Hot Stone Massage can be a dual purpose massage. Due to the heat of the stones, it is always a highly relaxing, stress reduction massage. The hardness of the stones allows the therapist to address specific problem areas with more detailed work or deeper pressure.

Basalt stones of various sizes, shapes and weights are used throughout. Some stones are the size of the tip of your thumb (these are used between the toes), while others can be very large - 2 or 3 pounds (1 to 1½ kg) in weight. These larger stones are normally used on the sacrum or low abdomen.

The stones are heated using water, and the ideal, safe temperature range of the heated water should range from 130 to 145 degrees Fahrenheit (54–63 °C). Heavy duty rubber gloves or a slotted spoon is used by the therapist to remove stones from the heating container. The job of the experienced, trained therapist is to closely monitor the heat level of the stones before placing on the client, plus keep track of which stones are to be used on various parts of the body. Stones which are too low in temperature fail to adequately relax the stressed muscle tissues and simply do not feel all that good. Alternatively, stones that are way too hot will impart extreme discomfort and anxiety to the client. Fortunately, the human body has an excellent temperature gauge and a client in most cases will and should, immediately respond in a negative way to an excessively hot stone, which tells the therapist to remove the stone. A good stone therapist will use a constant read digital thermometer in the heated water, keeping a vigilant watch on the temperature range.