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

 

 

How do massage therapists manage their own pain?

One of the most frequently asked questions I heard when I was practicing massage was “how often do YOU get a massage?” As massage therapists, we learn to get a good read on our bodies and learn what works well to prevent or manage our own pain.  Some of the LMTs on our team shared what works best for them, and their favorite referrals.

Camdine: I use a Lacrosse ball on my hips, back, and neck to massage painful spots. Camdine also uses locally produced Rapid Fire to reduce pain.

Julie: Daily stretches, epsom salt and Kneipp arnica bath soaks 3x week, a glass of warm Pure Inventions Tranquility tea (with magnesium) before bed, Rapid Fire to control small areas of pain, regular massages and chiropractic care as needed.

Julie’s favorite nighttime  drink is the Pure Inventions Tranquility which contains chamomile, passion flower, and magnesium.

Jamee: I use acupressure as a cure for everything but death, and I haven’t died yet. I see my personal massage therapist (co-worker Tiffany) regularly. I also purchased a Yoga trapeze that is a miracle for low back pain.

Heather: Massage 2-3x a month, regular visits with chiropractor Dr. Pulley (East Village Chiropractic)

Our employees massage each other and also see therapists outside the spa when their co-workers are booked. We all know the importance of “practicing what we preach!”

Hannah M: Staying active after a hard day reduces tension for me.

Jamee (cont’d): …On second thought, I should get a med alert bracelet made up that says in an emergency, call my massage therapist (Tiffany.)

Brandi: Yoga and using a foam roller, a 30 minute daily walk, get adjusted at Shine Chiropractic weekly, Fadeaway Flotation monthly.

Tisha: Rapid fire for aches, pains, and headaches, cupping therapy, foam roller, yoga, and a monthly massage (more often when needed!)

Most of our employees swear by Rapid Fire for muscle aches and tension headaches.

Conny: I’m not in pain often, but if it happens, I either overworked something or an emotional issue came up. For physical pain, I use rapid fire and a soak in a hot bath with epsom salts, receive massage twice a month. A good book, a glass of wine, and a friend for heartache.

 

Conny is especially partial to Kneipp bath salts because like her, they are from Germany.

Cassie: The older I get the more my joints act up, especially after running, biking, and swimming. In addition to regular massage, I see Dr. Pulley for chiropractic care when I overdo it or something feels “off.” I have done regular pilates at Gigi’s Pilates for about 6 years. Sometimes stretching isn’t the answer (or isn’t the only answer). The strengthening techniques in Pilates really help my low back and knees from screaming after longer runs.

If I miss to many pilates sessions, my body rebels and I get low back spasms that make it hard to run. I have learned the importance of strength training to keep everything working like it should!

Want to try massage therapy or one of our favorite pain relieving products for your own aches and pains? Stop into East Village Spa at 601 East Locust or book online!

Talk to your doctor about massage

When I was 22 (in about 2002), I picked up a small item from the floor as someone called my name. When I turned my head to see who it was, my neck caught. For a month, I had a stiff neck. Growing up, we never used chiropractic or massage therapy so my first instinct was to go to a walk-in clinic doctor. The doctor briefly assessed me, then told me I had arthritis and needed long term pain medication to treat this condition he presumed would plague me for life. That was that. I was too inexperienced to question him, but the visit literally took 10 minutes and I left thinking I had serious arthritis at 22. I took the medication for months, even though the pain had subsided after just a few days. When the medication was pulled from the market after dangerous side-effects emerged, my pain never returned.

I haven’t had any other issues related to that little injury and I truly believe, knowing what I know now as a massage therapist, that a trip to a good chiropractor coupled with a massage would have managed the pain I experienced at 22 just as effectively as the medication. Fun fact: that experience is one of the reasons I became a massage therapist!

I believe that had I experienced the same kind of injury today, doctors would have responded differently. In fact, a study published in the Annals of Internal Medicine in 2012 showed chiropractic care and specific exercise were more effective than NSAIDs or Narcotics for treating neck pain.

For acute or subacute low back pain, one of the most common reasons for physician visits, physicians are changing their tune as well. The American College of Physicians recommends in a 2017 report that physicians FIRST recommend treatment with heat, massage therapy, spinal manipulation, or acupuncture BEFORE resorting to pain medications. For chronic low back pain, physicians are instructed to recommend rehabilitation, spinal manipulation, stress management, exercises like yoga or Tai Chi, in addition to other non-pharmaceutical interventions.

Where does massage therapy fit into the mix? Many studies have shown massage therapy to be an effective treatment for pain, especially low back, neck, osteoarthritis, fibromyalgia, and more. A summary of some of the research is available through the National Centers for Complementary and Integrative Health. The Touch Research Institute has many studies about massage therapy available online as well. Because more research is always beneficial and because the guidelines for physicians are evolving, you can make a difference.

If you have had positive experience with  massage therapy for pain management, be sure to let your physician know what you are doing. It is always important to let your physician know all of the wellness services you are receiving so they have the whole picture of your treatment. Because some are less familiar with the benefits of massage therapy or see it as “merely” a pampering service, hearing first hand from their patients about the relief they get from massage is helpful in shaping how they might approach others with similar conditions or how they might answer questions for patients who broach the subject of massage for pain relief.

Haven’t tried massage for pain? We’d love to visit with you! Visit our website to learn more about our service and providers, or Book a service with one of our experienced, licensed massage therapists to see if massage therapy could be part of the solution for your own wellness and pain management.

Top 5 reasons we love Rapid Fire

Rapid Fire, locally developed and produced pain relief spray and roll-on products, have been gaining popularity in Iowa in recent years. In fact, Rapid Fire works so well that when our massage therapists attended a conference last year, they all came back begging me to replace our long-time, big name (that I shall not mention) pain relief spray with Rapid Fire. I dragged my heels for a bit, but kept stealing sprays from their Rapid Fire for my own aches and pains so I figured we needed to have this awesome product at the spa since it was what we were all using, even though we had shelves full of another product that was easily available. Here’s why we love it:

  1. Headache relief: This stuff is potent, so if you’re using it for headache relief at the temples, apply a tiny amount to your finger tips first, then massage into your temples and scalp. If your pain is at the base of your skull, feel free to spray or use your roll on. Be sure to wash your hands after touching it so you don’t get it in your eyes!
  2. Pure ingredients: Rapid Fire is made with wintergreen, a natural form of aspirin, peppermint for a counter irritant (to draw your attention away from underlying pain), spearmint and camphor which are analgesics (numbing agents). The active ingredients are blended in coconut oil which slows the absorption so it lasts longer than most products. It doesn’t contain alcohol found in many drug store pain relievers because alcohol makes the effect wear off faster.
  3. It passed the “Disney Test!”: Kelly suffers from horrible migraines and she swears that Rapid Fire is how she survived long days at the park on the rides, standing in lines, and walking for miles.
  4. It reduces soreness after deep pressure massages: If you feel like you need firm pressure to enjoy massage but experience soreness the day after, ask your massage therapist to use a spray of Rapid Fire over the area he or she worked to reduce inflammation and the likelihood of pain the next day. (As an LMT, I’d be remiss if I didn’t add that you can also ask your therapist to use less pressure, but we know not every client is cool with lighter pressure, though sometimes reducing the pressure a bit is more effective!)
  5. It is locally crafted by an individual who is incredibly passionate (maybe even a bit intense) about pain relief: Kevin Burns, a central Iowa MMA fighter, created an essential oil blend to help with his own pain, but quickly found himself helping other fighters. Eventually his business was born. There is something really satisfying about using a product that is so passionately and whole-heartedly backed by the person who created it, especially when the product actually works as well as he claims it does. Learn about Kevin and the company here.

In pain? Book a massage! Before your service starts, ask your massage therapist to grab a bottle of Rapid Fire to use on any sore areas. In a hurry? Stop in and ask our front desk to let you sample the product to see if it is the right pain reliever for you!

 

Try massage therapy first for pain!

eastvillagespa-tishaforearmmassageWhen I was 22 (so, awhile ago), I turned my head funny picking a very unlucky penny off the floor.  My neck ached for a couple of weeks so, being right out of college and not having a doctor in my new town, I went to an urgent care clinic for advice. The doctor felt my neck, did some range of motion exercises, and declared that I had arthritis, wrote me a painkiller prescription, and sent me on my way.

Not once did this doctor tell me, an otherwise healthy and active 22 year old woman to consider massage therapy, chiropractic, osteopathic manipulations, or other conservative forms of pain management.  When I did seek out massage on my own and realized how powerful it was, I knew I needed to become a massage therapist to help others.

I’ve been researching the nation’s opioid addiction crisis and wondering why traditional health providers are still not more widely educated on the benefits of conservative measures of pain relief for non-specific pain (i.e. back pain that is not caused by an underlying factor such as cancer) when massage therapy has been proven in multiple studies to be effective in relieving many kinds of pain.  I can almost give the doctor I saw back in 2002 a pass because massage therapy wasn’t as well-researched as it is today, but I feel like with our current information, there are no excuses.

According to the National Institute on Drug Abuse (drugabuse.gov):

  • From 1991-2013, opioid (Vicodin, Hydrocodone, Oxycontin) prescriptions rose from 76 to 207 million.
  • From 1990-2010 overdose deaths from prescription opioids tripled (and were more common than deaths from heroin or cocaine).
  • 14.4% of women are prescribed an opioid drug during pregnancy

eastvillagespa-juliemassagecloseupOver 100 million Americans suffer from chronic pain, 38 million of those need relief from persistent moderate to severe back pain (drugabuse.gov).  Massage therapy has been proven effective in treatment of non-specific chronic low back pain (The Annals of Internal Medicine).

  • 401 patients between the ages of 20 and 65 who had non-specific chronic low back pain for at least 3 months (rating a minimum of 3 out of 10 on a pain scale) received either general relaxation massage, structural (injury-specific) massage, or traditional medical care for 10 weeks.
  • After results measured at 10 weeks after treatment and 26 weeks after treatment, participants who received massage fared significantly better than those who received traditional medical care without massage.
  • There was no statistical difference between those who received general relaxation massage techniques and those who received structural massage techniques.

Massage Therapy Magazine cites several studies showing the efficacy of massage therapy for various types of pain and proposes that massage therapy can be a major player in helping to combat the opioid addiction epidemic by offering a conservative first line of treatment for pain.

While pain medications including opioids certainly have their place in patient care and are necessary for many people, we need to find a way to educate traditional healthcare providers that conservative treatments like massage therapy are effective. One way to start is by discussing massage therapy with your primary care provider.  Last year, 16% of respondents in the American Massage Therapy Association 2015 industry study indicated that they discussed massage with their physician.  If you have had positive benefits from massage, let them know!  We also need to encourage teaching hospitals and massage therapists to continue to conduct sound research to further share what many people who get massage already know: It works!

Ready to try massage? Click here to book with one of our experienced and licensed therapists.

Sources:

Massage Industry Fact Sheet 2015: American Massage Therapy Association https://www.amtamassage.org/infocenter/economic_industry-fact-sheet.html

Massage Magazine: Can Massage Help Combat the Opioid Epidemic? https://www.massagemag.com/can-massage-help-combat-opioid-epidemic-36842/

National Institute on Drug Abuse https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse

The Annals of Internal Medicine: A Comparison of the Effects of Two Types of Massage on Chronic Low Back Pain. 2011. http://annals.org/article.aspx?articleid=747008