Gua sha: what it does to skin, muscle and fascia, and what the evidence shows

Small trials, short-term relief

One session eased long-term neck pain more than a heat pad a week later, in 48 people. One or two sessions eased neck and low back pain more than waiting, over about a week.

Sources 1, 2, 3

Never tested against a convincing fake

No trial has used a convincing sham (fake) treatment. In back pain, the extra relief over a hot pack was small or absent, and a 2010 review called the evidence insufficient.

Sources 4, 5, 6

The red spots are tiny bleeds

The spots, called sha, are blood leaking from capillaries into the skin. They're made on purpose and fade in about 2 to 5 days.

Sources 7, 2

It doesn't reshape fascia

In a 2025 trial, the sheet of fascia across the lower back thinned no more with gua sha than with a hot pack.

Source 6

Facial gua sha: small changes at most

One 8-week trial with no untreated group found face measurements changed by 2 to 3 mm. Research hasn't tested the de-puffing claim.

Sources 8, 9

Gentle, clean, and never on the throat

Scraping the front of the neck caused throat swelling in a reported case. Use a clean tool on healthy skin, skip it with a bleeding disorder or broken skin, and ask first if you take blood thinners.

Sources 10, 7, 11

Scraping on purpose

Gua sha is press-stroking: a smooth-edged tool (a spoon, coin, horn, jade or steel) stroked in one direction over oiled skin to raise small red spots (petechiae) and bruising on purpose. It's also called coining, scraping or spooning.

Sources 7, 12

The red marksStrong evidence

The spots are blood leaking from capillaries into the tissue under the skin. Trials describe them lasting 2 to 5 days, a gua sha author says 3 to 4 days, and Henry Ford Health, a US hospital system, says redness or bruising clears over 1 to 2 weeks.

Sources 7, 2, 13, 11

A brief rise in skin blood flowEmerging evidence

In 11 healthy volunteers, blood flow in the skin rose fourfold for about 7.5 minutes and stayed raised for the 25 minutes measured. Tenderness eased at the scraped spot and elsewhere, which blood flow couldn't explain. There was no comparison group.

Source 12

An anti-oxidant response, shown in miceEmerging evidence

In mice, scraping switched on an enzyme (heme oxygenase-1) that breaks down the leaked blood and protects cells, for several days. In older people with back pain, markers of inflammation drifted down, but no outcome differed from a hot pack.

Sources 14, 5

No change to fascia beyond what heat doesEmerging evidence

In 32 people with long-term low back pain (27 finished), 4 weekly sessions thinned the thoracolumbar fascia, the sheet across the lower back, on ultrasound scans. A hot pack did the same: the difference between them was a quarter of a millimetre and could easily be chance.

Source 6

Clinic scraping

Physiotherapists and others use steel tools in the same way, called instrument-assisted soft tissue mobilisation (IASTM), such as the Graston technique.

Source 15

Neck pain: one open trial against heatEmerging evidence

In 48 people with long-term neck pain, one session of gua sha was compared with a heat pad. A week later, pain was about 30 points out of 100 lower with gua sha, and neck function and quality of life were better. People knew which treatment they'd had, and nobody was followed for longer.

Source 1

Neck and low back pain against waiting listsEmerging evidence

One session eased pain at a week in 39 people with neck or low back pain, and two sessions eased long-term low back pain in 50 people, compared with waiting. No serious side effects were reported.

Sources 2, 3

Back pain against heat: little or no differenceMixed evidence

In older people with back pain, gua sha didn't differ from a hot pack in any outcome. In 32 people over 4 weeks, it eased pain 0.67 points out of 10 more than heat, and disability by about 1 point on a 100-point scale: both small.

Sources 5, 6

Reviews: low quality and short termMixed evidence

A review of 10 back pain trials (627 people) found courses of scraping eased pain moderately in the short term, but a single session wasn't better than the comparison, only 3 trials followed people for 1 to 3 months, and quality was low. An earlier review of 7 trials called the evidence insufficient. A larger trial of 156 people combined cupping, scraping and a medicated balm, so it can't show what scraping alone does.

Sources 16, 4, 17

Heel painEmerging evidence

In 36 people with heel pain, one session of gua sha plus exercise eased pain more at a week than two other hands-on techniques. The 2023 US physiotherapy guideline for heel pain notes the changes didn't reach a size patients notice. Stretching the sole and calf has stronger support: the guideline's top grade, for short- and long-term pain.

Sources 18, 19

Clinic scraping adds little in most reviewsMixed evidence

Added to other treatment, instrument scraping made no meaningful difference to pain, function or range of movement across 46 trials (very low certainty). Another review of 11 trials found a moderate easing of pain. In neck pain, it beat doing nothing but not other physiotherapy.

Sources 20, 21, 22

One trial, with no untreated groupMixed evidence

In a trial, 34 women aged 20 to 50 used gua sha or a facial roller for 10 minutes, 5 times a week, for 8 weeks. Distances measured across the face shrank by 2.2 to 2.4 mm with gua sha and 2.8 to 3.3 mm with the roller. Without an untreated group, the changes can't be separated from time, measuring error or shifts in fluid.

Source 8

A short rise in skin blood flowEmerging evidence

Five minutes with a facial roller raised blood flow in that cheek for at least 10 minutes in 12 people, and 5 weeks of daily use improved that cheek's response to heat in 14 people.

Source 23

Puffiness and lymph drainage: untested

Cleveland Clinic says research doesn't address the claim that facial gua sha reduces puffiness. UK advertising rules need robust evidence for lymphatic drainage claims, and even for lymphoedema after breast cancer, the National Institute for Health and Care Excellence (NICE) found the evidence on lymph-drainage massage too uncertain to recommend it.

Sources 9, 24, 25

Too hard can harm

Long-term vigorous facial massage with a hard wooden block tore a neck muscle (the platysma) in one reported case, and the neck arteries tore after a facial massage in another. Keep facial gua sha light.

Sources 26, 27

On the upper back and shoulders

Our editorial starting point, with sources for the safety points and the trial doses:

• Use a clean, smooth, rounded edge that only you use: a smooth spoon works as well as jade.
• Oil or moisturise the skin first.
• Stroke in one direction along the muscle, with light to moderate pressure, 10 to 20 strokes per line.
• Stay on the muscles of the upper back, shoulders and back of the neck, beside the spine. Never scrape the front or sides of the neck.
• Stop when the skin reddens: you don't need dark marks.
• Let marks fade before scraping the same area again. Trials used one session, two sessions about a week apart, or weekly sessions for 4 weeks.

Sources 9, 7, 10, 1, 3, 6

On the face

• Clean your face and the tool, then apply facial oil or moisturiser.
• Use light pressure: enough to move the skin, not enough to hurt or bruise.
• Stroke outwards from the middle of the face in one direction: chin to ears, cheeks to temples, and along the forehead.
• Skip swollen areas, and (our advice) spots, broken skin and the skin around your eyes.
• The trial used 10 minutes, 5 times a week, for 8 weeks. Expect any change to be small and temporary.

Sources 8, 9

For a stiff neck or sore back, exercise helps moreEmerging evidence

Strengthening, neck control exercises, and yoga or Pilates all reduced long-term neck pain against no treatment, and even 2 minutes a day of band training helped office workers with sore necks and shoulders. Exercise reduced long-term low back pain across 249 trials, and NICE puts it first for back pain.

Sources 28, 29, 30, 31

Skip it, or ask your doctor first

The cautions with the clearest reasons:

• A bleeding disorder such as haemophilia: skip it.
• A known or suspected blood clot (deep vein thrombosis): don't scrape the area, and a swollen, painful, warm leg needs urgent checking.
• Blood thinners such as aspirin, warfarin or apixaban: ask your doctor first, as bruising will be worse.
• Broken, fragile, sunburnt, infected or inflamed skin, a rash, or a flare of a skin condition: keep off it.
• Pregnancy: ask your midwife first, and keep off the bump.

Sources 11, 9, 32, 33

More cautions from US hospital guidance

US hospital guidance (it doesn't give evidence) also lists cancer, chemotherapy, a pacemaker or defibrillator, organ failure, diabetes, poor circulation, nerve damage, anaemia, undiagnosed lumps, and giving blood in the last 2 months. Ask a doctor first if any of these apply to you.

Sources 11, 9

Side effects and reported harms

Expect soreness and some bruising or skin discolouration. Reported cases include:

• Swelling in the throat (the epiglottis), with difficulty speaking and drooling, after gua sha on the front and sides of the neck for a sore throat.
• A mycobacterial skin infection with painful lumps on the arms and legs after gua sha for body contouring.
• Long-lasting darkening of the skin.
• Marks mistaken for signs of abuse: tell any doctor who examines you.

Sources 9, 10, 34, 35, 36

Keep your tool clean

Scraping can draw blood and fluid through the skin, so a reused tool needs high-level disinfection. Better still, keep your own and don't share it.

Sources 7, 37

What UK physiotherapists say

The Chartered Society of Physiotherapy (CSP) says cupping and gua sha aren't regarded as physiotherapy treatments because they lack an evidence base, and one NHS trust excludes gua sha from practice.

Sources 38, 39

Call 999 (911 in the US)

Get help straight away if:

• You have difficulty breathing, swallowing or speaking, or you're drooling, after scraping near your neck (our advice, after a reported case).
• Red, hot, swollen skin comes with a very high temperature, a fast heartbeat or fast breathing, feeling faint, confusion, or cold, clammy skin.

Sources 10, 40

Get help from NHS 111 or an urgent GP appointment

• Scraped skin becomes painful, hot and swollen.
• You take blood thinners and have severe bruising, or bleeding that won't stop or keeps coming back: call 111 or go to A&E.

Sources 40, 41

See a GP

• Painful lumps, or spots with pus, appear in the weeks after scraping.
• Marks or darkened skin haven't faded after 2 to 3 weeks (our suggestion).

Source 34

"Gua sha breaks up fascia, scar tissue or cellulite"Emerging evidence

Fascia thickness changed no more than with heat, and we found no trial on cellulite. Bruising the skin isn't the same as changing it: see the fascia blasting verdict.

Source 6

"Facial gua sha drains lymph and sculpts your jaw"Mixed evidence

The one trial had no untreated group and found changes of 2 to 3 mm, research hasn't tested the de-puffing claim, and claims about lymph drainage need evidence that doesn't exist.

Sources 8, 9, 24

"Red marks show toxins or illness leaving the body"Strong evidence

The marks are blood leaking from capillaries under the pressure of the tool. They show where you scraped, not what was inside you.

Sources 7, 12

"Gua sha causes burns"Emerging evidence

The burn case often cited was fire cupping, which uses a flame. Gua sha uses no heat or flame.

Source 13