Gua sha is a versatile technique for relieving pain and resolving restrictions in the myofascia. Gua sha has its roots in ancient medicine and is still used today by acupuncturists to treat pain, inflammation, and disease.

In modern usage gua sha is also called scraping therapy, Graston, or instrument assisted soft tissue mobilization (IASTM), and is used to treat pain and myofascial restriction rather than disease or illness. There are many different kinds of tools out there for scraping therapy. Some are generic and marketed simply as gua sha tools, some are marketed to distinguish themselves from gua sha and have their own training systems to accompany the tools.

I am a practitioner and instructor of gua sha, with training both in Western and Chinese medical perspectives, and I have found that sometimes practitioners get stuck with inferior tools that limit the potential effectiveness of their treatment, or think they must purchase several very expensive tools in order to practice gua sha at all. In this article I hope to demystify gua sha tools and help you understand the advantages and disadvantages of the most common tools you will come across.

 

Material

The material determines the durability, porousness, strength, resonance, conductivity, and the cost of your tool. Almost anything can be made into a scraping tool, from traditional animal bone to modern polycarbonates.

 

Metal

Stainless steel, copper, silver, and titanium. In general, metal is the most durable, least porous, strongest, and most conductive and resonant in terms of being able to transmit information from the tissues being worked to the hands of the practitioner. Many of the quality stainless steel tools available now are highly polished, allowing a the treatment to go more directly to the fascial layers and bypassing some of the overstimulation that can cause the body to generate sha*.

Metal does not break, chip, fray, or easily melt and can easily last the lifetime of your practice. Copper and silver tarnish and may be mildly reactive with some people’s skin, or their skincare products. Stainless steel and titanium are fairly non-reactive although some people have metal allergies so be sure to check first before using a metal tool on a patient.

Copper and silver have healing properties and are very conductive to temperature and vibration which can be clinically useful. Metal tools in general will cost more than other types of tools. I am not a fan of aluminum scraping tools and do not use them.

A traditional form of gua sha called “coining” uses a coin to scrape the back, so technically a coin could be used in practice as long as it is completely disinfected.

In my experience the quality copper tool or small stainless steel tools are the best. I like how the resonance of the metal allows me to get palpatory information through the tool and feel connected to the patient while I’m treating. I find that well-made metal tools are easy to grip and have a nice weight and substance, and are overall excellent for clinical use.

 

Ceramic

The ceramic soup spoon is a traditional tool for gua sha. These tools are very affordable and work fairly well. I used the ceramic soup spoon for years in my practice before I found the metal tools that I like.

Even though the spoon feels smooth it is not highly polished as some of the metal tools and may cause a micro-abrasion to the skin. This may overstimulate the superficial blood vessels and generate sha without necessarily directly addressing the fascial layers. The spoons can break or chip so be aware to check the edge before use to make sure there are no sharp edges that could damage the skin. Some ceramic spoons have a metallic line painted around the edge, do not use this type of spoon on patients as the paint has the possibility of rubbing off.

 

Animal Bone or Horn

Bone, horn, usually from cattle. A tool made of animal bone or horn will be porous, more insulated, and more brittle or weak that other materials. The main problem with these for clinical practice is their porousness and tendency to fray or crack making proper disinfection of the tools unlikely, and the lifetime of the tool shorter.

 

Stone

Jade, rose quartz, bian stone. The semi-precious stones are often very smooth and can sometimes be difficult to get a good grip, but can be good for gentle work on the face and for more massage oriented techniques such as trigger point work. The stone tools are lower resonance than metal, and these tools can be disinfected.

The bian stone on the other hand can sometimes be slightly rough and cause micro abrasions to the skin so be aware of that. Stone is strong but can still break if dropped.

 

Plastic

Polycarbonate resin, other hard plastic. These tools are often inventive in terms of shape because of the relative ease of manufacturing a new design in plastic. They are more insulated than many other types of tools, they do not break, and and their ability to be disinfected is good, overall making them workhorses for clinical practice.

There are lots of tools like this on the market in many different shapes and sizes and varying degrees of quality. In my personal experience even the higher quality polycarbonate tools feel awkward and large in my hand, while the cheaper plastic tools feel flimsy and ineffectual.

 

Wood

Wooden gua sha tools can be difficult to disinfect properly and very likely to break down with continued use. They are nice and lightweight but probably best for home use.

 

Jar Lids

It may sound strange but jar lids, specifically metal Plastisol lined caps are the preferred gua sha tool of Dr. Arya Nielson, author of a book and many research studies on gua sha. The lids can be disposed of after a single use, which Dr. Nielson finds useful for her hospital practice. I have not personally used lids but this option can be handy for working in a hospital or other high volume setting where a single-use tool is necessary.

 

Infra-red “Gua sha” Tool

I include this as a warning to avoid using or receiving treatment from this so-called gua sha tool. There is nothing about gua sha in traditional or modern practice that requires it to be plugged in or for the tool to generate heat of any kind. I came across this unfortunately because a patient came to me who had received this treatment elsewhere and had severe burns that resulted in scarring, and ultimately a lawsuit against the practitioner.

 

Other Factors to Consider

Shape and Size

Gua sha tools come in all shapes and sizes. Larger tools are designed specifically for large areas of the body such as the illiotibial band, while smaller tools or tools with very small corners are meant for getting around small joints such as the vertebral facets.

A large tool is not always necessary even on a larger body part. If you can warm up an area before applying gua sha then the treatment area will be more focused and a smaller tool suffices. Also it is possible to get into small joint areas including the wrist, metacarpals, and vertebrae without a particularly small tool or small edge.

That said, I do try to match the size of tool or part of the tool with the structure that I am working on, and work within the patient’s comfort level so that it does not feel to pointed or sharp. For larger areas of the body I make sure the area is warmed up first so I’m not trying to break through a large swath of locked-up fascia with just a large tool.

Edge

A rounder edged tool will be more difficult to use for the scraping technique of gua sha and may be more effective as a massage tool. I find this to be true of many of the jade and rose quartz gua sha tools. A sharper edge will be more effective for scraping and generating sha but can also be less comfortable for the patient. The high quality metal tools will have a good scraping edge that is not too sharp, and some of the tools have one edge that is sharper and one that is more round.

Disinfection

If you are doing gua sha in a professional setting you must disinfect your tools, either with chemical disinfectant, heat such as an autoclave, or ultraviolet light. Be aware of how your disinfection method may compromise the integrity of your tool. Chemicals, heat, or moisture may break down or otherwise react with bone, horn, wood, certain plastics, and certain metals.

Safety

Materials that can break or get chipped such as ceramic, stone, plastic, or wood must be inspected before application to make sure there is no sharp edge that could break the skin.

Application and Preference

You should be able to hold the tool comfortably without it slipping or being the wrong size or shape for your hands. You should be able to use the tool without stressing your own shoulders, wrists, or thumbs. You should be able to generate enough pressure that sha can arise naturally, but not have to press so hard that there is bruising. You may prefer different tools depending on what you are doing or who you are working on.

As long as a tool is safe for professional use you should use whatever tool you prefer. Find a tool that fits in your hand, works with your body and the needs of your patients, and that you enjoy using.

 

*Sha is a Chinese term that roughly translates to “sand” or “silt”, indicating the granulated texture of tissues that are compromised by pain and lack of circulation. Sha is also the term for the discoloration that arises when the tissues relate the stagnant blood, fluids, and metabolic waste into the superficial vessels. Sha can also be translated to indicate disease, and in the Chinese medicine tradition gua sha can be used to treat disease, and the qualities and quantity of sha that arises helps with diagnosis and prognosis.

Gua Sha, Graston, IASTM. There is sometimes confusion about the different types of scraping therapies and what kind of practitioner can use them.

These are all therapies that use a handheld tool to scrape and pressure the body for therapeutic purposes.

One characteristic of these therapies is the generation of petechiae, a red, rash-like expression on the skin. Called sha in Chinese, this expression is a result of rapid increase in circulation and clearing of stagnant fluid.

In the Western perspective it is considered a byproduct of the therapy. In the Eastern or Chinese persepctive it is used diagnostically to indicate the nature of the condition being treated and the prognosis for recovery.

Gua Sha

A traditional therapy used throughout Asia for thousands of years. Gua Sha is a Chinese term that essentially means to “scrape out the disease”, and the term is used generically to refer to scraping therapies.

Tools: Tools for gua sha can range from traditional horn or stone to modern stainless steel and polycarbonates.

Purpose: Resolve muscle tension, nerve impingement, tendonopathies, scar tissue, and myofascial tension. To treat disease such as wind-cold invasion of the Lung (colds or flus), qi and blood stagnation (pain), fluid stagnation (edema, swelling), cold invasion (frozen shoulder). From a Chinese medicine perspective the color of the sha that arises is also significant for diagnosis of disease pattern, and prognosis of recovery.

Performed by: Acupuncturists.
Massage therapists, physical therapists, and chiropractors also use gua sha but without the Chinese medicine perspective.

IASTM

IASTM stands for Instrument Assisted Soft Tissue Mobilization. It is a non-copyrighted term to refer to scraping therapies. IASTM addresses myofascial, nerve, and tendon issues from a strictly Western perspective. It treats pain the exact same way that gua sha does but does not treat colds and flus or include any Chinese medicine diagnosis.

There may also be less emphasis on the sha or discoloration that arises, by using more polished tools that bypass the body’s reaction to generate sha.

Tools: IASTM tools are almost always stainless steel, but some practitioners use gua sha tools and call it IASTM.

Purpose: Resolve muscle tension, nerve impingement, tendonopathies, scar tissue, and myofascial tension.

Performed by: Acupuncturists, massage therapists, physical therapists, and chiropractors.

Graston

David Graston was the first to bring an aura of Western medical science to gua sha. He developed contoured stainless steel tools of varying sizes to help with his own recovery from an injury. He then created a system of training based around these tools. Graston Therapy is trademarked, so only practitioners who have trained in Graston can say they are performing that therapy.

The copyright on the Graston tools has since expired so stainless steel tools abound on the market. Some common ones are Myo-bar and the Edge tool, but there are dozens of others.

ASTYM (not to be confused with IASTM) is another trademarked scraping technique.

Graston therapy helped bring scraping therapy into the mainstream, partially by intentionally distancing it from gua sha. Scraping therapy or gua sha cannot be called Graston or ASTYM without the necessary training and certification. However, a competent and trained practitioner of gua sha with a good tool will achieve the same results as any trademarked technique.

Tools: Graston tools

Purpose: Resolve muscle tension, nerve impingement, tendonopathies, scar tissue, and myofascial tension.

Performed by: Acupuncturists, massage therapists, physical therapists, and chiropractors with the Graston training.

Gua sha is a traditional healing technique used for thousands of years, and is still a part of formal Chinese Medicine training today. Gua sha alleviates pain, congestion and toxins in the muscle tissues, and this simple technique is gradually becoming more well-known in the West as its benefits are rediscovered and appreciated.

Gua Sha uses a round edged tool to firmly stroke areas of soreness in the body, breaking up congestion in the muscles and tendons. It is a versatile and effective technique to treat all kinds of persistent muscle pain and tension including headaches, neck, shoulder, back and hip pain, and even plantar fasciitis.

Stubborn muscle pain or aches are diagnosed as “stagnation” in Chinese Medicine terms. Gua sha and cupping are both indicated for resolving issues related to congestion and stagnation by opening up superficial vessels so the area can drain and fresh circulation can occur, often reducing pain very quickly.

Gua sha is an excellent technique for focusing on chronic or acute muscle knots, especially stubborn ones that just seem to snap back into tension even after a regular massage.

Expect some colorful results on the treated areas, as gua sha draws out a temporary discoloration called sha, which is the superficial vessels flushing out the stagnated blood and fluids.

This discoloration goes away in a few days as normal circulation clears out the area and brings fresh blood flow. Sha is not the same thing as a bruise since the tissues are not injured but are releasing toxins, fluids and heat to the surface.

Often people experience soreness and an increase in warmth and flexibility after a gua sha treatment, and it is recommended to avoid physical exertion and exposure to extreme temperatures and direct sun.

This research study shows that gua sha increases microcirculation at the surface of the body for healing purposes, and is not causing bruising or tissue damage.

I have personally seen and experienced wonderful results with gua sha in my massage and acupuncture practice. Clients often feel immediate relief from stubborn pain and tension and it is often plays an important role in injury recovery.