Graston Technique

The Graston Technique® (GT) is a manual therapy used to diagnose and treat soft tissue injuries and pain. It involves using handheld instruments that allow clinicians to detect and treat scar tissue and adhesions in muscles, tendons, and ligaments.  It is usually performed to increase the range of motion of the soft tissues, especially after a soft tissue injury. 

It can be used to treat a variety of conditions, including tendinitis, plantar fasciitis, carpal tunnel syndrome, and rotator cuff injuries.  Short-term studies have shown that it successfully improves the range of motion with around six treatments for the ankle and elbow (1). 

Similarly, it can be used on the hamstrings and even lower back pain to treat tightness and muscular pain. Read further if you want to learn more about how the Graston Technique is used for therapy.

What Is The Graston Technique?

The Graston Technique is a method of instrument-assisted soft tissue mobilization (IASTM). In this unique method, dense stainless steel instruments are used to treat soft tissue dysfunction. At Centeno-Schultz, the Graston Technique has been utilized for several years now to:

• Amplify the effects of injection-based therapies performed by our Centeno-Schultz physicians
• Augment other adjunct therapies provided by the physical therapist at our Centeno-Schultz Clinic, such as functional dry needling
• Enhance the corrective-based home exercise program developed through the Centeno-Schultz Clinic

A typical Graston Technique treatment session usually lasts about 10 minutes. Because of the manual manipulation and mobilization required, there is commonly some minimal to mild bruising afterward. However, this bruising usually subsides within a week.

The History Of The Graston Soft Tissue Technique

The Graston Technique originated from a traditional Chinese medical treatment called Gua Sha, which used bone or jade tools to promote healing by scraping the muscles. This helped stimulate blood flow to the muscles.

In the early 1990s, David Graston, a chiropractor and amateur athlete, sought a way to effectively treat his own sports injuries.  He began experimenting with various tools and instruments and developed a variation of this Chinese treatment. He created a unique stainless steel tool and a form of massage to go with it, which came to be known as the Graston Technique. 

In 1994, Graston founded the Graston Technique® LLC, which began offering training and certification in the technique to healthcare professionals (2). Today, the Graston Technique is used by thousands of clinicians for the evaluation and treatment of soft tissue injuries and pain. 

How Does It Work?

The Graston Technique is performed by trained professionals that include physical therapists, chiropractors, and athletic trainers.

Evaluation of the area of injury is the first step, with close attention to the range of motion, pain level, and extent of scar tissue or adhesions.

Instrument selection is the next step based on the size, depth, and location of the affected tissue.

Next, the patient is asked to warm up the injured or dysfunctional muscle.  This increases blood flow to the region in preparation for the procedure.

Lubrication.  A lubricant such as lotion or oil is applied to the affected area to reduce friction and allow the instrument to move smoothly over the skin.

Treatment is the next step with specific Graston instruments to manipulate or massage the soft tissue. The instrument edges are very precise, so the massage technique is more specific when compared to using the hands or fingertips for a general massage. The practitioner uses the instruments to apply pressure and stretch the affected tissue, breaking up any scar tissue or adhesions that may be present.

Typically, each treatment lasts about 10 minutes. After the treatment, a re-evaluation occurs, documenting pain level, range of motion, and location and size of scar tissue or adhesions. The number of treatments needed depends entirely on the injury. 

Follow-up care may include exercises, stretches, and additional Graston sessions to optimize patient outcomes and prevent future injuries.

Acute injuries can respond fairly quickly to the Graston Technique, whereas longer-term injuries may take longer to recover, so need more mobilization sessions – especially if there is fibrous tissue. For those who have inflammatory conditions, treatments are only scheduled up to twice a week, so healing from the inflammation can occur between each session. 

Advantages Of The Graston Technique Over Other Physical Therapies

There are many advantages of the Graston Technique over other physical therapies. These advantages include the following:

Noticeable Pain Reduction

Studies have shown a noticeable reduction in pain after 3-6 sessions of the Graston Technique (3). There is more significant progress made after six weeks of therapy, with a more permanent pain reduction by then.

Can Be Used For Hypersensitive Patients

Not all patients have the same pain tolerance level. The Graston Technique is flexible and can be modified based on the patient’s sensitivity to pain. The therapist can change the intensity of the tissue mobilization based on the pain tolerance level, meaning the technique can be used for a wider variety of patients.

Significant Results Achieved Within 6-12 Treatments

When the Graston Technique is applied with a full treatment plan, including active stretching and dynamic exercises, people can see a complete resolution of their symptoms in about 6-12 treatment sessions. In fact, many people feel amazing almost immediately, although long-term results are usually only seen when using the technique consistently.  Graston Technique promotes tissue healing by breaking down scar tissue and increasing blood flow to the affected area. Some studies have documented can speed up the recovery progress (4,5). 

Detects And Treats Scar Tissue And Restrictions That Impair Normal Function

The Graston Technique is not just therapeutic but diagnostic as well. A good therapist or clinician will use the Graston instruments to identify the presence of scar tissue and restrictions in the soft tissue which prevents full mobility. The instruments used in Grason Technique allow for precise targeting of soft tissue dysfunction which can be more effective than traditional manual therapies.  Once identified, the therapist can precisely target the area of fibrosis and dysfunction and stimulate blood flow to that area.

Increased Rate Of Mobility Improvement

The Graston Technique can help increase the rate of mobility improvement. As the treatment promotes soft tissue healing because of the increased blood flow, it helps to alleviate pain and increase the range of motion. The muscles are manipulated by the instruments to break the fibrous tissue, which can improve the range of motion.

Can Be Combined With Rehabilitative Exercises And Other Modalities

The best part about the Graston Technique is that it can be combined with other rehab exercises, dynamic exercises, massage therapies, injection-based therapies, and modalities. It can easily be a part of your treatment plan in combination with other therapies.

Who Is The Graston Technique For?

Patient populations appropriate for the Graston Technique can vary from acute and subacute to chronic conditions involving the fascia and soft tissue.

The Graston Technique can be particularly effective for treating conditions that involve scar tissue and fascial restrictions.  Examples include:

1. Tendinitis and tendinosis
2. Plantar fasciitis
3. IT band syndrome
4. Tennis  and golfer’s elbow
5. rotator cuff injuries.
6. Adhesive capsulitis (frozen shoulder)

Typically, any orthopedic injury will have some associated soft tissue injury.  In most cases, these secondary issues can be treated with the Graston Technique.

 Is It Safe And Effective?

The Graston Technique works. It is a natural therapy that promotes muscle healing by increasing blood flow to the area. It is safe and effective when done by the right medical professional. Many individuals have tried to replicate the technique with butter knives at home only to find they have worsened the problem. A trained therapist knows how to apply the correct intensity to the dysfunctional muscle or soft tissue to maximize the benefit.

The Graston Technique At Centeno-Schultz

The Graston Technique is just one of many therapies utilized at the Centeno-Schultz to optimize patient outcomes. It is a very useful technique that can reduce swelling, inflammation, and pain and increase blood flow.  This allows patients to achieve the best clinical outcomes combined with PRP or bone marrow concentrate injections.

At CSC, we use a full treatment plan that includes exercise, stretching, and other modalities along with the Graston Technique to restore your range of motion and significantly lessen pain. Therapists decide on this treatment plan with your doctor, considering the type of injury, its duration, the primary treatment, and your pain threshold.

What To Expect With The Graston Technique

Most patients report stimulation of blood flow to the targeted areas and a reduction of their pain. Sometimes there may be some reddening (called petechiae) or bruising that can occur in the affected areas targeted with the Graston instruments. This is typically very short-term and resolves within a few days. Patients usually respond well after the bruising subsides, with improvement in both the pain as well as function.

Recovery After The Treatment

The recovery period after the treatment is short. Here’s what you can expect to experience with the Graston Technique:

• During the technique: Fine bruises may appear during the procedure, which usually resolve in less than a week.
• Immediately after the technique: It is normal to feel sore after a treatment session. You can use ice therapy for 15 minutes to relieve the soreness.
• In the days after the technique: Continue doing the stretches and exercises as the therapist prescribes. This will help the injured muscles to heal faster.

Other Alternative Therapies Available With Us

At Centeno-Schultz Clinic, we offer alternative therapies as well. These include:

Dry Needling/Intramuscular Stimulation (IMS)

Dry needling, or intramuscular stimulation, is a therapy where acupuncture or filament needles are inserted into trigger points and tight muscles. It is used for both acute and chronic conditions where there is neuromuscular dysfunction.

Cupping

Cupping is a form of alternative medicine where the therapists use special cups to create suction on the muscle, simulating a deep tissue massage. It is used to relieve inflammation.

Blood Flow Restriction Therapy (BFR)

In Blood Flow Restriction Therapy (BFR), the clinician uses a tourniquet to reduce arterial inflow and occlude venous outflow with resistance training or exercise. This stimulates muscular development and can increase strength.

Is The Graston Technique For You?

If you have a soft tissue injury from the past or a chronic joint condition like arthritis, there is likely to be some associated connective tissue dysfunction.

The Graston Technique is a unique treatment that has helped many individuals regain mobility and alleviate pain after a soft tissue injury. The Graston Technique can be used with your existing therapy, so it is a good treatment option to consider.

Contact us now to learn more about how the Graston Technique can help you.

Physical Therapists at Centeno-Schultz Clinic

Mark Reilly, PT, MS, IMS-P

Excercise Rehabilitation Director for the Centeno-Schultz Clinic. Mark Reilly, PT, MS, IMS-P, earned his Master of Science degree in Physical Therapy from Regis University in 1999. He began his career with the Centeno Clinic back in 2000, where he worked with a population that mostly consisted of chronic pain patients.

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References

1. Bush HM, Stanek JM, Wooldridge JD, Stephens SL, Barrack JS. Comparison of the Graston Technique® With Instrument-Assisted Soft Tissue Mobilization for Increasing Dorsiflexion Range of Motion. J Sport Rehabil. 2020;30(4):587-594. Published 2020 Nov 25. doi:10.1123/jsr.2019-0397
2. In 1994, Graston founded the Graston Technique® LLC, which began offering training and certification in the technique to healthcare professionals
3. Lee JH, Lee DK, Oh JS. The effect of Graston technique on the pain and range of motion in patients with chronic low back pain. J Phys Ther Sci. 2016;28(6):1852-1855. doi:10.1589/jpts.28.1852
4. Melham TJ, Sevier TL, Malnofski MJ, Wilson JK, Helfst RH. “Chronic ankle pain and fibrosis successfully treated with a new noninvasive augmented soft tissue mobilization technique (ASTM): a case report.” Medicine and Science in Sports and Exercise. 1998;30(6):801-4.
5. Loghmani MT, Warden SJ. “Instrument-assisted cross fiber massage accelerates knee ligament healing.” Journal of Orthopaedic and Sports Physical Therapy. 2009;39(7):506-14