Gua sha is a versatile technique for relieving pain and resolving restrictions in the myofascia. Gua sha has its roots in ancient medicine and is still used today by acupuncturists to treat pain, inflammation, and disease.
In modern usage gua sha is also called scraping therapy, Graston, or instrument assisted soft tissue mobilization (IASTM), and is used to treat pain and myofascial restriction rather than disease or illness. There are many different kinds of tools out there for scraping therapy. Some are generic and marketed simply as gua sha tools, some are marketed to distinguish themselves from gua sha and have their own training systems to accompany the tools.
I am a practitioner and instructor of gua sha, with training both in Western and Chinese medical perspectives, and I have found that sometimes practitioners get stuck with inferior tools that limit the potential effectiveness of their treatment, or think they must purchase several very expensive tools in order to practice gua sha at all. In this article I hope to demystify gua sha tools and help you understand the advantages and disadvantages of the most common tools you will come across.
The material determines the durability, porousness, strength, resonance, conductivity, and the cost of your tool. Almost anything can be made into a scraping tool, from traditional animal bone to modern polycarbonates.
Stainless steel, copper, silver, and titanium. In general, metal is the most durable, least porous, strongest, and most conductive and resonant in terms of being able to transmit information from the tissues being worked to the hands of the practitioner. Many of the quality stainless steel tools available now are highly polished, allowing a the treatment to go more directly to the fascial layers and bypassing some of the body’s reaction to generate sha.
Metal does not break, chip, fray, or easily melt and can easily last the lifetime of your practice. Copper and silver tarnish and may be mildly reactive with some people’s skin, or their skincare products. Stainless steel and titanium are fairly non-reactive although some people have metal allergies so be sure to check first before using a metal tool on a patient.
Copper and silver have traditional healing properties and are very conductive to temperature and vibration which can be clinically useful. Metal tools in general will cost more than other types of tools. I am not a fan of aluminum scraping tools and do not use them.
A traditional form of gua sha called “coining” uses a coin to scrape the back, so technically a coin could be used in practice as long as it is completely disinfected.
In my experience the quality copper tool or small stainless steel tools are the best. I like how the resonance of the metal allows me to get palpatory information through the tool and feel connected to the patient while I’m treating. I find that well-made metal tools are easy to grip and have a nice weight and substance, and are overall excellent for clinical use.
The ceramic soup spoon is a traditional tool for gua sha. These tools are very affordable and work fairly well. I used the ceramic soup spoon for years in my practice before I found the metal tools that I like.
Even though the spoon feels smooth it is not as highly polished as some of the metal tools and so may cause a micro abrasion to the skin. This is slightly over-stimulating the superficial blood vessels and generating sha without necessarily directly addressing the fascial layers. The spoons can break or chip so be very aware to check the edge before use to make sure there are no chipped edges that could break the skin. Some ceramic spoons have a metallic line painted around the edge, do not use this type of spoon on patients as the paint has the possibility of rubbing off.
Animal Bone or Horn
Bone, horn, usually from cattle. A tool made of animal bone or horn will be porous, more insulated, and more brittle or weak that other materials. The main problem with these for clinical practice is their porousness and tendency to fray or crack making proper disinfection of the tools unlikely, and the lifetime of the tool shorter.
Jade, rose quartz, bian stone. The semi-precious stones are often very smooth and can sometimes be difficult to get a good grip, but can be good for gentle work on the face and for more massage oriented techniques such as trigger point work. The stone tools are lower resonance than metal, and these tools can be disinfected.
The bian stone on the other hand can sometimes be slightly rough and cause micro abrasions to the skin so be aware of that. Stone is strong but can still break if dropped.
Polycarbonate resin, other hard plastic. These tools are often inventive in terms of shape because of the relative ease of manufacturing a new design in plastic. They are more insulated than many other types of tools, they do not break, and and their ability to be disinfected is good, overall making them workhorses for clinical practice.
There are lots of tools like this on the market in many different shapes and sizes and varying degrees of quality. In my personal experience even the higher quality polycarbonate tools feel awkward and large in my hand, while the cheaper plastic tools feel flimsy and ineffectual.
Wooden gua sha tools can be difficult to disinfect properly and very likely to break down with continued use. They are nice and lightweight but probably best for home use.
It may sound strange but jar lids, specifically metal Plastisol lined caps are the preferred gua sha tool of Dr. Arya Nielson, author of a book and many research studies on gua sha. The lids can be disposed of after a single use, which Dr. Nielson finds useful for her hospital practice. I have not personally used lids but this option can be handy for working in a hospital setting or otherwise high-volume setting where a single-use tool is necessary.
Infra-red “Gua sha” Tool
I include this as a warning to avoid using or receiving treatment from this so-called gua sha tool. There is nothing about gua sha in traditional or modern practice that requires it to be plugged in or for the tool to generate heat of any kind. I came across this unfortunately because a patient came to me who had received this treatment and had severe burns that resulted in scarring, and ultimately a lawsuit against the practitioner.
Other Factors to Consider
Shape and Size
Gua sha tools come in all shapes and sizes. Larger tools are designed specifically for large areas of the body such as the illiotibial band, while smaller tools or tools with very small corners are meant for getting around small joints such as the vertebral facets.
A large tool is not always necessary even on a larger body part. If you can warm up an area with manual therapy before applying gua sha then the treatment area is more focused and a smaller tool suffices. Also it is possible to get into small joint areas including the wrist, metacarpals, and vertebrae without a particularly small tool or small edge.
That said, I do try to match the size of tool or part of the tool with the structure that I am working on, and work within the client’s comfort level so that it does not feel to pointed or sharp. For larger areas of the body I make sure the area is warmed up first so I’m not trying to break through a large swath of locked-up fascia with just a large tool.
A rounder edged tool will be more difficult to use for the scraping technique of gua sha and may be more effective as a massage tool. I find this to be true of many of the jade and rose quartz gua sha tools. A sharper edge will be more effective for scraping and generating sha but can also be less comfortable for the client. The high quality metal tools will have a good scraping edge that is not too sharp, and some of the tools have one edge that is sharper and one that is more round.
If you are doing gua sha in a professional setting you must disinfect your tools, either with chemical disinfectant, heat such as an autoclave, or ultraviolet light. Be aware of how your disinfection method may compromise the integrity of your tool. Chemicals, heat, or moisture may break down or otherwise react with bone, horn, wood, certain plastics, and certain metals.
Materials that can break or get chipped such as ceramic, stone, plastic, or wood must be inspected before application to make sure there is no sharp edge that could break the skin.
Application and Preference
You should be able to hold the tool comfortably without it slipping or being the wrong size or shape for your hands. You should be able to use the tool without stressing your own shoulders, wrists, or thumbs. You should be able to generate enough pressure that sha can arise naturally, but not have to press so hard that there is bruising. You may prefer different tools depending on what you are doing or who you are working on.
As long as a tool is safe for professional use you should use whatever tool you prefer. Find a tool that fits in your hand, works with your body and the needs of your patients, and that you enjoy using.