Beibei Wang
Department of Exercise and Sport Sciences, Faculty of Graduate School, Khon Kaen University, Khon Kaen 40002, Thailand
Yang Hu
Traditional Chinese Medicine Characteristic Nursing Outpatient Clinic, Ganzhou City Hospital of Traditional Chinese Medicine, Ganzhou, 341000, China
Hongxiu Chen
Department of Exercise and Sport Sciences, Faculty of Graduate School, Khon Kaen University, Khon Kaen 40002, Thailand.
Dehui Lai
Department of Medical Technology, Gannan Health Vocational College, Gan Zhou, 341000, China
Wichai Eungpinichpong
School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
Keywords: Gua Sha, lumbar flexibility, heart rate variability, tissue hardness, pressure pain threshold, thoracolumbar fascia, skin temperature.
Abstract
This study investigated the potential mechanism of single Gua Sha therapy on thoracolumbar fascia thickness and related physiological parameters. Sixty-six healthy individuals participated, and they were randomly assigned to one of two groups: a 15 min Gua Sha group or a 15-min rest control group. Thoracolumbar fascia thickness, pressure pain threshold, tissue hardness, skin temperature, lumbar spine flexibility, stress index, and heart rate variability were assessed before and immediately after the interventions. The results revealed a significant reduction in thoracolumbar fascia thickness in the Gua Sha group (Left side: a reduction of 0.06 mm, p < 0.05, effect size 0.14; Right side: a reduction of 0.09 mm, p < 0.05, effect size 0.22). Skin temperature was significantly increased (mean difference: 0.66°C, 95% CI: 0.59, 0.72, p < 0.001) and lumbar flexibility was also improved (mean difference: 0.56cm, 95% CI: 0.30, 0.82, p < 0.01) between the groups, suggesting a softening effect of Gua Sha on the fascia. However, contrary to the hypothesis, the Gua Sha group showed a decreased pressure pain threshold and increased tissue hardness. Both interventions effectively reduced the stress index and enhanced heart rate variability, although there were no significant differences between the groups (p ＞ 0.05). In conclusion, this study found that a single session of Gua Sha therapy could induce a subtle but significant reduction in thoracolumbar fascia thickness and improve specific physiological parameters in healthy individuals, but the unexpected findings regarding the pressure pain threshold and tissue hardness require further investigation to elucidate the underlying mechanisms, offering insight into Gua Sha’s possible mechanisms.
References
Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat. 2012; 221(6):507-536.
Chen B, Liu C, Lin M, Deng W, Zhang Z. Effects of body postures on the shear modulus of thoracolumbar fascia: a shear wave elastography study. Med Biol Eng Comput .2021;59:383-390.
Brandl A, Egner C, Schleip R. Immediate effects of myofascial release on the thoracolumbar fascia and osteopathic treatment for acute low back pain on spine shape parameters: A randomized, placebo-controlled trial. Life. 2021;11(8):84-85.
Batool SA, Shakil-ul-Rehman S, Tariq Z, Ikram M. Effects of fasciatherapy versus fascial manipulation on pain, range of motion and function in patients with chronic neck pain. BMC Musculoskeletal Disord. 2023;24(1):78-79.
Yang C, Huang X, Li Y, Sucharit W, Sirasaporn P, Eungpinichpong W. Acute effects of percussive massage therapy on thoracolumbar fascia thickness and ultrasound echo intensity in healthy male individuals: A randomized controlled trial. Int J Environ Res Public Health. 2023;20(2):10-73.
Poojari S, Kamani NC. The influence of fascial manipulation on the shoulder range of motion, pain, and function in individuals with chronic shoulder pain. J Bodyw Mov Ther. 2024; 40:53-60.
Nielsen A. Gua sha research and the language of integrative medicine. J Bodyw Mov Ther. 2009;13(1):63-72.
Hartnett DA. Gua sha therapy in the management of musculoskeletal pathology: a narrative review. Phys Ther Rev. 2022;27(3):169-175.
Nielsen A, Knoblauch NTM. The effect of Gua Sha treatment on the microcirculation of surface tissue: a pilot study in healthy subjects. Explore NY. 2007;3(5):456-466.
Suarez-Rodriguez V, Fede C, Pirri C, Petrelli L, Loro-Ferrer JF, Rodriguez-Ruiz D, et al. Fascial innervation: a systematic review of the literature. Int J Mol Sci. 2022;23(10):5674 ;1422-0067.
Wang X, Chatchawan U, Nakmareong S, Silsirivanit A, Wang Y, Xie D, et al. Effects of Gas Sha on heart rate variability in healthy male volunteers under normal condition and weightlifters after weightlifting training sessions. Evid-Based Complement Altern Med. 2015; 10: 1741-4271.
World Medical A. World medical association declaration of helsinki: ethical principles for medical research involving human participants. JAMA. 2025:333(1):71-74.
Grimes DA, Hubacher D, Nanda K, Schulz KF, Moher D, Altman DG. The Good Clinical Practice guideline: a bronze standard for clinical research. The Lancet. 2005;366(9480):6140-6736.
Cuschieri S. The CONSORT statement. Saudi j Anaesth. 2019;13(1): S27-S30.
Kang H. Sample size determination and power analysis using the G* power software. J Educ Eval Health Prof. 2021; 18:1-7.
De Coninck K, Hambly K, Dickinson JW, Passfield L. Measuring the morphological characteristics of thoracolumbar fascia in ultrasound images: an inter-rater reliability study. BMC Musculoskeletal Disord. 2018; 19:1-6.
Larivière C, Gagnon DH, Preuss R. Structural remodeling of the lumbar multifidus, thoracolumbar fascia and lateral abdominal wall perimuscular connective tissues: Medium-term test-retest reliability of ultrasound measures. J BodywMovt Ther. 2021; 27:265-273.
Wilke J, Macchi V, De Caro R, Stecco C. Fascia thickness, aging and flexibility: is there an association? Anat. 2019; 234(1):43-49.
Damapong P, Kanchanakhan N, Eungpinichpong W, Putthapitak P, Damapong P. A randomized controlled trial on the effectiveness of court-type traditional Thai massage versus amitriptyline in patients with chronic tension-type headache. Evid-based complement Altern Med. 2015; 2: 20-15.
Liew B, Lee HY, Rügamer D, De Nunzio AM, Heneghan NR, Falla D, et al. A novel metric of reliability in pressure pain threshold measurement. Sci Rep. 2021; 11(1):6944.
Carpenè G, Henry BM, Mattiuzzi C, Lippi G. Comparison of forehead temperature screening with infra-red thermometer and thermal imaging scanner. J Hosp Infec. 2021; 111:208-209.
Amjad F, Bandpei MAM, Gilani SA, Arooj A. Reliability of modified-modified Schober’s test for the assessment of lumbar range of motion. JPMA. 2022;72(9):1755-1759.
Kaesaman N, Eungpinichpong W. The acute effect of traditional Thai massage on recovery from fatigue in basketball players. GEOMATE J. 2019;16(55):53-58
Oh J, Lee H, Park H. Effects on heart rate variability of stress level responses to the properties of indoor environmental colors: A preliminary study. Int J Environ Res Public Health. 2021;18(17):9136.
Oh J, Park H. Effects of changes in environmental color chroma on heart rate variability and stress by gender. Int J Environ Res Public Health. 2022;19(9):5711.
Andrade C. The ceiling effect, the floor effect, and the importance of active and placebo control arms in randomized controlled trials of an investigational drug. Indian J Psychol Med. 2021;43(4):360-361.
Hughes E, Koenig JM, Lee RS, McDermott K, Freilicher T, Pitcher MH. Pilot study assessing the effect of fascial manipulation on fascial densifications and associated pain. Eur J Transl Myol. 2022; 32(1): 10369.
Devantéry K, Morin M, Grimard J, Gaudreault N. Effects of a myofascial technique on the stiffness and thickness of the thoracolumbar fascia and lumbar erector spinae muscles in adults with chronic low back pain: A randomized before-and-after experimental study. Bioengineering. 2023;10(3): 2306-5354.
De Siqueira M, Barbalho M, Moraes PH. The effects of the gua sha technique (western view) on the recuperation of flexibility of the posterior chain in parkinson: case study. Eur J Res Med Sci. 2016; 4(1):3-73.
Karasuno H, Ogihara H, Morishita K, Yokoi Y, Fujiwara T, Ogoma Y, et al. The combined effects of transcutaneous electrical nerve stimulation (TENS) and stretching on muscle hardness and pressure pain threshold. J phys ther sci. 2016;28(4):1124-1130.
Tu W-z, Cheng R-d, Hu J, Wang J-z, Lin H-y, Zou E-m, et al. Combination treatment with Gua Sha and Blood-letting causes attenuation of systemic inflammation, activated coagulation, tissue ischemia and injury during heatstroke in rats. Chin J Integr Med. 2015; 21:610-617.
Min Y, Hongyan Z, Rongzhao Y, Qinchuan S, Yaoyao B. Gua Sha attenuates thermal hyperalgesia and decreases proinflammatory cytokine expression in serum in rats with lumbar disc herniation induced by autologous nucleus pulposus. J Tradit Chin Med. 2018;38(5):698-704.
Sheng Y, Zhu L. The crosstalk between autonomic nervous system and blood vessels. Int J Physiol Pathophysiol Pharmacol. 2018;10(1):1-7.
Dubinskaya AD, Yurova OV, Rogatkin DA, Glazkova PA, Glazkov AA, Krasulina KA, et al. Changes in Microcirculation During Gua Sha Massage. Bull Rehabil Med. 2023;22(2):112-119.
Yuen JWM, Tsang WWN, Sonny HM, Loo WTY, Chan S-T, Wong DLY, et al. 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. Complement Ther Med. 2017; 32:25-32.
Jadhav A, Gurudut P. Comparative effectiveness of Gua sha, cryostretch, and positional release technique on tenderness and function in subjects with plantar fasciitis: A randomized clinical trial. Int J Ther Massage Bodyw. 2023; 16(1):1-3.
Xu YC, Wang QQ, Chen MY, Gao YJ, Wang JY, Ge HT, et al. The effect of Gua sha therapy on pain in parkinson’s disease: A randomized controlled trial. Int J Gen Med. 2024; 10:2791-2800.
Saha FJ, Brummer G, Lauche R, Ostermann T, Choi K-E, Rampp T, et al. Gua Sha therapy for chronic low back pain: a randomized controlled trial. Complementary ther clin prac. 2019; 34:64-69.
Martínez-Aranda LM, Sanz-Matesanz M, García-Mantilla ED, González-Fernández FT. Effects of self-myofascial release on athletes’ physical performance: A systematic review. J Funct Morphol Kinesiol. 2024; 9(1):2411-5142.
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