Professional Evaluation of a Hot Stone Massage on a Cruise Ship

By Selena Belisle, CE Institute LLC Founder & Instructor

Please note that our professional evaluations do not name practitioner's or establishments. Any identifying information is purposely not shared. This is solely a learning example for to improve practices, and should not be used to embarass or cause harm to others: 

I recently enjoyed a hot stone massage on a Mediterranean cruise.  Here are some of the pros and cons that can be used to evaluate or hone hot stone massage skills:

The hot stone massage appointment started with a written health intake, followed by an oral review of medical conditions by the massage therapist. The LMT then asked me to undress to my bottom underwear and lie prone on the massage table:

CON:  The massage table had a very small hole for my face instead of an adjustable face cradle. The hole felt cramped, and I feared that it was not properly sanitized between sessions.  When I rolled from the pronated to supinated position later in the hot stone massage appointment, my neck felt still from lying on flat, nonadjustable “support”.

CON: I asked for an ankle bolster prior to the therapist leaving to start in a pronated position. The therapist then proceeded to place dirty rolled up towels on the table which I refused to use, so she provided a new clean towel as an ankle bolster.

PRO: When the massage therapist re-entered the room, she washed her hands.  Demonstrating proper hand hygiene before any massage appointment is a great start!

PRO: She then started the massage with hot towels on my feet to sanitize them. This again showed great sanitation, and feels lovely at the same time.

PRO: Full body compressions through the towel covering my body as draping was provided. She then proceeded to apply hot towels on my feet. This is a great way to scan the body for tension and areas to focus the massage for rest and relaxation, and then sanitize the feet before touching

CON: Applying full body compressions through the towel without viewing the area first may lead a practitioner to pressing on unknown bruises or other contraindications.  It is always best to visually inspect the skin of any area before pressing upon it.

PRO: The hands-on hot stone massage with oil started on the legs. Only one leg was undraped at a time, and the therapist warmed up the tissue with Swedish massage and an adequate amount of oil, which is a little greater than the average Swedish session, because greater oil is required to allow smooth gliding with the hot stones.

CON: I believe the stones for the massage were kept in a hot towel cabi.  Hot towel cabinet temperatures range around 150 degrees fahrenheit, which is too hot for hot stone massage application.  130 degrees fahrenheit is an approximate average maximum temperature that should be used for hot stone massage.  

MIXED: The massage therapist did allow the stones to cool once she removed them from the hot towel cabi.  This is better than massaging a client with 150 degree stones that could burn both the therapist and client. However, when allowing a black lava stone to cool in open air, ice or other cooler environments, the outside of the stone cools faster than the internal core.  Having an unbalanced heated stone with a cooler outside can still result in burns to the therapist and/or client once the inner core heats the outer surface of the stone again, if the stone has not entirely cooled off.

MIXED: It's best to keep stones immersed in a hot water bath for universal heating purposes as shown in the picture below. It's less desirable to when stones are less evenly heated than on a dry surface such as a hot towel cabi or griddle, it does take longer to properly sanitize a hot water bath stone service.  That’s because the bath container itself must be washed after each service when the stones are returned to the water bath for reheating.  Once the stones touch the client they are contaminated, so the water bath liner itself is contaminated when the stones are returned to the bath, and must be washed after every surface.  

PROFESSIONAL RECOMMENDATION: It would be important to keep the hot stone bath electricity OFF, and not heated while sitting in a treatment room, in case a client touches it and burns themselves. We recommend turning the hot bath equipment on at least 30-minutes prior to starting a hot stone massage service, so that the stones can be evenly heated. We also recommend keeping the stone equipment off when hot stone service is not in use, to avoid overheating the treatment room given the equipment itself can be very hot and emit excessive heat. And in the case of cruise ship hot stone massage, if the ship is rocky, a client could accidentally bump into the hot stone heater and burn themselves which is why it is recommended to only turn on the stone heater about 30-minutes prior to service, and to unplug it when approximately 10-minutes of hot stone service remain, to allow the bath to start to cool itself for easier handling during sanitation once the service concludes.

PROFESSIONAL RECOMMENDATION: While it’s best to use a hot water bath to heat stones, it does take longer between clients due to sanitation. This is regularly why the price of hot stone massage should be more than regular massage.  Hot stone massage should be charged at an increased price because:

• There is an added equipment expenses that should be recovered with each service.

• There is added time for labor, to properly sanitize stone equipment after each service.

• It usually takes more energy or is more exhaustive for the LMT, to handle and apply hot stones in this thermal therapy.

PRO: The massage therapist only used one thin two inch stone at a time to massage my leg. The thermal therapy of the singular stone was more than adequate, if not more appropriate to help avoid the bony landmarks of the epicondyles of the femur and the greater trochanter.  Using one stone at a time also allows longer use with less stones for hot stone massage application.

CON: The hot stone massage was what I call “dead fish” application.  I just lied there during the almost hour long appointment.  No range of motion was incorporated with the hot stone application, which usually feels better with thermal therapy application. This of course is a subjective evaluation; however, with over 30 years of experience, managing hundreds and training thousands of other hot stone massage therapists, the consensus is incorporating movement with hot stone massage is usually preferred.

PRO: Appropriate draping. Both legs were massaged individually prior to moving onto my back. Both legs were covered before my back was exposed for back massage application.

CON: The therapist started her hot stone massage on my low back.  The low back area is the most sensitive of the entire back area, so we recommend starting a hot stone massage on the upper back while the stone cools. Once the stones are cooler, then it would be appropriate to move into the lower back area that’s more sensitive to thermal applications such as hot stones.

PRO: Two stones were used when massaging the back, which felt cohesive when the stones were on both sides of the spine.  The two stones were also the same size, so the temperature also matched from one side of the back to the other.  When massaging the back or any area with two hot stones at a time, the stones should be of similar size and shape so they feel succinct and not distracting due to uneven temperatures or application.

PRO: The therapist had two different sized palm stones which is traditional of a polished lava hot stone massage kit.  When working on the back, the therapist removed the stones from the heating device, then after cooling, she used the smaller stones first before finishing the hot stone back massage with the thicker stones.  Thicker stones will retain heat longest while thinner stones will cool quicker.  If she had used the thicker stones first, then the thinner stones would not have had much heat in them to be enjoyable for a hot stone massage application.  Afterall, it’s the heated thermal therapy with appropriate application that makes hot stone massage enjoyable.

PRO: During the mostly Swedish massage strokes used to apply sufficient oil required for hot stone massage, the therapist practiced some type of percussion, or clapping of her hands to end a stroke. This didn’t happen after every stroke, and it was enjoyable.  It was almost like a feeling of completeness at the end of certain strokes.

PRO: The therapist lined the sink with towels, so that when the stones were cool, she placed them in the sink to sanitize later, and the towels in the sink prevented the noise of a hard stone clinging against the hardness of the sink. Lining the inside of a hot stone bath with a towel is also recommended to reduce the noise of the stones during treatment.

The supinated version of the hot stone massage was unremarkable.  All of the normal standards were met.

Overall the appointment was enjoyable, aside from the few CONS noted here in this article.  For greater hot stone massage information, please view our hot stone massage training available at: https://ceinstitute.com/collections/hot-stone