digging into my jaw.  The table itself might have been 40 inches wide, and the widest table I have ever seen for massage or spa bodywork. 

Electric massage tables of that width usually cost a small fortune, and are more difficult for a smaller practitioner with a smaller client, because they have to reach further to apply more pressure during massage appointments.  Wider tables are usually more comfortable for clients, so this establishment probably opted for this extra wide table to continue top notch service for their clients.  The table was covered with extremely high thread count linens and very soft padding including a beautiful top blanket for warmth.

After massaging my back with oil, she then proceeded with a heated poultice treatment. Two poultices began with dapping heat onto my back. I forgot where she started with them; however, proper procedure would start on the upper back, working your way down to the lower back given the lower back is the most sensitive area, so while allowing the poultices to cool with the dabbing while providing thermal therapy, they should be started at the top, working your way inferiorly to the sacrum.

After the hot poultices cooled, she then began to massage my back with warm poultices which felt really nice and exfoliating.  The muslin poultice application was a perfect combination of scratchiness and pressure. 

Once she finished the poultice application she moved onto bamboo massage.  The bamboo was heated; however, the heat dissipated rather quickly which is not her fault.  Bamboo retains heat for lesser time than other massage tools, such as basalt lava hot stones.  The bamboo massage was my least favorite of the three back massage applications given its hard surface.  It would be hard to chose which was better between the regular body massage or poultice bodywork on my back because both were fantastic.  All three massage applications were perfectly applied, and a favorite massage style would be a personal preference over any type of functional rating.

Once she finished my back, she then moved onto one leg, and then the other, perfectly draping both one at a time. She flexed my knee during some of the calf and foot massage which felt nice with the added range of motion. She also included shoulder range of motion techniques with the back massage, by placing both arms individually up on my back to reach deeper into the rhomboid muscles.

Once the posterior massage and bodywork was complete, she had me roll over onto my back for anterior bodywork.  She did lift the sheet well into the air completely exposing me, which made it easier to turn over; however, some clients might not want to be so exposed when changing position.  While the sheet covered her face, it is excessive nakedness that can be easily avoided.

Then she used the electrical components of the multipurpose spa treatment table to elevate my lower legs for knee bolstering.  She also place a decent sized pillow under my head to help drain my sinuses, which was wonderful after being pronated for so long during this 90-minute signature service.

She started the supinated body massage with each individual leg and foot, appropriately exposing one at a time.  She then moved up to each individual arm for the same. Nothing was more remarkable or worth noting beyond what is already explained with the pronated massage. When she finished with both the lower and upper extremities, she began my facial.

The facial started with her use of the electrical table to further elevate my head.  First she applied a skin cleansing balm with terrific facial massage application.  It was really wonderful.  She used a hot towel to remove the balm. A facial cleansing gel was applied for a second cleanse.  She used all new facial massage techniques with the cleansing gel which were really unique, thorough and wonderful.  She paid particular attention to my T-zone area which is brilliant during cleansing, given the T-zone would be the area that would need facial cleansing most.  She removed the gel cleanser with another hot towel.  It appeared their hot towels were hand mitts which are another uber expensive investment on behalf of the spa.

After removing both cleansers, she then performed two more applications which felt like a serum and moisturizer, again with perfect and more unique massage applications.  Her facial massage techniques deserve 10+ stars.  The serum and moisturizer appropriately remained on my face.  She ended the treatment with a really strong and fantastic scalp massage.

Once she was finished, she used the electrical components of the table to help me sit upright. This makes table dismount easier. It also allows a moment for blood pressure to regulate itself and help avoid postural hypotension at the end of a long tablework session like this one. The massage therapist washed her hands both pre and post treatment for an appropriate period of time. This is 100% excellent practice by the massage therapist.

At the end of the service, I asked the practitioner if I could keep the poultices if she was going to throw them away.  These shouldn’t be reused given they cannot be sanitized for another client, and any sanitation efforts would strip them of their therapeutic properties, so I was happy to take them instead of seeing them put them in the trash.  But the therapist insisted on providing me with new poultices instead which is not what I asked for.  I think she thought she was doing me a favor, but I would have preferred the ones that were used on me and already had oil on them, because that would have made a better bath treatment at home with the extra oil.  I would always recommend providing the used herbal poultices to clients post-treatment, and recommend they add their used poultice to an at-home soak or bath for further enjoyment.

The pros of this overall service are listed throughout this review. There are too many to list again. It was a wonderful and expensive experience that justifies its price.

I don’t really have cons for this tremendous appointment, but I do have some areas of improvement, which could hit this 5 star service further out of the park:

1.      I detected an extremely faint odor of bleach or chlorine in the hot towel mitts used with my facial, which is likely undetectable to someone who’s not a trained aromatherapist and practitioner like I am. It was good to know these are sanitized; however, soaking or wetting these with an herbal bath of floral waters, teas or essential oils could provide a heightened experience.  Because the treatment and spa are floral oriented, I would recommend geranium, jasmine or rose essential oil in a water bath when preparing the hot towels for the cubby.

2.      I’d like to see this service ended with hot towels on the feet to further remove the oil application, and cream or lotion used for the hand and foot massage.  While the therapist did compress the sheet on my feet which removed some of the oil before she moved onto my upper extremities, I’d like to see more of an effort there. The oil was as perfect as one can get for hand and foot application. There were not any abrupt slips which can happen with oil when using it on these areas of the body where the skin is thickest; but it’s still oil and more slippery which creates avoidable hazards post treatment for the client with table dismount, and until the oil has lost all of its slippery properties.

3.      Don’t ever let someone design a spa for you unless they’re a massage therapist or request onsite massage therapist input.  The treatment space for the oversized multipurpose spa table is not large enough to allow a massage therapist to lunge or use proper body mechanics to apply greater pressure for deep tissue work.  While they might be able to achieve deep tissue with improper application, it could lead to unnecessary injury for the massage therapist.  A larger treatment room would also allow the spa to use a separate face rest at the end of the table instead of pronating clients into a facial hole, which has questionable sanitation and less comfort than a separated facial cradle and cushion. It’s like someone purchased the most expensive equipment or gadgets, but sometimes functionality doesn’t need the most expensive, and better function can be achieved with lesser priced items (i.e. a table at least 2 inches more narrow would be more appropriate, especially when the practitioner is on the petite side themselves.)

4.      Allowing a real spa practitioner to participate in the design of the spa should allow for better judgement, especially when ordering massage equipment, for example oversized tables are expensive, unnecessary and could more easily injure staff. An experienced practitioner might also have added better privacy for the locker areas too.

5.      While I can appreciate the Japanese theme that was used to create and decorate this gorgeous and incredible spa establishment which now occupies the basement of Claridge’s hotel, from the door handles to all of the striking eye-candy finishes, the attire was another matter.  Guests and reception staff are dressed extremely similar, and it would be most awkward if one customer approached another for assistance, because they’re confused when everyone is dressed in similar fabric of the same colors with slightly different patterns. This is especially important when 90 minute services are promoted so that a customer can use the spa facilities including pool, free of extra charge. I would recommend dressing the staff in a light greenish bamboo colored uniform, instead of identical colors to the clients to make a better distinction between guests and staff.  This might have also been done if a real spa provider helped with the overall design and acquisition of materials.  In my opinion, a real practitioner did not participate in this, did not speak up during the design, or didn’t have enough experience to make these recommendations, and the establishment could have benefited even more than what they already have from such expertise and input. 

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