Hot Stone Massage article

Rockin’ all over the world! Hot Stone Fusion for the Treatment of Pain by Rachel Fairweather

Hands up if you thought hot stone massage was just a bit of luxury with no therapeutic effects – great for relaxation but not the domain of serious massage therapists aiming to alleviate and prevent musculo- skeletal pain. If so, cast your eye over the following comments from therapists and clients who have experienced the true power of Hot Stone massage taught the Jing way – a blend of creative and effective stone work known as Hot Stone Fusion.

“One of my clients had been in chronic pain with his neck after whiplash in two consecutive car crashes EIGHT years ago. He had never felt safe or comfortable enough to have anyone touch his neck.  He came to me and we worked gently on the area with the heat of the stones. He was so relaxed by the use of the stones but tensed up as soon as I put my (loving!) hands on his neck. We worked very deeply into trigger points and stretching with the stones and the results were incredible –  after only two sessions he was pain free”

“I have had massages with a therapist who did the stone course with you. I suffer from back pain that ranges from dull to piercing. Normally I would go for a purely therapeutic massage, but wanted to try the stones. Not only was the treatment amazing, but I had more pain relief from the use of placement stones and heated stones used to strip the muscles than I have had from any massage in a long time. While I adore just about every type of massage, the therapeutic qualities of Hot Stone Fusion massage outstrips them all.  I got a relaxation massage and a pain relief massage all in the same 85 minute session!”

“As a writer I spend long periods sitting at my PC, and have experienced a succession of different types of pain in my back and shoulders. After just one session of Hot Stone Fusion Massage, my back has improved and my shoulders haven’t felt so good in years. Fantastic!”

These results are not unusual. If you are taught to use the stones effectively and specifically, you have at your disposal an amazing tool that will help you to:

o    Alleviate both acute and chronic pain
o    Effectively address injury rehabilitation
o    Save your hands
o    Work deeply in a gentle and more effective way
o    Delight your clients
o    Build your practice
o    Earn more money

Back to Basics- the power of hot and cold in therapeutic treatment>

Why should using the stones be so helpful in the treatment of pain? The answer lies in the age old use of hot and cold as a therapeutic modality- physiotherapists, naturopaths and osteopaths are well aware of the efficacy of thermal modalities in bodywork, as was your mother who gave you a hot water bottle to soothe your sore belly when you were a child. Yet we find that massage therapists tend to be less informed about the therapeutic effects of using hot and cold in bodywork. This can give you great results with less effort from yourself.

The helping hand of heat in the chronic pain conundrum

Heat can be used very effectively in cases of CHRONIC pain. This is pain that has lasted for longer than 72 hours and is characterised by being dull, achy or long standing. In our experience this is a common phenomenen in the massage therapist’s clinic and we are much more often confronted with the conundrum of chronic pain than dealing with recent acute issues. If you have a busy clinic you are probably well acquainted with obstinate back pain, neck pain, RSI, plantar fascitis and other conditions that have persisted beyond an expected healing time.

It is fair to say that chronic pain is much more complex to treat than acute pain and usually requires a multi-faceted approach. Adding heat into the mix through the medium of hot stones can enhance your outcome significantly.

The positive effects for heat in chronic pain cases can be summarised as follows:

o    Psychological effects: Heat makes us feel nurtured, relaxed, cared for and positive –  attributes we want our clients to associate with our treatments. If our clients feel safe under our hands, their bodies relax and let us in to do vital therapeutic work without resistance. We instinctively feel that heat has a “feel good” factor – my best friend said to me once that if she ever feels out of sorts she just has a bath and it always makes her feel better! Following her advice has stood me in good stead and likewise applying heat in a clinical situation invariably has a postive effect.

o    Decreased muscle tightness and trigger point activity: Heat seems to have a direct effect on reducing tight muscles- often the primary cause of common pain conditions. Tight muscles also harbour pain referring trigger points – the bad boys of musculoskeletal pain. There is evidence that heat applications may reduce the firing rate of muscle spindle cells and decrease activity in the gamma efferent system of the spindles. This reduction in muscle spindle activity will have a direct impact on reducing muscle tightness.

o    Increased circulation and reduction of rehabilitation time: The local increase in circulation caused by heat application is beneficial in healing numerous injuries. Bringing fresh blood and nutrients to the areas helps maintain the optimum health of the tissues for injury repair.

o    Increased pliability of connective tissues: Heat applications help to improve the elasticity of fascia (connective tissue) therefore myofascial and therapeutic stretching procedures are much more effective if heat is applied beforehand. Research has shown that temperature increase in fascia of up to 40 degrees C leads to reduced stiffness and more rapid elongation of tissue which in part can be attributed to higher extensibility of collagen (Lehman et al 1970, Warren et al 1971). Therapists interested in the benefits of fascial work would do well to apply heat to the tissues first for even better and quicker results in fascial release.

o    Decrease in perception of pain: We natually turn to the healing properties of heat when in pain – hot water bottles, baths, jacuzzis and hot compresses are common self care measures for everything from sore backs to period pains. Heat can help to decrease the individual perception of pain and enable us to feel in control of our pain responses

Ice for Injury – the use of cold stones

Cold is an ideal treatment for ACUTE injuries i.e:  those where the injury is recent (less than 72 hours) and characterized by inflammation, swelling, lack of mobility and pain. A recently sprained ankle is a classic example of an acute injury.

Massage therapists often get confused about which injuries are acute and sometimes use ice or cold inappropriately. A good example is low back pain where therapists are often terrified of  mysterious “inflammation” that is not obvious but they are convinced must be there. Approximately 85% of low back pain is actually known as “non specific” – in other words we have no idea what the cause is – there is no injury and therefore no inflammation!

Clinical experience suggests that trigger points and myofascial restrictions are key components of this type of pain – such soft tissue restrictions actually respond much better to heat. In these cases ice may not be useful as it can trigger spasm of already overly tight muscles and cause those trigger points to start a-firing.

When used appropriately in acute pain, cold has highly beneficial effects in helping acute injuries to heal quicker:

o    Reduction in muscle soreness: Cold is of benefit in reducing certain types of muscles soreness, especially that associated with increased levels of unaccustomed exercise.

o    Cold slows down the cellular metabolic activity. In acute injuries, the increase in cellular metabolic activity is one factor that prolongs the healing process. Using cold immediately after injury shortens the recovery period.

o    Decreased nerve conduction velocity: This can be very beneficial in reducing pain sensations and increasing the pain threshold thereby providing pain relief

o    Decreased oedema:  Oedema is one of the primary causative factors in the perpetuation of acute pain. Cold is very effective in reducing oedema.

Best of both worlds- Hot and cold contrast applications

To get both the beneficial aspects of hot and cold, the technique of “contrast bathing” is applied. The use of hot and cold is alternated to a particular area. This is believed to cause a flushing of the tissue fluids and improve many of the neurological responses that will create the best environment for healing.

There are many ways to apply hot and cold to the body during bodywork, including hot and cold packs, infra red lamps, hydroculator packs etc. However, few have the unique advantage of the stones – namely that you can actually WORK with the stones while simultaneously applying wet heat/cold, thus enhancing greatly the time effectiveness of your treatment.

It is important to note that there are many hot/cold stone massages where hot and cold stones are run up and down the body quickly, often causing discomfort for the client. This is completely different, -here we are specifically treating an area of pain, tension, or injury to create a positive outcome for our clients.

What does the research tell us about use of hot and cold?

Although hot and cold has been used for decades as an important adjunct modality in the treatment of pain, supporting evidence from research ( as ever!) is divided.

Some research trials have been overwhelmingly positive in the support of the use of heat for pain reduction. In two trials of 258 participants with a mix of acute and sub acute low back pain, heat wrap therapy significantly reduced pain after 5 days compared with oral placebo.

In common with experiences in clinic where effects on pain reduction can in some cases be instantaneous, one trial of 90 participants with acute low back pain found that a heated blanket significantly decreased pain immediately after application (Both studies in French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. A Cochrane review of superficial heat or cold for low back pain. Spine (Phila Pa 1976). 2006 Apr 20;31(9):998-1006. Review. PubMed PMID: 16641776.)

Excitingly there is also some support for fans of the Jing approach to combining different approaches within a treatment to gain maximum results. One trial of 100 participants with a mix of acute and sub acute low back pain found that using heat in conjunction with exercise significantly increased pain relief compared to heat alone. This is an important finding and confirms our belief in the value of self- care suggestions for clients as an important part of the client-therapist interaction. Both local heat application and encouraging exercise and movement are easy and safe suggestions for the client in pain.

In conclusion, evidence is limited but encouraging as to using heat in treatment. The Cochrane review concludes
“There is moderate evidence in a small number of trials that heat wrap therapy provides a small short-term reduction in pain and disability in a population with a mix of acute and sub acute low back pain, and that the addition of exercise further reduces pain and improves function. There is insufficient evidence to evaluate the effects of cold for low back pain and conflicting evidence for any differences between heat and cold for low back pain”

Using the stones in remedial massage work

At Jing we teach you the skills to understand when hot and cold stone work should be used to treat different pain conditions and the confidence and creativity to design unique and luxurious treatments for all your clients

Some great techniques to play with

o    Large hot stones can be used over the drape to warm and relax the fascia and muscles in the area of pain for up to 20 minutes before treating the area directly.

o    Placing stones is a lovely part of the work we do, but it is only 10% of it.  Most of the work is done by dynamically and specifically massaging the body with the stones as extensions of the therapist’s hands.

o    Broad effleurage strokes are used to warm the area, before using smaller specific stones to strip and elongate the muscles fibres, searching for trigger points. This saves your precious thumbs and gives great relief to your client. For example to alleviate low back pain we could treat Erector Spinae, Quadratus Lumborum, Gluteal muscles and the lateral rotators with these techniques.

o    Cold stones can be used in a similar way for acute pain to decrease pain and swelling. Cold stones used in conjunction with deep transverse friction can be very effective.

o    Cold stones are usually not used longer than five minutes in any one area.

Creativity and Specific treatments

Jing therapists are trained to use the stones creatively.  On our courses. you will learn a fabulous head to toe full body massage, plus the freedom to blend remedial techniques such as trigger point therapy, myofascial work and clinical stretching to produce great results. Our students are given the confidence to combine the stones with existing techniques as diverse as energy work, reflexology, sports massage or aromatherapy. This leads to a confident and creative practice as outlined by the comments below from students who have worked with us:

Using Hot stone Fusion in:

Reflexology: “I’ve only used stones with reflexology, but even in this small area they are great. I’ve used them on  pregnant mums up the arms to remove tension and relax them.  I place them between the toes and under calves, clients love this”

Myofascial Work: “I feel results are much faster with the stones than with the hands alone…  There is no getting away from HOW THE CLIENT FEELS with  the warmth of the smooth stones gliding over them. They can be used without oil…just wet and then you can put a warm towel over the area to dry it and away you go with some myofascial techniques”

Aromatherapy: “Since doing the hot stone course with Jing and using it in my clinic alongside my aromatherapy practice, I have found in treating people with severe painful muscular complaints that the analgesic and muscle relaxant aromatherapy oils get in to the client’s blood stream quicker when using hot stones as opposed to traditional massage.

The benefit is that I can work deeper into the muscle tissue with the stones within 10 minutes, whereas with handwork I would have to take 30 minutes. So basically hot stones deliver better quality massage time for the client”

About Rachel Fairweather and the Jing Institute of Advanced Massage

Rachel Fairweather is co-founder and director of the Jing Institute of Advanced Massage. Based In Brighton, London and Edinburgh we run a variety of courses in advanced techniques to help you build the career you desire.

Our short CPD courses include excellent hands on learning in a variety of techniques including hot stone fusion, trigger point therapy, myofascial release and stretching. For the first time you are now able to learn these techniques at your own time and pace with our revolutionary online low back pain course aimed at giving qualified bodyworkers the skills they desire.

For the therapist who wants to be the best they can possibly be, we offer a BTEC level 6 (degree level) in advanced clinical and sports massage – the highest level of massage training in the UK.

Want to find out more? Please contact The Jing Institute!

Tel: 01273 628942



Instagram: @jingmassage 

Facebook:  Jing Institute of Advanced Massage Training

Copyright Jing Advanced Massage November 2013. Text Rachel Fairweather and Meghan Mari with thanks to Jing students Susky Hashemi, Christina Hitchins, Carmen O’Connor, Tara Hunt and Victoria Hayden. Photos Meghan Mari

Comments are closed.