A woman's hand moves a hot stone over a client's arm to illustrate the concept of hot stone massage.

The therapeutic value of working with stones is related to an intuitive nature that helps us feel a connection with the earth’s elements. As massage therapists, we can re-create that sense of relaxation and balance along with added health benefits for our clients using stone massage.

Since the beginning of its modern popularity in the 1990s, stone massage has been integrated into most massage therapy training programs and has evolved into a very common modality for massage therapists.

The tried-and-true basalt stones in a heating unit are the customary addition to the massage therapy treatment menu; however, there are several additional techniques that can add efficacy and interest to the average hot stone massage.

You can add gemstones, the use of cool marble stones, or such modalities as marma therapy and reflexology can take the average hot stone treatment to another level and are simple-yet-profound methods of tapping into the body’s innate healing mechanism to help find balance.

Always place a barrier such as a towel or blanket between hot stones and your client to avoid injury.

Stones in Massage & Thermotherapy

A well-done stone massage can have a myriad of benefits, like those of a regular massage, including increased circulation, enhanced performance, pain relief, increased lymphatic flow, stress relief, improved sleep and more. Additionally, stone massage has the added benefits of thermotherapy, or the use of hot or cold to help increase the effectiveness of massage therapy.

Contrast therapy, the use of alternating heat and cold, can be used by massage therapists to help treat pain and reduce swelling. Similarly, cool stones can be used in conjunction with manual therapies such as lymphatic drainage techniques and can also be used in place of ice during the acute phase of an injury to reduce local edema.

Warm stones are understandably one of the most popular spa treatments and can have a wonderfully relaxing and rejuvenating effect for clients and guests. Part of the value of this modality is the integration of the earth element of the stones for grounding and settling the nervous system.

Stones and The Elements

Ayurveda, the 5,000-year-old system of medicine from India, states that five elements are present in varying proportions in all things. These elements are Ether, Air, Fire, Water and Earth. According to Ayurveda, “like increases like” and “opposites can bring balance.”

For example, when we are too hot in the summer, we enjoy a swim in the pool, or conversely, there’s nothing better than snuggling up in a warm blanket in the middle of winter. This theory of opposites builds upon the elements and through this basic understanding, we can use the medium of stone therapy to help bring balance in our clients.

If there is an overabundance of fire in our bodies, it may manifest as inflammation, so the coolness of a marble stone can help balance this and decrease the symptoms of inflammation. If there is too much air element, it will show up as restlessness and anxiety, so this could be easily balanced by applying its opposite, the earth element within a warm stone, for grounding and heating.

Keeping the theory of balance in mind as we assess our client’s needs can be helpful when creating a treatment plan and can be easily implemented using stones.

Gemstones like these fluorite pieces can be used over clothing, sheets or directly on the skin.

The Use of Gemstones

Gemstone therapy is increasingly popular and can be an offering that can allow you to stand out from the crowd of other therapists as an interesting addition to your treatment menu. An array of crystals and affordable gemstones can be placed on the body to help balance the energetic system of the client and have many healing properties.

The theories of energetics that are associated with specific minerals has a rich history in the healing arts and have been used for thousands of years in India and China and other cultures.

On a purely therapeutic level, smooth palm stones or flat tools made from gemstones can be used to help break down fascial restrictions and can have a great benefit to the musculoskeletal system.

Contraindications and Precautions

Heat therapy requires special attention to the safety of the client. Most massage therapy liability insurance providers are now adding additional coverage for hot stone massage because there is an increased risk of injury to the client.

When using a typical hot stone warmer, the most important thing to do is to constantly check the temperature of the stones. The temperature of the water in the stone warmer should be 135 degrees Fahrenheit or lower, and it is important to monitor the temperature throughout the treatment by using a thermometer. Stones should remain at 100-105 degrees for the safety of the client. If a stone is too hot for the practitioner to touch, whether with fingertips or palms, it is too hot to use on a client, even with barriers and movement.

Never use tongs or a slotted spoon to retrieve the stones from the warmer. If the stones are too hot to handle, they are too hot to place on the client. There are also stone heating units available to massage therapists that don’t require water for heating. Always follow the manufacturer’s advice regarding heating the stones and precautionary measures.

Move stones briskly over the client’s skin after retrieving them from the warmer to reduce risk of burning.

The process for introducing the heated stones to the client’s body is to first oil the area over which you will be working. It’s best to use a natural oil such as sunflower or jojoba instead of a cream when working with stones because most creams have additives that will leave a sticky residue on the stones, even after washing.

Next, take the heated stone from the water, dry it with a small towel or washcloth and begin moving the stone over the skin immediately. To avoid burning, after retrieving the stones from the water do not allow them to rest in one place on the skin.

We’ve all seen the marketing photos for spas that show stones lying across a client’s back; however, this should not be done without an insulating barrier such as a towel or sheet & light blanket between the stones and client.

The client will still reap the benefits of the heat and weight of the earth element of the stones without the possibility of burning the skin. The stones may be placed directly on the skin, however, after they have cooled significantly through the massage movements.

Contraindications for hot and cold stone massage are like those of a regular massage, which include fever, inflamed or broken skin, and circulatory disorders, among others. It is also essential to have open communication with your client regarding the temperature of the stones.

Initiate a conversation with your client prior to treatment that allows them to feel empowered to speak up if they are uncomfortable at any point during the massage. While client communication is always important, it is especially crucial when using thermotherapy.

Cleanup & COVID Precautions

Sanitizing your stones between each client is imperative and although it takes a bit of time, once you become accustomed to the procedure, it is simple and effective. Never use the stones for multiple treatments without washing and sanitizing, even if you aren’t replacing them into the heater.

Simply clean the stones between each client in warm water, using antibacterial soap, then dry and spray with sanitizing spray recommended by the CDC. Remove the water from the warmer and wash, then spray the warmer with the sanitizing spray.

Be More Creative

The use of stones in massage therapy can be a great way to help your clients find balance on a deeper level and to help yourself by offering a modality that differentiates you from other massage therapists. Incorporating warm and cool stones along with gemstones can also accentuate the effects of other modalities you’re already offering.

The use of stones allows you to be more creative within the session, and if you know the considerations and cautions you can begin to find new ways of bringing balance to your clients through this ancient technique.

Jeannie Faulkner

About the Author

Jeannie Faulkner, LMT, AyT, M.Ed., is a licensed massage therapist, experienced educator, herbalist, yoga teacher and certified Ayurveda therapist. She is an NCBTMB Approved CE Provider and offers continuing education classes including Ayurvedic bodywork training, spa therapies, ethics and archetypes and elemental stone massage.