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 & C2 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.