Gua Sha therapy for chronic nonspecific low back pain?

Gua Sha is a form of so-called alternative medicine (SCAM) that I have reoprted about before, e.g.:

• Gua sha: who cares how it works, when it is unproven that it works?
• Gua sha, a reasonable therapy?
• Gua Sha: torture or treatment?

Chronic nonspecific low back pain (CNSLBP) is associated with thoracolumbar fascia (TLF) dysfunction. However, the structural effects of Gua Sha, a Traditional Chinese Medicine technique, remain unclear.

This study aimed to explore the acute and short-term effects of Gua Sha therapy on TLF thickness, pain intensity, and related physiological parameters in patients with CNSLBP.

Thirty-two participants with CNSLBP were randomized to receive Gua Sha or hot pack therapy, a commonly used conservative treatment for low back pain, once a week for 4 weeks. The effects of the two treatments were compared. TLF thickness, pain, and related parameters were measured at baseline and immediately after the first and fourth interventions. A 2 (group) × 3 (time) repeated measures ANOVA was used for data analysis.

With increasing intervention, both groups showed significant improvements in pain intensity and dysfunction (P < .001), significant reductions in tissue hardness and pressure pain threshold (P < .05), and significant increases in skin temperature and lumbar flexibility (P < .001). However, only the Gua Sha group significantly reduced TLF thickness immediately after the first intervention (MD = 0.388, 95% CI: 0.101-0.675; P = .01) and immediately after the fourth session (MD = 0.607, 95% CI: 0.199-1.015, P = .005). The heart rate variability-related indicators did not reach statistical significance (P > .05), but their trends were favorable.

The authors concluded that Gua Sha can effectively relieve pain, improve function, and regulate tissue mechanical properties in CNSLBP patients and its effects may be achieved through multiple pathways. Although the single and 4-session interventions were not significantly better than heat in improving fascial thickness, it performs better in pain and flexibility clinical outcomes, supporting its potential value as a complementary therapy. Future studies with larger samples and longer periods are needed to clarify its mechanism of action and optimize treatment options.

Gua sha, sometimes referred to as “scraping”, “spooning” or “coining”, is a traditional Chinese treatment that has spread to several other Asian countries. It has long been popular in Vietnam and is now also becoming well-known in the West. The treatment consists of scraping the skin with a smooth edge placed against the pre-oiled skin surface, pressed down firmly, and then moved downwards along muscles or meridians. According to its proponents, gua sha stimulates the flow of the vital energy ‘chi’ and releases unhealthy bodily matter from blood stasis within sore, tired, stiff or injured muscle areas.

It is easy to imagine that Gua Sha is associated with sizable placebo effects. This means one needs to think carefully about how to control for tham in clinical trials, if we want to know whether the treatment works beyond placebo. I am not sure how to achieve this, but I am quite certain that the current study failed to do it. Thus its results merely showed that Gua Sha is just as useless as another therapy thay is unproven for CNSLBP.

And what about the thoracolumbar fascia thickness? I think that its significance is entirely speculative. Moreover, the reliability of its measurement seems questionable. Most likely, it is yet another red herring in a paper already more than full of fishy stuff.

PS

I stated it many times before, but I must say it again: almost any odd SCAM (e.g. chiropractic!) works a little for back pain – particularly if you test it in lousy studies and don’t control for placebo effects.