IASTM and Gua Sha - Brisbane MSK Clinic

Gua Sha is a Traditional Chinese Medicine (TCM) technique that dates back over 2000 years. The method is an ancient form of what is now commonly known as IASTM, though with specific philosophical underpinnings and protocols. The technique's name translates as 'scraping sha-bruises'. In some cultures, the method is known as spooning, coining or scraping. Evidence exists of similar therapy techniques used with gladiators in ancient Roman times who needed to stay in peak fighting shape. Gua Sha is applied using specifically shaped tools. The shape and material used to make the tools can vary. Materials have different properties, and examples of traditional materials include bone, horn, bian stone, jade, quartz, ceramics, and metal. Each material has different physical properties, which can be relevant to traditional treatment philosophy. It is common to see tools made of plastic, resin, and more exotic metals in modern-day practice alongside more traditional tools. Practitioners apply a lubricant to the treatment area and repeat unidirectional strokes to the tissues, usually working along acupuncture meridian lines ('Chi' energy lines). Although there are protocols with Gua Sha, such as the number of unidirectional strokes and the stroke application direction, the method is not commercialised (patented, trademarked, etc.). The pressure of strokes performed in Gua Sha is often quite gentle and effectively effleurage techniques, or occasionally petrissage. The repeated strokes slowly produce what is known as 'sha', though the method tends not to create much physical bruising. The 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 ways to reduce energy or heat. Gua Sha treatments typically cover a wide body area, focusing on channelling the "heat" from within bodily tissues out to the extremities and as per the technique protocol. 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," and "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, which logically should aid tissue healing. Also, there is a particular localisation of heat to the areas of "Sha" appearance. However, the notion that "Sha" indicates the release of unhealthy elements is far less clear-cut, much like the "myth" that massage therapy releases "toxins". Although the "Sha" appears to be "bruising", it looks very different in practice and creates transitory therapeutic petechiae. The "petechiae" 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. The following image is a typical example of what a traditional Chinese Gua Sha back treatment looks like post-treatment, and although it looks really painful, it is generally not.

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 commercialised (patented, trademarked and branded), such as Graston Technique ®, Astym ®. Brand names are the simplest way for the public to view the various IASTM techniques that are specifically named. The granting of a patent for a soft tissue therapy technique does not necessarily mean the method is better than other non-patented techniques. However, patents and trademarks are commercially valuable and financially lucrative for the owner, enabling further technique marketing and promotion. Equally, a brand name helps one to differentiate from other IASTM techniques and market and protect the brand. Instrument-Assisted Soft Tissue Mobilisation - IASTM is a generic, non-trademarked, and non-patented way of treating soft tissues and fascia with specifically shaped tools. Graston Technique ® is a widely marketed, trademarked and branded technique with a patented treatment protocol with its own set of instruments (tools), though it is still IASTM. The commercialisation of a technique also enables the owner to place further requirements around individuals being able to utilise the brand name. Examples include additional and financially lucrative technique-specific 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 continual professional development. However, maintaining provider status and the legal ability to use the brand name requires using the specific Graston Technique ® tools and completing the necessary technique-specific training every two years.

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 predominately a type of friction massage, and there are limits on the tissues a therapist can access with their hands. The specially shaped tools allow access to and treatment of tissues in ways not possible with the hands. However, IASTM often involves effluerage and petrissage technique strokes during treatment. Unlike Gua Sha, IASTM treatments typically involve the application of technique strokes both longitudinally and transversely. 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.

As with most manual therapy techniques, IASTM can cause discomfort/pain, a sensation of heat, skin redness (erythema), a bruised sensation, or visible bruising. Such side effects are usually more noticeable around the areas of tissue treated. However, other areas may ache due to changes in biomechanics resulting from releasing fascial restrictions. However, it is very concerning to see professionals with popular social media followings posting videos of patients being "brutalised", resulting in extensive bruising. Such videos create the impression that IASTM should be hugely painful and cause substantial and widespread bruising. Equally, as with all techniques, there are times, a place, and specific circumstances relevant to deciding whether to use any particular therapy method. Broadly speaking IASTM 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, fibrosis or scar tissue. Some acute and chronic conditions can prove fairly sensitive at the start of treatment, in part due to inflammation. However, it is always good to see somebody struggling to walk into the clinic setting and then be able to walk out much easier. IASTM has gained popularity along with cupping after people saw such techniques in use at the Olympics.