09 Sep Should You Try Graston Technique?

If you’re reading this about Graston Technique, you’re probably an athlete who wants to increase performance and/or have been in pain for a period of time and you’re seeking better pain relief from some unconventional treatment.

If you’re either one, you’re in the right place.

In this post, I will discuss:

1. What Graston Technique is.
2. Where Graston Technique can work really well.
3. Where Graston Technique is completely ineffective.
4. If You Should Try Graston Technique or Not.
5. What You Should Expect if You Try Graston Technique.

What is Graston Technique?

Graston Technique is an instrument-assisted soft tissue manipulation technique (IASTM) started in 1994.

Don’t get confused by the acronym IASTM.

IA – Instrument-Assisted means the provider is a using a tool other than his hands.  Below are the Graston Technique instruments.

Picture courtesy of www.grastontechnique.com/gt-instruments

ST – Soft tissue typically means in and around muscles, which are soft.

M – Manipulation means touching and moving the muscles.

Graston Technique was originally designed by athletes, for athletes, to address scar tissue and fascial restriction for the purpose of increasing range of motion and ultimately, fixing pain.

Scar tissue means fascial adhesion caused by trauma.  To observe fascial adhesion in a model, below is Dr. William Brady of Integrative Diagnosis (1:38):

Fascial restriction means when the fascia is not able to move.  Normally, fascia stretches, slides, and is quite movable.

Going forward, I will use the term adhesion to identify what Graston Technique is treating.

If you were to experience Graston Technique yourself, the provider would have you either be still or move as he is treating you.  He would glide the tools over your body, looking for adhesion.  When he finds adhesion, he would continue to glide the tools over your body for a series of passes, with the purpose of breaking up the adhesion.  In doing so, the intent is that you experience less pain and increased flexibility.

Here is a short video on how Graston Technique works (3:29):

Where Graston Technique Can Work Really Well

If you’re going to try Graston Technique, you should know where it can work really well.

That means you need to understand a few principles of IASTM techniques.

Without understanding of these principles, you could fall prey to the technician who only uses Graston technique and no other tools.  Your potential for pain relief would have an artificially low ceiling.

Here, I’ll outline the principles. Below, I’ll dive into more detail so you own these concepts and can challenge your provider if they’re breaking any of Mother Nature’s rules.

She always wins.

Principles for IASTM Effectiveness

1. LOCATION: The adhesion must be less than 1″ away from the skin. (If the provider is trying to Graston your psoas through your intestines, run!).
2. MUSCLE FIBER DIRECTION: All muscles fibers closer to the skin must be parallel to the direction of the muscle where the adhesion lies.
3. PRESENCE OF FAT: There should be minimal superficial fat on between the skin and the adhesion.
4. TREAT PROBLEM AREAS ONLY: The instrument should only be used where the the instrument is vibrating as the adhesion catches on the tool and/or a sound is made as a product of effective treatment. In other words, the provider shouldn’t spend time treating already healthy tissue.  This might surprise you that it has to be said at all. But it does need to be said.

Location

Below is a list of areas where IASTM techniques (including Graston Technique) work really well.  Don’t be confused by the terminology of body parts.  I simply intend to distinguish between what is treatable vs. not treatable in nearby locations.

This distinction is important because many providers will shotgun an area, claiming that every body part is treatable with an instrument.  In our practice, Barefoot Rehab, I have found this concept to be false.

If you’re currently being treated with Graston Technique and you don’t notice any changes after 3-5 visits, feel the instrument working, or hear a noise that it’s working, you should question the provider.

• bottom of the foot and on the plantar fascia
• achilles tendon (but not the calf muscles due to Principle #2)
• front and outside of the shin
• knee capsule, MCL, and LCL ligaments
• patellar tendon
• superficial quad muscles
• hamstring tendons (but not hamstring muscles due to Principle #3)
• front and back of the forearms
• front and back of the hand and fingers
• bicep
• tricep
• latissimus dorsi (but not any of the rotator cuff muscles)
• Lumbar Spine: supraspinous ligament or erector spinae aponeurosis (but not the low back muscles due to Principle #2)
• Thoracic Spine: supraspinous ligament (but not the back muscles due to Principle #2)
• Cervical Spine: ligament nuchae (but not the neck muscles due to Principle #2)

Muscle Fiber Direction

For treatment to work in muscle #2, all of the muscle fibers in muscle #1 must go in the same direction.

In the image below, notice that muscle #1’s fibers are moving towards you while muscle #2’s fibers are running parallel to the screen.  This is a recipe for ineffective treatment.

Treating your mid-back muscles with an instrument is ineffective due to this phenomenon.

But treating your forearms, where the muscles closer to the skin run in the same direction, is a recipe for effective treatment!

Presence of Fat

When there’s fat in the way of the adhesion, treatment will be ineffective.

The fat phenomenon is the reason why the 30 year-old female with hip pain on both sides got 24 treatments of Graston technique with no improvement.

Treat Problem Areas Only

Imagine you have cancer.  If there were a treatment that removed only the cancer cells and left your skin, hair, energy level and immune system, untouched, would you want that treatment?

When it comes to removing your adhesion, there are ways to remove only the cancer and leave the rest of your body healthy.  Unfortunately, many providers today are still  “shotgunning” the area of complaint, hoping to get the problem area, damaging healthy areas at the same time.

The Chinese gua sha treatment is known for the bruising observed below.

Picture courtesy of https://en.wikipedia.org/wiki/Gua_sha

A qualified adhesion provider will remove only the dime-sized adhesion in a specific spot using the Test-Treat-Retest methodology before continuing.

If your problem area looks like this guy’s back, you deserve better.

Where Graston Technique Is Completely Ineffective

The list of effective treatment locations above includes some areas that are ineffective.

The distinction of what is treatable with Graston Technique (or other IASTM techniques) vs. isn’t is extremely important.  It determines the difference between you spending hundreds (if not thousands of dollars) and hours of time/wasted energy vs. getting out of pain rather quickly.

The doctor who gave one of our bilateral hip pain patients (the pain was present for 8 months before seeing us at Barefoot Rehab) 24 treatments of Graston Technique to her groin muscles had the right diagnosis. See the case study below (5:26).  Her adductors were one of two primary problems.

However, the groin is completely ineffective with Graston Technique due to Principle #3 – the presence of fat.  Three treatments of Manual Adhesion Release to her adductor magnus and posterior hip capsules and this patient noticed a dramatic, sustainable difference in her hip pain.

Three treatments of 80% improvement vs. Twenty-four treatments with 0 % improvement.

Choose the right practitioner wisely.

Here is the list of structures that are completely ineffective with Graston Technique (and other IASTM techniques):

• calf muscles
• hamstring muscles
• groin muscles
• deep thigh
• hip capsule
• low back, mid back, and upper back muscles
• front of spine (where the psoas is located)
• front or back of neck

I’ve heard legends that providers will “attempt” to treat the psoas muscle with an instrument.  Not only is the psoas sometimes 3″, 5″, or even deeper depending on how much body fat a person is storing in their abdomen, but their are intestines in the way.  The instrument “blade” is sharp enough to tear adhesion close to the skin.  Deep to the intestines and the belly fat, the instrument has ZERO chance of treating the adhesion present in the psoas.

I digress.

If You Should Try Graston Technique or Not

Use Graston Technique (or any other IASTM) when:

• you can find your pain on the list of structures where Graston Technique works really well.  If you aren’t being helped yet, find a provider of Graston Technique.

Do NOT use Graston Technique (or any other IASTM) when:

• the location of your pain is on the list of structures that are completely ineffective.

At Barefoot Rehab, we treat adhesion from the bottom of the skull all the way down to the pinky toe.  The approximate percentages we use an instrument vs. our hands is:

• 30% of the time, we use the instrument designed by Dr. William Brady of Integrative Diagnosis.  This is the gold-standard treatment for adhesion in specific areas of the body.
• 70% of the time, we use our hands with Manual Adhesion Release (MAR) or Active Release Technique (ART).  MAR is the gold-standard treatment for adhesion where an instrument is ineffective.

If you want to find the best provider possible to meet all of your chronic pain + adhesion needs, I recommend you find an Integrative Diagnosis provider.  There aren’t many of us out there. But if you’re lucky enough to live near one, ID Providers are training to humble themselves to do whatever a person in pain needs.  The goal is that patients don’t become pigeon-holed into treatments that a doctor uses on every single patient who walks through the office.

If you don’t live near an ID Provider, then do the best you can patchworking different providers based on your knowledge of your pain.

What You Should Expect If You Try Graston Technique

Make things as simple as possible, but no simpler. ~Albert Einstein

Here are the minimum, simple expectations for receiving effective treatment:

1. The pain should be reduced at least 10% in five visits or less.

If your pain isn’t reduced, something is wrong.  Even if you’ve had the pain for a long time.

Reasons for a lack of results include all of the following:

• you could be doing too much (excessive load) on the damaged body part (i.e. refusing to stop running or typing excessively while at work)
• the wrong adhesion can be treated (You have adhesion everywhere. The key question is to find the adhesion that is causing your problem.)
• the right adhesion can be treated ineffectively (You can get massaged all day long and not break up the adhesion.)
• you could have a metabolic or psychological issue (i.e. Celiacs disease, unmanaged veganism or vegetarianism, or you’re going through a divorce)
• you could have a degenerative structural problem (i.e. osteoarthritis or a disc problem)

Regardless of the reasons, your cue at visit 5, if you don’t have results yet, is to ask your provider how the plan’s going to change moving forward.  If he doesn’t sound like he knows what he is talking about, find another provider.

2. During the treatment, you should hear grinding and see micro-bruising (known as petechiae).

Be weary of the instrument holder who paints your arm pink.

You want to damage the sick tissue, not the healthy tissue.

3. Your flexibility should be immediately increased after the treatment and permanently increased after five treatments.

When your flexibility (or range of motion) has increased, you know that the adhesion responsible for your tightness has been removed.

If your tightness stays the same, whatever the problem is that is causing your tightness is still in your body.  This doesn’t mean that your pain can’t decrease if your range of motion stays the same.

4. Your treatment plan should involve more than Graston Technique.

Avoid reductionists at all costs.

A reductionist is a provider who reduces everyone’s problems to their specific solution.

If your provider is only delivering Graston Technique with no other solutions, a red flag should go up in your head.

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With this information, you are now empowered to judge for yourself, as a patient and client, what type of care you should be getting for your pain.  Unfortunately, we cannot trust our healthcare systems, the government, or even individual doctors to be an advocate for our most pain-free selves.

Being empowered means less pain in your body, more money in your pocket, and more energy to live the life you dream of.

Read The 7 Biggest Mistakes People Make When Choosing a Pain Doctor to save yourself some trouble.

By Dr. Chris

Dr. Chris Stepien, DC, Full-Body ID Certified, ART Certified, CSCS, and CrossFit Level 1 Certified, fixes your annoying and frustrating pains, even when it's been over 6 months and you've seen 3-5 other doctors or therapists without lasting relief Barefoot Rehab in Denville, NJ. And when you're sad, depressed, or not enjoying life, Dr. Chris wants to hug you. He invites you to reach out, no matter what your concern is. Barefoot Rehab is here to serve you.