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By Sophie Xie / May 27, 2016

Gua Sha: How to get bruised properly for amazing pain relief results

gua sha

In recent years, "Gua Sha", a traditional chinese treatment technique, has been rapidly gaining popularity in the western world. More and more people are fascinated by this strange treatment, wondering if this is going to be the next big trend in the world of holistic medicine. 

If you have received gua sha treatment, you will never be able to forget the experience. It may come as a shock, a misfortune or the best thing ever happen to you. ​

In this post, I will demystified gua sha treatment and help you to understand how this technique can help to relieve muscle and joint pain. 

Gua Sha in its original form

As a Chinese person myself, I often find it hilarious how most Chinese medicine treatments are rough and mean to the human body. Chinese herbal medicine tastes like a brewed pot of bitter mud and tree barks. The acupuncture technique consists of sticking needles into a patient's body. Tui na, a Chinese therapeutic massage technique, believes in the depth of massage to reach all the way to the bones. Gua sha is on the top of the list for being unpleasant to experience, and the scene is known to be even harder for the observers.

But hey, don't get scared away. Let me show you how gua sha can be a life-changing treatment for those with physical injuries and pain.

​Gua Sha means "scraping sand" in Chinese. The "scraping" is done using a flat tool with rounded edges over the skin with repetitive large form strokes performed by Chinese medicine practitioners. However, most traditional Asian families also perform gua sha casually with spoons or coins.

The "sand" is referring to the small red dots that appears on the skin once the body part has been sufficiently scraped. Traditionally, the sand is believed to be toxins from deep within the body, causing illness and pain, surfacing to the skin after the increased blood flow. ​

chinese median points

Gua sha is frequently used to treat all sorts of illnesses and symptoms including flu, stomach ache, migraines, etc. ​According to Chinese medicine philosophy, gua sha works by providing following benefits:

  • ​Connecting the flow of chi between each meridian point
  • Increasing new blood flow to the treatment area to drive away old, toxic blood
  • Balancing Ying and Yang of our body to promote systemic function

Traditionally, gua sha can be performed frequently to both healthy individuals and patients of various conditions. It is believed to be a wellness practice to maximize the human body's performance.

Regardless of your personal opinion on the Chinese medicine philosophy, the landscape of gua sha treatment has changed and adapted under the presence of modern medicine.

The evolved gua sha 2.0, as we know it today

muscles drawing

If you are to get gua sha treatment today the western society, it is very unlikely that you will receive the traditional gua sha treatment.

Ever since the western world started to look into alternatives for drugs and surgery, they began to see miraculous results in many Eastern medicine techniques. While most practitioners have a hard time wrapping their mind around Chinese's obsession over "chi", "ying and yang" or "meridian points", they are pleasantly surprised by the gua sha treatment's ability to kick start healing processes and alter tissue properties. 

Over the years, many western techniques have been developed, inspired by the gua sha treatment and have been widely used by health practitioners such as physical therapists, chiropractors, and some osteopathic doctors. Even the traditional world of Chinese medicine has been adapting gua sha techniques so that the treatment has sound medical explanations and research evidence. 

Thus, according to western medical science and findings, gua sha can benefit chronic musculoskeletal injuries and pain by:

  • Creating microtrauma to the site of chronic inflammation to revive the healing process, hoping the induced inflammation process can complete the healing job this time around.
  • Breaking down scar formations and opening soft tissue adhesions to improve joint range of motion and muscle performance.
  • Stimulating immune system to increase our body's performance in fighting systemic infections
  • Increasing surface microperfusion in treatment body part to provide temporary pain relief
  • Stimulating the nervous system by flooding the gateway system and potentially alter the pain neural pathway, in some cases

In the western medical system, you may be treated by scraping techniques that originated from gua sha, under names such as the Instrument Assisted Soft Tissue Mobilization (IASTM), ASTYM®, and Graston Techniques. These are tissue treatments evolved from gua sha techniques with commercialized tools and clinical protocols. Based on the clinician's skill, experience and treatment principles, the results are comparable. 

Gua sha or similar techniques mentioned above are known to benefit the following conditions

  • ​Chronic neck or lower back pain
  • Shoulder impingement syndrome, rotator cuff injuries
  • Tension headaches, TMJ problems
  • Muscle tendonitis, tendinopathy, synovitis
  • Tennis elbow, golfer's elbow, carpal tunnel syndrome
  • Forward head posture
  • Hip, knee and ankle pain from running, sport or athletic training
  • Hamstring or quadriceps strain
  • Patellofemoral syndrome, ACL and meniscus injuries
  • Post-surgical knee, hip and ankle rehab
  • Chronic repetitive ankle sprain, plantar fasciitis condition 

The traditional gua sha technique also claims to assist in recovery from the common cold, flu, bronchitis, and asthma. Chinese medicine also recommends gua sha for illness and injury prevention, organ detox, and to promote physical and emotional wellness.

Outside the field of medical use, gua sha is also used to reduce micro-edemas, improve skin elasticity, promote skin nutrient absorption, and induce slimmer facial/body contour.  ​Some place even claim to boost metabolism and assist the weight loss using the gua sha treatment. Of course, there is no evidence to support these claims yet.

Scientific evidence for gua sha and related scraping techniques

​In 2012, a group of clinical researchers performed a study with 40 individuals suffering from either chronic neck pain or chronic back pain. These people were randomly assigned to either receive no treatment, or receive one treatment of gua sha. They tested these people's pain intensity and threshold before and after the treatment. The results show that people who received gua sha treatment had significant reduction in pain intensity and improved health status compared to the control group. [Read abstract of this study here...]

A similar study was performed in 2011 with 48 patients suffering from chronic neck pain. They were randomly assigned to receive either gua sha or a heating pad. The result of these two studies both support gua sha as an effective treatment for chronic neck pain. [Read abstract of this study here...]

A more recent study in 2016 compared the outcome of 18 achilles tendonitis patients. They were randomly assigned to either exercise-only treatment or exercise and soft tissue scraping treatment(ASTYM®), similar to gua sha technique. Their recovery progresses were taken at 12, 26 and 52 weeks of treatment. While patients from both groups achieved significant improvement in their condition eventually, more patients who received the additional scraping soft tissue treatment showed successful outcomes at week 12. [Read abstract of this study here...]

A similar study was done in 2015 comparing outcomes of exercise and soft tissue scraping technique versus exercise-only treatment in 107 subjects with tennis elbow. Recovery progress was collected in short term at 4, 6 and 12 weeks of treatment and in long term 3 and 6 months after starting treatment. The patients with scraping treatment reported an average of 78% improvement in their elbow pain and function versus 41% from the exercise-only treatment group in short term. And benefits continued in the long term as well. [Read abstract of this study here...]

These are just a few of many studies and clinical trials done to examine gua sha's effectiveness in various musculoskeletal injuries and pains.

How is gua sha done?

There are plenty of videos circulating the internet on gua sha treatments. You may or may not have experienced or observed a gua sha session. Whatever your opinion might be, please remember that gua sha is a skilled technique. Every practitioner who is using this technique to perform treatment does it based on his or her own judgement.

How aggressive to go? How long to do it for? How many muscles and body parts to involve? And when is it okay to do it again? Following are my personal preferences based on my experience and feedback from patients.

I receive gua sha influence from my culture. My father is a trained western medicine physician and surgeon. However, he favors traditional Chinese medicine when it comes to his own body and health. I grew up watching a great uncle practicing gua sha on his patients in his Chinese medical clinic in China.

Later, I arrived to the States and attended physical therapy school. Scraping soft tissue techniques were not taught in school, but were very popular among practicing outpatient therapists. I learned the techniques of ASTYM and general IASTM from three different clinicians and have been doing these techniques since my clinical internship.

Scraping tools

Gua sha and similar scraping techniques can be done by using professional gua sha tools, or simply household items such as a spoon, butter knife or kitchen scraper. 


All the sources indicate that the best type of spoon to use for gua sha is a Chinese porcelain soup spoon. It is said that these spoon have more rounded edges, allowing even pressure and less skin irritation.

I personally find the Chinese soup spoon is too rounded for my preference. In my experience, it tends to cause more skin irritation without reaching deep enough to affect muscles or ligaments.

My suggestion would be a regular silverware spoon, preferably larger in size​, if you wish to give it a try at home. If you feel that it is too sharp or edgy for your preference, you can find a Chinese soup spoon in a local asian market.

Butter knives

Butter knives make great gua sha tool. Of course you should use the dull edge, not the wedged side. It allows you to work on larger muscles such as the hamstrings and quads effectively. The rounded tip also is able to reach tight spots. What's not to like?

Pan Scrapers

Most pan scrapers make great gua sha tools because they are meant for a similar purpose: to scrape. Pan scrapers are easy to hold and control. They allow you to utilize your wrist and body forces to perform the scraping motion, making your effort more effective and ergonomic.

This particular type of scraper is an excellent example. It has flat edge, dull and sharper corners, which can be good for most body parts. My colleague and I used to teach patients gua sha techniques with these scrapers so they could take it home.

Traditional gua sha tools

Professionally made gua sha tools can be used as an ornament, a beauty gadget or a pain relief tool. The traditional tools are often made from various precious stones or animal bones.

The pictures above show three popular types of gua tools for personal use. In general, these tools are made to make gua sha easier on both the receiver and the provider.

Gua sha techniques

gua sha calf

In a professional setting, the practitioner will position you to expose the area of treatment. He or she will apply a small amount of massage oil or cream for lubrication, and starts to apply unidirectional scraping strokes over the targeted soft tissues.

How deep: the scraper strokes should ​be firm but gentle at first and gradually exert more force once the blood flow increases and the body has adjusted to the stimulation. The treatment depth should focus on the location of the targeted muscle.

How long: the scraping strokes will continue over the same area until the skin is turns pink and small​ petechia appears. Petechia looks like small red dots in the skin thus known as "sha" or "sand" in Chinese medicine. It is caused by a rupture of superficial capillaries. The area with petechia is more likely to have muscle stiffness, scar formation or tissue adhesion.

Size of treatment area: the most popular treatment area in traditional gua sha is up and down the entire back along the spine. ​Treating along the entire spine is a great way to relieve back pain and neck pain. It is also believed that treating the entire back can help increase blood flow to all the meridian points along the spine, helping improve immune system function and detox all chest and abdominal organs.

Gua sha or any other scraping techniques usually produce better results when treating the entire chain of mechanisms in our body. For example, the entire hips and legs on both sides may receive gua sha for knee pain because painful movement affects all joints and muscles on both sides of our body. A complete gua sha treatment may stretch out over several sessions in a few weeks to achieve the best results.

Post treatment: All the petechia may turn into bruises a few hours after gua sha treatment​. However, it is not a concern most of time and will fade away in a few days. The 24 hours after a gua sha treatment is the best time to perform stretches and exercises to retain max amount of benefits from this treatment session. More importantly, your body will be going through a lot of chemical adjustment, thus it's important to drink plenty of water to help it rinse out bio residuals. 

Doing gua sha at home

gua sha at home

Traditionally, a lot of Asian families use gua sha to treat pain and illness at home casually with coins or spoons. If you have been benefited by gua sha or similar scraping techniques, you can learn to perform it at home, on yourself or for family members.

The best way to learn gua sha is from a gua sha practitioner. If you are currently seeing a health practitioner and are benefiting from gua sha treatment, you can ask to learn some simple techniques to use safely at home. You can also bring a family member to your treatment sessions to observe and learn with you. Health practitioners have a lot of faith in the treatment they do, and will gladly share their knowledge so that you can benefit from this treatment in the long term.

If you want in-depth knowledge on gua sha and how to use it to promote overall health and wellness for you and your family members, you will find books like this one very informative.

Controversies and risks of Gua Sha

​A few decades ago, there were many cases of domestic abuse reports on Asian children with severe bruising all over their backs. These cases were reported by health care providers seeing these children for common illnesses. Once the truth was discovered, these cases are written into school textbooks to educate new generations of health care providers about cultural differences and acceptance. 

gua sha

The truth is that an overdose of gua sha treatment can also have severe risks and negative side effects. Even in professional clinical setting, patients will refuse further treatment due to adverse physical and psychological reaction to gua sha or soft tissue scraping treatment. ​

Overdoing gua sha not only result in severe bruising of skin and targeted tissues, ​it can also induce fever, severe localized edema, muscle tissue damaging, infection and dramatic exacerbation of existing pain and injuries.

Should gua sha be painful? If so how much pain is acceptable? In fact, when gua sha or scraping techniques are done properly and skillfully, many times it will be pain free during treatment and soreness can be minimum after the treatment. When gua sha or scraping techniques are done for the first time on an individual, the pressure should​ be on the lighter side to observe for body reactions. In addition, some people are more easily bruised than others, and all practitioners should ask questions to identify these high risk individuals and adjust treatment accordingly.

Sometimes a gua sha practitioner will tell you it will hurt. Mostly likely he or her is telling the truth. Some tissue scars or soft tissue adhesions will need some "convincing" before letting go. Some body parts are simply more sensitive than others. They should also remind you to speak up when the pain becomes hard to tolerate. They then should repetitively check in with you to make sure you are handling the treatment okey.

There is no such thing as "how much pain is enough to get better". A treatment will only work if you and your body are okay with it. You don't need to tolerate the maximum pressure to benefit from gua sha or scraping techniques. 

Lastly, not every gua sha practitioner is a match for your. In some rare cases, your body may not be compatible to gua sha treatment no matter how much you look forward to the benefits. However, most oftenly, proper communication and education before and during the treatment will decrease the chances of adverse effects to minimum. Isn't that the case to everything in life?

In conclusion, gua sha, and scraping techniques derived from gua sha, are powerful and effective treatments for all types of physical injuries and pain, with supporting research data and studies. You can receive gua sha treatment from many treatment providers such as massage therapists, physical therapists, and some chiropractic and homeopathic doctors. If you are interested in gua sha treatment, ask your practitioner's expertise and skill set prior to making an appointment. Gua sha is by no means a relaxing treatment. So communicate with your practitioner to prevent unpleasant results. 

Thank you for reading, and I hope you find this post helpful.

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