Efficacy and Risks of Gua Sha for Neck Pain

Most of the evidence in favor of gua sha is anecdotal, based on small studies or what individuals have reported rather than large randomized controlled trial (RCT) studies. A complete review of the medical literature has found mixed results regarding the effectiveness of gua sha for relieving pain.1,2

The strongest research-based evidence for gua sha’s ability to reduce neck pain was from a small 2011 RCT study on people with neck pain. The study’s participants were divided into two groups: one group received gua sha for their neck pain while the other group received heat therapy. After one week, the gua sha group reported more relief from neck pain than the heat therapy group.2


Risks and Contraindications for Gua Sha

When performed by a professional trained in gua sha and the use of sterile equipment, the treatment is relatively safe. However, it is possible to apply gua sha too hard and/or cause adverse reactions. For example, one reported case of gua sha applied to the front of the neck for throat pain caused extreme swelling of the epiglottis, which resulted in temporary loss of speaking ability.3

Also, gua sha should not be directly applied to damaged skin, including:

  • Rash
  • Bruise
  • Sunburn
  • Cuts
  • Pimples or other growths

Gua sha may also be contraindicated for people, typically older adults, who have notable thinning of the skin or for those who take prescription blood thinners such as warfarin (Coumadin, Jantoven).


It should also be noted that the petechiae (redness from tiny capillaries breaking underneath the skin’s surface) resulting from normal gua sha may be misinterpreted by others as signs of physical abuse, especially when performed on visible areas such as the neck. Fortunately, these marks typically go away in a few days.


  • 1.Braun M, Schwickert M, Nielsen A, et al. Effectiveness of traditional Chinese "gua sha" therapy in patients with chronic neck pain: a randomized controlled trial. Pain Med. 2011; 12(3):362-9.
  • 2.Lee MS, Choi T-Y, Kim J-I, Choi S-M. Using guasha to treat musculoskeletal pain: a systematic review of controlled clinical trials. Chin Med. 2010; 5: 5.
  • 3.Tsai K-K, Wang C-H. Acute epiglottitis following traditional Chinese gua sha therapy. CMAJ. 2014; 186(8): E298.
Further Reading: Treatment for Neck Pain