Can Gua sha help relieve back pain?
The Gua sha Show Season 1 Episode 2
Most people suffer from back pain at some time in their lives and in this episode of the Gua sha Show, Clive Witham explores how Gua sha can help to relieve back pain. He looks at 2 recent reports on the treatment of lower back pain, one from Hongkong and one from Germany and then combines these with his own experience to show you how both to look at back pain and help to treat it.
In the show the following links are mentioned:
The Hongkong study: https://pubmed.ncbi.nlm.nih.gov/28619301/
The German Study: https://pubmed.ncbi.nlm.nih.gov/30712747
Here's the transcript:
Welcome to Episode 2 and it's great that you're here listening with me! This episode we're looking at back pain and how you treat it with Gua sha and you should come away with a clear picture of how its treated!
Hands up if you've got or have ever had back pain.
Okay, hands down.
Almost all of you listening right now. And that's how it is.
For current figures it's an easy search on the internet. 80% of people will have lower back pain in their lifetime and 25% in last few months (mayo clinic). Actually come to think of it, I've had back pain for the last few days. So I'm there in the statistics. There are all kinds of causes of the pain ranging from strains to structural skeletal problems. My back pain is from collecting wood for our fire. I haven't mentioned it yet in the podcast but I live in a forest.
And I mean I really live in a forest.
It's a natural park and one path runs in front of the house and another behind. It's maybe not for everyone but I get to see the stars a lot and sometimes I go outside at night and can hear absolutely nothing. The kind of nothing that makes you question if your ears are working. In this day and age, that can be a rareity. Anyway, so our heating in the winter is a fire and I get the wood from the forest floor and I'm a little too enthusiastic and go up and down the mountain far too many times/bend down at strange angles and use muscles I don't normally use. But I know that this soreness in my lower back will go with a few days rest but for many people that just doesn't happen. It stays and the more it stays, the more it affects your health and wellbeing, preventing you from living the life you want to lead.
It has to be the number one reason people come to my clinic. Number 2 is neck pain and number 3 is anxiety and depression. And often people have all of them.
So can Gua sha help with back pain? Let's start by looking at 2 recent studies - one from Hong Kong and the other from Germany. And let's see how Gua sha is used and how effective they say it is.
We'll start with a Hong Kong based study published in 2017 called "The effects of Gua sha on symptoms and inflammatory biomarkers associated with chronic low back pain: A randomized active-controlled crossover pilot study in elderly" hypothesized that Gua sha would have an anti-inflammatory effect in lower back pain by upregulating an enzyme called heme oxygenase-1 (HO-1) and increasing the local microcirculation by pressing and stretching of the superficial skin as well as the deep muscles.
The study consisted of just 1 session. Yes, one. Which quite frankly is a little strange. And it was small with only 12 back pain suffers between 60-87 years old. One group was given hot pack therapy and the other Gua sha and there was no control group.
So what did they do. Well, they used a spoon. See I'm not the only one! And each scrape was 25–30 cm in length either sides of the spine between T8-L5 until sha appeared which they say was typically after 8–12 strokes. They repeated the downwards strokes again on another line paralell to the first until "fully covered".
So the results were as thought, that the magnitudes of pain reduction and functional improvement were greater in the Gua sha-treated group than the hot pack group. But both interventions were shown to improve flexion, extension and bending movements of the lower back but with Gua sha with the longer lasting effect. So effectively treating using Gua sha and a heat lamp together is a pretty solid treatment. And I'd agree as it's what I usually do.
So now let's look at the other recent research paper. The German study from 2018 called "Gua Sha therapy for chronic low back pain: A randomized controlled trial" which set out to test the efficacy of Gua Sha therapy in patients with chronic low back pain. They had 50 patients (aged between 18 and 75) with chronic low back pain in 2 groups - one on a waitlist and the other had Gua sha.
The treatment consisted of 2 treatments (a week apart) of scraping down and across the back either side of the spine (between C7-L5) and also into the gluteus maximus muscle (your buttocks) and scraping down the neck C1/2 to C7. They continued until sha appeared. So this study covered more of the back and also the neck and probably more representative of a Gua sha treatment.
After treatment, patients in the Gua Sha group reported lower pain intensity and better overall health status compared to the waitlist group.
They conclude: "Gua Sha appears to be an acceptable, safe, and effective treatment for patients with chronic low back pain. Further rigorous studies are needed to confirm and extend these results."
So here we have 2 recent studies (albeit very small and limited) which treated lower back pain by scraping down the back and bringing sha to the surface of the skin. I would qualify this by saying that yes, that's my experience but not with everyone with back pain. Sometimes it wouldn't be sensible to treat over the painful area with Gua sha especially if the area is inflamed. And with some people their back pain isn't due to a localized pattern in the back. Sure the pain is there but it's caused by something elsewhere. So you might help or you might not.
What's missing, and what would be of great help, is a more nuanced understanding of back pain - after all pain is often a symptom of something else happening in the body. So if you incorporate the arm and leg channels of Chinese medicine in your understanding, you might want to treat the back of the leg and back of the arm. That would be the bladder and small intestine channel. And actually this isn't only Chinese medicine, modern research in fascia connectivity acknowledge connective bands of muscle which follow very similar trajectories to the channels.
But there's more. We can apply holographic principles to Gua sha - this is where smaller areas of your body can treat the larger areas and if you incorporate the imaging of the body on the scalp, for example, you might want to scrape on the midline at the back of your head. Or perhaps on the anti-helix area on your ear. Or the instep of your foot. Or the back of your hand. As you can see there are alot of places which can have an impact on back pain but you have to understand a little of the relationships in the body. And if you have these, you can also self-treat because you would have to be a contortionist to treat your own lower back. However, not so with the other areas.