The Risks of Spa Treatments

bath, get kneaded like a ball of dough, or indulge in any of the other countless treatments available today, you should know the risks involved.

Sure, spas have been around a long time -- since ancient times, in fact, when Roman soldiers in a small Belgium village called Spa first discovered the soothing effects that hot mineral springs had on their aching bodies. Up to the turn of the 20th century, doctors from various cultures routinely sent patients to soak in baths they believed to have restorative powers. But most of the spas of today bear little resemblance to those first "curative" spas.

Yet today, operators of the 10,000 or so spas in the U.S. continue to tout the treatments' health benefits. While most of today's spas promise to restore, refresh, and renew -- and some offer even more explicit health claims -- they generally don't warn you of the potential risks involved. But they do exist. Certain spa treatments can worsen chronic and acute health conditions. All spas can pose risks to the general public, particularly when operated in a state of uncleanliness.

We talked to medical experts and public health officials to learn just what these health risks entail and how you can avoid them.

Chronic Conditions
Pedicures: Dangerous with Diabetes People with diabetes need to take extra precautions when getting foot treatments. "Any break in the skin, potentially from aggressive trimming of a callous or cuticle, can increase the risk of foot infections called cellulitis," says Sharon Horesh, MD, an internal medicine doctor with Emory University's department of medicine.

That's not the only reason for precaution.

You can't always tell how clean a spa's water or supplies are. But you can minimize your risk of becoming infected by contaminated water or supplies. "If you have diabetes and you have ulcerations on your feet, bring your own container of water for a pedicure," says Louise-Ann McNutt, PhD, an epidemiology professor at the University of Albany. She also suggests bringing your own equipment, from bucket to emery boards. "It puts you in charge of how clean the supplies are," she tells WebMD.

Massage: Finding the Right Touch
When it comes to massage, experts say that the degree of risk involved depends on the type of touch applied. "The most important adaptation for chronic disease, like cancer, is touch level," says Kathleen Clayton, a licensed massage therapist and spokeswoman for the American Massage Therapy Association.

"In that instance, I might do a light touch, or foot reflexology."

Finally, she urges all potential massage-goers to receive massages only from licensed massage therapists. "Find somebody who will know what to look for and what to ask the patient," she says.

Acute Conditions
Pregnancy: What's the Rub on Massage?
While off-limits in the first trimester, massage may actually bring pregnant women great relief in the second and third trimesters. But the type of massage matters. "In the second and third trimesters, women should specifically seek a pregnancy massage therapist and avoid massage techniques that involve long strokes along the legs or pressure between the ankle and heels," Horesh tells WebMD.

There's good reason to heed this advice. "There's always a chance that it might make the baby dislodge, or induce premature labor," explains Clayton.

Massage and Menstruation
The combination of massage and menstruation is a double-edged sword. On the downside, it can increase menstruation flow. But because it improves circulation, massage may minimize some symptoms of menstruation. "It can reduce back pain and cramps and diminish the feeling of bloating," Clayton tells WebMD.

Saunas Exacerbate Respiratory Infections
Some people find it extremely relaxing to sit in a sauna, a wooden room infused with dry heat that supposedly eliminates toxins as it opens pores and promotes sweating. But if you have a cold, a respiratory infection, or an asthma flare-up, it's not the place for you. "Dry heat from saunas can make it uncomfortable to breathe," Horesh says. On the flip side, steam rooms with moist heat can improve sinus congestion, asthma, and allergies, she tells WebMD.

Public Health Risks
Chronic and acute conditions aside, all spa-goers need to be alert to the potential risks that may lurk in the very spas intended to relax us. A report released by the CDC in 2004 showed that more than half of all public hot tub spas in the U.S. violate public health safety standards. Of the 5,000 spas inspected, 57% breached at least one safety violation. Poor water quality was the most common violation.

Poor water quality can translate into a breeding ground for bacteria. Indeed, outbreaks of community-acquired infections from spas have occurred. In one such outbreak, more than 115 nail salon patrons contracted severe skin boils from a series of contaminated whirlpool footbaths used as part of the pedicure procedure. The boils resulted from a fast-growing form of bacteria called Mycobacterium fortuitum. Of the 61 clients that investigators tracked, most required a four-month course of antibiotics. The average disease duration was 170 days. The outbreak was reported in a 2004 issue of the journal Clinical Infectious Diseases.

Just how prevalent is this bacteria in salon whirlpool footbaths? In 2004, investigators in California set out to answer that question. They sampled 18 salons from five large counties in different parts of the state. They found the Mycobacterium fortuitum in 14 of the 30 footbaths surveyed. Other types of mycobacterium were also seen. Results were published in the April 2005 issue of the journal Emerging Infectious Diseases.

Short of swearing off pedicures and other spa treatments that involve immersing part or all of your body in heated water, what can you do to reduce your risk of infection at spas?

Do some detective work of your own before taking the plunge. "Look around at the spa for general cleanliness. Talk to people who have been there," McNutt suggests. She also recommends bringing your own equipment to avoid the threat of contamination. And, if you have any open cuts or abrasions, cancel your appointment until they clear. Any open area of your skin can invite infection. That's why it's never wise to shave your legs the day of, or even the day before, a spa treatment that involves immersing your legs, McNutt tells WebMD.

In spite of the potential health risks of spa treatments, most people who frequent them report positive experiences. Knowing the risks that pertain to you and carefully assessing the cleanliness and track record of a spa prior to making an appointment can go a long way to ensuring your safety and satisfaction. If you're uncertain about how a spa treatment might affect you, always consult your doctor first.

Just as in ancient times, many doctors today would agree that, under the right circumstances, a spa treatment can promote wellness. "In general, there are many benefits to spa treatments, perhaps the greatest being the relaxation and stress reduction they offer," Horesh tells WebMD. "They can also relieve muscle tension and pain in people who suffer from chronic back pain, fibromyalgia, or who have had an injury from sports or a car accident."