Heating Up Your Practice Safely: Feedback From Readers

By Dixie Wall

Heating Up Your Practice Safely: Feedback From Readers

By Dixie Wall

After receiving many compelling comments to the two-part series, "Heating Up Your Practice Safely," I was inspired to publish some of the common questions and insightful comments I received. As always, I appreciate your questions and comments and am always open to being educated by my readers.

"Thank you for the much-needed article on safety while using heat during massage therapy. I would just add multiple sclerosis to your list of conditions in which to avoid heat. Though it is considered to be an auto-immune condition, some may not know that and cause great harm. Thank you so much."

Thank you for your response to my article. Multiple sclerosis is an important addition to the list of diseases contraindicated for heat therapies. Multiple sclerosis is a chronic, often disabling auto-immune disease that attacks the central nervous system, which is made up of the brain, spinal cord and optic nerves. More specifically, the body's own defense system attacks the myelin sheath (the fatty substance that surrounds and protects the nerve fibers in the central nervous system) leading nerve fibers vulnerable to damage. The injured myelin forms scar tissue (sclerosis), which gives the disease its name. When any part of the myelin sheath or nerve fiber is interrupted by scar tissue, nerve impulses traveling to and from the brain and spinal cord are distorted or incomplete, producing the variety of symptoms that raise a red flag for heat therapies. Among these are numbness, tingling, weakness, spasticity and unsteadiness of a limb. Fever, hot baths, sun exposure, and stress have all been associated with triggering or exacerbating an attack. Thanks for your contribution.

"I enjoyed your article in this month's Massage Today on hot stone therapy. I practice in Florida and as of March of this year my liability carrier (International Massage Association) announced that due to the increase in claims due to burns, they will no longer cover hot stone therapy. I have talked to other massage therapist with different carriers and they have had the same response. I've also noticed in various spa advertisements that they have dropped hot stone therapy from their ads as well, and one has changed from hot stone to warm stone.

"I have wanted to take a course for some time now but am shying away from doing so because of the change in policy. My question to you is, if the client signs a consent form and ends up with a burn and the therapist is not covered, what the legal ramifications would be. Of course this would have to happen now! Thanks for your input and I look forward to your forthcoming articles."

It appears as though your current massage malpractice insurance policy no longer meets your individual needs. I don't give legal advice, but I do know it's never wise to gamble with one's livelihood by carrying a policy that does not cover all the modalities you practice. It may be time to switch insurance carriers.

"I think you have pointed out a lot of great things in your article about hot stones. I would have liked to have seen something about the hygiene, i.e., how to care for the stones, cleaning and sanitation, since the stones are kept in the perfect environment for bacteria to flourish."

Thank you for your response. You bring up a crucial issue. Due to the increase in bacterial and virus outbreaks over the last decade, the Centers for Disease Control & Prevention (CDC) has put a major emphasis on hand washing and routine sanitary procedures, especially in health care settings. Hospital and clinical settings are a major cause of the spread of many of these "super bugs." Unlike the common cold or a flu virus, these new super bugs spread by direct skin-to-skin contact or with contaminated objects. Carelessness or lack of proper sanitation procedures may make the massage therapist a perfect route for transmission of infection.

According to the South Carolina MRSA Infection Protection Act: "Methicillin-resistant Staphylococcus aureus (MRSA) is a common staph infection which is resistant to many antibiotics and which is increasingly prevalent in health care settings. A study published in the 2007 issue of the Journal of the American Medical Association, found that MRSA infections occur in approximately 94,000 persons each year and are associated with approximately 19,000 deaths; approximately eighty-six percent are health care associated."

In our practices, we have an obligation to ensure each client is protected from these "super bugs" with the safest routine clinical procedures. Different practitioners have their own unique way of sanitizing and/or cleaning their stones and massage tools. Some boil their stones in salt water or wipe with alcohol, others scrub the tool with soap and hot water. I've even heard of therapists using the dishwasher to sanitize the stones. With all the different methods of sanitation what is the safest standard procedure?

One of my teachers, Jenny Ray at Sacred Stone Therapy, has provided me with the latest information on sanitary procedures from the Geothermal Therapy Association (GTA). According to Ray, "The CDC has recently approved GTA recommendations as sufficient for protecting the client from H1N1, HIV AIDS, MRSA and other staph infections. The recommendations are as follows:

  • Water must be changed between each client, and the heating unit wiped out with antibacterial disinfectant.
  • A hospital-grade antibacterial agent such as monochlorophenol must be active in the water at all times.
  • Each stone must be sprayed with isopropyl alcohol and dried after each use, prior to being placed back in heating unit.
  • Stones should be scrubbed with a brush and antibacterial soap if they have any porous surface.
  • All cold stones must be wiped with alcohol between uses.
  • Any stone soaked in an alcohol bath for 10 minutes will not need scrubbing.

Stones should be washed as soon as possible after treatment, as the longer the oils and bacteria stay on, the harder they may be to remove. The critical issue is that the antiseptic routine must be done between each individual client. For more information, refer to the GTA Web site at www.stonewalkersassociation.com which will soon be moving to www.geothermaltherapy.com.