by Pat Mayrhofer

Stone Massage and the Elderly, MASSAGE MagazineMany massage instructors try to convince their students that their modality is best for helping clients with physical ailments. As an instructor of stone massage for 14 years, I can state with confidence that working with stones—hot or cold—makes every modality better; however, every modality has its “dos and don’ts.” Stone massage is no exception.

In the next few months I will focus on contraindications and indications for stone massage. This month, I would like to discuss working with the elderly.

First, we need to look at what is meant by “elderly.” It was mentioned in an online stone class that after age 65, the therapist needs to treat the individual as an “old person.” Many seniors would beg to differ with that assumption. At age 70, 75, 80 and beyond, you can find this geriatric population working out at the gym, walking for exercise, working, traveling and keeping themselves active. Rather, we should look at an individual’s condition. A client could be frail at any age. Retirement communities have many residents who travel around the world at advanced ages, and many of these residents receive massage regularly—and they admit it is the massage that keeps them going.

All recommended contraindications for manual massage apply to stone massage as well. The therapist needs to pay particular attention to conditions like cancer, diabetes, vein inflammation, heart condition, blood clots and abdominal aneurysm, to name a few. In these instances, massage may need to be avoided.

For the robust senior who is active and in good health, the therapist can use hot or cold stones during massage. A combination of manual massage and stone massage feels just as wonderful to aging muscles and joints. It is not necessary to alter the temperature of the stones or lighten up on the pressure of the stones for this population. When the client is reaching an advanced age, such as in the 80s or 90s, the therapist may consider a shorter treatment or avoid a full-body massage with stones. The therapist should also suggest the client drink more water than usual after a manual massage, because heat from the stones tends to dehydrate the body and also increases metabolism more than manual massage. In addition, the therapist should inform the client that he or she may have an increase in urine output for a day or two.

A frail client should be treated with tender, loving care. Many cannot lie in a prone position. Lying face down could be difficult for the delicate client for many reasons, such as breathing difficulties or a pacemaker implant. You must accommodate fragile clients by positioning them on their side on the massage table, with pillows to support their head. The placement of additional pillows is important to prevent them from rolling forward.

Hot and cold stones can be added to the massage routine for this clientele. Spot treatments, rather than a full-body massage, would be best for the frail client. Warm stones help to warm their inner soul and are nurturing. You should work at a temperature between 125 and 127 degrees Fahrenheit, depending on the comfort level of the client.

To the surprise of many, the muscles of the frail client embrace cold, marble stones. The marble can be used right from the refrigerator and is comforting to any client. If a pacemaker is present, the therapist must be aware of the location of the devise, so as not to massage over it. The high iron and magnesium in the stones could affect the transmission of the pacemaker, or the therapist could also dislodge the connections on the pacemaker. Usually a pacemaker is inserted on the upper-left chest wall, but in some cases it is inserted on the upper-right chest wall. In rare cases, the fragile client may have two pacemakers due to the failure of one.

In the event a client is too weak for massage, then the use of warm placement stones is recommended. The use of massage-stone wraps helps to keep stones in place and prevent them from sliding—and most importantly, they protect the skin from burning.

The majority of insurance claims are for stone massage and geriatric massage. It is important to always follow certain basic rules:

  • Never place a hot stone on bare skin without moving it.
  • Water temperature for the stones should be between 120 and 130 degree Fahrenheit.
  • Always use an introductory stroke.
  • Wash the stones and change the water after each treatment.
  • Use a sufficient amount of pressure. Remember the nerve endings are at the surface of the epidermis, so if your pressure is too light, you risk burning the client. It is important to palm the stones and apply pressure, which pushes heat into the muscle, instead of sliding the stones on the skin.
  • Most importantly, always work with good intent.

Please look for future articles on, as I explore the exciting arena of stone massage. I will write about safety issues, contraindications, the expansion of stone therapy to different modalities, the evolution into cold-stone therapy with marble stones and now the resurgence of stone massage with the innovation of carved basalt stones. I will also discuss accessory products, such as massage oil, essential oils, heaters, textiles, DVDs and seminars. I look forward to an ongoing conversation with you.

Pat Mayrhofer is president and founder of Nature’s Stones Inc., an international massage-stone, and education and supply company. She is a massage therapist with more than 15 years of experience, having taught for 13 of those years in Italy, Austria, the Dominican Republic and the U.S. Mayrhofer and her staff have created a comprehensive series of live, hands-on training programs, educational DVDs available for distance learning and a line of associated stone and textile products. For more information, visit