This is How Updated Protocols Protect Your Practice

In this article, we will review some of the latest hot stone massage safety protocols, given that some of our decades-long hot stone massage applications have been modified or retired. 

Hot stone massage has become a favored choice by clients, especially during vacations or in colder climates, but not practicing hot stone safety could leave a practitioner in hot water. An internet search shows that some clients were injured once the massage industry started rocking these popular appointments.  

130-degree Fahrenheit water can burn human tissue within one minute, according to the American Burn Association, yet the average operating temperature of a hot stone bath is approximately 130 degrees. Additionally, a practitioner’s hands can become increasingly desensitized with repeated hot stone treatments. As such, a practitioner could unintentionally yet easily burn a client with their mineral marvels. This has created some significant safety protocol updates for the practice of hot stone massage.  

The Massage Stone Heater (aka Stone Bath Unit)

Practitioners are using turkey roasters, crock pots, kitchen griddles, hot towel cabins, kettles, heating pads and other types of heating devices, in addition to professional stone massage bath units, to heat their stones. For best practices, all stones must be fully immersed in water within a heating unit. This is known as the bath. Stone bath units that have a built-in temperature gauge within a hot stone bath operating range are preferred. 

Alternative heating sources that do not include a total water immersion can create uneven stone surface temperatures. Unevenly heated stones are not reliable or safe to use, especially when working near maximum operating temperatures.  

Stone bath units must also have an adjustable temperature control. Practitioners must continually adjust the bath temperature as needed, especially if cooler stones are returned to the bath, to maintain a proper operating temperature. 

Temperature Measuring Devices 

Because of various logistics, including unreliable gauges, temperature accuracy comparisons, and temporarily lost thermometers in the stone bath, it is now advisable to use two temperature measuring devices during hot stone massage. A meat thermometer and stone bath unit with a built-in temperature gauge are the most popular choices. Measuring devices should be easy to view in a dark treatment room setting and have available readings within a proper hot stone massage temperature operating range.  

Temperature Operating Range 

At CE Institute LLC, we teach our students to operate their hot stone baths between 120 to 135 degrees Fahrenheit. A hot stone bath should be operated between 120 to 135 degrees Fahrenheit.  

There are some schools, instructors and practitioners who work at slightly higher and lower operating temperatures, which is an individual choice. Best practices should instill a conservative approach to balance safety and comfort with thermal therapy enjoyment. 

Temperature Management 

Check the stone bath temperature every time the stones are removed from the bath and at least once every five minutes during any hot stone service. That means the operating temperature should be visually inspected a minimum of 12 times during a one-hour hot stone massage appointment. 

It is critical to frequently monitor the stone bath operating temperature and adjust it accordingly when the calefaction is headed in the wrong direction. Regular checks will allow for manual temperature adjustments as needed, to maintain a proper temperature operating range.  

Heating (and Overheating) Stones 

Provide ample time to heat your stones prior to an appointment. Cranking the stone bath unit to preheat mode or absurd temperatures to quickly heat the stones will usually result in the outside surface of the stone becoming hot but leave a colder core inside the stone. That is an unsatisfactory effect when the stones quickly cool during hot stone massage application.  

Conversely, in an attempt to quickly heat stones, the bath and stones can overheat. Never cool the bath with cold water or ice. Cold water or ice can cool the outside surface of the stone while the inside core temperature could still be burning hot. Eventually, that core temperature inside an overheated stone will make its way to the stone’s outer surface. A roguishly cooled 200-plus-degree inner core stone can burn the client once that inner temperature reaches the stone’s outer surface. 

It is recommended to turn off the stone bath unit and continue with regular massage when a bath has overheated. Do not use overheated stones under any circumstance. 

Placement Stone Use

Placement stones are arranged on the body without movement. They are also called static stones. A minimum of two barriers are required between the client’s skin and a placement stone. The two barriers can be a sheet plus a blanket, or a sheet plus a towel or any two barriers that seem appropriate.

Common areas for placement stones include laying stones over the sternum, sacrum, back, palms of hands or soles of feet.  (You might need to explain the need for the two barriers to the client, because  more than half of stone massage stock photos that depict a client receiving a stone massage show a placement stone sitting on a client’s bare skin.  Hot stone massage advertisements should depict updated applications that demonstrate either working stones in motion or placement stones applied over a minimum of two barriers—or both.)

A practitioner should inspect the client’s skin periodically after a placement stone is applied over two barriers. That means removing the barriers (without overly exposing the client) and looking at the client’s skin to ensure it is not welting, blistering, unnaturally discolored or showing any other sign(s) of distress. The practitioner should also touch the skin to ensure it is not excessively hot. The goal is to safeguard the client from being burned. 

Retired Placement Stones 

The following placement stone applications have been discontinued in most work settings: 

  • Facial stones and cozy stones between the toes, because two barriers are difficult to achieve with either. 
  • Abdominal stones, because it is awkward and difficult to make visual safety observations on the sensitive skin of a client’s tummy. 
  • Back stones while a client is in supine position, because a client should never lay their full body weight on top of a heated modality that has the potential to burn or harm them. 
  • Any stones that cannot be placed with a minimum of two barriers between the stone and client. 

For modified practice, room temperature placement stones can be used when hot stones cannot be safely applied with two barriers. Most hot stone massage appointments continue to include both placement stones and working stones in motion.  

Hot Stone Safety and Gloves 

Never wear gloves for hot stone massage. That is because any stone that is too hot for a practitioner’s hands is likely too hot for a client as well, regardless of what the thermometer says.   

Never trust a temperature measurement if the stones feel too hot. If the temperature feels wrong, simply stop using the stones until the temperature devices can be verified for accuracy prior to reuse. 

Practitioner Skin and Heat Sensitivities 

Practitioners should reconsider the provision of hot stone service if they are uncomfortable with a 120- to 130-degree Fahrenheit hot stone operating range. It is critical to be able to handle a hot stone comfortably so that it is not improperly applied due to practitioner discomfort. 

Hot Stone Safety and Bone 

In addition to a potential burn, an injury can happen when the hard surface of a stone inappropriately contacts human bone. Avoid applying pressure with stones into superficial or protruding bone. 

Hot Stone Safety Client Communication  

Practitioners should frequently check in with a client about stone temperature, especially with each new work area, such as when the bodywork moves from the arms to the legs. Immediately remove all stones if a client says it is too hot or painful and do not continue unless it can be assured that the: 

  • Bath temperature is within operating range. 
  • Client is comfortable and wants to continue with hot stones. 
  • Client has not been injured or burned. 

Do not rely on client communication for a proper hot stone operating temperature. A client could fall too far into their mental vacation to provide critical feedback during a hot stone massage.  

Practitioners must engage in active strategies to ensure practical safety beyond verbal communication. This includes frequently checking the bath temperature plus visually inspecting and touching the skin among other available remedies, to prevent injury. 

Infection Prevention 

Anything that comes in direct or indirect contact with a client must be sanitized between every consumer – period.  

Hot Stone Safety Training 

The thermal ritual of hot stone massage can offer an incredible vacation on a table experience but this service does require special training. While this article focuses on hot stone massage safety, a quality CE class can provide a more complete education of stone massage safety advisories, practices, applications, precautions, protocols, and contraindications. 

About the author 

Selena Belisle

Selena Belisle teaches the hot stone, lomilomi and aromatherapy massage curriculums at CE Institute LLC in Miami, Florida. She often teaches these subjects together with ancient healing rituals woven into modern day practice. You can learn more about her training and CE classes at ceInstitute.com.  


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