Graston Technique: is it a Gimmick?

The Graston Technique for Chronic Low Back Pain, Shoulder and Ankle Range of Motion

There are a number of healing modalities for soft tissue pain and injuries available, from prolotherapy to platelet rich plasma and even biofeedback. 

But one that has increased in popularity recently is the Graston Technique. The Graston Technique is a form of Instrument Assisted Soft Tissue Mobilization. 

Instrument assisted soft tissue mobilization (IASTM) is becoming more popular in western medicine. It is used to break up scar tissue and adhesions in order to improve mobility and minimize pain in places like shoulders, lower back and ankles. The Graston Technique is a form of IASTM. 

Through the use of stainless steel instruments that look like they are straight out of a horror film, therapists can identify areas of fibrosis or soft tissue adhesions that may be contributing to restricted movement and pain. 

Using these tools, the therapist gently scrapes at the surface of the skin where adhesions and scar tissue is thought to be, in the interest of improving mobility and reducing pain. These tools also increase blood flow to a given area which can encourage the body’s natural healing process. 

So, is it successful? 

That would depend mostly on the severity of the injury, the skill of the practitioner and the willingness of the patient to continue addressing the injury through other means like stretching and exercise. 

Is it a gimmick? 

So far, research has shown that it can be effective for reducing pain and improving tissue healing when performed correctly. Some are skeptical, claiming that any benefits seen can be chalked up to the placebo effect.

Let’s look at how the Graston Technique is performed, what body parts it can help and what the research says about its effectiveness so that we can conclude whether it is a useful modality for pain relief. 

How it Works

The Graston Technique is a form of instrument assisted soft tissue mobilization that uses stainless steel instruments to detect and treat areas of scar tissue and adhesions. The goal is to break down these adhesions, reduce pain and improve tissue healing.

It was developed in the 90’s by Dr. David Graston, a chiropractor and former athlete. 

The Graston Technique uses specific tools, sometimes made of metal or plastic, to gently scrape across the skin to break down scar tissue and adhesions. These tools allow the practitioner to detect scar tissue and adhesions and promote blood flow to an injured area which helps to “break up” the aforementioned scar tissue, as well as improve tissue healing and increase range of motion. 

A trained professional will apply controlled pressure to a specific area that is injured or typically experiencing pain. This applied pressure can be intense but is necessary to break up adhesions and promote blood flow to the injured area. There may be soreness and bruising following the session. Proper hydration afterwards is imperative. 

The Graston Technique can be used for any parts of the body that are known for overuse injury. These areas form scar tissue possibly because of repetitive use and constant breakdown. 

The Graston Technique is commonly used for:

  • Shoulders – For rotator cuff injuries and improving shoulder impingement
  • Neck and upper back – For muscle stiffness and postural issues
  • Lower Back – For chronic pain and stiffness
  • Knees – for patellar stiffness after knee surgeries
  • Ankles – for achilles tendonitis

A Quick Side Note on the History of the Graston Technique

While the Graston Technique was popularized in the 90’s here in the U.S., this type of modality may have been around for longer than you think. 

Gua Sha is a traditional Chinese healing technique that uses a jade tool to scrape along the skin. Gua referred to the scraping of the skin with the tool and Sha referred to the marks it left on the body that was believed to be palaces where the qi was being blocked and was unable to move about the body. 

Gua Sha has been practiced for thousands of years with its origins tracing back to ancient China. The technique is rooted in the belief that if the flow of qi, the body’s life force, can be improved, then the body will be rid of pain and illness.

Qi is considered the vital life force that flows through the body. It is believed that the smooth flow of qi is important for life and gua sha ensures that the body’s qi is flowing without interruption. 

During a session, the therapist uses specific tools to scrape at areas of the body, typically along the meridians which is thought to be where qi is flowing. If these pathways are not clear, it can lead to pain and illness. 

This process sounds familiar, doesn’t it? 

What Does the Research Say?

Researchers have shown a recent interest in the Graston Technique and IASTM in general and its effectiveness in healing long term injury. 

While research is still ongoing, several studies have shown positive results. 

  • Shoulders – For rotator cuff injuries and improving shoulder impingement
    • A 2012 study found that patients with decreased range of motion were able to restore range of motion after 1-3 sessions of Graston Technique
  • Neck and upper back
    • A 2021 study found that the Graston Technique, when combined with an exercise program was able to decrease pain and headaches in patients with cervicogenic headaches in only 4 weeks of intervention
  • Lower Back – For chronic pain and stiffness
    • In a 4 week study, Lee et al., found that the graston technique increased lumbar flexion, lateral bending and hip flexion compared to general exercise and the Graston Technique also decreased pain in patients with chronic low back pain 
  • Knees
    • In 2021, Tsokanos et al., found that manual therapy can induce a short term reduction in pain and increased range of motion in patients with osteoarthritis but concluded that more research is needed
  • Ankles
    • A 2019 systematic review concluded that instrument assisted methods could improve range of motion of the elbow and ankle. 

How does the Graston Technique and IASTM compare to some less invasive therapies?

  • Massage Therapy
    • A 2014 study found that massage therapy and the Graston Technique were similar in their ability to increase blood flow to the leg muscles. This would make sense as that is the aim of both modalities. Research is limited in terms of this comparison.
  • Foam Rolling
    • A 2020 randomized control trial found foam rolling to be just as beneficial as IASTM in terms of improving knee range of motion and decreasing perceived pain in 20 participants with quad pain and knee restrictions. 
  • Physical Therapy
    • A 2004 study found that deep friction therapy (Cyriax Method) was more effective than physical therapy in patients with adhesive capsulitis (frozen shoulder). 95 percent (19/20) of participants that used the manual therapy experienced greater range of motion and less pain while only 65 percent (13/20) of the participants that performed physical therapy exercises saw increases in range of motion and reduction of pain. 
  • Stretching
    • In a 2017 study, Moon et al., found that the Graston Technique was more effective than static stretching at improving hamstring length according to the sit and reach test

Key Takeaways:

  • Several studies suggest that the Graston Technique can improve range of motion.
  • While this looks promising, after diving into the research, I found limitations to each and every one of the studies, from small sample sizes to results relying on the patient’s ability to describe how their pain level has improved, while perceived pain can range from person to person. 
  • Studies suggest that, while graston technique can increase blood flow to an injured area, it is still too early to tell if it is capable of reversing long term injury. 
  • Some studies have postulated that IASTM can mitigate pain and improve the function, especially when combined with other interventions like stretching or corrective exercise but more research is needed. 

Conclusion

It is difficult to determine the effectiveness of the Graston Technique because in many studies, it is combined with another modality to improve tissue health like foam rolling or stretching. There is also the placebo effect to consider. Perceived pain is an interesting topic that requires a deeper dive. 

The Graston Technique is certainly not a gimmick. It has been used in some form for over 2000 years.  If you are injured, maybe the Graston Technique or IASTM is exactly what you need to start the healing process. It is not expensive typically ranging from 50-75 dollars but that may vary depending on your area. 

But like many modalities its effectiveness will range from person to person and it shouldn’t be used as the only form of intervention. Corrective exercise and joint mobilization should be included in your training as well. 

While the technique has been used for decades in western medicine, more research is necessary to be able to conclude that this is a worthwhile modality for pain and injury. As always, consult a doctor or physical therapist to decide if it could be helpful for you and your chronic pain. 

References:

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