6 Hot Stone Massage Benefits and Risks, Explained by an Expert

Massages are a wonderful way to unwind and bask in some much-needed me-time. When hot stones are added to the equation, a routine massage quickly becomes next-level indulgent. The warm stones are surprisingly comforting and can be placed almost anywhere you’re feeling pain or tension. Think: along the curve of your spine, on the backs of your thighs and calves or even on your stomach and neck.

But what is it, exactly, about adding some heated rocks to the equation that actually promotes healing? And when—if ever—is this form of treatment a bad idea? We reached out to Brooke Riley, a licensed massage therapist and the operations specialist for Massage Heights, a San Antonio-based massage chain and Dr. Nicole Glathe, a board-certified acupuncturist and co-founder of the holistic healing brand, Elix to get to the bottom of it.

During a hot stone massage, a massage therapist will place smooth, heated stones—typically made of basalt, a type of volcanic rock that retains heat—on specific parts of your body. According to the American Massage Therapy Association stones should be heated in water between 110° F and 130° F—hot enough to be beneficial but not so hot as to burn the skin. Sometimes the therapist will also hold the stones in their hands as they knead any parts of the body that are crying for some TLC.

Research shows that localized heat—like the kind experienced during a hot stone massage—is effective at increasing blood flow and circulation to the area where it’s applied. This improved circulation aids the healing of soft tissue and reduces muscle tension. Once the muscles are warmed up and relaxed, it is easier for a massage therapist to work on them. (You might notice that all kinds of massage typically start with the massage therapist buttering you up, so to speak, before they really dig in.) Finally, the heat from the stones also enhances whole body relaxation (like a hot bath would) and thus can reduce anxiety and promote a sense of well-being.

Hot stone massage is not off-limits for pregnant women, but raising core body temperature is not recommended during pregnancy. As such, many massage therapists do not feel comfortable using this technique on pregnant women. Still, it’s worth noting that research has shown that gentler (and less heated) prenatal massage techniques have myriad benefits, particularly after the first trimester. Pregnant women should always consult with their healthcare provider before engaging in any type of massage (hot stone or otherwise).  

Some people with diabetes can get hot stone massages, but it’s best to consult your physician first to rule out symptoms of neuropathy. Neuropathy is a common symptom of diabetes that involves a loss of sensation, and anyone suffering from this symptom is not eligible for hot stone massages because they might not be able to feel when the stones are uncomfortably hot and, thus, might not be able to communicate it to their practitioner. 

Individuals who take blood thinners are at a higher risk of bruising and bleeding. Due to the increased circulation (i.e., blood flow) that hot stone massage achieves, this risk is heightened. As such, hot stone massage is contraindicated for anyone taking anticoagulants. 

Sensitive skin is, well, sensitive…which is why expert sources confirm that even warm stones can irritate the skin. People with skin conditions such as eczema, psoriasis and dermatitis should avoid this type of massage. Generally speaking, if you have fragile or sensitive skin, hot stone massage is probably not for you.

Placing smooth, round stones on pressure points and knotted muscles all over the body before a massage helps loosen everything up and gets both your mind and body in the mood for what’s to come. Think about it in the same way that you’d apply a primer to your face before your foundation—hot stones are an essential ingredient to get the most out of this treatment. 

“Hot stones allow you to get way more out of your massage,” Riley explains, because “heat promotes muscle relaxation. By placing hot stones at key points on your body before your massage begins, the massage therapist is alleviating muscle tension before they even place their hands on you, making it easier for him or her to give you a soothing deep-tissue massage.”

It’s the heated part that is most important when getting a hot stone massage because the temperature works with your body from the outside, in. As Glathe explains it, you need the raised temperature of the stones to get your blood flowing to your muscles because it’s how oxygen is transported throughout our systems. More oxygen = faster recovery.

“Heat dilates the capillaries, bringing fresh blood to the area, which means built-up elements like lactic acid are flushed away, while healing nutrients, oxygen and new tissue building blocks are brought in,” she says. “Heat is also shown to be comforting from a neurophysiological standpoint and allows for all of our stressors to decrease.”

Just like all massages are good for your circulatory system, they’re also great for anyone dealing with chronic pain issues, like arthritis. A hot stone massage is especially effective because of the deep-tissue action it allows, says Riley. Even if your pain isn’t recurring and is just a random kink in your neck, your massage therapist will know how to manipulate the stones ahead of your session to help you feel better walking out than you did walking in.

“Many of my patients living with chronic pain see benefits from hot stone massages,” she says. “The heat allows the massage therapist to manipulate deeper muscle tissue, which leads to greater muscle relaxation, decreased muscle spasms, increased range of motion and—most importantly—reduced pain.”

Believe it or not, you can find happiness at the, err, hand, of a heated stone, say the pros. More study is needed to determine the exact neurological connection between our pressure points and stress hormones but, as Riley explains, hot stone placement is key to leaving your appointment feeling super zen. 

“The stones are placed at specific pressure points in order to relieve tension, elevate your mood and combat stress,” she says. “This physical reduction of pressure actually helps reduce mental stress because when the body is relaxed, the mind is able to relax, and you can leave the hot stone massage feeling rejuvenated.”

Think about trying to touch your toes when you've been sitting in your cold office for hours versus when you're in a hot shower. The latter is way easier, right? As mentioned above, a hot stone massage can relax and loosen muscles, thereby improving flexibility. Time to nail that tricky yoga pose, we think.

If you've tried melatonin gummies, chakra meditation and everything in between, but are still struggling to fall and stay asleep, you might want to consider adding hot stone massages to your wellness repertoire.  In 2001, researchers at the University of Miami found that infants who had trouble sleeping were able to fall asleep faster when given a 15-minute massage by their parents. On top of that, the infants were more alert, active and positive when they woke up. 

We know now that heat generates blood flow and gets it moving straight to those hot spots to help ease sore muscles, promote better circulation and reduce chronic pain. But unlike a mid-day latte pick-me-up, heat isn’t always a good idea. Here are a few risks of hot stone massages. 

“Heat should not be used in acute inflammation or fresh injuries, as increasing blood flow would increase swelling,” says Glathe. For these ailments, it’s best to RICE it: rest, ice, compression, and elevation, and follow your doctor’s orders, of course.

If you’re on blood-thinners or any medication that has heat-related side-effects, you likely want to skip a hot stone massage. Consult with your doctor.

If you have skin conditions like psoriasis or eczema, the heat used during a hot stone massage can aggravate the skin further; stick with non-heated massage.

The question of which type of massage is better largely comes down to your personal preference (and whether or not you fall into the categories of people who should stay away from hot stone massages, as outlined above). Some people prefer the feeling of hot stones, while others would rather skip the heated element. Both massage therapies can be beneficial, just keep in mind that it's important to do your research on your spa and/or practitioner to ensure you're getting the safest and best treatment possible.

Keep in mind that one of the great things about a hot stone massage—the ease with which your therapist will be able to give you a deep-tissue massage—might also make you quite sore the next day. You shouldn’t be “can’t-take-the-stairs” sore, but you’ll definitely feel something other than relaxed. (But trust us, it’s worth it.)