The Graston technique is a form of manual therapy that uses specially designed stainless steel instruments to break down scar tissue and fascial restrictions in muscles, tendons, and ligaments. A practitioner glides these instruments across your skin with controlled pressure, targeting areas where soft tissue has become stiff, scarred, or restricted due to injury or chronic overuse. It falls under a broader category called instrument-assisted soft tissue mobilization (IASTM) and is used by chiropractors, physical therapists, athletic trainers, and other licensed practitioners.
How the Technique Works
The core idea behind the Graston technique is controlled microtrauma. When a practitioner applies pressure with the instruments across damaged or restricted tissue, it creates small-scale disruption at the cellular level. This triggers your body’s natural healing response, specifically by increasing the production of fibroblasts, the cells responsible for building and repairing connective tissue. Research on animal models has shown that fibroblast production is directly proportional to the amount of pressure applied, meaning the practitioner can adjust intensity based on the severity and location of the restriction.
This controlled irritation essentially “restarts” the healing process in tissue that has settled into a dysfunctional state. Scar tissue and adhesions form when injuries heal improperly or incompletely, leaving collagen fibers laid down in disorganized patterns. The instruments help break up that disorganized tissue so the body can replace it with healthier, more functional collagen. Over multiple sessions, this remodeling process gradually restores flexibility and reduces pain.
Why Instruments Instead of Hands
You might wonder why a practitioner would use metal tools instead of their hands. The instruments offer a few practical advantages. First, they amplify tactile feedback. As the clinician scans the tool across your skin, they can feel subtle vibrations and textural changes (sometimes described as “grittiness”) that signal exactly where restrictions and adhesions are located. This makes the assessment more precise than what fingertips alone can detect.
Second, the instruments allow deeper force transmission with less effort. A clinician’s hands can fatigue quickly when applying sustained deep pressure, especially over dense tissue like the Achilles tendon or plantar fascia. The tools concentrate force through a smaller contact area, making treatment more effective while also reducing repetitive strain on the practitioner’s hands and wrists.
Conditions It Treats
The Graston technique is used for both acute injuries and chronic conditions involving soft tissue. Common applications include:
- Plantar fasciitis (heel and arch pain)
- Tennis and golfer’s elbow
- Achilles tendinosis
- Carpal tunnel syndrome
- Rotator cuff tendinosis
- Shin splints
- Lower back strains and sprains
- Neck sprains and strains
It tends to be most effective for conditions driven by scar tissue buildup or chronic soft tissue restriction rather than acute inflammation or structural damage like a torn ligament.
What the Research Shows
A randomized clinical trial on patients with chronic plantar fasciitis found that those who received the Graston technique alongside conventional physical therapy improved significantly faster than those who received conventional therapy alone. After four weeks, the Graston group showed large, statistically significant improvements in both pain and foot function. The effect on pain was already measurable by the second week, suggesting the technique accelerates early-stage recovery. That said, general foot health scores didn’t differ significantly between groups by the end of four weeks, indicating the benefits are most pronounced for pain relief and functional improvement rather than broader outcomes.
Research on chronic low back pain has similarly documented improvements in both pain and range of motion. The overall body of evidence supports the technique as a useful complement to other therapies, though most studies are relatively small, and it’s rarely studied as a standalone treatment.
What a Session Feels Like
A typical session lasts 20 minutes to just under an hour, depending on how many areas are being treated and the severity of your condition. The practitioner applies an emollient (like lotion or cream) to reduce friction, then uses different shaped instruments to scan and treat the affected area. You’ll feel firm pressure and a scraping sensation. Some areas, especially those with significant restriction, can feel uncomfortable or tender during treatment.
Mild bruising, redness, and soreness afterward are common. These are considered normal responses to the controlled microtrauma and typically resolve within a day or two. Most treatment plans involve two sessions per week for about five to six weeks, with at least 48 hours between sessions to give your tissues time to heal and remodel. Some people notice improvement within the first few visits, while chronic conditions may take the full course of treatment.
Sessions are almost always combined with stretching, strengthening exercises, or other rehabilitation work. The Graston technique loosens restricted tissue, but exercise is what helps your body maintain the new range of motion and build functional strength around the treated area.
Who Can Perform It
The Graston technique is a proprietary method with a formal certification process. Eligible practitioners include chiropractors, physical therapists, occupational therapists, athletic trainers, osteopaths, medical physicians, podiatrists, acupuncturists, and even some certified personal trainers and massage therapists. Certification requires completing an essential training course on basic principles, followed by advanced training covering more complex clinical applications, and finally passing a credential exam. U.S. massage therapists face additional requirements, including a current license and at least 750 clinical hours of education.
If you’re seeking treatment, it’s worth confirming that your provider has completed the official certification rather than simply using generic instrument-assisted tools, since the training includes specific protocols for pressure, stroke direction, and treatment progression.
Safety and Contraindications
The Graston technique is generally safe when performed by a trained practitioner, but there are situations where it should not be used. An international expert consensus study identified several clear contraindications: unhealed or unstable fractures, blood clots or bone infections, open wounds, skin scrapes or blisters, acute skin inflammation, acute systemic infections or fever, and allergies to metals or the emollients used during treatment.
Conditions that require extra caution (but don’t necessarily rule out treatment) include rheumatoid arthritis, blood-thinning medications, mild to moderate skin hypersensitivity, and psoriatic arthritis. Some conditions fell into a gray area where experts couldn’t reach consensus, including cancer, lupus, varicose veins, healing surgical scars, and high-risk pregnancy. For these, the decision depends on your specific situation and should involve a conversation with your treating practitioner.
People with bleeding disorders like hemophilia, those with pacemakers or insulin pumps (when treating near the device), and those with severe skin hypersensitivity were also flagged as higher risk, though with slightly less consensus among experts. If you bruise very easily, are on blood thinners, or have any condition affecting your skin or blood vessels, mention it before treatment begins.