European Spa Tour Part 5: Austrian “Kur,” Radon pools, and spa massage

Just tuning into my European spa adventure? Click here to start from the beginning!

Our European Spa Tour started in Switzerland and progressed to Austria where we learned about the 3 week “kur” (pronounced “cure”) and got to experience a spa relaxation style massage at one of the sauna and thermal bath complexes in the most beautiful town surrounded by the Alps, Bad Hofgastein. Like our tour of the Reha Clinic in Switzerland, the rehabilitation clinic at Alpentherme in Bad Hofgastein offered therapeutic medical massage alongside physical therapy, exercises, prescribed “fresh air” walks, sauna and hydrotherapy.

The Kur

At Alpentherme, we learned about the Kur, or a 3 week wellness program that most Austrians qualify for about every 5 years under their government health insurance, depending on what conditions they have and their occupation (i.e. physically demanding jobs or injuries). During the kur, residents spend 3 weeks at the clinic receiving prescribed therapies, eating healthy foods (ideally) doing exercises, saunas, and hydrotherapy programs. Our tour guide stated that her taxes were roughly 50% of her income, which is how they fund such comprehensive wellness programs. Research has shown that for some conditions that are quite expensive to manage, an annual Kur helps to cut costs of medications and more costly interventions so some disabilities qualify for more frequent visits.

She also stated that recently, the government guidelines for treatments are requiring a bit less “passive” therapy like massage and more active therapy like physical and exercise therapy so their treatment providers must coordinate with each other to ensure they meet qualifications for reimbursement. Medical massage therapists seemed able to provide similar services to those at the clinic in Switzerland.

Anyone up for a radioactive dip?

One of my most memorable moments on the tour was when our guide explained that one particular soaking pool for pain and inflammation was available by physician prescription only and with close monitoring. At first we were positive we were missing something in translation. “This one is full of ‘rah-dohn'”

“What? Surely you are mis-translating ‘MAG-NES-IUM’, or something else, right?”

Oh what’s that? A radon pool? Okie Dokie!

“No, no, it is ‘rah-dohn….radon’ pool. See? Look at the brochure!” Our guide pointed to the description in the pamphlet and sure enough, we were looking at one of the radon therapy pools…and once we picked our jaws up off the floor, we had a few questions. “What about the therapists working in the pools?” (According to our guide it is too little radon to hurt the therapists but just enough to help patients) “Has anyone researched this?” (Oh yes! It is very good!) “Should we remove our radon mitigation systems and open health centers in our basements?” (No. Use is closely monitored by physicians.)

I did do a bit more research at home. Interesting.

Spa Massage Therapy

Like in Switzerland, the massage therapist qualified to provide the medical massages have several years of training. I’m unsure of the training required to provide massage therapy in the spa, but if I understood correctly, it sounded like it might be flexible, with some apprenticeship programs available. The spa at Alpentherme was very well-appointed, but there are some stark contrasts from what people expect from a spa massage in America. Amenities like warm herbal compresses and hot stones, hydrotherapy tubs with color changing lights, plus a table used for body scrubs and a warming table used for body wraps were among the options for therapists.

L-R Bright treatment room with paper coverings and towels for draping, hydrotherapy table for body scrubs, herbal compresses for massage

My massage therapist was very professional, but the service was quite different than what Americans expect from a spa service. The rooms were bright (as bright as in the above photos) and the tables were very firm like in a medical office with paper covers plus towels. The music was static from a local radio station, more like a background noise like in a doctor’s office in America than typical spa music designed to enhance the experience. When my massage started, it was so hard to keep from laughing as Despacito crackled through the speaker.

My husband and I had had the same therapist and he stayed in the room while we got on the table, but turned his back. He asked us both to keep our underwear on.  Others in our group who received different types of massage like hot stone were given a disposable thong. I laughed because they said they were watched by the therapists as they changed, not in a sexually inappropriate way, but in a matter-of-fact clinical way.

The massage I received was very light and rhythmic. It felt like a full body lymphatic drainage technique, lots of repetitive circles over and over. I know that in the countries we visited, they feel that lymphatic massage is very important. It was not a massage to reduce muscle tension or deep tissue by a long shot, but I know I did briefly doze off. My husband reported his treatment was the same.

Crystal healing

One interesting and unique feature of the spa we visited is that one of the spa directors takes much pride in creating herbal, aromatherapy, and crystal blends to enhance the services. While I’ve never personally subscribed to crystal healing, I can appreciate the love and care he imparts into his craft so much that I bought two blends to bring home. For months, crystals, essential oils, and herbs soak infuse a base oil. The spa even puts large crystals into their drinking water for guests. It was a nice touch and an interesting point-of-differentiation that I think fans of crystals and gemstones would enjoy.

L-R An oil infused with crystals, herbs, and essential oils sits for months until it is ready to use. A menu of their specially crafted oils for incorporation into services or purchase for home use, drinking water infused with crystals.

I was thankful for such a comprehensive tour and behind-the-scenes from our gracious tour guide. I love that so many of the pool and sauna complexes have spas or massage clinics attached because there is nothing like relaxing your muscles with heat and hydrotherapy before a massage and continuing the relaxation with a stunning walk in the gorgeous village.

The scenery was as therapeutic as the spa.

Stay tuned, my last two posts on the trip will be coming soon! My next post will be about my Traditional Thai spa experience in Munich, Germany and my last post will be a few highlights.

European Spa Tour Part 4: Rehabilitation in Switzerland

Just tuning into my European Spa Tour series? Click here to start from the beginning and catch up!

Of all the stops on our tour, I’m most appreciative of the opportunities to tour two rehabilitation centers and learn how massage therapy is integrated into the fabric of healthcare in some European countries. For our first stop, we toured the Reha Clinic in Bad Zurzach, Switzerland with our guides Thomas and Julia. Julia trained as a massage therapist in Florida 25 years ago, but that training did not qualify her to practice massage when she returned to Switzerland. In Switzerland, she practices the Trager method. In the United States, many massage therapists know this as one kind of approach to massage or techniques they integrate into their traditional settings. Some of the East Village Spa therapists integrate similar techniques into sessions. In Switzerland, it is a more widely-recognized therapy and according to Julia, it is 80% covered by insurance. (Click here for a brief explanation of the Trager approach).

American Massage Therapists and our Swiss Hosts Thomas and Julia at Reha Clinic

The rehabilitation clinic was in a complex with a large pool and sauna facility that was open to the public and used by patients. The clinic itself was for stays of 2 weeks to 4 months with some outpatient care. I would compare it to a place people would go in America after a joint replacement surgery or hip fracture when they needed intensive therapy but not long term care.  The facility employs 13 licensed massage therapists (Plus physical therapists, doctors, and nurses) and additional technicians to do wraps for patients being treated for lymphedema.

I was most excited to learn how massage therapy is covered by the national insurance plans in Europe. As far as I understood, medical massage is covered in treatments like the Reha clinic, but the massages are quite different than what my clients and the typical massage therapy client would expect and if I’m being honest, they are probably not what the majority of our clients would want for their routine massage therapy, but these sessions would be immensely helpful in a rehabilitation setting.

L-R: Thomas shows us how they make their saline towels for hot compress treatments, The massage treatment rooms in the new wing, and some of the treatment tables in the therapy center. Quite different than the atmosphere many Americans think of and prefer for massage.

Probably the coolest feature of the facility was their therapy garden. I initially assumed that this served as a place to practice physical and occupational therapy exercises or that the herbs grown were used in preparations, but I was absolutely delighted to learn that the primary purpose was chronic pain relief. According to our guide “Patients who are in pain forget the things that are not pain. They work in the garden to forget their pain and get new ideas.”

The following are the answers to my 3 most burning questions for our guides about what it is like to work as a massage therapist in a setting like their clinic.

Q: What kind of training is required for massage therapists in a facility like yours?

A: Typical is about 2 years of full-time (40 hours/week) study to become a licensed massage therapist. A relaxation or spa therapist can learn basic “feel-good” massage in about 2-3 weekends, but relaxation massage is not covered by insurance and isn’t licensed. Relaxation massages are out-of-pocket expenses. According to our tour guides, the licensed medical massage therapists respect the spa and relaxation massage therapists and see a need for their services as well.

Q: What type of services do the medical massage therapists offer and how do their services fit into the comprehensive medical treatment?

A: Medical massage therapists work as a treatment team with the physical therapists, doctors, and nurses to deliver rehabilitation treatments including aquatic therapy. They can offer hydrotherapy baths and exercises, and also perform treatments with tens units and lymphatic drainage machines. Therapists use saline (salt) wraps and hot packs. Our guide said “Massage therapists decide when a patient needs treatment like a tens unit. The massage therapist will call up the doctor and suggest it.”

Left: Warm water pools for aquatic rehabilitation. Right: Hydrotherapy tubs that massage therapists could use for treatments.

Our guides said that the types of treatments are generally prescribed by standard guidelines depending on the condition they’re being referred for (i.e. how many hours of massage, aquatic therapy, exercise, physical therapy, etc…). For example, before a patient comes to the clinic to recover from a hip replacement, he gets a plan of care. The treatment team meets weekly for an hour to discuss about 30 patients in their care and their schedule of therapies. Massage sessions are typically 25 minutes long except for lymphatic drainage therapy for lymphedema which usually consists of a 30 minute morning session and a 60 minute evening session.

Q: What kind of ambiance (lighting and music) do you provide for massages?

A: (Confused looks from our guides). “Why would we play music?” We laughed. The massage rooms are stark and brightly lit, patients bring the sheets from their rooms with them to the massage therapy room unless they are paying extra out-of-pocket for special care. I love the idea of “why would they need extra sheets? They have sheets on their bed!”

Q: What is a typical workday like?

A: Perhaps a team meeting to discuss patient care, a full day of back-to-back prescribed sessions with about 2 minutes in between to do notes and clean your table and supplies, a short lunch break. A typical day for a massage therapist in their clinic is far busier and more fast-paced than for most American massage therapists I know, especially because the sessions are so short and they see so many patients.

My takeaway:

I LOVE that massage therapy training in Switzerland is so comprehensive! I have always wished that we had tiered licensing in the United States for therapists who wish to progress into a more medical/treatment oriented setting v. therapists who wish to provide relaxation and stress-relief massage only. I was glad to return to our clients and report that “Yes, massage IS covered by their national healthcare, but not the kind of massage therapy that you are accustomed to and only when prescribed for a particular ailment.” I suppose a benefit of not having massage covered under American insurance is that we can completely customize treatments for our clients and make sessions relaxing, therapeutic, and exactly what our clients want on a given day.

Overall, because of the amount of training for therapists in the medical settings and the very low requirement of training in the spa and relaxation settings, it is hard to accurately compare Swiss and American massage therapists or make accurate professional comparisons, but this tour was probably the highlight of my trip and I’m glad our hosts were able to take time out of their busy therapy schedules to visit with us!

Click here to keep reading! Part 5: Austrian “Kur,” Radon Pools, and Spa Massage

 

 

European Spa Tour Part 2: Avert your eyes!

Have you read part 1 of my European Spa Tour entries? Click here to get caught up!

Before I get too deep into any other entries, I’ll address the elephant in the sauna: nudity. I think it is fairly common knowledge that in Germany and some other European countries, children aren’t raised with the same body shame we are in America. This is referred to as Freikoerperkultur or Free Body Culture (Click for a GREAT recent article on the background of nudist culture in Germany).

This way of life and body acceptance is definitely a very cool, but very foreign concept to this Iowa lady. Even parks in Munich have large nudity areas, though they were more widespread before the Munich Olympics. (Our bike tour guide: “Germany didn’t think worldwide tourists would be great standing in line for a beer with naked strangers”).The sauna complexes we visited in Switzerland, Austria and Germany were part of the Free Body Culture, with nudity being a normal element.

This is a dramatization of my anxious brain’s image of the European sauna before my visit. Obviously I didn’t take photos in the saunas we enjoyed. I promise, they were nothing like this.

I wondered aloud for months how I’d handle the nudity and get over my own issues, growing up swimming 3-4 hours daily wearing practically translucent competition suits, I’m not sure how I acquired so much Midwest prudishness about nudity, but I did. I even joke about my issues at work. I realize this normally would not be workplace appropriate, but remember, I own a spa that does Brazilian waxing. I’ve been a massage therapist since 2005 but still keep my undies on when I get a massage (I know, I know…but WHAT IF THERE IS A FIRE?) Our German massage therapist Conny cornered me before my trip and urgently pleaded with me “Promise me you vill NOT vear your bathing suit in za sauna. Vee think zat is very unsanitary!”

That being said, you can wear a towel and you most definitely should sit on a towel in saunas and steam rooms. In fact, during the pool and sauna facility tours we received, the guides expressed that the reason they are so anti-bathing suit is that they don’t feel bathing suits are properly cleaned in the wash and that they harbor bacteria. It is quite a contrast in policy to the spa and thermal waters complex my friend just checked into in New York where the website clearly stated “Bathing suits are required. If you do not bring one, we will provide one free of charge.”

Now, in all but one of the complexes visited on the group, bathing suits were fine (and required) in most pools, but there were some separate pools where they were not allowed. I’ll be honest, I stuck to the bathing suit pools. They were more fun anyway. I mean, LOOK at this thermal pool that shoots you around like a high powered, warm water lazy river!

As far as the saunas went, I was fine being wrapped in a towel and didn’t feel judged. Honestly, I max out at about 3 minutes in a Sauna anyway. The facility we visited in Austria even had a female-only sauna and steam facility in addition to the co-ed sauna complex. The co-ed complex was age 15 and older but they have hours where families and children of all ages are welcome. I skipped the smaller more urban sauna complex in Munich (to visit a different spa) but that pool and sauna were all nude, with showers and lockers all around the pool’s perimeter so privacy wasn’t an option there.

The spa facility in Switzerland had two saunas that permitted bathing suits, but the gist of what we heard on the tour was was “I mean, if you want to sit in the ‘basic’ gross saunas for people in dirty, bacteria-ridden bathing suits, go ahead. But the cool nude saunas have a day of activities including a person cooking SOUP on the sauna coals! Bamboo Massage! Free refreshments! But whatever.” I was surprised how fast I made a beeline to the cool nude sauna because REFRESHMENTS!

The pool and sauna complex in Bad Zurzach Switzerland. This pool is indoor/outdoor. To the top right is the “cool” detached sauna complex where the nude people get to hang out and eat snacks.

As much as I was anxious about the culture shock of being around lots of naked people, I found it fascinating to hear from one employee at a thermal pool facility about the modern day issues they face in their long history of body acceptance and open nudity. With international tourism and new residents who come from countries with a far less of an acceptance of public nudity than even this Iowa lady, it sounds like they face a delicate balance between honoring traditions and helping all guests to feel comfortable. I’m curious to see how, over time, these facilities manage to do that and hopefully it won’t be too long until I’m able to go back for another visit to find out!

Continue reading part 3: Public Sauna and Pool Complexes here!

European Spa Tour Part 1: “Midwestern massage therapists go to Europe”

I was fortunate to have the opportunity to travel with other Midwestern Massage Therapists to Switzerland, Austria, and Germany and visit spas and massage clinics in each country, speaking to therapists, spa managers, and citizens about their experiences receiving massage therapy. I was excited to learn the truth about a belief commonly held by American massage therapists and their clients: “In Europe, everyone gets massage and it is covered by their health insurance.” On our tours and visits I received tons of great information, but with language barriers and info overload, I think I returned with more questions than I had when I arrived in Europe. My research continues!

Clockwise from left: Matt (my husband who was more interested in HVAC systems and mountains than massage) Dale (LMT from Kansas, our fearless leader), Melissa (LMT from Iowa), Barb (LMT from Illinois), Julia (LMT from Illinois), Erin (LMT from Illinois, and Emily (Along for the ride!) and me (Cassie, LMT from Iowa)

For example, on our last night, I visited with a great German couple over dinner and asked if they had ever personally received massage therapy covered by their insurance. The husband stated that his physician prescribed 10 medical massages by a physiotherapist (I’m not sure if this is a physical therapist or medical massage therapist based on what he described) to recover from knee surgery. He has private insurance in addition to the government insurance, so his treatments were covered, but not all massage therapy and not all massage therapists are covered by health care.

I asked our new friend if he understood different licensing and training between the therapists who provide insurance-covered massages and relaxing massages. He stated “Spa therapists are like on Baywatch”  (Record scratching…”WHAT?”) His wife went on to explain “Yes, like, lifeguards. It is the same kind of training. In the spas the massage therapists are also the lifeguards.” (Pro tip: DO NOT Google “German Lifeguard Massage”) Honestly, I think that our new German friends just wanted to perpetuate a stereotype and found any reason to casually steer the conversation to David Hasselhoff.

NOT a massage therapist.

It took awhile to Google the correct phrases, but I eventually realized that, at least in Germany, a 2+ year training program is required to become an accredited massage therapist and “medical pool attendant,” which makes sense because the medical massage therapists we met could do really great therapies in the many warm water pools and could prescribe hydrotherapy. If they continue a year to a year and a half in their training, it appears they would be working toward their physiotherapist qualifications. It seemed like that was similar to the case in other countries we visited. The medical massage therapists typically had a higher level of training than in the U.S. but physical therapists seemed to have a slightly lower amount of training than in the U.S. so the occupations didn’t have quite such a qualification gap.

In this blog series you’ll learn about my spa, massage clinic, and pool/sauna complex visits and experiences our group of midwestern licensed massage therapists enjoyed on our European spa tour!

Click here to read part 2: Avert your eyes!

 

Massage acceptance, a step backward?

I try to keep politics out of the spa (politics is about the least relaxing topic ever). However, our guests value massage therapy and right now massage therapists are caught in a precarious battle to maintain their professional credibility and guarantee clients safe, convenient access to massage as healthcare.

I’ve been on an amazing tour of European massage therapy clinics, spas, and wellness centers with licensed massage therapy colleagues from Iowa, Illinois, and Kansas this week. It has been fascinating to learn the long history of therapeutic and medical massage and how it is an integral and accepted part of European healthcare.

In stark contrast, I woke up two days ago to some distressing news. A city ordinance proposed in Clive, IA would impose additional regulations on legitimate massage therapy businesses in that city. This is a trend in Central Iowa in response to the alarming number of illigitimate businesses, however there are already laws in place regulating licensed massage therapists AND laws against human trafficking and prostitution.

In my visits to the wellness clinics in Switzerland, Austria, and Germany, I’m learning how public visitors can enjoy relaxing massage therapy for stress relief and overall wellness, and patients recovering from surgery, injury, workplace strain, and living with disabilities receive prescribed medical massage alongside physical therapy, exercises, hydrotherapy (soaks in pools and theramal water) and more. These facilities are very accessible and are frequented by senior citizens, families with children, and the population in general.

Meanwhile, back in Central Iowa my colleagues received letters from the police department informing them of proposed restrictions on their business hours (this could especially impact therapists serving shift workers and athletes who like early morning massages before work or in conjunction with gym schedules), additional background checks, fees and more. Seeing the acceptance of massage therapy in Europe compared with our regression in central Iowa was particularly painful.

I agree that human trafficking is a huge problem in the United States and there are an alarming number of illicit human trafficking operations in Central Iowa, but Licensed Massage Therapists are educated, trained healthcare providers that benefit the lives of many of their clients. The State of Iowa licenses massage therapists and has laws regulating the professional, ethical, competent practice of massage. The illicit businesses are easy to spot already, bars on the windows, inappropriate advertisements online, and not following licensing laws. One such business has a handwritten sign instructing cars to park behind the building (out of view of the street, presumably).

I’m hopeful that we can come to a compromise that doesn’t restrict ethical practitioners and the public will continue to receive massage therapy that is convenient, as an effective means of reducing stress and pain. I hope that the municipalities proposing (and passing) additional restrictions on legitimate massage therapy businesses don’t discourage therapists from opening in their areas, making it less convenient for residents to use their services to enhance their quality of life.

If nothing else, I’m thankful to start the conversation. The public needs to be aware of the benefits of massage therapy and learn to speak out against unethical human trafficking operations without damaging the licensed professionals who have the primary goal of making life easier, less stressful, and healthier for the citizens of their communities. I applaud municipalities for making the fight against human trafficking a priority, but please recognize that license massage therapists are heartbroken that these illegal and unethical businesses are masquerading as a profession we love. It adds insult to injury for these legitimate therapists to feel as though they are being punished and lumped in with the people perpetuating these crimes against the victims of human trafficking.