Body gua sha on the upper shoulders is one of the most useful things I teach patients to do at home. The top of the shoulder and the back of the neck are where most of us carry the day, and a few minutes of scraping there often loosens what a week of stretching has not. It is also easy to do too hard, too often, or in the wrong place. This is how to do it well.

If you are after the gentle, no-marks facial version, that is a different practice with different tools; the gua sha tools guide explains the difference and which tool to buy for each.

What it does, and what the red means

Gua sha means, roughly, “scraping sha”. You press a smooth-edged tool firmly along the skin in one direction, over and over, until the area flushes red and sometimes shows small red or purple speckles. That speckling is the sha. It is blood from tiny surface capillaries, it is expected, and it fades in two to four days. It should not hurt afterwards beyond feeling a little tender, like after a firm massage.

People usually notice the muscle feels looser, warmer and less ropey straight away, and the neck turns more easily. The evidence for gua sha is modest and mostly small studies. It is reasonable to treat it as a good way to ease muscle tension rather than a treatment for anything specific. It does not remove toxins, and the colour of the marks does not diagnose anything. They are more like the marks from cupping: a sign of where pressure met a tight, congested area.

Before you start

  • A tool with a smooth, rounded edge. A stainless steel body tool is best. A traditional ceramic soup spoon works in a pinch. Run a fingernail along the edge; if it snags, do not use it.
  • Oil. The tool should glide, never drag. Any plain, unscented massage oil works.
  • Bare, warm skin. A warm shower first helps.
  • Ten minutes when you can keep your shoulders warm afterwards. Evening is ideal.

Where to scrape

Stick to the muscle, and keep off the front of the neck.

  • The top of the shoulder. The thick band of muscle from the side of your neck out to the tip of the shoulder. Jianjing, GB21, sits on the highest point of that muscle, halfway along, and is often the tenderest spot.
  • The back of the neck, to either side of the spine. The long muscles on either side of the bones of the neck, from the hairline down to where the neck meets the shoulders. Fengchi, GB20, is in the hollows at the base of the skull, and the strokes can start just below it.
  • The upper back between the shoulder blades, if someone else is doing it for you. It is hard to reach on yourself.

Never scrape the front or sides of the throat, where the large blood vessels run, and never directly over the bony ridge of the spine.

How to do it

  1. Oil the area generously, from the hairline to the tip of the shoulder.
  2. Hold the tool at about thirty degrees to the skin, not upright. Lead with the flat edge.
  3. Stroke in one direction only, downward and outward: from the base of the skull down the back of the neck, and from the side of the neck out along the top of the shoulder. Lift the tool and return to the start each time. Do not saw back and forth.
  4. Strokes of four to six inches, firm but not painful. On a scale of one to ten, aim for a five or six. It should feel like pressure, not scratching.
  5. Twenty to thirty strokes over one area, or until the skin has turned evenly red, then move on. If speckles appear, that area is done.
  6. Do one side, then the other. Five minutes total is usually plenty.
  7. Wipe off the oil, cover up, and keep warm. Avoid cold wind or a cold shower on the area for the rest of the day, and drink some water.

Unscented body massage oilFor glide

A light, unscented oil gives the tool enough slip to glide without dragging the skin. Fractionated coconut oil stays liquid and washes out of clothes easily.

  • Lets the tool glide instead of dragging
  • No fragrance to irritate freshly scraped skin
  • One bottle lasts months
Find it on Amazon (affiliate link, opens in a new tab)

How often

Once the marks have faded completely, you can do it again. For most people that means once or twice a week at most. More is not better; scraping over marks that have not cleared just irritates the skin. On the days in between, acupressure for tension headaches covers points you can press without a tool, and a warm pack on the shoulders helps too.

Putting it together

Warm skin, plenty of oil, a smooth tool at a low angle, one direction, firm but not painful, and stop when it turns red. Five minutes, then keep warm. Once a week is enough for most people. If the tension keeps coming back, look at what you are doing for the other eight hours of the day; the desk worker kit is a good place to start.

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Content on this site is educational and is not a substitute for individual medical advice, diagnosis or treatment. Talk with your own healthcare provider before starting any new therapy, especially if you are pregnant, have a medical condition or take medication.