Scraping in chiropractic refers to a hands-on technique where a practitioner uses a smooth-edged tool to apply repeated strokes across your skin, targeting the muscles, tendons, and connective tissue underneath. The formal clinical name is instrument-assisted soft tissue mobilization, or IASTM. It’s one of the more common soft tissue treatments offered in chiropractic offices, and it has roots in an ancient Chinese healing practice called gua sha.
How Scraping Works
During a session, a chiropractor glides a specially designed metal or plastic tool along the surface of your skin using firm, controlled strokes. The tool allows the practitioner to detect and treat areas where the soft tissue feels dense, restricted, or scarred. The pressure and friction are the point: they create a controlled, localized inflammatory response in the tissue being treated.
That controlled inflammation kicks off a chain of biological events. The number and activity of fibroblasts (the cells responsible for building connective tissue) increase in the treated area. This triggers the production of new collagen and other structural proteins, which helps remodel scar tissue and adhesions that may be limiting your movement or causing pain. The stroking action also increases blood flow to the area, improving the delivery of oxygen and nutrients to tissues that may have been slow to heal on their own.
IASTM vs. Gua Sha
Scraping in a chiropractic office descends directly from gua sha, a traditional Chinese medicine technique that has been practiced for centuries. Both involve pressing and stroking the skin with a smooth tool. The differences are mostly in the tools used, the depth of treatment, and the clinical goals. Gua sha typically targets pain, inflammation, and stiffness closer to the skin’s surface. IASTM, sometimes called the Graston Technique after the athlete who popularized it, tends to go after deeper muscular issues, particularly in areas like the lower back, shoulders, and thighs. IASTM also uses cross-friction strokes designed to introduce micro-trauma to injured tissue, prompting the body’s repair process and improving range of motion.
What Conditions It Treats
Chiropractors use scraping for a broad range of musculoskeletal problems. The technique is most commonly applied to soft tissue injuries: chronic tendon issues, lingering muscle strains, fascial restrictions, and overuse injuries common in athletes. Conditions like plantar fasciitis, tennis elbow, carpal tunnel syndrome, and IT band syndrome are frequently treated with IASTM in practice.
Not every condition is appropriate for scraping, though. An international expert consensus identified several situations where IASTM should be used cautiously or avoided altogether. These include acute sprains and strains (where the tissue is freshly injured and inflamed), unhealed bone fractures, osteoporosis, and inflammatory joint conditions like rheumatoid arthritis and psoriatic arthritis. Conditions involving abnormal bone growth in muscle tissue are also flagged as contraindications.
What a Session Feels Like
If you’ve never had scraping done, expect a sensation that falls somewhere between a deep tissue massage and mild discomfort. The practitioner will apply a lubricant to the treatment area, then use the tool in long, sweeping strokes or shorter, more targeted passes depending on the tissue they’re working on. You’ll likely feel pressure and a gritty or bumpy texture as the tool moves over restricted tissue. Some areas will be more sensitive than others, particularly over bony prominences or spots with tight, dense tissue.
Temporary redness in the treated area is normal and expected. This is simply increased blood flow to the surface. Some people develop petechiae, which are tiny reddish-purple dots that look like pinpoint bruising. Research suggests petechiae are more likely to appear over thin tissue that sits directly on bone, and that heavy pressure alone isn’t necessarily the cause. One study applying IASTM with heavy pressure over a long treatment period found no petechiae at all, only temporary redness that resolved on its own. Your skin may feel warm or slightly tender for a day or two after treatment.
Does the Evidence Support It?
A 2025 systematic review and meta-analysis pooling data from multiple clinical trials found moderate-certainty evidence that IASTM reduces self-reported pain in people with musculoskeletal disorders. Across 11 trials involving 427 patients, the pain reduction was statistically significant. The same review found low-certainty evidence that IASTM improves physical function, based on eight trials with 333 patients. The effect on function was real but smaller and less consistent across studies.
In practical terms, this means scraping has a reasonable evidence base for pain relief, but the case for functional improvement (things like being able to move more easily or return to activity faster) is less firmly established. The technique appears to be most useful as part of a broader treatment plan rather than a standalone fix. Many chiropractors combine it with stretching, exercise, and manual adjustments.
Who Performs It
IASTM is practiced by chiropractors, physical therapists, athletic trainers, massage therapists, and occupational therapists. There is no single required certification, but several continuing education programs offer practitioner-level training. The Graston Technique has its own certification process, and broader IASTM certification courses are available through professional education organizations. These programs are open to practitioners across disciplines, and each provider is responsible for ensuring the technique falls within their licensed scope of practice.
If you’re considering scraping as part of your care, ask your chiropractor about their specific training and which IASTM approach they use. The branded techniques (Graston, ASTYM, and others) differ somewhat in their protocols and tool design, but the underlying principle is the same: using a tool to mobilize restricted soft tissue and encourage your body’s natural repair process.