IASTM and Gua Sha - Brisbane MSK Clinic
Gua Sha - Instrument Assisted Soft Tissue Mobilisation
There are many ways to treat restricted mobility and myofascial pain. Therapy approaches may look to achieve the same objectives, though they often work differently to achieve the desired outcome. Equally, techniques are not always appropriate or unsafe and contraindicated in given circumstances. Instrument Assisted Soft Tissue Mobilisation (IASTM) is a broad term for a group of approaches which utilise myofascial release tools to treat myofascial pain and MSK conditions. Although IASTM is a broad category for a group of techniques that use instruments/tools to treat soft tissues, IASTM techniques are also a specific form of myofascial release therapy. Foam rollers, trigger point therapy tools, massage therapy balls, etc., are also myofascial release therapy tools, though they do not work like IASTM. There are limits on what is achievable in a self-treatment context and other safety considerations.
Gua Sha is a Traditional Chinese Medicine (TCM) technique that dates back over 2000 years and translates as 'scraping sha-bruises' and is sometimes referred to as spooning, coining or scraping. Evidence exists of a similar therapy in use with gladiators in ancient Roman times and who needed to stay in peak fighting condition. Gua Sha is applied using specifically shaped tools. The shape and material used to make the tools can vary. Materials have different properties and, stone, horn, ceramics and metal are common. Practitioners apply a lubricant to the treatment area and then apply repeated unidirectional strokes to the tissues, usually working along acupuncture meridian lines. The pressure of the strokes is quite gentle, and the repeated strokes slowly produce what is known as 'sha'. Therapy is usually applied in either a laying or seated position and requires direct skin contact.
In ancient Chinese medicine, "Sha" is believed to release unhealthy elements from within the injured tissues and promote blood flow and healing. Ancient Chinese medicine views excess heat within the body as pathogenic, and so many therapies focus on releasing said heat. Gua Sha treatments typically cover a wide body area, focusing on channelling the "heat" from within bodily tissues out to the extremities. Many soft tissue therapy techniques increase blood flow to the treated tissues, producing heat and erythema. Technically even massage therapy and techniques such as effleurage aim to encourage the movement of fluids within tissues, including lymph and veinous return. However, massage does not produce the characteristic appearance of "Sha" equally, "Sha" does not appear on all tissues treated with the technique. It is easy to see and feel how the method encourages blood flow to the tissues, and logically that should aid healing. Also, there is a particular localisation of heat to the areas of "Sha" appearance. However, the release of unhealthy elements is far less clear-cut. Although the "Sha" appears to be "bruising", it looks very different in practice and creates transitory therapeutic petechia. The "petechia" looks like tiny droplets of blood below the skin's surface. The "Sha" resembles a "love bite" or "hickey", though it tends not to be painful.
Image showing 'Sha' after application of treatment
Traditional Chinese Medicine considered blood stagnation pathogenic. Hence, raising the 'sha' was thought to be an essential aspect of maintaining health. Traditionally, practitioners have treated a wide variety of ailments, including; pain, headaches, stiffness, nausea, vomiting, wheezing, coughs, colds, chills and fevers. Recent studies have shown that the technique may somewhat stimulate the immune system. Other studies have shown that a similar tool-based myofascial techniques can increase collagen production within treated tissues. There is limited evidence within the Western medicine field covering Gua Sha with few studies. Studies that do exist include those covering persistent or Chronic Pain treatment. Examples include Chronic neck pain , Chronic back pain  and the effects of the method on microcirculation . It is essential to understand the limitations of the research. However, many research papers from China supposedly cover the technique, though they require translation.
Instrument Assisted Soft Tissue Mobilisation (IASTM)
In many respects, Instrument Assisted Soft Tissue Mobilisation (IASTM) is a modern take on the ancient technique of Gua Sha, and there are various adaptations, tools and protocols. Some of these styles of treatment have been patented or trademarked, such as Graston Technique ®, Astym ®. Brand names are the simplest way for the patient to view the various specifically named IASTM techniques. The granting of a patent for a soft tissue therapy technique does not mean the method is better than other non-patented techniques. However, a patent and trademark are commercially valuable and financially lucrative for the owner. Equally, a brand name enables one to differentiate from other IASTM techniques and market and protect the brand. id="iastm-graston" class="anchoffset">Graston Technique ® is a particularly well-known brand with a patented protocol and instruments (tools), which again does not mean the method is necessarily better. Gaining Graston Technique ® Provider Certification requires completing the various training modules and buying the Graston Technique ® instruments (tools). There are also other additional training requirements, which need to be completed every two years depending on the level of the practitioner. The principal Myotherapist at TotalMSK has previously studied Graston Technique ® as part of his continued professional development. However, he does not use the specific Graston Technique ® tools and so does not meet the requirements of provider status. Unlike, Gua Sha most IASTM techniques are not purely applied along meridian lines, though often along the kinetic chain (see the section on acupuncture vs dry needling for further details on meridian lines). IASTM tends to be used primarily to treat Musculoskeletal / MSK-related ailments, rather than fevers, colds etc. IASTM therapy also uses specially shaped tools, often made from surgical-grade stainless steel, plastic, or other materials. The practitioner then uses the instrument with a lubricant to treat the affected tissues.
The method is a type of friction massage, and there are limits on the tissues a therapist can access with their hands. The specially shaped tools make it possible to access and treat tissues in ways not possible with the hands. It is possible to apply IASTM along or across the fibres of soft tissue structures. One can also treat tissues in weight-bearing or non-weight-bearing positions, actively (moving) or passively (still). In Gua Sha, practitioners are looking to produce 'sha' , whereas 'sha' is not the objective of IASTM though it may appear. The pressure level with IASTM tends to be firmer and more focused on problem areas. Hence, there are many differences between the two therapy methods. Also, some bruising can occur with IASTM, especially when treating acute or chronic tissues.
However, it is very concerning to see professionals with popular social media followings posting videos of patients being "brutalised". Such videos create the impression that IASTM should be hugely painful and create substantial and widespread bruising. Equally, as with all techniques, there are times, a place and specific circumstances relevant to deciding if to use any specific therapy method. That said IASTM therapy is commonly used to treat soft tissues, such as muscles, tendons, ligaments, fascia and connective tissues which are exhibiting acute or chronic inflammation, degenerative changes or fibrosis. Such techniques have gained popularity along with cupping after people saw such techniques in use at the Olympics.
At TotalMSK Gua Sha or IASTM is typically used to treat:-
- Acute and Chronic Pain and inflammatory conditions.
- Sports and overuse injuries.
- Work related injuries.
- MSK and Myofascial Pain conditions affecting fascia, muscles, tendons or ligaments.
- Fibrotic tissues, including scar tissue.
The clinic has specialists in IASTM and advanced myofascial techniques for treating musculoskeletal work and sports injuries, scar tissue and myofascial pain conditions.
Chronic Pain and "breaking down Scar Tissue"?
There are many myofascial release therapies, which, when used correctly, can create some hugely positive change in the cases of chronic pain and scar tissue. IASTM and Gua Sha can work extremely well when dealing with scar tissues and chronic pain. Sadly, many professionals wrongly talk about breaking scar tissue down with various soft tissue therapy treatments. The simple fact is that "scar tissue is scar tissue" and essentially a repair, not tissue regeneration. Hence, scar tissue has different properties compared to "normal" tissue (see the article on Soft tissue repair, healing and scar tissue). However, one can work on other soft tissue structures to improve circulation, nerve innervation, and function affected by the scar tissue. Even general medicine cannot change scar tissue into normal tissue. The medical solution to deal with severe and restrictive scar tissue is often further surgery to remove it. Each surgery creates tissue trauma and scarring, though there are occasions where surgery is necessary and life-saving. It is down to the skill, knowledge and experience of a soft tissue practitioner to get the best possible function from the injured/changed tissues.
Our principal practitioner has been using friction-based soft tissue therapy techniques since 2008, including ice massage and cross-fibre friction. He also experimented extensively on his own body with various shaped tools and soft tissue friction techniques. Rather than just learning any old IASTM technique, he was much more interested in learning and understanding the basis for such treatment methods. Hence, in 2015 he trained in the ancient art of Gua Sha. He has found the techniques instrumental in the right circumstances, alongside other soft tissue therapy skills.
Myofascial Pain Relief - Treatment and Techniques
- 1) Effectiveness of Traditional Chinese “Gua Sha” Therapy in Patients with Chronic Neck Pain: A Randomized Controlled Trial.
- 2) The effects of Gua sha on symptoms and inflammatory biomarkers associated with chronic low back pain: A randomized active-controlled crossover pilot study in elderly.
- 3) The Effect of Gua Sha Treatment on the Microcirculation of Surface Tissue: A Pilot Study in Healthy Subjects.
Massage and Myotherapy Registrations
Terry brings over 16 years of experience treating in the MSK Therapy field back to Brisbane from the UK. He is highly qualified with relevant education and training spanning from Certificate level through to higher education and a Masters. His training and experience cover many assessment methods, treatment types and soft tissue therapy (STT) skills. Besides the sixteen years of clinical experience, Terry has a further eight years of experience training and working at the highest physical performance levels within the elite British forces environment. He has a personal experience with a range of running injuries and a vast amount of professional treatment experience. He is still an avid distance runner to this day. Such knowledge has proved highly valuable in the treatment of elite-level athletes and members of the public. His ongoing sporting activities, experiences and interests have naturally led to him specialising in human performance and treating trauma and myofascial pain. He also taught as a senior course coach on the first myotherapy course in Brisbane. His skills are now available at the Morningside clinic, where he works as a Myotherapist.