Related Terms

• Adhesions, carpal tunnel syndrome, chronic inflammation, connective tissue, fascia, fascial restrictions, GASTM, Graston Augmented Soft Tissue Mobilization, Graston Technique® Instrument-Assisted Soft Tissue Mobilization, repetitive stress injury, scar tissue, soft tissue fibrosis, soft tissue injury, sprains, strains, subluxations, TherapyCare Resources.

Background

• Graston Technique® is a patented form of non-surgical instrument-assisted soft tissue mobilization that is used to break down scar tissue and restrictions in fascia (connective tissue present throughout the body, surrounding blood vessels, nerves, muscles, bones, and organs).

• The Graston Technique® uses a unique set of stainless steel instruments designed to break up scar tissue buildup in body areas such as the shoulder or wrist, which are often associated with acute or chronic soft tissue injuries. Soft tissues include skin, muscle, nervous (neurological), and connective tissues. Examples of soft tissue injuries include strains, sprains, subluxations (partial dislocation of joints), carpal tunnel syndrome, and repetitive stress injury. Treatment using the Graston Technique® involves sliding a stainless steel instrument designed for a particular body part over the surface of the skin in a back and forth motion. Generally, advocates suggest several Graston Technique® sessions for treatment of soft tissue injuries.

• Scar tissue is a type of fibrous connective tissue that may occur in any area of the body. This tissue generally receives a smaller blood supply than normal tissue and stretches less. Scar tissue also tends to be thicker than the tissue it replaces after an injury. Scar tissue may build up around muscles, tendons, and ligaments as the body heals from an injury. As a result, the movement of the surrounding body tissues may be impaired, or the patient may experience pain when they try to move. Clinically, the buildup of tissue after an injury is called soft tissue fibrosis, but most practitioners refer to these areas as adhesions.

• An athlete invented the Graston Technique® after experiencing an incomplete recovery from a knee injury. Surgery and other forms of conventional therapy did not return the athlete to full functionality. In order to find a way to fully recover from the soft tissue injury, the athlete used his background in machining to create the first templates of the stainless steel instruments used in the Graston Technique®. The parent company of the Graston Technique® is TherapyCare Resources. The first clinic using the Graston Technique® opened in 1994. Since then, several major sporting organizations use the Graston Technique® for professional athletes. Several bodywork therapy schools have integrated this modality into their curriculum.

• Advocates claim that the Graston Technique® may treat a number of conditions, including neck pain, temporomandibular joint (TMJ) pain, pain between the shoulder blades, lower back pain, hip pain, groin pain, hamstring pain and tightness, quadriceps pain and tightness, knee pain, ankle pain, plantar fasciitis (a painful condition affecting the foot and the foot arch), rotator cuff pain (a type of shoulder pain), tennis elbow, golfer's elbow, wrist pain, finger and toe pain, numbness or tingling at the extremities, carpal tunnel syndrome, and headaches.

• Several clinical trials are underway to evaluate the Graston Technique® for a variety of applications. Additional high-quality clinical research is needed before a firm recommendation can be made.

Technique

• The first part of the Graston Technique® treatment involves a patient warm-up, in which the patient moves the areas of soft tissue fibrosis. The area may be covered with warm packs, or the patient may receive ultrasound in the area. All of these warm-ups are intended to render the scar tissue more receptive to the treatment with the stainless steel tools and to decrease patient sensitivity to the pressure and friction that are applied to the scar tissue through the skin.

• A stainless steel tool is chosen based on the body part where the injury occurred. The tools are designed for following the length of muscles or other connective tissues that have been affected by the soft tissue injury. The Graston Technique® is used on a variety of body parts, including the shoulders, wrists, or calves.

• The clinician holds the instrument with one or both hands and positions it at about a 45 degree angle. The clinician then presses the edge of the tool into the skin and slowly slides it along the surface of the body area being treated. When the tool slides over an adhesion, it feels as if it has come into contact with what proponents call a "speed bump" or a "gravel-like grittiness." Both the clinician as well as the patient usually feels a change in the way the tool feels when this scar tissue is encountered. Adhesions are not usually visible on the surface of the skin, and conventional health care providers are not trained to detect these areas. Generally, the pressure is increased as the clinician rubs over the adhesions in order to induce some movement in these areas. Clinicians may also use the tools to detect scar tissue buildups that may not be visible on the surface of the skin.

• Through a Graston Technique® training course, clinicians learn the "feel" of an instrument as it slides over problem areas. Once the clinician identifies a problem area, it is evaluated for treatment. The tools are considered useful for identifying areas that may need treatment.

• The area of the injury is usually treated by repeatedly rubbing the stainless steel instrument over it. However, clinicians usually rub the instrument around other nearby areas to test for adhesions that may not be causing noticeable symptoms for the patient.

• Some individuals experience minor discomfort during a Graston Technique® treatment. Some individuals may experience bruising in the treatment area as well. Patients should always attempt to communicate the sensations they experience during a session to the practitioner. The person providing the treatment may adjust the rate of rubbing or the amount of pressure applied to the body area.

• The tools used on the smaller parts of the body, such as the wrist, may be used with one hand. However, instruments designed for larger parts, such as the back, require two hands and more effort on the part of the clinician.

• After each treatment, the injured area is stretched. The clinician may apply cold packs if the patient experiences soreness.

• Treatments typically last 30 to 60 minutes. Most patients receive two treatments a week for a course of four to five weeks. Patients are advised that they can expect to experience relief by the third or fourth treatment.

• Only individuals who undergo at least one Graston Technique® training course may purchase Graston Technique® stainless steel tools. Healthcare providers who typically use the Graston Technique® include athletic trainers, occupational and physical therapists, chiropractors, and manual therapists.

Theory/Evidence

• Injuries that may result in adhesions include pulled hamstrings, meniscal tears, plantar fasciitis, tight hip flexors, metatarsal phalangeal joint sprain (turf toe), shin splints, hip pain, IT band syndrome, shoulder pain, and a lack of flexibility or decreased stride length.

• Individuals who have not suffered a major injury but who experience some form of tightness in muscles, ligaments, and fascia are believed by proponents to also potentially benefit from the Graston Technique®.

• When a person is injured, scar tissue and adhesions may occur in the skin and the layers of tissue immediately below the skin. Adhesions and scar tissue are thought to prevent body structures underneath them from moving properly, and as a result, muscles, tendons, ligaments, and surrounding tissues (such as fascia) may be unable to move freely.

• After an injury, a person may describe an area of physical trauma as tight or painful. Some individuals are unable to move the injured area of the body as well as they once could. The abnormal binding of scar tissue is considered by Graston Technique® practitioners as the cause of these symptoms.

• Scar tissue and adhesions are thought to be problematic because they bind to fascia (connective tissue present throughout the body, surrounding blood vessels, nerves, muscles, bones, and organs). If fascia is involved in an injury, then the nearby tissues or organs may be abnormally held in place, or their movement may be restricted, a condition called a fascial restriction.

• Adhesions may also occur on a much smaller scale than an entire muscle or tendon. For instance, the tiny microfilaments that make up part of a muscle may have microscopic adhesions, as a result of cross-linking of muscle fibers that may prevent the muscle from contracting properly. Muscles may also develop adhesions to one another.

• Advocates claim that over time, due to the wear and tear of everyday life, performing physical labor or as a result of athletic activity healthy muscle fibers may adhere together in an irregular pattern, which results in rope-like structures. Graston Technique® tools are believed to move the adhered fibers and allow them to begin to separate. This process of muscle fiber separation is thought to release the pain and loss of functional mobility associated with adhesions.

• Advocates claim that the Graston Technique® may perform several important functions to restore functionality in the area of an injury. The rubbing of the Graston Technique® instrument over the affected area of soft tissue may stretch, separate, and break down the large number of collagen cross-links which form after a soft tissue injury. The friction of the instrument over the skin may also increase the temperature in the area and the volume and rate of blood flow to the affected tissues. Proponents also believe that a Graston Technique® therapy session may boost the cellular activity in the region and encourage the presence of some types of immune system cells, such as fibroblasts, which help to synthesize new cellular matrix, and mast cells, which help to minimize inflammation.

• A 2006 case study by Howitt et al. documented the progress of a patient with trigger thumb. The patient was treated with Active Release Technique and the Graston Technique®. After the treatment, the patient reported an improvement in pain.

Safety

• A qualified healthcare provider should be consulted before making decisions about therapies and/or health conditions.

• Some patients may experience a minor amount of discomfort during Graston Technique® treatment.

• Bruising at the area of the Graston Technique® treatment may occur.

Author Information

• This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

1. Aspegren D, Hyde T, Miller M. Conservative treatment of a female collegiate volleyball player with costochondritis. J Manipulative Physiol Ther. 2007 May;30(4):321-5. View Abstract

2. Graston Technique. www.grastontechnique.com. Last assessed August 24, 2007.

3. Hammer WI, Pfefer MT. Treatment of a case of subacute lumbar compartment syndrome using the Graston technique. J Manipulative Physiol Ther. 2005 Mar-Apr;28(3):199-204. View Abstract

4. Howitt S, Wong J, Zabukovec S. The conservative treatment of Trigger Thumb using Graston Techniques and Active Release Techniques(R). JCCA J Can Chiropr Assoc. 2006 Dec;50(4):249-54. View Abstract

5. U.S. Centers for Disease Control (CDC). www.cdc.gov. Last assessed August 24, 2007.