Too often spa owners, spa managers, and even spa therapists don’t insist on a thorough health history intake process, placing clients at risk. While spa treatments are often designed to promote relaxation, some spa products have physiological effects on the body that could cause complications for some people; failure to define and enforce safety procedures can also lead to injuries.

General Considerations

Like massage, spa treatments might be contraindicated completely, contraindicated without a doctor’s release, contraindicated for a specific body area, or require adaptive measures and increased vigilance. The spa products chosen for a particular treatment, the surface area of the body it will cover, and the overall condition of the client need careful consideration. A spot treatment may be safe when a full-body application is contraindicated. If the product or its ingredients can penetrate the skin and enter circulation, it must be used with more caution.

If the client is taking a prescription or over-the-counter medication that distorts his or her perception of hot, cold, pain, or pressure, postpone the treatment. For the same reason, clients under the influence of drugs or alcohol should not receive a treatment. Offering wine, champagne, or other alcoholic drinks as part of the spa package endangers the client and may affect the legal liability of the clinic or spa. An up-to-date medical dictionary, drug reference, and pathology reference books should be readily available to research unfamiliar conditions and medications. If there is any doubt about the suitability of a given treatment for a client, suggest a different treatment or postpone the treatment until you obtain a doctor’s release.

Ensure that your health history intake form asks questions about allergies to herbs, essential oils, iodine (present in seaweed), or other ingredients. Heat increases the irritation potential of any product being applied to the body, so clients are at greater risk for developing skin irritation during treatments like hot sheet wraps, hot stone massage, or hydrotherapy tub immersions.

Aromatherapy Cautions

When therapeutic grade essential oils are used at low concentration (1–3 percent or 6–18 drops to every fluid ounce of carrier) and applied externally, negative reactions are minimal. Some oils contain chemical components that may cause liver or kidney irritation when used—even topically—for prolonged periods. Generally, an oil should be used continuously for no longer than two weeks to prevent sensitization of the kidneys, liver, or skin. Eucalyptus, peppermint, and rosemary essential oils will counteract the effects of many homeopathic remedies.

The most likely undesirable effects common with use of essential oils are skin irritation and phototoxicity. When large amounts of certain oils are used topically, or when oils are used with heat, irritation is more likely. The term phototoxicity refers to an increased sensitivity to the sun. Oils containing compounds called coumarins and furocoumarins increase the skin’s tendency to burn. Clients should avoid tanning for 24 hours after the application of these oils. The sidebar on page 123 lists oils that should be avoided or used with caution.

Body Wrap Cautions

Hot sheet wraps, cold sheet wraps, or wraps that promote aggressive detoxification should not be used on children, the elderly, pregnant women, or people with a heart condition or high blood pressure. Hot wraps are contraindicated if clients have recently been in a car accident or suffered a soft-tissue injury, and for clients with rheumatoid arthritis or nerve damage that interferes with their ability to give feedback on temperature. Hot and cold sheet wraps increase the load on the cardiovascular system and kidneys and may aggravate an existing condition. For example, clients with impaired circulation, or those with advanced or poorly treated diabetes, should not receive hot or cold wraps. Tension wraps (when cellophane or herbal infused bandages are wrapped snugly around body areas) are contraindicated for individuals with spider veins, varicose veins, weakened veins or arteries, or those with poor circulation.

Body wrap clients can suddenly become anxious or panic. Therapists should never leave a wrapped client alone; this may result in injury if the client becomes claustrophobic and struggles to get out of the wrap.

Exfoliation Cautions

Avoid the use of exfoliation products or dry skin brushes on open wounds or broken skin, on clients with chronic skin conditions (unless recommended by a physician), on sunburned or inflamed skin, over varicose veins, or immediately after waxing or shaving. Using exfoliation products in these circumstances may cause irritation or complicate the condition.

Fangotherapy Cautions

Peat or mud should not be used on broken skin or over skin conditions. While peat and mud are used regularly in Europe and by estheticians for skin care, broken skin is prone to infection. Peat and mud are not held to any standardized quality requirements, are often shipped from overseas, and may contain pathogens. Clay can be used with oily skin that has minor blemishing, but severe acne, which might be located on a client’s back, should only be treated by an esthetician or dermatologist. 

Hot Stone Massage Cautions

A number of claims are filed with massage insurance companies each year because of burns from hot stone massage. If stones hot enough for treatment are left resting on bare skin, they can burn the client; the stones should be moving constantly. Hot stones meant to sit in one place should always be insulated with a thick drape like a bath towel. Therapists’ hands grow accustomed to the heat of the stones quickly and so their ability to accurately assess a safe temperature is impaired; temperature must be monitored constantly by thermometer. The water in the heating unit should never be hotter than 140°F, and the safest temperature is between 130 and 135°F. As with any treatment, it is better to err on the side of caution and give a warm stone massage rather than endanger a client in any way.

Stone massage should not be used on clients with advanced or poorly treated diabetes, circulatory conditions, deep vein thrombosis, edema, gout, heart disease, a serious heart condition, high blood pressure, high risk pregnancy, neuropathy, renal diseases, rheumatoid arthritis, or thrombus. Broken or inflamed skin, recent soft-tissue injury, sunburned skin, and varicose veins are site contraindications. Use caution on elderly clients who may have thin, delicate skin, and on very thin individuals who are likely to be more heat sensitive. 

Hydrotherapy Cautions

The use of full-body hydrotherapy treatments (immersion baths, contrast Vichy or Swiss showers, saunas, and steam treatments) is contraindicated for individuals with serious heart, circulatory, nervous system, or systemic conditions. Open wounds and skin rashes are also contraindicated when using hot- or cold-water treatments.

A clients’ general health and vitality will determine the appropriate length of a hydrotherapy treatment. Elderly clients or people in a weakened condition should only receive hydrotherapy under a physician’s supervision. People who lack general fitness should not spend more than 15 minutes in hydrotherapy tub treatments, steam rooms, and saunas. Healthy individuals can remain in such treatments between 20 and 30 minutes.

Thalassotherapy Cautions

Seaweed is one of the most potent substances used in spa treatments and so the appropriateness of the treatment must be considered in relationship to the client’s overall health. Seaweed is not suitable for use on children, the elderly, people in a weakened condition, or pregnant women. Brown seaweeds have high concentrations of iodine and may overstimulate the thyroid gland. In a healthy person, this usually results in a feeling of increased energy and well-being. For those with thyroid disorders, a full-body treatment may throw the body out of balance. Until more research is available, it is best to avoid giving full-body brown seaweed treatments to clients with thyroid disorders. Choose green or red seaweed treatments instead, or only apply the seaweed to one area of the body.

When taking clients’ health histories, it is important to check for shellfish or iodine allergies. Allergic clients should not receive a seaweed treatment; small amounts can cause serious allergic reactions.

When Adverse Reactions Happen

With any client, the therapist should watch for increased pain, discomfort, agitation, nausea, headache, or dizziness. If any of these symptoms occur during a treatment, the therapist should stop the session and allow the client to relax in a quiet environment at a normal temperature. Monitor the client at all times and do not allow him or her to go home until symptoms have disappeared. Most often, symptoms like nausea and headache are the result of accelerated detoxification. If the symptoms persist after the session has ended, a physician should be consulted. If the symptoms increase rapidly at any time, the therapist should call emergency services.

Therapist Safety

Therapists working in a spa are often exposed to a number of potent products during the course of a workday. In some cases, this has resulted in severe contact dermatitis or in persistent chronic dermatitis. Vinyl gloves can be worn in most cases to protect the hands from reaction to products. Heavy gloves should be worn when working with strong sanitation products.

 Anne Williams is a licensed massage therapist, esthetician, aromatherapist, certified reflexologist, registered counselor, educator, and author. The work outlined in this article is adapted from the author’s textbook, Spa Bodywork: A Guide for Massage Therapists (Lippincott Williams & Wilkins, 2007). Williams is also the education program director for Associated Bodywork & Massage Professionals. She can be reached at anne@abmp.com or anne@spabodywork.com.