In 2018 I experienced “physiotherapy” from many years ago; at the Igalo Spa in Herceg Novi, Montenegro. That’s not me in the photo above, just an indication of what is to come. To give some background about the Igalo Spa I’ve taken a few excerpts from their website at www.igalospa.com:
The Institute for Physical Medicine, Rehabilitation and Rheumatology “Dr Simo Milosevic” JSC Igalo is considered to be one of the largest and most famous institutions for multidisciplinary spa treatment on the Balkans. Following the old European tradition of natural treatments, the Institute has gained an international reputation for its successful treatment of its clients with a wide range of medical problems in the field of rheumatologic, cardiac, neurologic, pulmonary and orthopedic diseases. Being a unique blend of a hotel and a health and rehabilitation center, with the help of non-invasive methods and by an experience-based application of natural factors of Igalo (healing sea mud, mineral water, mild Mediterranean climate), the Institute approaches each guest with an individually tailored medical program. Among others, treatments include also, hydrotherapy, balneotherapy, electrotherapy, thalassotherapy, individually tailored exercise programs and different types of massage.
Upon arrival, the Institute is as impressive in size as it is in name – eleven stories high and spread over hectares. Diametrically opposed in appearance to the brutalist concrete Socialist-era apartment blocks next door, the Institute gives an impression of a 70’s excess. Everything is glorious, with an entrance hall thirty-five paces from front door to reception desk and twice as wide. The corridors are more spacious than most Montenegran roads, and there are chandeliers, wooden panels, glass and marble throughout.
The Institute’s staff roster is equally impressive with 36 medical doctors, 54 nurses and 203 physiotherapists! There are other health professionals including recreational and cultural staff, and beauty therapists.
At this stage you may be wondering how I came to be here. The answer is both opportunity and curiosity. I dragged my wife half way around the world as part of a holiday to visit the home of her ancestors and discovered the opportunity to experience physiotherapy as it once was in Europe. And this unique combination of hospital, hotel and recreational facility (did I mention the twelve lane x 25 metre swimming pool, basketball court and two lane bowling alley), from a former Socialist powerhouse was not to be missed.
To receive therapy at the Institute, one must first undergo an initial assessment by a nurse (past medical history, medications and blood pressure), and then from a medical practitioner. Interestingly both of these assessments were included in the price of our accommodation, whereas the cost of treatment is based on each service received.
In the interests of full disclosure I admitted to the doctor that there were was nothing wrong with me and that I was there to experientially satisfy my professional curiosity. She understood and prescribed a range of treatments including breathing exercises, bubble bath, water gym, magnetotherapy and peloid applications. There was little opportunity for discussion and input, so the underwater massage, hydrogalvanotherapy, vaginal fogging, electrophoresis, diadynamic currents, microwaves, ultrasound, laser and massage were unfortunately excluded.
As we arrived on a Sunday, we had to wait until the next day for our therapies, which gave us the afternoon to explore the Institute further.
Whilst an enormous campus, there were plenty of patients to fill it. A second, older building a block away, also belonging to the institute appeared even busier. The patients were generally older, many with clear orthopaedic and rheumatologic conditions, while some were rehabilitating with strokes and other neurological conditions. Some younger adults and children were also present. Although English is spoken, often as the Lingua Franca, native English speakers were rare. Large tour groups from Denmark and Norway had also arrived with us.
The accommodation fee also included breakfast and dinner in a dining room capable of seating 400 or more, with serving staff assisting people to carry their food to their tables as required. In case you were wondering the food seemed more directed towards catering for larger numbers rather than dietary improvement.
In the evening we went on a guided tour of former Yugoslav President Tito’s Galeb Villa, just next door. Unused since his death in 1980 it is frozen in time. There were many fascinating elements like the bomb shelter; swimming pool with salt, fresh or mineral water; and the blue marble bathroom. Now the property of the Institute, our guide proudly showed us the personal therapy services used by Tito for his peripheral vascular disease, including the very unique Scottish Shower where he was sprayed with alternating hot and cold water to facilitate vasodilation and constriction.
Therapy day dawned and the most striking experience was that all the patients/guests donned the white, terry-towel robes provided. Doctors wore white coats and physiotherapists white polo shirts. Now that everybody was appropriately identified, the therapies began.
First up was our breathing class; a fifteen minute series of exercises in the garden of the facility. Primarily aimed at thoracic mobility, the movements were inconsistently coordinated with inspiration and expiration (or was that just me?). I guess everybody could do with some breathing.
We then trotted off to our Bubble baths. Ushered into a partitioned room I stepped into a bath (clothing optional) and sat upon a diffuser that blew bubbles for fifteen minutes. My physiotherapist checked I was okay at the beginning and halfway through and then handed me a towel when it was time to get out. In between she sat outside pouring over her mobile phone. A quick chat with her at the end elicited that she trained at the institute over three years, and received a Bachelor physiotherapy qualification.
Next up was hydrotherapy. Amongst fifteen patients in one of the four (yes, four!) 32 degree hydrotherapy pools, my wife and I did about ten lower limb stretches and buoyancy exercises, culminating in two walking laps (on heels and then toes). Our land-based instructor communicated his intent by mime and occasionally corrected errant individuals.
A short break and then magnetotherapy where I lay upon a plinth with a vinyl mat atop. My physiotherapist set a timer to twenty minutes and instructed me to see myself out when it rang. Throughout the treatment I did not feel anything happening so wasn’t sure the machine was on, but with a little wriggling I followed a cord coming from the mat connected to a box with a reassuring blinking green light. At the end of the session I wandered off unsure of what I had just experienced.
The final session of the morning was a peloid application. A plastic sheet was laid on a plinth and my physiotherapist ladled a special “therapeutic” mud from a bucket upon the sheet where my back, knees and ankles would rest. I was instructed to lay supine and the plastic sheet was wrapped around me and then we were covered in blankets. A warm gooey feeling enveloped as I quietly dozed for twenty minutes. The best part was getting hosed off with a powerful warm water spray.
It was an exhausting half-day of passivity.
Clearly identified by my robe I adopted the role of patient and blindly followed the instructions of my physiotherapists as they, in turn, blindly followed the instructions of the doctor. Needless to say the job must be mind-numbingly boring for the physiotherapists who do nothing but provide the same intervention over and over (not sure of the job rotation schedule). No assessment, no reassessment, no review, no tailoring. I was not surprised when one practitioner reluctantly advised me that she had returned to university to study pharmacy for more stimulation and reward.
Let it be clear that my experience at the Institute was that of a healthy man, and would not be representative of Montenegrin physiotherapy, nor was it possibly completely representative of physiotherapy at the Institute. Rather, I expect my experience was an isolated pocket of the historical European Spa industry that refuses to progress. Clinging to ‘natural’ methods and given credence by medical imprimatur, it has garnered a willing market for over a hundred years and will continue as long as the market is available.
In this place of physiotherapy that time has forgotten, I was reminded of:
- the extraordinary progress of the physiotherapy profession from medical servant to independent practitioner,
- the importance of the scientific method in advancing the profession, and
- that all three pillars of evidence based practice need to be used in clinical practice.
Nevertheless, it was a great experience that just might suit some people.
Hi Glenn , thanks for an enlightening and entertaining read, reminds me somewhat of a day I spent at a hospital in Budapest some years ago. Cheers Rod Farr