Gua Sha: Another Form of Mechanical Load
By Warren Hammer, MS, DC, DABCO
Every technique that creates compression or tensile stretch to soft
tissue creates a mechanical load that is necessary for tissue change.
Gua sha
represents another form of mechanical load on soft tissue that claims
healing results and, like all other soft-tissue methods, begs for
research to prove its value.
Arya Nielsen, PhD, adjunct faculty in the Department of Integrative Medicine at New York Beth Israel Medical Center,
Continuum Center for Health & Healing, and a strong proponent of gua sha, wrote an interesting article in the January 2009 issue of the Journal of Bodywork and Movement Therapies (JBMT).1
She states that often the literature incorrectly describes the results of
gua sha as causing battery trauma, bruising, burns, dermatitis, pseudo bleeding and even hematoma.
Although
gua means to "scrape" or "scratch" in Chinese, the skin always remains intact and there are no abrasions.
Sha
represents the "transient therapeutic petechiae." The extravasated
blood appears as red macula and fades to ecchymosis immediately,
blending into an ecchymotic patch. The scraping reveals blood stasis and
its use removes blood stagnation that is considered pathogenic, thereby
promoting normal circulation and metabolic processes.
Gua sha lets blood from the tissue and
is not let from the skin.2
This method originated in Asia and is used today in East Asian medicine and
by acupuncturists.
Nielsen mentions its use for colds, flu, fever, heatstroke, asthma,
bronchitis and emphysema, as well as musculoskeletal problems including
fibromyalgia to severe strain. Improving blood stasis and sha may even be significant in asymptomatic subjects who are considered healthy.
A recent study using laser Doppler imaging was used to make sequential measurements of the microcirculation of surface tissue
before and after gua sha treatment3
in order to relieve pain.
The result was a fourfold increase in
microcirculation for the first 7.5 minutes following treatment and a
significant increase in surface microcirculation during the entire 25
minutes of the study period following treatment. There was a decrease in
myalgia not only locally but also in sites distal to the treated areas.
The authors stated that the distal area of relief was not due to a
distal increase in microcirculation and asserted, "There is an
unidentified pain-relieving biomechanism associated with
gua sha."
Recent
theories based on tensegrity and the fascial continuum help to explain
distal results from localized mechanical load. Ingber, who has written
much on
our tensegrity structure,4
demonstrates how living cells and tissues sense and respond to
mechanical stresses and in the rearrangement of the structure become
mechanochemical transducers, whereby mechanical signals create chemical
responses affecting local and distal parts of our structure.
Fibroblasts are the chief cell in the extracellular matrix and reproduce the extracellular matrix upon being loaded;
it is thought by Langevin, et al.,5
that the existence of a cellular network of fibroblasts within loose
connective tissue may have considerable significance, as it may support
as-yet unknown bodywide cellular signaling systems. She states that
fascia may serve as a bodywide mechanosensitive signaling system with an
integrating function similar to the nervous system. Regarding gua sha and GT, increasing the microcirculation may stimulate platelets which release growth factors related to the healing of tissue.
Graston Technique (GT) has been compared with
gua sha, and I have even heard some say that GT adopted the
gua sha concept. GT was initially used on a postsurgical knee. It is extremely doubtful that the discoverers were at all familiar with
gua sha,
but even if they were, the GT application is significantly different.
GT research has been directed toward the musculoskeletal system and its
effect on various soft-tissue conditions. New studies are continually
appearing demonstrating how it may be affecting soft tissue. It has its
own protocol and uses instruments of different weights, shapes, and
sizes to conform to the bodily contours. Its stainless-steel vibratory
effect is used to detect restricted areas after functional tests are
performed to determine the involved location.
While both
methods can create petechiae, the stroking is not performed in the same
manner. GT often achieves results without creating any petechiae at all.
GT uses at least seven types of strokes, while
gua sha repeats a stroke in one direction about 4-6 inches long specifically to create "therapeutic" petechiae.
1
A variety of instrument angulations and pressures may be used in GT depending upon the area of the body treated.
Doctors
trained in both methods realize the vast differences. Both methods have
their place and there is some obvious overlap, but the differences
between the methods are significant. At present, all soft-tissue loading
methods are still in their infancy regarding research as to how they
affect our structure and function.
Einstein referred to a unifying theory of the universe. Hopefully, there might someday be one for soft tissue.
References
- Nielsen A. Gua sha research and the language of integrative medicine. JBMT, January 2009;13,63-72.
- Nielsen A. Gua Sha: A Traditional Technique for Modern Practice. Edinburg: Churchill Livingstone, 2002.
- Nielsen A, Knoblauch N, Dobos G, et al. The effect of gua sha treatment on the microcirculation of surface tissue: a pilot study in healthy subjects. EXPLORE: The Journal of Science and Healing, September 2007;3(5):456-66.
- Ingber DE. Tensegrity: the architectural basis of cellular mechanotransduction. Ann Rev Physeal, 1997;59:575-99.
- Langevin H, Cornbrooks CJ, Taatjes DJ. Fibroblasts form a body-wide cellular network. Histochem Cell Biol, 2004;122:7-15.
A little Background:
Graston Technique
From Wikipedia, the free encyclopedia
Graston Technique (GT) is a
trademarked therapeutic method for diagnosing and treating disorders of the
skeletal muscles and related
connective tissue.
The method employs a collection of six stainless steel tools of
particular shape and size, which are used by practitioners to palpate
patients' bodies in order to detect and resolve
adhesions in the muscles and
tendons.
[1]
Practitioners must be licensed by the parent corporation in order to
use the Graston Technique trademark or the patented instruments.
[2]
Criticism
The Graston Technique has not been rigorously scientifically tested
and its evidence basis and assumptions are considered questionable by
physician Harriet Hall.
[3]
However several examples of Graston treatment have been tested in combat sports where scars and contusions are common.
[4
Gua Sha
From Wikipedia, the free encyclopedia
Gua Sha as practiced in Bali, Indonesia
Gua sha (
Chinese:
刮痧;
pinyin:
guā shā), literally "Scrape Sand" in
Chinese
(more loosely, "to scrape away disease by allowing the disease to
escape as sandy-looking objects through the skin"), is a form of folk
medicine. Sometimes referred to as "spooning" or "coining" by English
speakers, it has also been given the descriptive French name,
tribo-effleurage.
[1]
The
Vietnamese term for this practice is
cạo gió. This term translates roughly "to scrape wind", as in Vietnamese culture "catching a cold" or fever is often referred to as
trúng gió, "to catch wind".
The origin of this term is the
Shang Han Lun,
a ~220 CE Chinese Medical text on cold induced disease - like most
Asian countries China's medical sciences were a profound influence in
Vietnam, especially between the 5th and 7th Centuries CE.
[2] Cạo gió is an extremely common remedy in Vietnam and for
overseas Vietnamese. There are many variants of
cạo gió.
Some methods use oil balm and a coin to apply pressure to the skin.
Others use a boiled egg with a coin inserted in the middle of the yolk.
The egg is wrapped in a piece of cloth and rubbed over the forehead (in
the case of a fever) and other areas of skin. After the rubbing, when
the coin is removed from the egg, it will appear black.
It is also used in Indonesia. It is a traditional Javanese technique, known as
kerikan (lit., "scraping technique") or
kerokan, and it is very widely used, as a form of folk medicine, upon members of individual households.
Technique
Gua sha involves repeated pressured strokes over lubricated skin with a smooth edge. Commonly a
ceramic
Chinese soup spoon was used, or a well worn coin, even honed animal
bones, water buffalo horn, or jade. A simple metal cap with a rounded
edge is commonly used.
In cases of fatigue from heavy work, a piece of ginger root soaked in
rice wine is sometimes used to rub down the spine from head to feet.
The smooth edge is placed against the oiled skin surface, pressed down firmly, and then moved down the muscles—hence the term
tribo-effleurage (i.e., friction-stroking)—or along the pathway of the
acupuncture meridians, along the surface of the skin, with each stroke being about 4–6 inches long.
This causes extravasation of blood from the peripheral capillaries and may result in sub-cutaneous blemishing (
ecchymosis), which usually takes 2–4 days to fade.
Sha rash does not represent capillary rupture (
petechiae)
as in bruising, as is evidenced by the immediate fading of the markings
to echymosis, and the rapid resolution of sha as compared to bruising.
The color of
sha varies according to the severity of the
patient's blood stasis—which may correlate with the nature, severity and
type of their disorder—appearing from a dark blue-black to a light
pink, but is most often a shade of red.
Practitioners tend to follow the tradition they were taught to obtain
sha: typically using either
gua sha or
fire cupping. The techniques are sometimes used together.
[3]