Gua Sha is an instrument assisted soft tissue mobilization technique originating from Chinese medicine. Pressure strokes are applied to muscular regions using a blunt tool such as a ceramic soup spoon or metal wand. This technique breaks up adhesions, scar tissue, and fascial restrictions, reduces pain, and promotes optimal mobility. Gua Sha leads to superficial capillary flushing (seen as a temporary reddening of the skin), known in Chinese medicine as “sha,” and in biomedical terms as “transitory therapeutic petechiae.” Research has shown that through the production transitory petechiae, Gua Sha increases microcirculation and thereby reduces pain and facilitates muscular repair. Gua Sha has also been shown to reduce local inflammation through the upregulatation of heme-oxygenase-1 (HO-1), an antioxidant enzyme that plays a critical role in both cellular homeostasis and the breakdown of heme from deoxygenated red blood cells. Gua Sha is a highly effective, comfortable, and non-invasive technique that leads to rapid improvement in myofascial conditions.
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Cupping is a myofascial decompression technique using suction by heat or mechanical device to dilate superficial capillaries and create a prolonged tensile stress on myofascial tissue. When connective tissue fibers become tangled, due to injury, surgical incision, or overuse, they lose their elasticity and local blood flow is reduced. The decompression achieved by cupping stimulates blood flow through vasodilation, activates mechanoreceptors linked to pain inhibiting neural pathways, and produces improved fascial mobility. There is also evidence suggesting that the pain relieving effects of cupping may be due to the local production of heat-shock proteins and β-endorphins. Like Gua Sha, cupping flushes superficial capillary beds, which may result in transitory therapeutic petechiae, or “sha” along the skin’s surface. Cupping can be performed using a variety of methods. In our clinic, we often combined active movement with cupping along specific myofascial groupings to bring an active release element to the therapy.
Tui Na is the traditional Chinese word for massage, meaning to “push” and “grasp.” It incorporates deep tissue compression as well as soft tissue and joint mobilization to rehabilitate muscles, joints and connective tissues. The therapeutic benefits of massage stem from a variety of mechanisms including biomechanical, physiological, neurological, and psychosocial. Tui Na can be used to reduce pain, increase mobility, lengthen fascia, activate the parasympathetic nervous system, and promote relaxation.
A combination of manual therapies may be used with or without acupuncture and other techniques as part of Physical Medicine appointments.
Want a better look at the primary structures affected by manual therapy? Strolling Under the Skin provides an incredible view of living connective tissue. Although not gory or graphic (most of the blood shown is zoomed into the point you can see the individual red blood cells) this video is of actual connective tissue under the skin in living organisms.
- Nielsen, A., Knoblauch, N. T., , Dobos, G. J. , Michalsen, A., & Kaptchuk, T. J. (2007). The effect of Gua Sha treatment on the microcirculation of surface tissue: a pilot study in healthy subjects. Explore(NY), 3(5):456-66. DOI:10.1016/j.explore.2007.06.001
- Choi, A., & Alam, J. (1996). Heme oxygenase-1: function, regulation, and implication of a novel stress-inducible protein in oxidant-induced lung injury. American Journal of Respiratory Cell and Molecular Biology, 15(1):9-19. DOI:10.1165/ajrcmb.15.1.8679227
- Subadi, I., Nugraha, B.,, Laswati H., & Josomuljono H. (2017). Pain Relief with Wet Cupping Therapy in Rats is Mediated by Heat Shock Protein 70 and ß-Endorphin. Iranian Journal of Medical Sciences, 42(4):384-391.
- Weerapong, P., Hume, P. A., Kolt, G. S. (2005). The Mechanisms of Massage and Effects on Performance, Muscle Recovery and Injury Prevention. Sports Medicine, 35 (3): 235-256.