IASTM and Gua Sha - Brisbane MSK Clinic

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.

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.