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The spa is the fastest growing trend in the wellness industry today and a common household word for many, if not most, of us. The spa industry is second only to the esthetics industry as the fastest growing service industry in the world.


October 23, 2009
By Cidalia Paiva

The spa is the fastest growing trend in the wellness industry today and a common household word for many, if not most, of us. The spa industry is second only to the esthetics industry as the fastest growing service industry in the world. Price Waterhouse Coopers suggests that spas are the fastest growing business in Canada with an average growth of 16 per cent per year (growth over the last five years has been 97 per cent). There are an estimated 2,100 spas in Canada as compared to 12,000 in the United States. According to the Canadian Spa Association, spas in Canada employ 8,200 full-time employees and 2,500 part-time employees. “Spa Finder,” a media and travel company, has estimated spa revenues in the U.S. and Canada to total 12 billion (this number includes travel and housing expenses). As the statistics and trends analysis studies continue to inform us, this growth will continue and prevail in the 21st century.

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The word spa is believed to have derived from the Latin phrase (salus per aqua) (health from water). Spas have a long history of medicinal use and applications in the healing arts that goes back to ancient civilizations. The Egyptians, Arabs, Romans and Greek, Chinese and Japanese all used spa therapies such as massage, hydrotherapy (therapeutic baths) and herbal and mud packs to treat a variety of diseases and health problems.

By the late 1800s, the development of modern spas had moved to include every part of the continent. Spas co-operated with physicians, and the medical use of water therapies, massage, aromatherapy, body wraps and herbal applications is well documented in the history of North American medicine. Unfortunately, the prime, so to speak, of great North American spa and spa physicians was virtually over by the 1940s and almost non-existent by the ’50s. This was largely due to a scientific boom and the discovery of miracle drugs such as antibiotics and advances in surgical techniques that created a growing belief that medical science and technology would soon provide all the answers to sickness and disease.

In the late ’70s and early ’80s a true renaissance occurred in the U.S. and Canada. Public interest in natural medicine grew as people sought ways to maintain and restore health using natural remedies. North Americans, like their European counterparts, became fanatically committed to finding ways and means to “live better” not just “longer.” Today’s spa is an oasis for health and wellness that includes medical, hospitality, esthetics and fitness services that offer rest, pampering, pleasure, renewal, rejuvenation and nourishment of body, mind and soul.

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Spas come in many shapes, sizes and focuses – from day spas, where you can get a single treatment, to destination spas, where you can stay for a week or more at medical spas that treat cosmetic and chronic health problems. Spa practitioners today may work at: club spas, cruise ship spas, destination spas, medical spas, mineral springs spas or resort/hotel spas. Or they may find work in the fields of merchandising, scientific, communications, instruction in public and private vocational and technical schools, spa program direction or management, or spa consultation and analysis.

The leaders and drivers of the spa industry in North America and Europe are known as the International Spa Association or ‘ISPA’. ISPA is recognized worldwide as the organization and voice of the spa industry representing more than 2,300 health and wellness providers in 70 countries around the world. The mission of ISPA is “to educate the public about the value of the spa experience and engage their participation.”

The International Spa Association has organized and categorized spa offerings into the following areas or as they describe these “domains” or “segments” of the industry.
1. “The Waters”
2. Food, Nourishment, Diet and Nutrition
3. Movement Exercise and Fitness
4. Touch, Massage, and Bodywork
5. Mind/Body/Spirit
6. Aesthetics, Skin Care, Natural Beauty Agents
7. Physical Space, Climatology, Global Ecology
8. Social/Cultural Arts and Values, Spa Culture
9. Management, Marketing and Operations
10. Time, Rhythm and Cycles

What accounts for the phenomenal growth of the spa industry in North America?

There are obviously a multiplicity of driving forces behind the exceptional growth of the spa as a movement and industry in North America. Three of the most significant consistently cited in trend-analysis studies are an aging demographic, the stresses of modern life and a faltering health-care system.

Perhaps the most significant factor contributing to the burgeoning spa industry today is aging baby boomers’ refusal to accept aging and the requisite limitations, including chronic health complaints, that were once accepted as part of what was typically called the “third passage.” Today baby boomers not only want, but expect, to live longer and to live a longer life with a quality of life previously unparalleled. To achieve this end affluent boomers are prepared to spend vast amounts of surplus income in order to stay well and as young as possible for as long as possible.

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The stresses and pressures of modern life including demanding careers, children and sometimes extended family, as parents age, create serious physical, mental and emotional overloads. For many people life is a treadmill they feel they will never get off and they look to the spa for reprieve in the form of stress management. North Americans take courses in yoga and Pilates, buy books and CDs and retreat to the spa. Spas enter the picture by providing us with a place where we can slow down, decompress and rest our bodies, minds and spirits. The modern spa is the answer to down time, quiet time, rest, space and access to a wide range of wellness modalities that are often perceived as cure-alls for a wide range of stress-related maladies.

Unfortunately, the Canadian health-care system – certainly as we knew it in our young adult lives – has dramatically changed. The number and quality of health-care services available to the general public has certainly suffered a significant decline in the last two decades. Hardly a day goes by without a magazine or newspaper article publishing disturbing reports of poor, delayed, hurried or inaccessible hospital treatments and services. We remain skeptical of our politicians’ promises to deliver the radical reform that we direly need, given an aging population and advances in new technology. In the absence of a viable health-care system to address our needs and in the vibrant wake of the patients and consumers’ rights movement in North America, more and more people are taking responsibility for their health and well-being and proactively seeking new services to maintain their health and wellness.

Who are today’s spa service providers?
In the U.S., massage therapists and holistic practitioners are trained in a multiplicity of modalities such as ayurvedic, hot stones, and aromatherapy. In Canada, estheticians and bodyworkers, and sometimes estheticians who are also bodyworkers – given that many spas prefer to recruit multifaceted employees with cross-over skills – are spa service providers. What about credentials? Personality and attitude for most spas are more important than training and credentials, although some high-end spas who wish to utilize insurance  billing will often employ registered massage therapists in order to avail themselves of their extended health-care coverage. In Canada we have no commonly agreed upon language to provide us with a title or designation for spa service providers. We call them practitioners at best and sometimes the somewhat awkward term Spa Technologist first coined by Langara College in British Columbia.

What is the scope of practice of spa service providers and who monitors the practices of these practitioners and ensures that they do not enter the realm of therapeutic massage? At this point in time, certainly no regulatory board or college, given the fact that the spa industry is unregulated. Moreover, the spa industry is not sufficiently evolved (in the area of the medi-spa where a scope of practice designation could reasonably be expected to emerge) to provide a scope of practice and this will undoubtedly prove a daunting task, given the breadth of spa services. However, a number of spa training programs have emerged all over Canada, including Ontario and British Columbia, two of Canada’s three regulated provinces (the other being Newfoundland and Labrador), who offer both spa and registered massage therapy training programs. In the absence of a spa scope of practice, these institutions have “de facto” carved out a spa job description to assist them and the public in separating and distinguishing between the services of the two groups.

Some of these schools offer layered programs, which consist essentially of the first year of a two- or three-year program of study with minor modifications, as a spa program of study. Others offer stand-alone programs that encompass a variety of spa modalities, including manual skills, wraps and peels, hot stones, Ayurvedic, Thai and shiatsu massage, and have been custom tailored to today’s spa marketplace.

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These institutions, primarily in the regulated provinces of Ontario and British Columbia, distinguish these services in the form of two different job descriptions. The first job description essentially consists of the scope of practice of Registered Massage Therapy. Registered massage therapists are described as skilled clinicians who provide therapeutic services and treatment and often work on general and orthopedic pathologies such as tendonitis, muscle strains, sprains, headaches and low back pain. They will also explain that registered massage therapists will often utilize hydrotherapy in conjunction with their advanced massage therapy skills. Accordingly, they offer that registered massage therapists are part of a regulated health-care profession and must be graduates of a 2,200-hour or a 3,000-hour training program (in British Columbia, where these schools must also be accredited by professional and government regulatory bodies) in order to apply and hopefully obtain licensure in these provinces.

In contrast, they will explain that spa practitioners/technicians are persons who typically work in such spa environments as club spas, cruise ships, day spas, destination spas and resort hotel spas, and offer relaxation and stress management services in addition to a variety of modalities that support the goal of relaxation and stress management. These modalities include aromatherapy, reflexology, hot stones, wraps and peels, Ayurvedic, Thai and shiatsu massage. These individuals are graduates of a private institution that offers training in spa services and may be members of a professional association such as the International Spa Association or Spa Canada. As to the question of who should a particular client see, the answer – in school clinics at least – is that it depends on whether the nature of the service the client is seeking is massage therapy treatment or spa relaxation services.

Are these distinctions helpful to the public? In these training institutions, at least, apparently so. In fact, some of these schools offer public teaching clinics where spa students provide referrals to RMT students for therapeutic services and RMT students provide referrals to spa service providers for a broad range of spa modalities that focus on relaxation and stress management services.

Is there a place for both of these services in the massage therapy marketplace? Apparently so, as more and more heath consumers begin to discover the difference between them and demand the right to choose.


Cidalia Paiva, PhD, author of Keeping the Professional Promise and Ethics and Professionalism – for Regulated Healthcare Professionals, is one of North America’s leading experts on ethics and professionalism in massage therapy today. Dr. Paiva brings more than 25 years of knowledge, experience and wisdom to the challenge of empowering regulated health-care professionals to understand and embrace their professional promise – to protect and serve the best interests of their patients – with integrity in touch.


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