Gua Sha Therapy — Does It Work for Strength Athletes?

There are a lot of methods a strength athlete can utilize to help them recover. Besides your typical eat well and get a good night’s rest, there are methods that involve soft tissue massage. In the strength and conditioning world, we’re beginning to see older methods (thanks to Instagram) become more Westernized such as cupping and Gua Sha.

More than likely you’ve seen pictures of athletes with the cup imprints and what look like bruised scrapes throughout their body. These scrapes are a result of what’s known as Gua Sha (pronounced Gwah Shah). It’s a form of Traditional East Asian Medicine (TEAM) that involves softly scraping soft tissue with the aid of a tool for recovery purposes, but does Gua Sha have benefits?

To provide more background and insight on whether Gua Sha is really beneficial for strength athletes, I reached out to Dr. John Rusin DPT, CSCS, and owner of Functional Hypertrophy Training, along with Dr. Jason J. Peloquin, Certified Chiropractic Sports Physician (CCSP) at Hands of Gold Chiropractic.

What’s the Background on Gua Sha?

Gua Sha is one the original forms of instrument-assisted soft tissue mobilization (IASTM) that lets a clinician effectively break down the fascial restrictions in order to promote healing. The aim of the Gua Sha is to create micro-traumas at the damaged tissue to enhance healing,” explains Dr. Peloquin.

This style of therapy may look new to most lifters, but it’s been around for thousands of years. “This ship is literally thousands of years old, it’s an ancient Chinese technique that they’ve been doing for literally thousands of years,” explains Dr. John Rusin.

“It’s relatively new in our fitness/rehabilitation westernized industry, because people starting making their own tools and monetizing upon those tools, and then running courses to teach people how to use those tools,” says Dr. Rusin.

How Can Strength Athletes Benefit From This Form of Soft Tissue Therapy?

“When you look at any type of soft tissue modality, or manipulation and you look at two windows where it can be beneficial,” states Dr. Rusin. “The first window would be actual therapeutic benefit, so you have pain alleviation, movement enhancement, and performance enhancement. Those things happen in the pre-training routine, so if you’re working on something like a mobility deficit, then this could play a role in enhancing your mobility, and that’s just one example,” explains Dr. Rusin.

A more intriguing second window, especially for the fitness population is Gua Sha’s role in recovery. I use it sparingly now, but it’s a way to manipulate bigger musculature, so something like ART or manual manipulation soft tissue therapy are hard to go through something as big and thick as the quad, so Gua Sha allows you to use a tool that literally coerces the muscle and the dermatome over that muscle more importantly. It’s something you can get a little bit more of a quick result from by using broader stroke, so to say,” says Dr. Rusin.

“Healing needs to take place after treatment in order to see the therapy gains. A recommended time lapse is a minimal two days between Gua Sha therapy sessions, or until the slight bruising has subsided,” states Dr. Peloquin. “Continually damaging a tissue without letting it repair will eventually weaken the tissue and lead to further complications or injury.”

Can Some Strength Athletes Benefit More from Gua Sha Than Others?

Gua Sha could be a useful therapy for pre-workout purposes and recovery. I was curious if certain strength athletes could tell if they’d benefit more with Gua Sha than other therapies. “No, I’m a big believer in everyone’s going to respond differently to different stuff. It’s figuring out which modality you respond best to,” says Dr. Rusin.

“Personally in my practice I’ve helped multiple groups of strength athletes.” Peloquin explains that whether you’re focus is heavy lifting or endurance work, then you may benefit from Gua Sha. “The heavy lifters always seem to have grip strength problems due to the static load being endured on their forearms/hands. As opposed to strength athletes who endure repetitive endurance exercises that lead to poor biomechanics as they fatigue. This can create a myriad of biomechanical stressors thus leading to conditions mentioned above.”

Is Gua Sha Safe For Strength Athletes?

The bruising you frequently see on athletes via Instagram videos and photos getting Gua Sha done often looks alarming. My next question involved the Gua Sha side effects that illicit these bruises and if it’s actually normal/safe.

Dr. Rusin pointed out that there’s a controversy currently going on in the industry, which could make Gua Sha an issue for some. “Non-licensed people are doing Gua Sha illegally on athletes, clients, and the general fitness population. Unless you’re a licensed practitioner such as a chiropractor, acupuncturist, physical therapist, osteopathic doctors, licensed athletic trainer, licensed massage therapist, to list a few, then you really shouldn’t be using a Gua Sha tool on people. It’s 110% illegal,” states Dr. Rusin.

“I saw some Gua Sha posts and mentions following the Arnold, and it should be noted that this is therapy that licensed practitioners do under their scope of practice. It’s not something your strength coach should be doing on you. There’s always the inherent risk of people not possessing the diagnostic capabilities. It’s the difference between pointing out something like a malignant tumor, which presents itself as a soft tissue issue in your leg, or just understanding neurological trigger points. The risk comes with the safety of the practice and the possibility of misdiagnosis,” sum up Dr. Rusin.

Are Those Red Marks Side Effects of Gua Sha?

Dr. Peloquin pointed out that these marks can be a side effect of Gua Sha and it can be normal for some athletes. “There may be some degree of discomfort during the procedure that should resolve spontaneously – within a few days. Some patients may develop mild bruising, which is normal and resolves on its own.”

Dr. Rusin pointed out that a lot of bruising may not be ideal for this style therapy. “A lot of people don’t know how to use Gua Sha’s tools, because in ancient China they used to use it as a systemic health method. They would literally scrape to the point of bruising through the tissue (red blood cells coming to the surface). They would think that the bruising was what caused systemic recovery.”

“The more science and more research that’s out there shows this is not a mechanical process. If you’re going to get Gua Sha done on you, or any form of tool-assisted work and you’re bruising, then there’s a serious problem. That’s not something that’s warranted. People go super hard, way to heavy, and they traumatize the tissue they’re trying to target.”.

“You’re always looking for a result, but if the result is you being purple up and down your IT band, then that’s not what you’re looking for. Softer is often better because we’re trying to illicit a neurological adaptation. There’s no breaking of scar tissue or realigning of sarcomeres, there’s no mechanical processes happening, which a lot of people wrongly state,” explains Dr. Rusin.

[If your IT band is causing you trouble, take a look at the best foam roller for the IT band.]

What are the Benefits of Gua Sha?

The real benefits of Gua Sha revolve around what’s actually happening with this soft tissue therapy. “What’s happening is a neurological adaptation that occurs from the sensory feedback from the tool going over your durmatomal patterning. There’s different nerve roots that come out to the skin, and they control sensory feedback on the skin and the underlying tissues. All Gua Sha is really doing is going over durmatomes and areas with correlations to nerve roots to illicit a relaxed and recovered parasympathetic response from the underlying tissue,” says Rusin.

Dr. Rusin also pointed out the misconceptions people have with Gua Sha. “People think, ‘we’re breaking up scar tissue,’ but in reality you’re not doing that whatsoever. For example, look at the layers of the skin and how deep those are. You have your cutaneous tissue, subcutaneous, adipose tissue, and then you have the muscle belly. In reality, you’re an inch or two away from the stuff you think you’re breaking up scar tissue on.”

So What’s the Call on Gua Sha Therapy?

Gua Sha has been used as a therapeutic modality for thousands of years, and only recently has it become more popular in the fitness industry. Much like other forms of soft tissue therapy, there’s always an inherent risk with its practice. The risk, as Dr. Rusin states, often comes from those who lack the experience or knowledge to utilize Gua Sha therapy properly.

If you’re interested in Gua Sha, use the information provided above to assess how you could use this therapy for your benefit. Also, ensure you seek out a licensed professional when using any form of tool-assisted therapy.

Featured image from @dominiquematthews_ifbbpro Instagram page.