(Don’t) Feel the Burn: Hot Stone Massage

By Mary Nelson, September 1, 2010

You are a massage therapist for a variety of reasons, and most, if not all of those reasons involve helping your clients feel better.

Whether helping them relax, heal from an injury or decrease pain, you know massage therapy works. Massage works because you’re committed to continually learning and honing your skill in the modalities you practice.

Taking continuing education, studying with massage therapists who have been in practice or who are especially adept at particular modalities, all combine to make you a better massage therapist.

And when dealing with your clients, knowledge is power—especially when using modalities that have the potential to harm. Following, you’ll learn more about how to safely practice with hot stones.

The Technique

As with all massage therapy approaches, many factors will guide you when determining how to incorporate hot stone techniques into a client’s session—if at all. For example, a hot stone session with a client who has multiple health problems will be necessarily different than a session where the client has no health concerns.

When using hot stones, too, you want to make sure that you don’t overdo it the first time you use the technique with your clients.

This modality, like most massage techniques, is meant to build over a period of weeks, and your clients should always leave the session feeling revived, energized, relaxed and supported. If a client feels sick or in pain—or the temperatures overworked their internal systems—they may rethink returning. Remember, your goal as their massage therapist is to help them realize the gentle benefits of receiving ongoing hot stone massages.

Hot stone can be used with several massage modalities, including Swedish massage, as well as placed on the client’s body. When placing stones, however, you must remember to use a sheet, towel or clothing between the client’s bare skin and the hot stone.

During stone placement, the heat takes 3 to 4 minutes—on average—to fully penetrate the layers of resistance/material before your client can accurately discern if the stones are too hot. (This average time varies, too, according to the thickness of the material being used, as well as the health of the client, and temperature and placement of stones.)

The Musts

Know your client

Especially with hot stone massage, ensuring your massage clients fill out a detailed intake form is necessary. Massage therapists need a full understanding of the client’s health to determine what temperature would be appropriate.

Be sure you know if your client is suffering from any injuries, dealing with chronic tension, taking any medication or plan to have any other treatments (For example, if a client is receiving multiple services throughout the day at a spa, one heated treatment in a six-hour timeframe is an acceptable guideline to follow.)

Keep in mind that the client’s health not only dictates the temperature of the stones, but also how long heated (or chilled) stones can be offered to a client’s body.

Proper hydration

Hydration is vital when doing hot stone massage, both internally and to the client’s skin. Without proper hydration, burns often occur, so if the client’s skin appears dry, applying some form of moisturizer, such as massage oil or lotion, is a must.

Keeping the client’s internal system hydrated is just as important, however. Have clients drink water prior to, during and after their stone session. Think about it like this: Adding temperature to Swedish massage, for example, demands the body respond not only to the technique, but also to the increase of blood flow encouraged by the temperatures. Again, proper hydration is a must.

Heat stones properly

First, the only proper way to heat stones is in professional massage stone heater. Microwaves, hot plates, slow cookers and ovens—to name only a few—are never appropriate places to heat massage stones.

Also, the only safe way to heat stones is in water, as you can accurately control the heat of the water, making sure the stones don’t get too hot. You should invest in a calibrated thermometer, however, to test the temperature of the water instead of relying solely on the thermostat of the heating unit. Any heating unit you purchase should have a temperature control so you can adjust the temperature of the water as needed.

Generally, water between 110–130 F will get your stones to the proper temperature. To start, place a hand towel at the bottom of your heating unit’s insert and then pour enough water to cover the stones. You need to make sure the entire stone is covered.

How will you know if your stones are a safe temperature for your clients? A good indication is if you can hold the stones comfortably in your hands. Squeeze or hold the stone in your hand for a count of five seconds: If the stones are too hot for you to hold then they are too hot for the client.

You also need to consider how the stones will be used during the session to gauge the proper temperature. For example, using the stone during a massage is different than placing a hot stone on the spine, and you need to take this difference into consideration when heating your stones. Massaging with hot stones, for example, will raise the core temperature of a stone, sometimes rapidly.

Conversely, stones resting on a client’s body might hold their temperature for a longer period of time.

Understand the body's reaction

Applications of heated stones (or chilled) produces a series of internal responses. Working with temperatures acts as a derivative—decreasing blood and lymph in one area by increasing blood and lymph in another.

Prolonged application of heated stones to a reflex area causes dilation of the blood vessels of related organs. In other words, the use of heated stones on isolated areas pulls blood from the refl ex organs to the tissue in those regions, resulting in warm, flushed skin. Often, this result opens the door for therapists to work even deeper on trigger points or really tight muscles.

The amount of time you use heated stones on a client’s body is determined by how strong your client’s body is at the time of the massage therapy session. The stronger the constitution of your client, the more time you can introduce heat to the body; the weaker your client’s body, the less time you’re going to want to offer heated stones.

Remember above all else, however, that if you are in doubt about how a client can handle hot stone therapy, you should always error on the side of caution and limit the time you use heated stones.

Why Clients Get Burned

When done properly, there is no reason for a client to get burned during a hot stone session. That’s not to say, however, that burns never happen. Many times, if not in all cases, a burn could have been prevented.

The following are some common reasons clients have been burned that massage therapists need to be aware of: 

The client wasn't empowered

Massage therapists need to make sure their hot stone clients actively participate in the session and know they not only can—but absolutely should—let them know if the stones are too hot or they’re uncomfortable. Also, massage therapists can check in with clients, asking the client specifically about the temperature of the stones and if adjustments need to be made.

Lack of information

The importance of a thorough intake form cannot be overstated when talking about working with hot stones, as a variety of conditions are contraindicated. Sometimes, however, clients might not list specific conditions on the form, perhaps not realizing the potential for adverse reactions.

Perhaps talk with your clients directly about some of the conditions that are contraindicated as you discuss the treatment plan with them before starting the session.

Stones were heated improperly.

Heating stones in any device other than a unit specifically designed for this task is never appropriate. Crockpots, slow cookers, microwave ovens, ovens, heating pads and hot plates, to name a few, aren’t acceptable devices for heating stones—ever. Also, burns can happen when the water is too hot, so be sure you have a thermometer you can calibrate to properly monitor the temperature of the water you’re using to heat your stones.

Not enough material between the stones

When using hot stones, massage therapists need to be sure there is some type of material between the stone and the client’s skin. Burns can result if you leave stones that are too hot sitting on the client’s skin. Although this situation may seem obvious, massage therapists need to continually monitor the temperature of their stones, particularly when they’ll be sitting on your client’s skin instead of being used during a massage.

When placing stones, you must remember to use a sheet, towel or clothing between the client’s bare skin & the hot stone.

Using Cold Stones

Hot stone massage is a popular technique, but your clients might really benefit from using a combination of hot stone and cold stone massage therapy. Similar to when heating your stones, however, you need to make sure you chill your stones properly. You can place your stones in the refrigerator or on a bucket of ice.

As with hot stones, you need to use a calibrated thermometer to ensure the stones are the right temperature—ranging from room temperature to 25 F.

Chilled stones can be particularly effective for chronic and acute conditions, such as injuries and inflammation. Cold stones help remove heat from the body and allow the client to relax the affected area.

Massage therapists might consider using chilled stones for trigger point work, as well as cross-fiber friction.

Using both heated stones and chilled stones during a massage can be very effective in reducing inflammation and congestion in isolated areas. Between the applications of heated stones and cold stones in an isolated area, however, you need to be sure you warm your hands before placing hot stones on your client, as they may still be cold from working with chilled stones. Without warming your hands first, accurately gauging the temperature may be difficult.

After alternating between hot and cold stones in an isolated area, it’s best to end with a cold application to allow the body to continue to reduce any inflammation and congested blood and or lymph in the area, resulting in less pain and stiffness for your clients.

This final application of cold stones in an isolated area will be a “heating response” and will support the body to internally heat itself. The results will be long lasting for your client—sometimes for hours after the session has ended.

When to Use Stone Massage

There are myriad circumstances where hot stone massage makes sense. If you have a client who has a sprain, strain or acute bursitis, for example, stone massage can help alleviate the pain associated with these conditions. Someone dealing with a sports injury, like tennis elbow, might also benefit. Common ailments, such as headache and bruises, might also be helped.

Again, having a good understanding of a client’s health and the basics of hydrotherapy, however, are absolutely necessary when designing a hot stone treatment plan. If a client has a condition that might benefit from hot stone massage therapy but is suffering from an ailment that contraindicates hot stone massage, error on the side of caution when developing a treatment plan. In this case, protocol dictates “less time, less temperature.”

Contraindications & Considerations

As with all techniques, hot and cold stone massage isn’t going to appeal to every client. And, as is also the case with most every massage therapy modality, there are clients who shouldn’t receive hot stone treatments.

This list is not exhaustive, and massage therapists need to take a client’s full health history as presented during the intake into account before performing hot and cold stone massage.

• Diabetes
• Cancer
• Autoimmunce dysfunctions
• Epilepsy
• Neuropathy
• Heart disease
• Skin conditions
• Recent surgeries
• Pregnancy