What is the Graston technique and when is it used?

Graston is an instrument-assisted soft tissue mobilisation (IASTM) technique using stainless steel tools of varying shapes to detect and treat areas of collagen disorganisation and fascial restriction. The instruments transmit feedback through the tool to the practitioner's hand, allowing identification of tissue changes that may be difficult to palpate with fingers alone.

The technique was developed in the 1990s and has a growing evidence base for specific presentations, particularly chronic tendinopathies and post-injury fibrosis.

Graston creates a controlled micro-inflammatory response at the treatment site. This sounds counterproductive, but it is not: the controlled stimulus recruits fibroblasts (collagen-producing cells) to the area, initiating a remodelling response in disorganised collagen. In chronic tendinopathy and post-injury scarring, this remodelling is the mechanism of recovery.

It also disrupts adhesions between fascial layers using shear force, similar to MFR but with the added ability to reach tissue depths and apply directional specificity that manual techniques alone cannot achieve.

Graston is most appropriate for: chronic Achilles and patellar tendinopathy where tissue quality is poor, post-injury fibrosis (scar tissue from a healed tear or surgical repair), plantar fasciitis in the chronic phase, and fascial adhesions that have not responded to manual pressure alone.

It is not appropriate for: acute injury (first 72 hours), active inflammation, open wounds, clients on anticoagulant medication, or presentations where the primary problem is neuromuscular rather than structural.

Graston is applied with lubricating gel over the treatment area. The sensation is described as scratching or scraping, not comfortable, but not aggressive. Post-session bruising (petechiae) in the treated area is normal and indicates the controlled inflammatory response. This fades within 3–5 days.

Sessions using Graston are typically shorter in duration for the technique itself (5–10 minutes on a specific area) and combined with other manual work and loading guidance.