Gua Sha

What is gua sha?

Gua sha is the first known instrument assisted soft tissue mobilization technique (IASTM). Gua means “to scrape” and “sha” is a reference to petechiae. Petechiae are clusters of red blood cells released from capillaries near the skin’s surface. Striking in appearance, petechiae have a rash like appearance that later fades to resemble a bruise and then resolves completely. 

Is gua sha effective?

The evidence base for gua sha includes studies regarding neck pain1, back pain2, improving circulation and tissue temperature3, and flexibility4 in addition to initiating a healing response5.

What is gua sha used for?

Gua sha has been used for over two thousand years in Traditional Chinese Medicine for muscle aches and pain as well as digestive and respiratory conditions. The technique is particularly useful for chronic conditions where circulation and flexibility is limited and pain persists into the maturation phase of healing. When neighboring tissues becomes adhered due to scarring from direct trauma or gradually as a result of repetitive activity gua sha can offer relief. 

How does gua sha work?

Gua sha leverages and magnifies the body's ability to heal. Gua sha initiates an inflammatory response that begins with the release of histamine. Pressure sensitive mast cells in the skin release granules containing histamine from direct stimulation. Histamine interacts with smooth muscle fibers found in both blood vessel walls and fascia. Stretching after gua sha yields dramatic changes in soft tissue elasticity due to increase in tissue temperature and relaxation of smooth muscle in fascia. Blood vessel walls become leaky allowing the tool's edge to extravagate red blood cells that form petechiae. Petechiae become visible as clusters of red dots that gradually fade to resemble a bruise. The striking similarity of petechiae with a bruise leads to the inaccurate conclusion that gua sha is harmful. The body responds to petechiae exactly like a trauma. The presence of red blood cells in the interstitial space chemically attracts macrophages to the area to begin the process of clearing devitalized tissue followed by production of new tissues.

New Insight

Recent research indicates another possible mechanism to explain gua sha in regards to the role of the mast cell in chronic conditions like tendonosis. While mast cells are known to initiate inflammation they may also be responsible for neurogenic inflammation that occurs in the chronic pain6. Gua sha results in degranulation of mast cells, the release of histamine and relaxation of smooth muscle in blood vessel walls. This makes the release of petechiae possible. Mast cells have the ability to regenerate and subsequently release additional histamine. However, mast cells eventually become resistant to degranulation. It has been hypothesized that gua sha clears stagnant fluid from the affected area to assist in restoring homeostasis. And subsequent sessions of gua sha do result in the diminishing appearance of petechiae. But maybe gua sha is not clearing stagnant fluid at all. Perhaps the benefit of gua sha occurs by blunting the harmful effects associated with concentrated numbers of mast cells that occurs in the vicinity of the affected soft tissue. More research is needed to determine the physiological effects of gua sha.

When is gua sha contraindicated?

Gua sha should not be used for acute conditions. An exception to this rule may be a muscle spasm. Waking with a sore neck after sleeping in an awkward position may respond favorably to massage with a gua sha tool.  Red, warm, swollen tissue that has recently been injured is not an appropriate choice for gua sha. Once the inflammatory phase has moved into the maturation phase of healing but remains painful with limited flexibility, gua sha may be considered. Other contraindications include fragile skin, immature scar, open wounds, cancer, pregnancy, obstructive edema, blood clots and infection.  Insensate skin and any raised areas on the skin including moles are also avoided.

How is gua sha used?

Gua sha is appropriate for clients with chronic soft tissue pain and limited flexibility. Myofascial pain, tendonosis and pain persisting into the maturation phase of healing after traumatic injury and surgery are possible candidates. Gua sha is my first choice for chronic soft tissue pain that occurs in the absence of trauma. It is not uncommon for provocative tests to be negative when pain is referred from a proximal source or is myofascial in origin. The technique is so effective that when combined with dynamic cuppingone can rule out localized soft tissues as the source of pain and consider differential diagnoses. The histamine response is useful for improving tissue temperature prior to stretching or addressing trigger points.  In the case of tendonosis where healing has failed to progress, gua sha can re-initiate an inflammatory response and subsequent healing.  Dense, adherent scar tissue that has entered the maturation phase of healing can also benefit. In regards to scar raising petechiae is not the goal. Instead, the tool manipulates, massages and increases tissue temperature prior to stretching, exercise or fabrication of a custom orthosis designed to restore joint motion. Teaching clients to use gua sha in their home program can decrease the number of therapy visits if the individual is able to demonstrate an understanding of precautions and proper application.

Is gua sha used with other modalities or techniques?

Gua sha may be used as a stand-alone treatment. However, for most clients gua sha should be used in preparation for stretching and restoring flexibility of fascia, scar and muscle. Gua sha is an excellent pre-treatment for cupping therapy and may also be used in conjunction with dry needling and acupuncture.

Who can perform gua sha?

Anyone can learn the technique and with practice become proficient. Treating oneself prior to treating others provides valuable insight regarding the amount of pressure needed to elicit both the histamine response and raise petechiae. A heavy handed approach is rarely successful. Begin with light strokes and progress to firmer strokes as tolerated. In all cases, the client dictates how much pressure is comfortable and tolerable. The treatment manual found here provides an in-depth description regarding technique.

What should I expect with gua sha?

 All clients are educated regarding petechiae and the possibility of skin discoloration that may last up to a week. Most clients report a sensation of dull pain that also feels good at the same time. Always begin with light tolerable pressure and check in with the patient as pressure is gradually increased. It is important to observe facial expression, breathing patterns and muscle tone. Squinting the eyes, holding breath and tensing muscle indicates an overly aggressive approach. Clients need to be in control of how much pressure is used. Typically, once the histamine response occurs and skin is visibly red and warm firmer pressure is tolerated. Results vary from 1) no change in symptoms (in this case begin looking for another cause of pain), 2) slight increase in pain lasting 2 to 3 days followed by improvement to 3) immediate reduction or resolution of pain. Treatment is typically provided once a week. Gua sha can remain part of the treatment plan until no further decrease in pain occurs.

Why do our gua sha tools excel?

  • Anatomy specific shapes
  • Edge design provides efficiency and sensitivity
  • Ergonomic design protects the user's hand
  • Unbreakable, lightweight material
  • Free replacement guarantee
  • Compatible with all emollients
  • Compatible with all disinfectants   

Our tools provide shapes that match specific muscle and body contours. Our edge is both efficient for mobilizing soft tissue and raising petechiae while maintaining a comfortable experience for the client. In addition our material is lightweight, unbreakable and chemically resistant so that any cleaning solution or skin emollient is appropriate. The material is sensitive allowing the user's hand to feel the texture of the soft tissue. Further our tools provide a thoughtful ergonomic design that protects the user's hand. Lastly our customer service is unrivaled. All tools are guaranteed for life. Any broken tool will be replaced free of charge. Any tool can be returned for a full refund if it does not meet your expectations.


  1. Braun et al. Effectiveness of traditional “gua sha” in patients with chronic neck pain: a randomized controlled trial. Pain Med, 2011; Mar;12(3):362-9.
  2. Saha, J Felix, et al. Gua Sha therapy for chronic low back pain: A randomized controlled trial. Complementary Therapies in Clinical Practice, Volume 34, February 2019, Pages 64-69
  3. Nielsen A., 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. 2007; Volume 3, Issue 5, Pages 456-466.
  4. Barbalho, M. de S. M., & Moraes, P. H. (2016). The effects of the Gua Sha technique (western view) on the flexibility of the posterior chain: series of cases. Manual Therapy, Posturology & Rehabilitation Journal, 1–5. The evidence base for gua sha includes studies regarding neck pain1, back pain2, improving circulation and tissue temperature3, and flexibility4 in addition to initiating a healing response5.
  5. Thomas L. Sevier et al. Astym treatment vs. eccentric exercise for lateral elbow tendinopathy: a randomized controlled clinical trial. PeerJ. 2015; 3: e967. Published online 2015 May 19. doi: 10.7717/peerj.967.
  6. Do Mast Cells Have a Role in Tendon Healing and Inflammation? MA Alim, M Peterson, G Pejler - Cells, 2020 -

  7. Escalone et al. Cupping with neural glides for the management of peripheral neuropathic plantar foot pain: a case study. J Manip Ther. 2019 Feb; 27(1): 54–61.