Gua sha (pronounced gwah sah): this traditional east Asian healing technique – also known as cao gio, coining, scraping, and spooning – uses friction and scraping on the back to treat numerous conditions from pain and inflammation to stiffness and soreness.
All of the muscles of the body are encased in fascia, a thin membrane. This membrane may become tight or constricted due to various conditions, not the least of which is injury or chronic pain.
Gua sha is one way to help restore circulation to the fascia and break up tension and tightness. “Gua” means “to scrape,” and “sha” refers to the red rash that is a result of this scraping. According to Chinese practitioners, this friction breaks up adhesions in the tissues and releases stagnant “winds” or qi, releasing blockages in meridians that can be causing pain or soreness in the body.
Physiologically, gua sha increase blood circulation within the tissues and for this reason can be used for any conditions that may be caused by poor circulation of blood (e.g. inflammation). The Graston technique or augmented soft tissue mobilization (ASTYM) is a similar technique used by athletic trainers to focus on releasing scar tissue and easing fascial constriction. Other therapists, such as massage therapists and chiropractors, may use ASTYM to treat acute or chronic soft tissue pathology.
What does a gua sha session look like?
Most gua sha sessions begin with a deep tissue massage or palpations along the back to find adhesions or scar tissues. When an area of the skin is pressed, it will turn pale. After the pressure is released, that area should quickly refill with blood. A slow capillary response where blood does not quickly rush back to the area when pressure is released means that circulation to that area may be compromised. This tells the therapist which areas need more pressure. Massage, palpations, and testing capillary response help the therapist identify potential areas that need more pressure.
The therapist will use a circular tool – spoons are common- and either oil or an abrasive substance to sweep down the back, increasing microcirculation in the tissues of the back. The result is a rash underneath the skin caused by petechiae or ecchymoses (small leakages of blood). The color of the rash (dark or light) helps the gua sha therapist to plan future treatments.
This treatment can be extremely uncomfortable (bordering unbearable for some).
Who is gua sha for?
Gua sha can be used to treat the following conditions:
- Flu and fever
- Respiratory conditions (e.g., common cold, asthma, bronchitis, and emphysema)
- Musculoskeletal problems (e.g., fibromyalgia, strain, and spasm)
There are a few patients who should avoid gua sha, including pregnant women, those taking blood thinners, anyone with a bleeding disorder, and people with open sores or wounds on their backs. Because of the discomfort of the procedure, it is generally not performed on children.
What does the research say?
Research on gua sha is in its infancy. Scientifically valid studies of its efficacy are small, few, and far between, but there does seem to be a push for a deeper look based on a few solid positive outcomes.
One study of 48 patients with neck pain in Kliniken Essen-Mitte, Academic Teaching Hospital of the University Duisburg-Essen, Germany found that those in the gua sha group found that their neck pain decreased significantly when compared to the control group (which utilized a heating pad for pain relief).
Another study wanted to examine the claim that gua sha increased microcirculation. Increasing circulation in the body can help on a number of levels, including in reduction of inflammation and pain. Researchers at the Beth Israel Medical Center’s Continuum Center for Health and Healing found a fourfold increase in microcirculation shortly after gua sha treatment was administered, a result that was significantly more pronounced in female study participants. This same study also found that there was a pain-relieving mechanism to the treatment, but researchers were unable to identify it.
There is also research that supports ASTYM, the therapy that is very similar to gua sha. This research is sponsored by the company that makes ASTYM therapy tools, but the results span the U.S. and include data from 10,000 study participants. The full report includes promising results, such as:
- Decreased pain and increased range of motion where scar tissue is present
- Increased fibroblast activation and number (fibroblasts are the most common cells in human connective tissue and help with wound repair and construction of cartilage)
- Improved tendon repair
Yet another meta-analysis of studies looking at gua sha found five randomized controlled trials and two controlled clinical trials that presented scientifically valid conclusions. The analysis focused on musculoskeletal pain and identified three possible pain-relieving mechanisms:
- Increase in microcirculation
- Stimulation of serotonergic, noradrenergic, and opioid systems to relieve pain
- Interference with the nociceptors, pain sensors, that then minimizes pain
A total of 224 articles on gua sha were located and examined, but researchers rejected the vast majority as not relevant due to study design (including no control group or gua sha in use with other therapies). Although the results of the remaining seven studies were not strong enough to prove the claims of gua sha practitioners, the study authors found enough evidence to recommend larger, controlled studies to investigate further.
Gua sha is an out-of-the-box therapy with limited scientific research but much anecdotal support. For those suffering from chronic pain, this may be enough to give gua sha a try. Would you test this treatment?