At TotalMSK Gua Sha or IASTM is typically used to treat:-
- Acute and Chronic inflammatory conditions.
- Sports and overuse injuries.
- Work related injuries.
- Musculoskeletal / MSK conditions affecting fascia, muscles, tendons or ligaments.
- Fibrotic tissues, including scar tissue.
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 tend to cover a wide area of the body, focusing on taking "heat" from the body out to the extremities. As mentioned earlier, the areas of "Sha" also produce heat and do not appear on all tissue the method is applied. It is easy to see and feel how the method does encourage blood flow to the tissues, and logically that should aid healing. 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 surface of the skin. 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 as 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 appears to stimulate the immune system to some extent. Other studies have shown that a similar tool based myofascial techniques can increase collagen production within treated tissues.
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 ®. 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 level of pressure 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 consumers 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 is a time and place to use a therapy method or not. That said IASTM therapy is commonly used to treat soft tissues, such as muscles, tendons, ligaments, fascia and connective tissues which are exhibiting chronic inflammation, degenerative changes or fibrosis. Such techniques have gained popularity along with cupping, after people seeing such techniques in use at the Olympics.
Image showing application of IASTM
Chronic Pain and "breaking down Scar Tissue"?
There are many myofascial release (MFR) methods, 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 (see the article on Chronic Pain for further details on aspects of such conditions). Sadly, many professionals wrongly talk about breaking scar tissue down with various soft tissue therapy (STT) skills. 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 tissue healing). 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.
Myofascial Pain Relief - Treatment and Techniques
Massage and Myotherapy Registrations
Terry brings over 15 years of experience working in the MSK Therapy field back to Brisbane from the UK. He is highly qualified with training and experience covering many assessment methods, treatment types and soft tissue therapy (STT) skills. Terry's sporting activities, experiences and interests have naturally led to him specialising in the treatment of trauma and myofascial pain relief. He also taught as a senior course coach over seven years ago on one of the first myotherapy courses in Brisbane. His skills are now available at the Morningside clinic, where he works as a Myotherapist.