Nari, the masseuse, begins her treatment by rubbing the insides of my thighs with weak hands, her hands wandering closer and closer to my crotch. I feel nothing but a faint tickle on the skin.

This massage is going to be a waste of time and money, I think, lying on the bed naked apart from wide spa-pants.

I’ve heard much criticism of massages in Phnom Penh – that they are low quality and have even led to back injuries, due to poorly trained masseuses. Last week I decided to find out for myself. I frequented different spas and spoke to physiotherapists and doctors to decipher the difference between an excellent and lousy massage.

Nari works at a spa in BKK1. At $7 for a 60 minute Khmer full-body massage, the treatment that I choose is in the middle-priced segment. The ambience of the room is tasteful and relaxing –a panelled mahogany ceiling, the scent of lemongrass wafting from an oil-burner and ethereal music set the scene. The right environment can enhance a good massage – however the experience with Nari makes me wince.

The massage doesn’t increase in strength and she keeps on focusing on the insides of my upper thighs. She makes me a special offer that I kindly refuse. When she knows that I am here only for a massage, she slings her legs around one of my legs, leans back and then swings around with the full weight of her body. My spine cracks. When she wants to repeat this procedure with my other leg I tell her to stop. I also tell Nari to stop when she jams her elbows in the vertebrae of my back and neck.

The kind of treatment I experienced can result in a back injury that has to be fixed by a medical professional. French physiotherapist and medicinal masseur Jean Jaques Dhuez has been practicing in Phnom Penh for 21 years. “When they twist your back this can put the vertebrae out of place causing a lot of pain,” he says.

“Many people that come here have never had a massage before and they think Southeast Asia is the homeland of massage, when in fact the standard of massage is very low in Cambodia.”

Every month around two patients seek out Dhuez after suffering massage-induced injuries, most in plenty of pain after visiting cheaper and unprofessional spas. In his light-filled practice on street 306, he explains that while some of the people looking for back pain relief have been completely healthy before receiving a dodgy massage, most of them already had a problem then made worse by untaught hands. People with tight, painfully rigid muscles in the back tend to ask the masseur to work extra hard on the affected area, resulting in injury.

“Pushing too hard in the wrong places can cause further tension in the muscle,” Dhuez explains. If it is only a muscle the tension and pain can usually be cured by a professional massage and some exercises. Sometimes, however, ribs, vertebrae and other bones have to be manipulated and readjusted back into place.

I remember how Nari jammed her elbows into my spine and I am glad that no bone in my back had to then be manoeuvred back into place.

“If you have any pain you should consult a doctor or a medical practitioner,” Dhuez says, rather than seeking further massages to ease the aches.

Other medical professionals agree with him. French doctor Christophe Savouré specialises in chiropractics, the treatment of problems related to nerves, muscles, and bones. He opened the first chiropractic clinic in Phnom Penh nine months ago and knows that people often avoid seeking the professional help they need.

“People skip the doctor, don’t get diagnosed and walk around with different conditions for years,” he says, adding that the plethora of medical conditions that can arise from medicore massages were far too complex for an untaught masseur to treat.

The problem, it seems, is that the boundaries between medicinal massage and recreational massage often overlap. For this reason people underestimate the effects a massage can have on their health.

“Everything that affects our health and body should be regulated,” says Savouré.

Unlike many other countries, in Cambodia the education of masseurs is completely unregulated- anybody can open a massage parlour. In Germany, a masseur has to complete 3200 hours of training before he or she can lay hands on a patient or a client, while a masseur education in France takes three years. Not only is a certificate not compulsory in Cambodia but there is a lack of massage schools and training facilities.

In the USA alone there are 1300 massage therapy schools teaching the basics in anatomy and physiology. Even in Thailand massage is regulated by the department of Thai Traditional Medicine, although regulations and certificates are loosely enforced, according to Dr. Savouré, who has practised in Thailand for 6 years.

The owner, Oern, of the BKK1 spa I visit, says they don’t have a teacher for their masseuses but is adamant she only hires staff with experience, which Sophary doubts, as “they usually don’t bring in any certification.”

Oern admits that her staff are “in and out.” The spa owner says that most of the girls only stay for just one to three months before leaving. Nari had only been at the Lotus for one week when she gave me the massage.

A low salary of $70 a month plus one extra dollar per massage and tips may not prove a great incentive for the girls to stay in the profession and deepen their knowledge before a more lucrative and less physically challenging job in a different field comes along.

Yet shutting down the whole low-income industry is neither possible nor necessary.

Sauvouré says that a visit to the spa shouldn’t be problematic if a person is healthy, the parlour is hygienic, and the masseurs avoid pushing too hard and using dangerous techniques such as walking on the back, cracking the neck and back, and pulling fingers and toes. He adds that people with systemic diseases such as high blood pressure, cancer, and diabetes should always consult a doctor before getting a massage.

But greater than potential health threats is the chance of receiving a massage that is not worthwhile.

For that reason, Dhuez himself is opening a massage parlour next week. “I want to boost the standard of massage in this country,” he says. As there is no massage school in Cambodia, Dhuez has trained the massage staff in the necessary techniques and the basics of anatomy himself. His masseurs won’t be able to give a medicinal but only recreational massage.  

“One of the most important things for a masseur is to know when not to give a massage,” he explains. “If I don’t know how to treat a problem I pass the patient on to a different professional.”

Dhuez was not the first who came up with the idea of setting new quality standards in massages. Vothy Rith and his wife opened the La Rose Spa and Boutique Hotel on Norodom Boulevard in October 2012. “Before our 20 massage therapists get to treat a client we train them for eight months,” he says. It makes for a more expensive treatment:  at $25 an hour for a Khmer massage, the price is more than three times higher than at the Lotus. “Cambodians and foreigners start to value a good massage, but you get what you pay for,” Vothy explains.

I am allowed to try the La Rose massage free of charge. Before I can lie down on the massage bed I fill out a medical form that informs therapist Mealea of any medical conditions I might have. Lying facedown on the bed, Mealea works her way up and down the back muscles along my spine. When she gets to my shoulder blades she hesitates.

There is a lot of tension. She begins to massage it in concentrated, circular movements while increasing the pressure. Without any mention from me, she has spotted the core of my back tension. Her movements on my back muscles seem natural and intuitive. My mind slips away and I am soothed into a deep sleep. After 60 minutes Mealea gently wakes me up.

I think of Nari’s unwelcome wandering hands. Then of Dhuez’s words: “Once you’ve had a good massage you’ll never want a bad one again.”  

To contact the reporter on this story: Julius Thiemann at [email protected]