Chiropractic Corner
This is an introduction to some unique, but effective treatments for patients who are interested in alternative therapies they may have not tried before. There are a group of tool-assisted soft tissue techniques which address pain originating from muscle, tendon, ligaments, and/or fascia. Fascia is the connective tissue that surrounds every individual muscle in our bodies. Think of fascia like the casing of sausage. Muscles, tendons, ligaments and fascia consist of living connective tissue formed primarily of collagen fibers. The collagen fibers within these soft tissues are prone to painful fibrosis and adhesions. Adhesions and inappropriate fibrosis within soft tissue can result from trauma, surgery, immobilization or repetitive strain. These tool-assisted treatments are able to help separate the layers of fascia and break up adhesions and fibrosis.
What is it?
Gua sha is the traditional Chinese term for a method of increasing microcirculation and releasing tissue adhesions through applying friction across the skin. The word ‘gua’ can be translated as ‘to scrape’ and ‘sha’ refers to the acute rash, specifically a ‘reddish, elevated, millet-like skin rash.’ Scraping the skin, or application of surface friction (gua), brings this rash to the surface, which in traditional Chinese medicine is said to be releasing stagnation of qi and blockages of meridians, which cause pain. The skin always remains intact and there are no abrasions. Gua sha moves blood within the tissue and is not let from the skin. The sha rash represents the transient therapeutic petechiae. Petechiae (pronounced puh-TEE-kee-ee) are round dots that appear on the skin as a result of blood underneath the skin. The skin will appear red, brown or purple. The scraping reveals blood pooling and is used to remove blood stagnation that is considered pathogenic. This increase in blood circulation is believed to promote normal circulation and metabolic processes. This method originated in Asia and is used world-wide by doctors who practice acupuncture and Oriental medicine.
There are similar treatments for tissue fibrosis or chronic inflammation, such as the Graston Technique or augmented soft tissue mobilization (ASTYM) which focuses on fascial restrictions and scar tissue. These techniques are used by athletic trainers, physical therapists, chiropractors, and occupational therapists as a treatment method for acute and chronic soft tissue pathology. Studies suggest that these types of treatments may promote healing at the cellular level by increased fibroblast recruitment and activation. Although these techniques are currently utilized in many state of the art treatment facilities and by professional athletes, research still needs to be done in regards to tool assisted soft-tissue methods. Who does it help? Gua sha is most often used to alleviate chronic pain derived from muscular origin, and has also been used to help alleviate pain from acute or chronic injuries. The areas it is most commonly applied to are the upper neck, upper back, shoulders, elbows and knees. The modality can also be used to treat post-surgical pain in joints (e.g. knee, elbow, hip), sciatica, lower back, and has been effective in helping to treat headaches.
Due to the nature of these treatments, there are some contraindications such as: abrasions, bruising, sunburn, rash, break in the skin, pimples, moles, abdomen of pregnant women, and over skin previously gua sha’d with petechiae still visible. Although the treatments often look abusive, most patients feel relief immediately after completion of the treatment. Patients with extreme sensitivity to touch generally do not tolerate the intense nature of these treatments.
How does it work?
These types of treatment work by increasing the microcirculation of the area. This may stimulate platelets which release growth factors related to the healing of tissue. While all of the methods can create petechiae, the stroking is not performed in the same manner. A variety of instrument angulations and pressures may be used depending upon the area of the body treated.
Researchers have begun to explore the physiology behind Gua Sha. In 2007, researchers from the Beth Israel Medical Center in New York took measurements of the microcirculation of surface tissue before and after gua sha treatment 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 muscle pain not only at the site treated but also in sites surrounding and around 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.”
Graston and ASTYM are designed to stimulate the breakdown of fibrosis and adhesions within the soft tissue and allow functional restoration to occur. This controlled micro-trauma physically breaks up the adhesions and initiates a local inflammatory response that leads to the re-absorption of inappropriate fibrosis or excessive scar tissue. In chronic tendonopathies, doses of controlled micro-trauma stimulate regeneration of the affected tendons. Following these techniques, existing collagen is further remodeled and new collagen can be created by an exercise and rehab program.
