Fascia guide
Muscle scraping means a clinician stroking a rigid, smooth-edged tool along a muscle or tendon. Clinicians call it instrument-assisted soft tissue mobilisation (IASTM), and branded versions include the Graston technique and Astym. It's sold as a way to break down scar tissue and adhesions, but that hasn't been shown in people, and reviews disagree on whether it adds anything to exercise.
This guide covers what the tools do to skin, fascia and tendon as far as studies show, what trials found against sham treatments, exercise and stretching, why scraping can bruise, who should avoid it, and how it differs from gua sha. The loading exercise that does most of the work for heel pain is shown in 3D.
A clinician strokes a rigid, shaped tool over skin coated with a cream or gel, along one muscle or tendon, usually as one part of rehab with exercise. Clinicians in one US survey used more than 34 different tools; the Graston technique uses a six-piece stainless steel set.
Across 46 trials, adding scraping to other treatment made no meaningful difference to pain, function or movement, on very low-quality evidence. Another review of 11 trials found a moderate, short-term easing of pain, on moderate-certainty evidence. In neck pain it beat no treatment, but not other physiotherapy.
The Graston technique did no better than a placebo for upper back pain at any point up to a year (143 people), and matched a sham scrape for pain in 84 women with muscle pain. One small knee trial favoured real scraping 48 hours after treatment.
The healing studies were in rats. In people, one session lowered plantar fascia stiffness by about a tenth without changing the foot's structure, and dense fascia needs far more force than hands or tools apply to change shape.
Temporary bruising is the harm the tennis elbow guideline lists, and even the Graston company warns that improper pressure can cause excessive bruising. Only 10 of 46 trials reported side effects, so no one knows how often they happen.
A clinician applies a cream or gel, then strokes the tool along the muscle or tendon. In a survey of 853 US athletic trainers and physical therapists, 83% used scraping. They used more than 34 different tools, spent 1 to 5 minutes on each spot and about 15 minutes per session on average, and 71% didn't know how to measure, or didn't try to measure, the force they used.
The Graston company sells a six-piece stainless steel instrument set with clinician training, and says a typical course runs over 4 to 5 weeks.
The Graston company says its tools break down scar tissue, stimulate collagen and reduce inflammation. Astym is another branded method: its main trial describes it as shown in animal studies to promote healing, and a review describes its aim as getting the body to reabsorb unwanted scar tissue.
Gua sha is press-stroking that sets out to raise red spots (petechiae, tiny bleeds under the skin) over an area. A 2026 review groups gua sha, spoon-rubbing and clinical instrument scraping together as scraping therapies that can raise petechiae and bruising. The differences are the tools, who does it and the setting: a clinician working along one structure, as one part of a rehab plan. Our gua sha guide covers gua sha and scraping at home.
Massage uses hands, and rollers and balls use your body weight. A review of rolling tools concluded that calling them release devices is misleading, because their effects can be explained without releasing anything, and the same physics limits what a scraping tool can do to dense fascia.
Fascia blasting is a consumer tool sold for use at home; our fascia blasting verdict covers its evidence. It isn't the clinical technique tested in the trials on this page.
Against: a 2023 review of 46 trials found that adding scraping to other treatment made no statistically significant or clinically meaningful difference to function or pain for up to a year, on very low-quality evidence. Nor did it give a meaningful gain in movement. It also warned that more scraping trials were appearing in suspected predatory journals. An earlier review of 9 trials found the evidence didn't support it.
For: a 2025 review of 11 trials (427 people) found scraping with other treatment eased pain moderately (moderate certainty) and helped function (low certainty), though 6 of the trials were at high risk of bias. A 2026 review of 20 trials (1,420 people) found it eased pain, more consistently when added to rehab than when used alone.
In 143 people with upper back pain, the Graston technique did no better than placebo ultrasound for pain or disability at 1 week or 1, 3, 6 or 12 months; all groups improved with time. In 84 women with neck and shoulder muscle pain, all doing exercise, Graston and a sham scrape eased pain equally, though Graston did better for disability and low mood.
In 30 people with knee osteoarthritis, real scraping with exercise helped pain and knee bend more than sham scraping 48 hours after the last of 4 sessions. A 2026 review of the Graston technique for back pain found 1.45 points less pain out of 10 than with placebo, but no difference in disability and none against active treatments.
Across 24 studies (1,060 people), scraping beat no treatment or control treatments for neck pain, disability and movement, but did no better than other standard physiotherapy.
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Pooling 9 trials (450 people), scraping added about 5 degrees of movement in people who were stiff or had a muscle or joint problem, and about 2 degrees in people who weren't, on very low to low certainty evidence. In 60 people, one session of scraping raised ankle bend about as much as calf stretching did. How long the gain lasts is unknown.
The 2023 US heel pain guideline gives clinician hands-on treatment its top grade, A, and counts scraping within it; its scraping evidence is one trial against ultrasound and small Graston trials. In 69 people with chronic heel pain, all stretching twice a day, adding Graston gave better foot function at 6 months than stretching alone.
The NHS suggests stretching, insoles and night splints first, then steroid injections or shockwave therapy, and doesn't mention scraping.
The 2022 US guideline says clinicians may use scraping combined with exercise (Grade C, weak evidence). It rests mainly on a trial of 113 people in which Astym plus exercise did better than exercise alone at 6 weeks, but not at 6 or 12 months. The trial's lead investigator declared a conflict of interest as medical director for the instruments used. A smaller pilot found no difference.
For Achilles pain, the 2024 US guideline makes heavy tendon loading the first-line treatment (Grade A) and allows hands-on soft tissue work only on expert opinion (Grade F). For heel pain, stretching gets an A and resistance training a B. The authors of the 46-trial review advise clinicians to consider exercise and physical activity instead.
The idea of healing through controlled micro-damage comes from rats: scraping chemically injured rat tendons increased the cells that make collagen, more so with heavier pressure.
In people, one session on the sole lowered plantar fascia stiffness by 10.8% without changing the arch (28 young men). One session on the lower back briefly reduced how much a layer of fascia moved and slid, and improved a hamstring flexibility test, against a pressure-free placebo (67 footballers). Ten minutes of Graston warmed the calf skin, though less than massage did. Squeezing dense fascia by even 1% would need forces far beyond what hands or tools apply.
Expect a few minutes per area and about 15 minutes in all. Trials used 4 sessions over 2 weeks up to 10 sessions over 4 weeks, and the Graston company says a typical course runs over 4 to 5 weeks. If nothing has changed after a few sessions, ask what else is in the plan (our advice).
The guideline grades are for scraping as one part of care. The loading that carries the evidence:
Consumer scrapers are sold for home use, but we found no published trials of them. If you use one, keep the pressure light enough not to bruise, keep off the areas listed under safety, and keep the tool clean and your own, because scraping can draw blood and fluid through the skin. A massage ball or roller gives a similar short-term feel (our editorial view).
Steps and dose from the move's page, which takes them from a heel pain trial. The 2023 heel pain guideline grades resistance training B and counts clinician scraping within its Grade A for hands-on treatment, as one part of care (Koc 2023). If your heel is clearly worse the next morning, lighten the load.
Loading the 3D figure…
The movement on the figure: Heel raise with a towel under the toes
Heel and Achilles moves first, then tennis elbow: use the dose on each move's page where it gives one.
3D demoHeel raise with a towel under the toesIntermediate · A step + Other / check instructions
3D demoIsometric calf raise holdBeginner · A wall
3D demoPlantar fascia stretch (seated)Beginner · A bench or box
3D demoTyler twist (flexible bar, for tennis elbow)Beginner · Other / check instructions
3D demoWrist-extensor eccentricsBeginner · A dumbbell
3D demoWrist extensor stretch (tennis elbow stretch)Beginner · No equipmentA roller or ball changes how an area feels for a while, as scraping does, for free: about 90 seconds per calf, 1 to 2 minutes per foot and 45 to 60 seconds per forearm, as their move pages suggest.
The heel, calf and forearm routines are the loading; the ball and roller routines are the free version of the short-term feel.
Plantar fascia and calf stretches, a gentle foot roll and the towel heel raise: the exercises the 2023 heel pain guideline supports.
8 minBeginner7 movesA bench or box, A massage ballA 25-minute calf workout with a step and a dumbbell: single-leg raises for the big calf muscle, then seated raises for the soleus, with gym swaps for each move.
25 minIntermediate7 movesA wall, A stepWrist mobility and forearm strength for desk work, climbing, push-ups and handstands.
10 minBeginner7 movesA wall, A dumbbellA 15-minute massage ball routine for desk-tired feet, forearms and chest: slow pressure on each, then the stretch that goes with it. No floor needed.
15 minBeginner8 movesA massage ball, A bench or boxA 10-minute foam roller routine for calves, thighs, glutes and upper back: about a minute per area, moderate pressure, slow rolls.
10 minBeginner6 movesA foam rollerAn international panel of 24 experts agreed scraping shouldn't be used with:
The same panel listed blood-thinning medicines and rheumatoid arthritis, among other conditions, as reasons for caution. Blood thinners make you bruise more easily. Never let anyone scrape a leg that is swollen, throbbing, red or darkened, which can be a clot.
Temporary bruising is the harm the tennis elbow guideline lists. The Graston company says improper pressure, technique or tool choice can cause excessive bruising, inflammation or discomfort. Only 10 of 46 trials reported side effects at all, so there are no reliable rates.
Scraping can draw blood and fluid through the skin, so tools should be cleaned between people. The gua sha guide covers cleaning.
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The healing studies were in rats. In people, stiffness fell by about a tenth for a short time without changing structure, and dense fascia would need far more force than a tool applies. We found no published trials of scraping on scar tissue in people.
That idea also comes from rats. In people, guidelines put loading exercise first and rate scraping only as one part of care: within Grade A hands-on treatment for heel pain, and Grade C with exercise for tennis elbow.
Bruising is a harm, not a sign of benefit, and even the Graston company warns that improper pressure can cause excessive bruising.
Graston matched a placebo for upper back pain up to a year and a sham scrape for muscle pain. One small knee trial favoured it 48 hours after treatment.
Skin temperature rises for a while, less than with massage in one study, and no study in people links that to healing.
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We found no published trials of home scrapers. Even in clinics, the force used is rarely measured, and the largest review found scraping added little to other treatment.
Instrument-assisted soft tissue mobilisation: a clinician strokes a smooth-edged, rigid tool over the skin along a muscle or tendon, usually as part of a rehab plan with exercise. The Graston technique and Astym are branded versions, and people often call it muscle scraping.
It's a branded form of muscle scraping that uses a six-piece stainless steel tool set. Reviews disagree: across 46 trials scraping added nothing meaningful to other treatment, while a review of 11 trials found a moderate short-term easing of pain. Against a placebo, Graston did no better for upper back pain over a year.
It can ease pain and loosen movement a little for a short time, but reviews disagree on whether it adds anything to exercise. In neck pain it beat doing nothing, but not other physiotherapy. Use it, if at all, to help you move and load, not instead of loading.
They're cousins. Gua sha deliberately raises red spots over an area, while clinic scraping is worked along one muscle or tendon by a clinician as part of rehab, and both can leave redness and bruising. The gua sha guide covers scraping at home.
No. Temporary bruising is listed as a harm, not a goal, and the Graston company itself warns that improper pressure can cause excessive bruising. Tell your clinician if marks are large or last more than a few days.
It's generally low risk, but experts advise against it on broken, infected or inflamed skin, over an unhealed fracture or an inflamed vein, with a fever, with a bleeding disorder, or with a metal, cream or latex allergy. Ask first if you take blood thinners, as you'll bruise more easily.
Home scrapers are sold, but we found no published trials of them. If you use one, keep the pressure light enough not to bruise, avoid the areas above, and keep the tool clean and your own. A massage ball or foam roller gives a similar short-term feel.
Not as far as anyone has shown in people. The healing studies were in rats, and in people a session lowered tissue stiffness by about a tenth for a short time without changing structure. Dense tissue needs far more force than a tool applies to change shape.
For heel pain, one trial found Graston plus stretching gave better function at 6 months than stretching alone, and the heel guideline counts clinician scraping within its Grade A for hands-on treatment. For tennis elbow, scraping plus exercise gets only a Grade C, mainly from one trial whose lead researcher had a commercial interest in the instruments. In both, loading exercise is the core of care.
There's no established dose. Trials used 4 sessions over 2 weeks up to 10 sessions over 4 weeks, and the Graston company says a typical course runs over 4 to 5 weeks.
Both change how an area feels and moves for a short time, and neither has been shown to release fascia. A roller or ball is cheap to use at home, and the foam rolling and massage gun guides cover them.
No. Fascia blasting is a consumer tool, which our fascia blasting verdict covers, while IASTM is a clinical technique with mixed trial evidence. Neither has been shown to break up fascia.
Movement education, not medical advice. Stop for sharp or increasing pain, numbness or tingling, and get individual advice if you are pregnant, after an injury or surgery, or managing a health condition. Health disclaimer.
