Graston Technique: A Case Study and Other Thoughts on Instrument Assisted Soft Tissue Mobilization Techniques

UPDATE: There is a new article that discusses my current recommendations for the best IASTM tool.  This newer article contains my updated recommendation for several Graston alternatives and information on my online educational programming teaching you how to use IASTM.

Today’s guest post is quick overview of the Graston technique and it’s application within a case study by Eric Schoenberg, MSPT, CSCS.  I thought Eric did a great job with the post and have will share some of my thoughts on instrument assisted soft tissue techniques, such as Graston technique, at the end of this article.

Graston Technique

graston techniqueRegardless of treatment philosophy, it is difficult to dispute the importance of soft tissue work to help treat pathology, correct muscle imbalance, decrease recovery time, and restore proper muscle recruitment and firing patterns.

While there are many available soft tissue options, in my practice, I have found Graston techniques to be particularly useful in both treatment and evaluation.  Many people don’t realize that the Graston technique can also be a valuable diagnostic tool to quickly “scan” or evaluate a patient’s soft tissue quality and determine its contribution to a patient’s current symptoms or injury risk factor.

The Graston technoique concept is grounded in the works of English orthopedist James Cyriax and the concept of cross fiber treatment. The treatment edge of the Graston instruments allows for improved precision in the treatment of fascial restriction and fibrotic/scar tissue.

I wanted to share my experience and techniques with the Graston technique and will use a case study to illustrate the benefits and specificity of the Graston Technique.

The patient is an 18 year old male who is a 3-sport athlete (football, basketball, baseball) presenting with 9 month history of anterior knee pain consistent with patellar tendinosis. The patient presents with the following objective findings at evaluation:

  • Point tenderness at inferior pole of patella
  • Pain at end-range supine and prone knee flexion
  • Pain with resisted concentric and eccentric knee extension (Kendall MMT position)
  • Decreased hip mobility B
  • Decreased ankle DF ROM B
  • Decreased lumbopelvic/hip and single leg stability
  • Decreased gluteal/core strength B

The patient is participating in pre-season football conditioning with emphasis on sagittal plane squat/split squat/lunge activities, sprinting (including hills), and plyometrics (sagittal plane). He is using foam roller daily on own to improve tissue quality. His symptoms are gradually worsening with increased training intensity.

After evaluating the patient, I decided to include Graston technique treatment focused on the quadriceps, ITB, adductors, hamstring, gastroc/soleus, and tibialis anterior muscle groups.  Here are a couple of examples:

Graston Technique – Seated Quadciceps

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Graston Technique – Seated Patellar Tendon

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One specific application of Graston technique is the ability to effectively treat the injured area in positions of provocation. This patient experiences symptom reproduction in the split squat/forward lunge position:

Graston Technique – 1/2 Kneel Position

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Graston Technique – Dynamic With Squat:

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Treatment Outcomes

The patient was seen for 3 treatments with full resolution of symptoms. Treatments consisted of the following:

  1. 1. Tissue quality: Graston technique, daily lower body foam roller program
  2. 2. Mobility: hip and ankle mobility exercises, active warm-up corrective exercises
  3. 3. Multiplanar strength: frontal and transverse plane strength (emphasized single leg activity, band walks, lateral lunges, lumbopelvic stability- chops/lifts)
  4. 4. Activity Modification: patient educated in proper jump/land technique, limited sagittal plane repetitions, proper muscle firing patterns

Clinical Observations From Using the Graston Technique:

1. The specificity of the treatment edge and the ability to provide uniform pressure is what sets the technique apart from other manual approaches.

2. The instruments truly enhance the clinician’s ability to detect and treat fascial restrictions and adhesions (particularly effective in positions of provocation).

3. Incorporating stretching and strengthening (tendon-loading) exercises with the instrument assisted soft tissue mobilization is the key to promoting re-alignment of the fibers and helping to fully remodel the injured tissue.

4. Coupling Graston in the clinical setting with self myofascial release (SMR) products, such as foam rollers and other similar equipment at home or in an athletic setting (pre/post activity) is an ideal way to achieve maximum success.

Lastly, at least for me, the most exciting part of using Graston Technique in the clinical setting is feeling better suited to treat the more difficult diagnoses (plantar fasciitis, chronic tendonosis, etc) with the expectation of good clinical outcomes.

 

My goal in writing this article is to present a simple case to allow the reader to appreciate the functionality and ease of use of the Graston Technique. In addition, it is important to note that Graston (along with any soft tissue treatment) should be used in conjunction with skIASTMilled movement evaluation and prescription of corrective exercise to allow for the most effective clinical outcomes.

Eric Schoenberg, MSPT, CSCS is co-owner of Momentum Physical Therapy with offices in Milford, MA and Wellesley, MA.  The owners of Momentum PT are experts in the human movement system. Their mission is to bridge the gap between traditional medicine and fitness with emphasis on patient education and injury prevention.  Visit eric’s blog at www.momentumptblog.blogspot.com.

 

Mike’s Thoughts

UPDATE: There is a new article that discusses my current recommendations for the best IASTM tool.  This newer article contains my updated recommendation for several Graston alternatives and information on my online educational programming teaching you how to use IASTM.

Eric, great article and examples of use of the Graston technique.  I’m sure the patient got better from your very well thought out treatment plan and all of the techniques and exercises you performed in combination with Graston technique.

It is important to note that while this article is specifically about the Graston technique, it also applies to instrumented assisted soft tissue mobilization (IASTM) techniques in general.  Late last year I polled my readers and 20% of you said you used IASTM, including Graston technique, SASTM, and ASTYM.  We could also group in the traditional Gua Sha to this mix as well.

I have used these techniques and do incorporate IASTM in my practice, I have also taken the basic Graston class (though have not taken SASTM and ASYTM classes and have not used their tools).  Here are my thoughts:

  • IASTM is a valuable component of my treatments, but just a component.  Just like everything else, it has its value and it has areas where I would choose another technique.
  • There are a lot of misconceptions here and the internet makes this worse – a huge black and blue down the leg is not what you are trying to achieve using IASTM.  I consider this a sign that you’ve done too much.  This is a misconception.
  • The actual Graston Technique tools and courses are really good.  If you have the budget to go all out for these, great, they will be great to work with. Visit their website for more info, I would be surprised if you were not satisfied with the course and their tools.  They have put a lot of thought and effort into their technique and tools.
  • I do not use the Graston instruments.  I think many more people should learn IASTM techniques.  If you really like the technique and want to learn more or get the better Graston tools, great.  But cost should not be a reason that you don’t learn how to use IASTM.
  • In regard to tools, I go traditional Gua Sha from China.  I have tried other tools, like the Starr Tool, they are good, but more expensive.
  • In regard to Gua Sha tools, you can Google them, there are many shapes and materials for anywhere from $2 to $10.  Horn is a good starting point, but in the grand scheme I would grade them as stone > jade > horn.  Just my opinion.  I have a bunch of horns as they come in a variety of versatile shapes, and a few jades and stones.  So far Bian or Energy stones have felt best for me, but these are closer to $20-$40.  Still cheap in contrast to some of the other instruments.  If you are not sure, start with the horn.

 

What do you think?  What has been your clinical experience with Graston technique, instruments, and other instrument assisted soft tissue mobilization techniques?

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51 Responses to “Graston Technique: A Case Study and Other Thoughts on Instrument Assisted Soft Tissue Mobilization Techniques”

  1. Great post, Mike & Eric, and well-done embedding videos for a case study. I first experienced Graston on my tennis elbow that resolved itself after 2 treatments. I have tried other tools and techniques, but find the heavier steel Graston tools give me better feedback and less effort. I now help teach an advanced technique using Graston tools called FAKTR (http://www.faktrpm.com). It incorporates motion, resistance, and proprioception with IASTM… I see some amazing results. Graston Technique is also a great program to market to the public and referring physicians. But I agree with you that using the ancient Chinese tools is excellent as well!

  2. Mike,
    I enjoyed the post on Graston technique, We use quite often in the clinic and I am interested in trying some of the alternative tools you have recommended you use. It is important for us as clinicians to continue to evolve and expand our skill set to provide the best results for our clients. Thank for keeping us thinking and current.
    Best
    AR

  3. I concur with Phil’s and Andrew’s comments. We have incorporated Graston Technique in our outpatient facilities for nearly 5 years. Mike your comments are on point, but I would like to add thought regarding the business side of what we do as clinicians. My problem (as a PT owner) is potential liability with using something “home-made” or “plastic / bone.” How will you answer the question on the stand…? “Where did you get your training? Oh you took a Graston Course… Great, do you use the instruments taught in the course? No, what do you use? A plastic, bone do-wickee? I see the jury eyes rolling… Also, I like idea (research and comment please…) that I can clean steel with a good cavicide or equivalent… What about ASTYM, SASTM or star tool being plastic and porous? Can you get your patients skin cells out / off it before your next patient? Not sure. As for total cost, I agree that the price point is a bit high, but so is the cost of a good US machine or a quality Hi-Low table both of which will probably not last as long. Best wishes.

  4. I am familiar with graston, but have never taken a course or directly experienced it myself. Several colleagues use it daily with reported great success, of which I do not doubt. We have never really discussed how you choose the target. In your case study you stated, “I decided to include Graston technique treatment focused on the quadriceps, ITB, adductors, hamstring, gastroc/soleus, and tibialis anterior muscle groups”. Curious as whether you targeted all these in one treatment session or in different sessions. If they were treated in different sessions, how did you chose which muscle to direct treatment toward first, and which did you treat subsequently and why? How many muscles can you treat in a session? How long does a session last and much time do you need between sessions? Is there a sequence or an algorithm that you follow? Impressive results! Sorry for all the questions, and thanks in advance for the answers.

    • Thanks for the questions Larry.

      On evaluation, the Graston instruments allow for a quick “scan” to determine tissue quality and areas of fibrosis are easily identified and become possibilities for treatment. In this case, the distal quadriceps and patellar tendon were the most fibrotic and therefore treated first. In addition, treating the tendon was the most direct way of restoring painfree ROM. Progression of treatment is dictated by the greatest ability to restore proper firing patterns, eliminate movement dysfunction, and assist in restoring normal joint mobility (i.e. talocrural joint). It is important to note that Graston is used as a component to the overall plan of care and is most effective when coupled with corrective exercise and neuromuscular re-education. Session length or treatment time on each muscle is arbitrary and is determined by tissue quality. (no different than other manual technique). In the case of Graston, the “manual time” is greatly reduced. Hope this helps!

    • Good answer Eric. Larry, the scanning with the tools is helpful in finding areas of restriction, but I also use the tools to work on other areas that may be impacting the site of injury. Sort of like the anatomy trains concept.

      In regard to timing etc, I usually only hit one area for 1-3 minutes, in my experience they wont need longer and you risk some capillary damage and the nasty black and blue.

      I stop when I start to see some redness develop, not bruising.

  5. Hi Eric,

    Do you have any research on the ability to identify these fascial restrictions / adhesions? Is there any valid way which shows these restrictions connect to the painful problem? Is the force utilized in your treatment sufficient to make a structural change? I’ve ran numerous marathons and have been told I have various fascial restrictions through my lateral quadriceps and ITB, but yet I have no history of knee pain. Do you consider nonspecific and placebo effects as a result of your treatment success (which I am npt denying), or are you familiar with the research coming out on the effects of manual therapy

  6. Hi Daniel-

    Thanks for the post. There are links to research on the Graston Technique on their website: (http://www.grastontechnique.com/Research_Reports.html)
    In addition, there is a nice JOSPT article http://www.jospt.org/members/getfile.asp?id=4495
    Beyond that, it is important to recognize that there a lot of people that have fascial restrictions that are asymptomatic. This does not mean that in conjuction with muscle imbalance, faulty movement patterns, and pattern overload, that these people are not at risk of developing symptoms. In addition, it is clear that manual therapy is an art form as well as a science and is only as good as the particular practitioner. So yes, I do feel that Graston played a key role in this particular patient’s progress, however, without increasing ankle and hip mobility, increasing gluteal and lower abdominal firing patterns, and modifying his jump/land technique (among a host of other changes)this patient would not have done as well.

  7. I agree that cross friction massage/IASTM can be useful in an overall treatment plan.

    I would like to point out that ASTYM is not a form of IASTM. There may be some confusion because the research that resulted in ASTYM treatment began some time ago with research on manual therapies, including friction massage, and how the addition of tools may assist in those approaches. However, the focus of ASTYM research quickly turned away from those manual therapies and concentrated on how certain physiological changes can be induced on a cellular level with the proper stimulation. Inducing the desired underlying physiological responses which result in healing and regeneration became the fundamental factor that guided the development of protocols and application of the ASTYM process.

    Rather than trying to mechanically break down tissue as IASTM does, ASTYM treatment focuses on activating an underlying physiological response leading to the regeneration of soft tissues.

    • Tom, appreciate the clarification. I don’t have experience with ASTYM so this was insightful. Thanks!

    • Hey Tom. Thanks for your response. You obviously have been trained in ASTYM. I’m not sure if they are teaching this in the courses, but both ASYTM and Graston were invented by David Graston. The company had some internal issues and divided into 2 entities. ASTYM and Graston are both more than cross-friction modalities and have much the same science behind them. The only real difference are the tools!

      • There seems to be some significant misunderstanding about the history of ASTYM and Graston, and also about the differences between ASTYM treatment and IASTM (Graston, Sastm, etc.). For those interested, I have posted blog articles that give the details about the history of ASTYM and Graston, in addition to reviewing the substantial differences in the goals and application of ASTYM and the various IASTM approaches. Here are the links:
        http://blog.astym.com/blog/astym-3/astym-vs-iastm-graston-sastm-etc-how-they-are-different
        http://blog.astym.com/blog/astym-3/graston-sastm-and-astym-what-is-the-history-v2

        • Hi Tom – I want to believe, but I have to admit, the “science” behind ASTYM isn’t there for me, the website uses vague statements like:

          “ASTYM treatment focuses on activating an underlying physiological response leading to the regeneration of soft tissues.”

          I want to believe… make me a believer!

          • The ASTYM program is committed to science in the traditional sense – studies conducted under widely accepted scientific/medical standards for research. To date, the research team has successfully conducted a number of basic science studies, case series and case studies, outcome studies, and controlled clinical trials. Here is a link to my blog entry discussing the controlled clinical trial on lateral epicondylitis that was presented at the American Society for Surgery of the Hand:
            http://blog.astym.com/blog/astym-3/effective-treatment-for-tennis-elbow-presented-at-hand-surgeons-meeting
            Also, here is a link to other peer-reviewed research references and summaries for ASTYM:
            http://astym.com/professionals/research.asp
            If you have any questions, or would like to talk by phone, I would be happy to discuss the research and scientific basis of ASTYM further with you at your convenience, just email me directly to set up a time to talk.

            • Thanks Tom, interesting. Great to see articles like this and the database concept is impressive. Truth be told, I still know very little about ASTYM, the website is very vague and there is a lot of “mystique” about it that I can see may turn some people off. Regardless, I am intrigued… Email me by hitting the “contact” button at the top of this page.

              Best,
              Mike

  8. Tom,

    Out of curiosity, what are you referring to when you say, “certain physiological changes can be induced on a cellular level with the proper stimulation. Inducing the desired underlying physiological responses which result in healing..”

  9. Mike, great post & really liked the embedding of the videos. Just a couple of points on the tools themselves – we have used the SASTM tools in our clinic – less expensive than Graston and owned rather than “rented”. However, several of them have already been broken from being dropped on the floor. Otherwise, I like them OK. I do like the contouring of the Graston tools. We considered getting the gua sha tools for the clinic but I too was a little worried about the cleaning of them. I am planning on ordering some for personal use.
    RE: training – I have not taken a Graston course but did the basic SASTM. How shall I say – even though it was for a small, casual group, one had to abandon our idea of a professional presentation and the use of current supportive research for the course that was presented to us.
    That being said, I agree with most, that it is a great adjunctive tool in our box.

  10. I have not used any of these tools myself, but I am looking forward to learning. The clinic that I currently work at uses the Graston Tools and I think a few of the clinicians have become too dependent on them.

    It’s another tool that you have to determine what is best for each individual case…

    Thanks guys!

  11. Kenneth Cieslak, DC, ATC, CSCS Reply January 30, 2011 at 5:58 pm

    I just came across this thread, and would like to add my “2 cents”.

    There are actually many different instruments out there that are effective for performing IASTM. I actually researched this topic, as I gave a workshop on it at NATA. I examined all the primary IASTM treatment systems (ASTYM, GRASTON, SASTM, Gua Sha), as well as Active Release Technique and John Barnes MFR. It goes over the research each technique has had published, as well as some of the basic science. In reality, they are all effective in the hands of the right clinician. Tom Sevier, who commented earlier, is actually an MD who was part of the initial research on IASTM with David Graston, but they parted ways back in the 90′s. FAKTR-PM is where I believe the best results are headed. As for instruments, stainless steel does appear to resonate best (atleast to me, and many clinicians I have consulted)and heavier instruments allow you to push less, which improves tactile sensitivity. As for cost, some less expensive options for SS instruments include the Narson Body Mechanic (www.narsonbodymechanic.com) and the Scimitar Tool (www.scimitartools.com). I use the Scimitar tool myself, and think it is a great value. You can even go as cheap as an Aluminum Shrimp Deveiner ($2.99 Ebay) but it is really light, and gets exhausting to use repeatedly. Cheers!

    • Thanks for the comments Kenneth. Any interest in sharing your presentation from NATA???

      • Kenneth Cieslak, DC, ATC, CSCS Reply February 1, 2011 at 6:22 pm

        Hi Mike,

        Actually, I accidently left it out of my last post, but I did present the same lecture on Sportsrehabexpert, as a webinar back in the fall (?). It is in the archives of the website, and is titled, “Evaluating the Popular Soft Tissue Therapies: Choosing Which is Best for Your Athletes”. It is also archived on Anthony Renna’s StrengthandConditioningWebinars website.

  12. I am new to Mike’s site and have enjoyed the information and posts. I have been a Graston practitioner for 3 years, finished the M2 course in sept of 09. I find remarkable results in my setting . . . which is intercollegiate athletics. I do find that you have to know what types of injuries/conditions respond to it, have an extensive understanding of anatomy and pathomechanics and know your client/patient. Some people just don’t like the idea of you coming at them with “metal tools” no matter how nicely you explain it to them, but most athletes I work with love it.

    I am most impressed when I treat an athlete with IASTM who has had pain for long periods of time with non-IASTM interventions and in 1 treatment they are 90% if not 100% pain free. As Eric said, it is 1 component of a comprehensive program, but it can really make a difference.

    I would really like to try the Gua Sha techniques. I do not have any experience with the other techniques mentioned.

    • Good comments Jeanne, I agree with your thoughts regarding the “metal tools!” But they always end up liking it in the long run. Also agree with your comments on specific conditions.

      I personally do not like using these instruments on acute injuries and on many ligaments. Too aggressive to me and would rather just use my hands.

      I actually questioned this at the Graston course and received a less than perfect response. They originally said that this is perfect for acute injuries and acute ligament injuries but when I questioned they backed down and basically just left it as go easy and just use it to pump away edema. To me, there are better ways to do this without the tools.

  13. Kenneth Cieslak, DC, ATC, CSCS Reply February 1, 2011 at 6:35 pm

    I agree Mike on your approach! I do recall that the Graston Staff did suggest they were effective on acute injuries, but there is no research that I am aware of that supports this hypothesis. In fact, one of the most recent research articles by Loghmani (who is one of their key researchers) looked at the use of IASTM on the MCL of rats, and essentially concluded that the use of IASTM did hasten the healing response, but in fact, did not change the end result of healing much from the control group. So based upon that study, it would be hard pressed to even suggest that IASTM (Graston) improves final healing outcomes vs any other approach (though it may speed it up somewhat). I think the use of IASTM is a valuable tool… but again, just one of many tools in our therapeutic toolbox. My primary concern is with clinicians who decide it is the best approach to use with every condition. You know the old saying, “If all you have is a hammer, everything looks like a nail…”

  14. Hi, I came across this page whilst searching for Kenneth Cieslak, DC.(who commented above) I’ve just watched a webinar he did on this subject which was really Informative. I started making IASTM tools last year after my wife returned from a FAKTR-PM course and one of the first things I realized was that an IASTM tool is very personal..Whilst one person will prefer a certain tool, another will prefer something completely different, yet they may both have attended the same course to learn the technique. One problem I have at the moment is that over in the UK there is still only a handful of Therapists trained in IASTM techniques, and what I would love to do is to work with someone like Kenneth Cieslak, DC, or someone similar who has had a lot of experience using different tools. The way my business is set up allows me to design tools which can be made specifically to suit an individuals own requirements and I believe their is a need for something like this, but until someone challenges me to design one to suit them personally, I’m uncertain if this side of my business is required. Kenneth..can you help?

  15. Great post Mike. how would you apply Graston on a shoulder condition – client in a dynamic position? would it be something like holding a pushup position, while the therapist uses the instrument?

    • It could be, but would say that is pretty advanced, think just arm movements specific to the muscle

    • Hi Ben. A nice feature of Graston is the ability to treat patients in positions of provocation (i.e. squat, lunge, pushup, etc.) However, with that said, these are also the easiest positions to make a patient’s symptoms worse. (depending on the skill of the clinician). Graston does a nice job of training this topic in their higher level modules. Thanks for the comment.

  16. Thanks Mike and Eric. I’m not a chiro, but going to start chiro first year and little bit of exposure to massage… i have tried the tcm instrument and tried scraping (gua sha) on some shoulder areas and get the reddish effect which i guess would be labeled as hypoxia (in tcm they might have a differen explanation), so i guess it’s a case of many roads leading to rome. But as mentioned in somebody’s post, holding the tcm instrument can be tiring.

    btw, re itb and tfl, i managed to use my thumb to dig in the thigh area and then kinda grasp, release n grasp to break the adhesions / knots… surprising to also get the (temporary) bruising (black n green).. not worried though cos after a few days the marks disappear. For me, i have found this more useful than scraping (or foam rolling).
    Dunno what you would call this technique ha!

    Thanks again for sharing everyone!

  17. Mike this has been a great conversation. I am always looking for discussion on the topic and to see how other clinicians are utilizing IASTM. I was first exposed to IASTM during the first year of physical therapy school. My classmates and I cringed at some of the costs. I started making a tool, Fibroblaster, out of stainless steel for us. Check out http://www.fibroblaster.com for a quality IASTM tool. Thanks for all the information. I will be sure to pass this onto other that I know, so they too can learn.

    • Jacob, kudos to you for doing this. Email me througgh tue contact page, would like to try one, maybe if I like it I can somehow help get the word out? Best,
      MR

    • Jake, I love the Fibroblaster. I have had some great results with my patients. Thank you for making a quality IASTM tool at a reasonable price.

  18. Great article! Thanks for writing and posting! Some great insights and ideas. I’ve used IASTM as part of my therapy protocols for several years with great success. I have several IASTM tools that I have or am currently using. Most recently I picked up a Scimitar Tool from a DC in Colorado and considered one called the Narson N6 from another DC in Florida. Initially, I started with a set of polycarbonate tools by GuaShaTools that were inexpensive and served me and my clients well.

  19. Hey Mike,
    I would like to try these tools, but i’m having trouble seeing their benefit over using my hands. What areas/diagnosis do you find it’s worth using these tools instead of using your hands?

    • I felt that way initially too, there are different and the technique is different. I feel they are complementary to using our hands. I’ve been playing with IASTM for some time and really find it useful on chronic posture adaptations, which is pretty much everything!

    • Hey Nick-

      Give Graston a try. Huge difference from using your hands. It is not possible to feel the “gritty” fibrotic tissue to the same degree with your hands vs. the instruments. They are excellent for post-op rehab., ms. strains, epicondylosis, tendinosis, plantar fasciitis, etc. Used in conjuction with a properly prescribed therex program, the results are impressive.

  20. Nick,
    If you go to the Graston website they have a slide show which shows what happens to the tissues and how the tools can help you to get results that your hands wouldn’t be able to achieve alone (slides 7,9 & 10 in particular)
    My wife is trained in Sports Therapy, CranioSacral Therapy and more recently Functional Therapy, and like yourself would never have believed that a tool would give her a better result than her physical touch, until a friend of ours returned from one of the FAKTR-PM courses. He didn’t have a tool with him at the time (not even a tea spoon, coin or key was to hand), so he simply used his nail on various points on my wife to demonstrate the technique, and she was amazed at the immediate results it gave. She returned home and spent the next couple of months experimenting with a spoon from our kitchen and some cheap Gua Sha tools bought on e-bay. During this time (and before I’d even manufactured her first tool) she had many amazing results with clients and booked on to the next available FAKTR course here in the UK.
    The reason I mentioned that story is that though there are some amazingly good courses out there, it’s really the clinicians experience and knowledge that will enable someone to get good results from knowing when to apply this effective technique.
    Although I’m certain that all of the methods/courses out there are excellent, we only have experience of the FAKTR course and we particularly liked its emphasis on load and motion, combined with the opportunity of using different tools to find out your preferences. There new website is now http://www.faktr.com by the way. We’ve heard equally good reports on Graston, SASTM, AYSTM etc, as ever it’s about finding what’s right for you.
    Hope this is useful..
    Malc

  21. Here’s a link from a presentation prepared by an Orthopaedic Manual Therapy Fellow regarding soft-tissue mobilization including IASTM. It include basic science references regarding the physiologic response of tendons to manual vs instrument imparted linear forces. It is a little long, but I found it very infomrative.

    https://connect.regis.edu/p78856226/

  22. Got my first taste of the Graston Technique this weekend. I completed the 12-hour M1 training. It was an excellent course! And definitely another tool to add to my rehab toolbox. I’m excited :)

  23. Hi Mike,

    Never read your Graston Case Study post, so it was great to hear and read about Gua Sha. Unfortunately, for a student such as myself, it’s simply not feasible to get work done by a PT often (or at all since it costs an arm and a leg) or afford expensive tools. Did some exploring and I’ll probably buy a horn for my first go around.

    Anyways, really enjoy your work and how you make it free to all of us. I cite you often over at a bodybuilding.com.

  24. Richard Bartlett Reply March 30, 2012 at 7:58 pm

    I am a massage therapist in Michigan who heard about Graston tools but have no way to afford those. I watched a few video demonstrations of Graston and other IASTM practitioners, then did some practice on myself and my wife (she has juvenile rheumatoid arthritis and lots of contractures and adhesions) with, believe it or not, a common teaspoon! Turned in different ways, the handle has straight, concave, or convex surfaces, and the oval part can be used for small or medium areas. After a few sessions with this, I was able to release one surgical adhesion, and increase circulation and reduce her edema markedly, for several days following each massage. I worked out swelling and tendon adhesions in my own hands with it as well. I was impressed with the results enough to buy The Edge, which seems to be a variant of the Fibroblaster tool. Both are available for just over $100.

    A lot of the same motions that can be done in manual swedish massage can be done with a tool. Effleurage and lymphatic drainage are very effective, and it is the best weapon I have found against edema. Deep tissue work feels much less deep to the client and yet is more effective, in a session that is about one quarter of the length. The tool seems to do a combination of compression and stretching to an area just a few cells wide, and flushes the capillaries almost immediately. I have been able to improve circulation, work out trigger points, and make fascia more pliable with a much shorter session than I would have needed with manual techniques.

    Also, from what I understand, IASTM in any form can increase the healing and pliability of tendons. I cannot see how different trademarked forms of IASTM can be significantly different in effect, having seen results myself from the simplest applications of the principle. Many of the comments in this regard seem to be mere posturing by proponents of one system or another. Any qualified massage therapist with any knowledge of anatomy can do this.

  25. Hi Mike,
    I am wondering if you are aware of any legal issues with the use of Gua Sha or IASTM techniques as a Physical Therapist, having never taken an official course (so no certification), but having learned from reading descriptions of the technique and demonstrations from other PTs. I have used Gua Sha with excellent results over the past year, but have been warned that this may be out of a PT’s scope of practice.
    Thanks for any insight at all.

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