Gua Sha vs. Graston – What is the difference?

Janki KotakGua Sha, Muscle Scraping, Technique7 Comments

There are a variety of Instrument Assisted Soft Tissue Techniques in the world of rehabilitation and musculoskeletal care. The two very popular and different techniques are Gua Sha and Graston. The main idea for both these techniques is to heal the body by intentionally producing micro-traumas in specific regions to bring heat to the area. Although both tools are addressing the body in the in a similar way; they each have a very different approach in the way the tools are made and used.

Gua Sha

Gua Sha is used in Chinese Medicine and all throughout different parts of Southeast Asia. Gua Sha uses a scraping technique on the skin to create the red, bruised marks commonly seen with this treatment. Traditionally, thick oil is used to lubricate the skin before the smooth edge of the instrument is used to create redness and bruising with a variety of long and short strokes. This technique is commonly used by many Acupuncturists to compliment their practice.

With Gua Sha, there is a practice of using this technique commonly in “yang areas” of the body, including the back, neck, shoulders, buttock, and limbs. It is believed that Gua Sha helps with symptoms and prevention of the common cold, flue, asthma, and acute and chronic pain. Gua Sha is also used commonly for respiratory conditions and high fever. By bringing heat to specific areas of the body, Gua Sha releases the excess heat and toxins through the surface.

The different colors have different meanings in the Gua Sha technique: Light red color means deficiency in blood; dark red means the condition is acute; black or purple means there is a long standing condition; brown means there is dryness and a lack of fluids in the body; and dark deep red shows an excess of heat.

Gua Sha tools are usually made of buffalo horn, water buffalo horn, a piece of jade, a Chinese soup spoon, and many other materials with smooth rounded edges. A study conducted in 2011, tested the effectiveness of Gua Sha in patients with chronic neck pain. The patients of this study had a significant decrease of neck pain in the visual analog scale after 1 week of treatment.

Graston Technique

The Graston Technique was developed by David Graston to break up soft tissue fibrosis and decrease chronic inflammation in specific areas of the body.  This technique uses stainless steal tools to create deep, rhythmic pressure in specific areas. The goal of the Graston technique is to break the adhesions formed in and around the muscles to bring inflammation to the area. The inflammation brought to the area will create a healing process that will not only heal the new micro-traumas caused by this technique; but will heal the original damaged tissue that caused the adhesions to form initially. The Graston Technique focuses on mobility and function of the body and removing the restrictions preventing the body from working optimally. In a case study, treatment of subacute lumbar compartment syndrome, using Graston resulted in improved functional testing and a decrease in symptoms.

Gua ShaGraston
Materialbuffalo horn, water buffalo horn, jade, chinese soup spoon, other materialsstainless steel
HistoryUsed by Traditional Chinese Medicine practitioners for 2000+ yearsDeveloped by David Graston in 1994
Theoryredness, toxins, and heat brought to the surface to be released to promote healing Breaking up of adhesions and fibrous tissue
Redness, bruising, micro-traumasRedness, bruising, microtraumas
Methodscraping deep, rythmic pressure
Areas of the Body"yang areas"areas of adhesion, tightness, and limited motion
Application1 type of stroke7 types of strokes


Both Graston and Gua Sha are based on the inflammatory process bringing heat to the area of treatment and resulting in positive effects in the body. Both techniques use tools made from different materials. Gua Sha has been around for several thousand years in Chinese traditional medicine. Graston is a newer, modern technique. Both techniques are effective and have different idealistic histories and beliefs.

Graston is focused more on the breaking up of adhesions and healing through the start of the inflammatory process; whereas Gua Sha is focused on bringing toxins and excessive heat to be released at the surface of the body. Both techniques are effective in promoting healing.

Sidekick offers it’s own tools in both a Stone and Stainless Steel material. These are the Curve and Echo respectively. Sidekick tools are based on gua sha and are also comparable to Graston tools.


Braun, Maximillian M.D. Schiwckert, Miriam M.D., Nielsen, Arya PhD. “Effectiveness of Traditional Chinese ‘Gua Sha’ Therapy in Patients with Chronic Neck Pain: A Randomized Controlled Trial”. Pain Medicine. Volume 12, Issue 3. March 2011.

Hall Harriet. The Graston Technique-Inducing Microtrauma with Instruments. Science-Based Medicine. 2009.

Hammer, Warren I. “Treatment of a Care of Subacute Lumbar Compartment Syndrome Using Graston Technique”. Journal of Manipulative and Physiological Therapeutics. National University of Healthy Sciences. 2005.

Suttie, Emma D.Ac,AP. “Gua Sha”. Chinese Medicine Living.  Accessed July 2016.

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Dr. Janki Kotak, a Board Certified Chiropractor in the Upstate New York Region, has experience with several Chiropractic techniques, such as NIMMO, Cox Flexion-Distraction, Instrument Assisted Soft Tissue Manipulation, Diversified Adjusting Techniques, and Rocktape. She is a Chiropractic Physician at NYON Health and Wellness in Buffalo, NY. She is active in the Chiropractic community through her board position for the Regional District of the New York State Chiropractic Association.

7 Comments on “Gua Sha vs. Graston – What is the difference?”

  1. Can you use a Gua Sha tool to produce the same results (“breaking up of adhesions and healing through the start of the inflammatory process”) as the graston-technique?

  2. I have chronic pain & fatigue & thought this tool would be very helpful. Is this tool easily used by oneself or is it easier to have someone else to do the technique on you?

    Looking on Amazon there are so many Gua Sha tools to choose from, is there a big difference between tools or are they all similar? Some look very different than the one shown in this article.

    1. Hi Kathy,

      Gua Sha can easily be applied on yourself – except on certain body parts such as the back where you’ll need someone to help you.

      There are certainly many options to choose from however we think ours is far superior than any others because of the size, weight and ergonomic design. Whilst there are tools in many different shapes, our tool has several curvatures to it that is suitable for every body part, so you’ll only need one tool.

      Hope that helps!

      PS. we have rebranded to – please visit us there for our products.

  3. Hello,

    Could you contrast the theories behind using things such as a tools made of synthetic substances, such as plastic or something of the like, a transition metal such as copper, steel or titanium, opposed to an earth substance such as wood, opposed to a bovine tool such as a horn. Many different types of tool. After some reading about the 5 element theory i cant decide where to begin to start initiating therapy. Im interested in being efficient and also effective.

  4. I think there is a misunderstanding here. “Gastron Technique” is exactly the same as Gua Sha. It is just rebranded and renamed. But why? To sell tools?

    To say that Gua Sha is not breaking up of adhesions and healing through the start of the inflammatory process, is misleading the public and giving false information. Gua Sha does just that. Just call it for what it is -Gua Sha-. This is a trick to reinvent an ancient, effective modality, in order to make money. Gua Sha tools can be made of metal as well, that’s how many of them are made in China.

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