Manual lymphatic drainage (MLD) education for post-surgical conditions is a growing interest amongst our students. But, many manual lymphatic drainage techniques were created for oncology treatment and chronic swelling conditions. What's important to note today is that old school MLD techniques used for lymphedema should not be the same treatment for acute post-surgical MLD. Treating a client's post-surgical swelling the same as chronic lymphedema with MLD is ill-advised.
SWELLING IS A GENERAL PHYSICAL BODYWORK CONTRAINDICATION! Almost ALL chronic or acute swollen soft tissue can TEAR with inappropriate pressure and movement. As such, MLD practitioners must be extremely careful when working with swelling. Manual lymphatic drainage techniques are designed to relieve swelling without damaging the underlying tissues when properly applied.
As such, practitioners should be using different MLD techniques and protocols to treat acute swelling versus chronic swelling. If you are new to the MLD industry, be sure to seek education including protocols and techniques that provide both. And if you have previously trained in MLD, think about the strokes and techniques that you are using and adapt accordingly if you are able, or consider training in these new adaptions with an educational provider like us. Anyone who is practicing the same techniques for both acute and chronic swelling may have less effective treatment than a practitioner who has specific strokes, techniques and protocols for chronic versus acute medical conditions.
To learn more, please register for quality, affordable, professional training at: https://ceinstitute.com/
Here's an 11-minute free manual lymphatic drainage training video that explains this concept and more:
Hot stone massage has been normally contraindicated for past oncology clients; however, as oncology treatments have improved, our hot stone massage treatment options have as well.
According to the National Cancer Institute, it is estimated that there are more than 16.9 million cancer survivors alive in the U.S. today and that number will grow tomore than 22.1 millionby 2030. Additional statistics show that almost half of men and one-third of women in the US will receive a cancer diagnosis in their lifetime. Because our oncology population continues to grow, most massage therapists will find themselves working with both cancer patients and survivors at some point in their careers.
This increasing oncology populace is due, in part, to the advances in oncology treatments that are used to prolong life and fight cancer. And while cancer is not a general bodywork contraindication, some oncology treatments are, especially with the application of hot stone massage.
Luckily, today we have better academic recognition of how hot stone massage can and cannot be applied with several oncology treatments. After all, fighting cancer should not end all possibilities of enjoying a hot stone massage for those who love it or just want to try it. Instead, oncology practitioners should review how a hot stone massage service can be provided or modified with various oncology treatments for this vulnerable and rising population.
And with full disclaimer, this article specifically speaks to the application of hot stone massage with three popular forms of oncology treatments. This article does not speak to working with oncology or massage as a whole.
Primary Oncology Treatments
The three primary forms of oncology treatments used to fight cancer today are surgery, radiation, and chemotherapy. Most will receive at least one or a combination of the three to combat their cancer diagnosis. Let’s look at how these three oncology treatments affect hot stone massage practice.
Oncology Surgery
Surgery creates an acute medical situation. In simplified terms, tissues are cut, inflamed, and then heal, in most circumstances. After healing, the surgical site scar may be sensitive and is prone to further damage. Placement and working stones should never be applied directly over a dermal scar.
Nervous system innervation can be cut or pierced during oncology surgery. And in some surgeries, major nerves can be briefly retracted from a surgical site, which could cause a temporary, delayed or permanent dysfunction of sensory abilities.
Aside from the immediate surgical site, most cancer survivors should be able to receive hot stone massage after oncology surgery without adverse effect, minus a few exceptions, such as nervous system damage or additional oncology treatments.
Oncology Radiation
Healthy tissues, including nervous system innervation, are often destroyed alongside cancer cells in radiation treatments. Survivors who received external radiation decades ago have likely lost some or all sensation in the treated area. Areas that have had been treated with internal or external radiation can be severely damaged and are a permanent local contraindication for hot stone massage. Do not ever place or move hot stones over radiated tissues.
Modern day oncology radiation recipients may have less damage due to incredible technological advances; however, all radiated tissue is susceptible to a lifetime potential of greater injury, regardless of when the radiation was administered.
Some radiation clients will have tiny dot tattoos that show where their external radiation was focused. Practitioners can work around a radiated tissue if they are 100% certain they are able to avoid all of it. Consider using a cooler stone bath for these clients.
Oncology Chemotherapy
An oncology client who has received a recent dose of chemotherapy is not a good candidate for hot stone massage. Practitioners should not promote thermal therapy manual circulation during the tissue metabolism of chemotherapy without specific approval from the prescribing oncologist.
An active chemotherapy cancer patient may also have a port or another external device affixed to their body. All externally affixed body devices are a local contraindication for both placement and working stones.
A cancer survivor who has completed their chemotherapy treatments may be a great fit for hot stone massage. However, there are a few caveats. For example, those who have lost nervous sensation. Chemotherapy can damage nerve cells throughout the body, which can result in neuropathies and more.
Hot Stone Massage and the Nervous System
All hot stone massage recipients must be able to feel the heat of a stone to help avoid the potential of being burned by it. Hence, their nervous system’s sensory capabilities must be intact and fully functioning. Practitioners should avoid areas that have lost sensation as a local contraindication and not administer any hot stone massage at all if the entire body’s nervous sensation is impaired.
Chilling with Oncology Treatments
Many oncology treatments can leave a client feeling cold. The thermal therapy effects of hot stone massage can be remedial for a chilled client, once all other bodywork considerations have been addressed.
Other hot stone massage considerations for oncology surgery, radiation and chemotherapy treatments include:
•Lymph Nodes and Swelling
Oncology treatments often focus on lymph nodes because they are a common area for metastatic cancer. Lymph node cancer treatments can create swelling in the localized treatment area. Do not apply hot stones or massage therapy to any areas of swelling.
•Fatigue and Frailty
Oncology treatments can cause extreme fatigue. These treatments can also cause a deterioration of skin, muscle, bone or any combination of the three.
If an oncology client seems excessively frail or in need of a colossal doze, consider switching the hot stone service to a bodywork that does not require frequent verbal communication and solely uses the hands instead of the harder surface of a stone. Frail and fatigued oncology clients will normally benefit from some adequate rest and doubly so with the correct massage.
• Additional Side Effects
Almost all cancer survivors will have a lifelong impact from their oncology treatment(s). However, survivors are usually better candidates for hot stone massage than those who are actively fighting cancer.
Active oncology treatment recipients have an extensive list of possible side effects, such as mouth sores, lowered immunity or hand-foot syndrome, which all create additional oncology bodywork considerations. Sometimes, these side effects can last longer than the oncology treatment that caused them, but the severity does lessen for most survivors over time.
Modifying Hot Stone Massage for Oncology Treatments
In review, we have shown that these three primary oncology treatments chiefly create local contraindication sites more than full-body or total service contraindications for hot stone massage. As such, think about how hot stone massage can be adapted for local contraindications. For example, the arms and legs make up over half of the human body’s surface area.
Applying hot stone massage to an oncology client’s extremities is a great modification to work the majority of the body when the head, chest or organ areas have local contraindication(s). Even with a modified application, the thermal therapy effects of hot stone massage may be a wonderful relief for oncology clients who have pain, feel cold, or just want a special volcanic retreat from their everyday life.
Still, because there are so many medical considerations with oncology treatments, partial or full body hot stone massage should only be provided on a case-by-case basis for multiple reasons beyond any single list that can be conceived here or anywhere. Keep in mind that all general hot stone and oncology bodywork contraindications, such as fever, active vomiting, infection and more, are still applicable.
Consultation and Training in Oncology and Hot Stone Massage
Unfortunately, like many bodywork subspecialties, we have very little research with oncology hot stone massage. Until we do, it is safest and best practice to consult with the client’s oncologist prior to administering hot stone massage for individual concerns and needs.
While we have addressed hot stone application with three different oncology treatments here, general oncology bodywork and hot stone massage education is another matter. Specific oncology and hot stone massage CE classes should be sought prior to practicing either. Training in both should help provide knowledge of the adaptations, precautions and contraindications necessary to practice hot stone massage with cancer patients and survivors.
CE Institute LLC Oncology & Hot Stone Massage Instructor Selena Belisle will share some ideas of how hot stone massage could be applied for cancer patients and survivors in this brief 18-minute video.
Communicating the therapeutic benefits of aromatherapy today can be like walking a tight-rope. Common claims once shared amongst aromatherapists may no longer be used due to a FDA crack down on aromatherapy and essential oil language. Some practitioners have unfortunately made unsubstantiated claims which have created greater government oversight to ensure that the public is not deceived by false claims or practices.
Ensuring professional and efficacious practice is any modality is extremely important, so it is more than acceptable that proper oversight is governing how therapeutic benefits are communicated within the public to avoid fraud.
In this brief 7-minute video, we'll share some guidelines of how to responsibly communicate your aromatherapy bodywork and practice with your clients.
Some schools and instructors have claimed that prenatal massage in the 1st trimester is not safe. This is untrue. Prenatal massage in any trimester is perfectly safe, as long as proper training, contraindications and service precautions are observed and followed by the prenatal massage therapist.
There are some pregnancy medical conditions that are unsafe for massage practices in ANY trimester, which is why it is important to see appropriate prenatal massage therapy training PRIOR to working on this vulnerable population.
In this brief 5-minute video, we'll share our thoughts of why we feel prenatal massage in perfectly safe in the first trimester for practitioners who are professional trained to provide prenatal services.
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.
In this 25-minute video below, we'll review these up-to-date practices of hot stone massage in better detail, as well as those older hot stone massage practices that have been "retired" (or discontinued).
Gout is a bodywork and massage therapy contraindication. In this brief 3-minute video, we'll briefly review the medical condition of gout. In general, any medical condition that results with swelling would be contraindicated. Massage therapists should never press, pull or manipulate swollen soft tissue with massage techniques. Please view the video below to learn more about gout.
The pH of skin is vital for protection against harmful bacteria, virus, mold and other microbial agents. In this brief 5-minute video, we'll review why any healthcare provider or cosmetologist who is working on human skin should know about it's acidic mantle and pH. A client's acid mantle should be preserved at all times for continued physical and physiological protection.
The pH of skin is taught in some of our oncology, manual lymphatic drainage and other classes as a vital part of our client healthcare bodywork and practice.
To learn more about massage precautions, etc., please register for quality, affordable, professional training at: https://ceinstitute.com/
Many massage therapists, bodyworkers and more are taught that working around the ankles could cause a miscarriage. In this brief 5-minute video, we will review whether or not it is safe to press around the ankles in a prenatal client.
For the past several years, CE Institute LLC has offered in-person training and trade show education, providing thousands of CE hours to students and trade show participants, until COVID19.
Today, much of our population continues to self-isolate, suffer or lose their lives to this horrible virus. Our thoughts and prayers are with all those who suffer. We hope here will be an end to this soon.
At CE Institute LLC, we will not schedule any in-person training for the rest of 2021 due to the close personal contact our bodywork training entails for many hours at a time. With great effort and expense, we have successfully launched our live interactive webinars which have been a tremendous success. We hope to see old faces and new in any of these successful and discounted educational offerings.
Unfortunately, we are unable to plan future in-person training until we can better understand how to prevent the acquisition and/or transmission of this lethal contaminant. And while we've become better as a world in recognizing the symptoms and treating this illness, plus developing a vaccine to help prevent hospitalization, our goal would be to hold an in-person training that provides minimal to zero risk to all participants.
We will continue to monitor the progress of COVID19 prevention and treatment options and plan in-person training according to COVID19 prevention and treatment success. So the answer is yes, one day we will resume in-person training when it is safe to do so. We do not feel it is worth the risk to anyone's life to hold an in-person training, whether it be the student themself or someone else they could trasmit the virus to. As such, until minimal to zero risk to in-person class participants can be achieved, we will not schedule or hold any in-person classes.
Check out CE Institute LLC's Hot Stone Safety Updates Featured on the Cover of MASSAGE MAGAZINE(written by Instructor Selena Belisle) by clicking HERE!
