Over the last decade, many bodyworkers have begun using stones, not to replace human touch but as an additional relaxing and leveraging technique. Traditionally used by Egyptians, Shamans and American Indians, stones have a long history of therapeutic use and spiritual healing. Today, incorporating stones in one's practice offers this ancient tool, to not only relax clients but also give our hands a rest. Hot stones are a form of thermal and magnetic therapy, requiring a unique trust between the client and practitioner. A respect for the trust bestowed in us by our clients need to be developed by a safe and meticulous protocol to perform this primal technique.

After attending a hot stone seminar this summer, I was immediately reminded how splendid hot stone massage is, not only for the client but also for the therapist. Throughout my years of practice, I was always hesitant to use any type of tool, I never cared for the way the tools felt on my skin, either giving or receiving. Yet with rocks, especially smooth and warm ones, the feeling is different. There is an instant primal connection to a real rock from the ocean or a riverbed, which is relaxing to the spirit and nurturing to the soul.

Hot stone massage is usually done with basalt lava stones, which contain high levels of calcium, magnesium and iron. These minerals can facilitate balance within our energy centers or chakras, and they can move stagnation within our channels and meridians. Many therapists use cold stones as well. These may be smaller marble stones or quartzite crystals. Cold stones are commonly used on the face.

Stones and heat are both very powerful. When not treated with respect and vigilance, they can actually injure the client. Other types of heat therapy to keep in mind include hydroculator wet packs, water bottles, herbal compress bags and infra-red heat lamps.

Last fall, I published a three-part series on malpractice and liability claims. Many of these claims frequently involve burns from hot stones, cupping and hydroculator packs.

And while we are well aware of all the benefits of hot stones and other heat therapies. Over the winter months, we will discuss several treatment procedures, contraindications and cautions of which we should be aware as we provide therapeutic heat, especially hot stones to our clients. This month, we will discuss treatment procedures, skin typing and informed consent.

Treatment Procedures

It is of utmost importance to have set procedures. We must follow a methodical, yet simple, protocol in our treatment rooms to ensure the safety of ourselves and our clients. Sloppy procedures and little or no training are the number one causes of burns in the treatment room. Why do client's get burned? Usually because stones are too hot.

According to Michael Schroeder, vice president of the American Massage Council, "The most common problem with hot stones is the method therapists are using to cool down the stones. If they are too hot, therapists often use cold water to cool them down, but this only cools the external layer of the rock.

"After placing them on a client, the superficial layer of the stone quickly becomes hot again, sometimes burning the client. The therapist doesn't realize they have only temporarily cooled the external layer. This means if the stones are too hot, the only way to cool them down is time. We can put them on a washcloth next to the heater, turn down the temperature and wait for them to cool."

Additionally, always test stones on your own forearm before placing them on the client. Our own hands may not be a safe temperature gauge because they are less sensitive to heat than the rest of our bodies.

Never give a hot stone massage using silicon gloves. If you use a glove rather than tongs or a skimmer to remove the stones out of the water, never put them straight onto client. If the palm of your hand cannot hold the stone, most likely the client will not tolerate the heat. Again, test the temperature on your own forearm first.

Always use a temperature gauge in the water while heating up the stones. Warm stones (90 F - 110 F) are used for those with sensitivity to heat or for large stones that are going to compress the body without a sheet or towel. Hot stones (110 F - 125 F) are used for active massage. Temperatures will vary according to client, always test your equipment, set the heater at low without a cover and go from there.

It's better to start on tougher (yang) areas first (back and lateral portions of the body), then work toward medial and anterior portion (yin).

In general, "stones do not care for bones". We should avoid all bony clefts and spinal processes. No stones should be placed on the eyes if the client wears contact lenses.

Fitzpatrick Classification Scale

Skin Type	Skin Color	Characteristics
I	White; very fair; red or blond hair; blue eyes; freckles	Always burns, never tans
II	White; fair; red or blond hair; blue, hazel, or green eyes	Usually burns, tans with difficulty
III	Creamy white; fair with any eye or hair color; very common	Sometimes mild burn, gradually tans
IV	Brown; typical Mediterranean Caucasian skin	Rarely burns, tans with ease
V	Dark brown; Middle-Eastern skin types	Very rarely burns, tans very easily
VI	Black	Never burns, tans very easily

Skin Typing

Another tool we can use to keep our clients and ourselves protected is becoming familiar with skin typing. The Fitzpatrick Classification Scale (developed in 1975 by Thomas Fitzpatrick, a Harvard Medical School dermatologist) classifies a person's complexion and tolerance of sunlight. The scale is used by several different health practitioners to determine how their patients will respond to heat therapies.

We can educate our clients by including a skin typing chart in our initial examination documents or by incorporating it into our informed consent documents.
Any practitioner using heat therapies should exercise concern with Skin Type I and Skin Type VI. The first skin type may burn easily, and we should remind these clients to always communicate any discomfort they might be having during any type of heat therapy treatment. Also beware of Skin Type VI. This client does not burn easily, however if they are burned, they will scar easily and likely to be permanently disfigured.

Informed Consent

Another important facet of a long-term successful practice using heat therapies is always having the client sign an informed consent document, specifically for hot stone therapy, before receiving treatment. This document may explain benefits and risks of hot stones therapy, contraindications and cautions, and explain the skin-typing procedures.

By enlightening our clients through a professional intake procedure, we further establish a foundation of love and trust that facilitates their healing.

In the chilly months ahead, heat therapies may be suitable to offer your clients as a seasonal special or a holiday gift. When incorporated into practice with a healthy respect and awareness, we can securely integrate these healing modalities into our current practices. In the coming months, we will discuss contraindicated diseases, conditions and medications for heat therapies.

I would love to hear your experiences or comments. Please feel free to contact me at dixiewall@hotmail.com.