Graston Technique / IASTM

What it is

Graston Technique belongs to the broader category of instrument-assisted soft tissue mobilization, a clinician-applied method in which purpose-built, beveled metal instruments are stroked across skin and underlying tissue to locate and treat areas of fibrosis. Fibrosis refers to the abnormal buildup of dense, disorganized collagen that forms after injury, repetitive strain, or surgery. Normal tendon and muscle tissue has a parallel, organized fiber arrangement. Injured tissue heals with cross-linked, randomly oriented collagen that is stiffer, less vascular, and more sensitive to mechanical load. The instruments transmit a tactile signal back to the clinician's hand that is difficult to reproduce with fingertip palpation alone, making it possible to map adhesions along a tendon or fascial plane with considerable specificity. Common indications include chronic tendinopathies such as lateral epicondylitis (tennis elbow) and Achilles tendinitis, plantar fasciitis, iliotibial band syndrome, and postoperative or post-injury scar tissue. ^[1]

The proposed mechanism operates on two levels. Mechanically, the instrument introduces controlled microtrauma to pathological tissue. This brief, targeted disruption is thought to restart the normal inflammatory cascade, drawing fibroblasts and growth factors to a site that had stalled in a chronic, non-healing state. Biologically, the reactivated healing response promotes the synthesis of organized collagen and improved local circulation. At the same time, the technique stimulates cutaneous and subcutaneous mechanoreceptors, which may modulate pain perception through spinal and supraspinal pathways. Research pairing Graston Technique with graded exercise has shown measurable improvements in functional and sensory outcomes across several musculoskeletal conditions, suggesting the mechanical and neurological effects work together rather than independently. ^[3]

What to expect

A Graston session at begins with a brief postural and movement assessment. identifies the affected tissue, applies a lubricating emollient to the skin, and selects from a set of instruments shaped to match the contours of different anatomical regions, flat instruments for broad muscle bellies, convex or concave instruments for tendons and joint margins. He then performs systematic strokes across the target tissue at controlled angles and pressures, pausing when the instrument transmits the characteristic resistance associated with fibrotic or adhered tissue. Patients often feel a mild scraping sensation and localized warmth. Petechiae, small reddish spots caused by capillary dilation near the surface, are a normal tissue response and typically resolve within a day or two. Transient soreness in the treated area is common for 24 to 48 hours after each session.

A typical course of care involves multiple sessions spaced several days apart to allow the tissue response to cycle between treatments. Graston Technique is almost always combined with therapeutic exercise, including stretching and isometric contractions, because movement loads the newly stimulated tissue and guides collagen remodeling along functional lines. Studies examining this combined protocol have compared Graston Technique plus exercise against exercise alone, finding the combined approach to produce greater improvements in both function and pain in conditions such as tendinopathy. ^[2] Most patients begin noticing a change in tissue texture and a reduction in movement-related pain within the first several sessions, though the total number of treatments depends on the chronicity and extent of the fibrosis present. For details on what a full course of care might include, see .

Key benefits

• Graston Technique restores normal collagen fiber orientation in chronic scar tissue by reinitiating a controlled inflammatory response that stimulates organized healing. ^[1]
• The stainless steel instruments extend the clinician's ability to detect subtle fibrotic changes in tendons and fascial planes that standard manual palpation can miss.
• When paired with corrective exercise, including stretching, isometric contractions, and postural correction, the technique has demonstrated clinically meaningful functional improvement in tendinopathy patients. ^[3]
• Addressing the soft tissue component of a complaint alongside spinal care helps correct the full mechanical picture, since restricted fascia and muscle adhesions alter load distribution across joints.
• The method is applicable to a wide range of common chronic conditions, from plantar fasciitis and Achilles tendinitis to iliotibial band syndrome and postoperative adhesions, making it a versatile addition to a chiropractic care plan. ^[1]

Who benefits most

Patients with chronic soft tissue injuries are among those most likely to benefit. The defining feature of a chronic injury is a tissue that has transitioned out of the acute healing phase but has not regained normal structure or function, often because the inflammatory response that drives organized repair has downregulated prematurely. This pattern appears frequently in repetitive-use injuries of the shoulder, elbow, forearm, knee, and ankle, as well as in the tissue changes that follow orthopedic surgery. Patients with Low Back Pain or Neck Pain who have a palpable myofascial component alongside their spinal complaints are also common candidates, since adhesions in the thoracolumbar fascia, paraspinal musculature, or cervical soft tissues can limit the range-of-motion gains that spinal care alone produces.

Athletes returning from injury, desk workers with cumulative strain patterns, and post-surgical patients managing scar tissue formation represent the populations seen most often in clinical practice. Contraindications exist and are taken seriously. Open wounds, active inflammatory arthritis, anticoagulant therapy, thrombocytopenia (low platelet count), and local malignancy all preclude treatment over the affected area. conducts a thorough intake and physical examination before recommending any soft tissue intervention, and patients whose presentation involves significant neurological findings or systemic conditions are evaluated and referred appropriately. The goal is to identify the specific tissue problem and match it to a technique that addresses the underlying pathology rather than just the symptom.

How it connects to chiropractic

Graston Technique fits naturally into a chiropractic practice because the soft tissue system and the articulating skeleton function as a single mechanical unit. Adhesions and fibrotic restrictions in muscle, tendon, and fascia alter the tensional environment around spinal and peripheral joints, changing load distribution and limiting the range of motion that the joint would otherwise achieve. When a joint is chronically restricted by the surrounding soft tissue, a chiropractic adjustment addresses the articular component, and IASTM addresses the fascial and myotendinous layers simultaneously. Neither modality accomplishes alone what both accomplish together. Research on spinal adjustments has demonstrated a large positive effect on cervical range of motion, with links between improved joint mechanics and broader neuromuscular function attributed to input changes at the central nervous system level. ^[5] Graston Technique acts on the peripheral tissue that supports that improved range of motion, reducing the mechanical pull from fibrotic structures that would otherwise draw the joint back toward restriction.

The neurological rationale for combining these approaches is well supported. Spinal adjustments have been shown to affect neuromuscular function through central nervous system pathways, a mechanism investigated and described across multiple convergent models in the chiropractic literature. ^[7] IASTM adds a peripheral mechanoreceptor stimulus that modulates local and segmental pain processing, complementing the centrally mediated effects of the adjustment. Patients presenting with neck pain who have both cervical joint dysfunction and myofascial adhesions in the upper trapezius or suboccipital region illustrate this synergy clearly. The same logic applies to low back pain cases where lumbar spinal dysfunction coexists with iliotibial band or thoracolumbar fascial restriction. For patients whose presentation also involves a degenerative disc component, spinal-decompression can be layered into the plan to address the intervertebral space, creating a multi-tissue approach that targets bone, disc, joint, and soft tissue within a single care episode. Clinicians pairing these methods with therapeutic exercise, the same exercise protocols studied alongside Graston Technique, have reported functional outcomes that exceed what any single modality achieves in isolation. ^[4] Techniques such as Active Release Technique (ART) and Myofascial Release address overlapping tissue layers and are available alongside Graston Technique at this practice. To learn more about's background and clinical approach, visit . To take the next step toward resolving a persistent soft tissue complaint, reach out through .

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