How I Use Muscle Energy Techniques

Muscle Energy Techniques

The latest webinar recording for Inner Circle members is now available below.

Muscle Energy Techniques

This month’s Inner Circle webinars shifted gears a little bit.  Rather than talk about a specific injury or treatment focus, we discussed a general technique, muscle energy techniques.  I liked this approach as I think there are a lot of immediate clinical implications that will allow you to start using muscle energy techniques right away.  Here is just a few of the things we covered:

  • The history and background of muscle energy techniques from both the physical therapy and osteopathic fields
  • The effects and efficacy of muscle energy techniques
  • A review of some of the various different methods of using muscle energy techniques
  • How I use muscle energy techniques to increase motion, decrease guarding, reduce hypertonicity, perform joint mobilizations, and teach self-stretches
  • How you can start integrating muscle energy techniques into your current skill set.


To access the webinar, please be sure you are logged in and are a member of the Inner Circle program.

3 Tools to Get More Out of Your Programs in 2013

Ah, it’s that time of the year again, time for New Year’s resolutions!  While many people will be taking the plunge and dedicating some time and energy to fitness goals, the real challenge is sticking to these New Year’s resolutions for more than a month!  There are many reasons why people don’t stick to their workouts and fitness New Year’s Resolutions.  Some of them are just facts of life, such as time commitments, financial concerns, and lofty expectations.

Two common reasons for not sticking to your fitness resolutions that I have observed are soreness from the initiation of a new program and plateaus in your progress.  These are much more manageable and something that I think are sometimes related to mobility issues that can be addressed.

For the person just beginning a fitness program, muscle soreness and tightness after performing new exercises is essentially expected.  But there are some ways to reduce this soreness and get over the initial hump a little easier.  Movement and massage are two prime examples.  For the person that has some workout experience but aren’t working with a qualified professional, they often have some muscle imbalances and movement restrictions because someone isn’t helping them address their weaknesses.  Everyone wants to work on their strengths, right?

These are both obvious reasons as to why you want to work with a qualified strength and conditioning coach or personal trainer that can help identify and address your mobility concerns.  But what if you don’t have the access to a great coach and just want to start a home workout program or buy a generic gym membership?

Here are 3 tools that I recommend for you to get more out of your programs in 2013.  For a small amount of money, you can start your own package of tools that you can use at home between workouts.  Use these tools daily for 10 minutes and you’ll move and feel better between workouts, which will allow you to get more from your programs.



Foam Roller

GRID foam roller Foam rollers are a staple for many people and certainly not anything new.  While foam rollers are popular at the gym before a workout, having one at home to use between workouts is a must as well.  Many people consider a foam roller a “self-myofascial release” tool.  I’m not sure if we are making any significant fascial changes when we foam roll, but the combination of the compression on the tissue and movement associated with foam rolling likely has a positive effect on neuromodulating tissue soreness and tightness.  What does this mean for you?  You’ll feel better and move better when you are done!

How to Use a Foam Roller

I recommend two uses for foam rollers – 1) as a generalized full body program, and 2) on specific sore muscles.  I would recommend rolling out the major hot sports of the body, such as:

  • Low back
  • Mid back
  • Posterior shoulder
  • Lats
  • Glutes
  • Hips
  • Quads
  • Hamstrings
  • Groins

I essentially recommend 5-10 full length rolls of each area, performed in a slow and controlled pace each day.  If specific muscles are sore after a workout, I would emphasize these and perform another 5-10 reps, however, if you find a specific point of discomfort, you can pause at that spot for 10 seconds.  Take a few deep breaths and try to relax.  I would also recommend performing a few thoracic spine extensions while rolling the mid back.  Here is a great video demonstration from Eric Cressey.  He hits a few different areas, however, the general concepts are the same and these are great examples.  There are also a few trigger point ball examples towards the end, but more on that later:

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What Foam Roller to Buy?

I currently recommend two foam rollers, one for beginners that are just looking to incorporate foam rolling and another for more advanced uses that don’t mid spending a little more.

  • For Beginners: Perform Better Elite Molded Foam Rollers.  Pretty much a great basic foam roller that you can get for around $25
  • For Advanced Users: The Grid Foam Roller.  When you are ready to step up to a more firm roller, the Grid is by far the best on the market.  I don’t really think all those ridges and nubs do anything, but this is a great firm and durable roller that will last you a lifetime.  It’s a bit pricier between $30 and $40, but worth it.



Massage Stick

theraband massage rollerWhile foam rollers are great, they aren’t perfect for every body part.  Essentially, if you can’t put a lot of weight through the foam roller, it doesn’t feel like you are doing much.  If you notice the above list of muscle areas does not include the entire body.  To hit more specific areas, a massage stick is a great tool and essentially a foam roller with handles!  You can use your hands to put more pressure into the movement when body weight isn’t available.  I see a foam roller and massage stick as complementary, and a massage stick is great for:

  • Calfs
  • Outer side of lower leg
  • Upper traps
  • Forearms

As you can see, pretty important areas, and spots that foam rollers really don’t hit well.  Not only do these areas get sore, but limitations often result in poor performance when training.

How to Use a Massage Stick

I use a massage stick just like a foam roller, with about 5 full length rolls on each area.  If sports are sore, which is pretty common in the calf and upper trap, I will pause there for about 10 seconds.  Here is a demonstration I have used in the past on how I use massage sticks for the forearm:

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What Massage Stick to Buy?

I have used several massage sticks in the past and must say that there is only one I would currently recommend as it is by far superior to the others:

  • TheraBand Roller Massager+.  I was skeptical when I first used this massage stick, assuming that the ridges were just a way of separating themselves from the rest of the market.  However, the combination of the ridges and the material of the roller makes for a great combo and the best roller on the market!  The material grabs the skin well and the ridges create a drag sensation in addition to the compression.



Trigger Point Ball

sklz reaction ballWe have progressed from a foam roller, to a massage stick, and now to a trigger point ball, the third component of a great self-help tool package!  Even with a roller and a stick, there are still some areas that are just too hard to get to.  As you can see, we are getting more specific with each tool.  Here is what I use trigger point balls for:

  • Specific trigger points in the glutes and hips
  • The QLs
  • Upper and middle trap areas
  • Posterior rotator cuff
  • Plantar fascia

If these are areas of concern for you, you’ll want to get some sort of trigger point ball to hit these spots with ease.

How to Use a Trigger Point Ball

Using a trigger point ball is a little different from a roller or a stick, I usually don’t recommend rolling the body on the ball, but rather just stick to a trigger point release.  These balls can get to a small specific spot, so you can hit multiple points in each area, holding each for about 10 seconds.  Here is an example of using a trigger point ball on the posterior shoulder:

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What Trigger Point Ball to Buy?

I typically use a couple of different trigger point balls, depending on how firm I want the ball to be.  I would recommend the softer balls for beginners and firmer for advanced users.  I think lacrosse balls are great, but they are pretty firm and don’t have a small nub to use, making them less than ideal for some areas.  Here is what I recommend:

  • For Beginners: Trigger Point Therapy Massage Ball.  These are a little more expensive than lacrosse balls at about $15, but they are softer and have a little nub than you can wedge into different areas, which I like.  This is a good starting point, but if you weigh a lot or plan on using it exclusively for the glutes, the brand new Trigger Point Therapy X-Factor Ball is a little larger and more firm.  I use these a lot.
  • For Advanced Users: SKLZ Reaction Ball.  You know those little yellow reaction balls that you drop and bounce all over the place?  A friend just recently turned me on to these as trigger point tools!  They work great!  They are firm and have great little nubs to really get in to the tissue.  Plus you can usually find them for under $10.
  • You can always just go with a simple lacrosse ball as well.  But they are pretty firm for beginners some times and don’t have the added benefit of any points or nubs to emphasize an area.  That being said they are under $2!


By combining these 3 tools, you’ll have a perfect home kit to help you move better and feel better between workouts, which means you’ll get more out of your programs and hopefully stick to those New Year’s resolutions!




Frontal Plane Stability, Soft Tissue Duration, and Cash Based Practice

This week’s stuff you should read comes from Chris Johnson, Patrick Ward, and Jarod Carter.


Inner Circle Update

This month’s Inner Circle webinar is actually happening later today!  We will be talking about how I integrate science and evidence into exercise selection.  I love topics like this and feel that little tweaks to exercise can you make you look like a rock star.

Inner Circle members can head over to the dashboard to sign up for the webinar.  I’ll get a recording of the video posted ASAP afterward as well.  Click here to learn more and join the program. Update

There were a few new webinars added to this week!  We have a ton more coming too.  Here is what was new this week:

  • Part 2 of Kevin Wilk’s Current Concepts in ACL Rehabilitation covering several concepts of biomechanics, exercise, and neuromuscular training during the intermediate phase of rehabilitation from week 2 to week 10.
  • Peripheral Neuropathies by Dr. Mike Ellerbusch, who I have collaborated with in past EMG studies
  • Surgical Options for Knee Arthritis in Young Athletes by Dr. Lyle Cain.

And also working on a ton more webinars including kinesiology taping, integrating neuroscience, and more strength and fitness webinars.



Frontal Plane Stability Drill

Chris Johnson shows a nice video of a frontal plane stability drill he uses in runners.  I like the thought and emphasis on the stability of the leg on the ground and the core.  Notice how well Chris performs the exercise and doesn’t allow a hip hike o r



Cash Based Practice Advice 

Jarod Carter includes a nice video of his speech to a group of physical therapy students about cash-based practice.  Nice message and Q&A session.



How Long Should We Spend on Soft Tissue

Patrick Ward answers a question he received regarding how much time we should spend on soft tissue.  To summarize, as long as we need to produce the desired effect!  But how many times in a crazy outpatient setting do we get rushed?



Self Myofascial Release for the Forearm

I wanted to show a quick video of a technique I use for self-myofascial release of the forearm.  Obviously, this is a hard area to get with a foam roll and some of the techniques I have seen using the various trigger point balls don’t seem to apply enough pressure for me.  Here is a quick clip demonstrating:

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The video uses the new Thera-Band Roller Massager+.  Obviously you can use you stick of choice, like the original Massage Stick or Tiger Tail, however I must admit that the Thera-Band stick is my current go-to massage stick device.  I was a little skeptical at first about the ridges, thinking it was just a way to differentiate itself from the competition, but it really does feel better than the other sticks.  The rubber surface with the ridges makes for a nice combination of compression and superficial drag.


Self Myofascial Release for the Forearm

In the video above you’ll notice a few things:

  • I position the stick at an ~45 degree angle and really wedge it into a firm surface.  This gives me a nice rigid platform to roll on.
  • I use this just like a foam roll.  I start with simply rolling back and forth the length of the muscle groups, then stop on any trigger points that I find and hold for a sustained released, then I progress to include multidirection movements that include fascial release techniques.
  • For the flexor and pronator group, I start with the wrist flexed and pronated and as I roll I extend and supinate.
  • This is reverse for the extensor and supinator group, I start with the wrist extended and supinated and as I roll I flex and pronate

This is a great warm-up for the forearm and also a great technique to include in home exercise programs for those with injuries such as medial epicondylitis and lateral epicondylitis.  Try it and let me know what you think about this or if you have any other self-myofascial release techniques for the forearm that you find to be helpful.

Trigger Point Dry Needling for Lateral Epicondylitis

Today’s guest post is from Ann Wendel on trigger point dry needling and the effect of dry needling for lateral epicondylitis. Dry needling is gaining more popularity and becoming another great option when dealing with trigger points. Ann went through Myopain Seminar’s dry needling certification. I have had the pleasure to get to learn from some of the instructors of the trigger point program, including Katie Adams, and definitely recommend them if this is of interest to you.

Trigger Point Dry Needling


 Trigger Point Dry NeedlingDry Needling is a physical therapy modality used in conjunction with other interventions to treat myofascial pain and dysfunction caused by trigger points. Myofascial trigger points (MTrP’s) are defined as hyperirritable nodules located within a taut band of skeletal muscle (Simons et al., 1999). Palpation of a MTrP produces local pain and sensitivity, as well as diffuse and referred pain patterns away from the affected area. Painful MTrP’s activate muscle nociceptors that, upon sustained noxious stimulation, initiate motor and sensory changes in the peripheral and central nervous systems. (Shah et al., 2008).

Trigger point dry needling can be used to achieve one of three objectives. First, trigger point dry needling can confirm a clinic diagnosis by relieving the patient’s pain or symptoms of nerve entrapment. Second, inactivation of a MTrP by needling can rapidly eliminate pain in an acute pain condition. Third, inactivation of the MTrP through needling can relax the taut band for hours or days in order to facilitate other therapeutic approaches such as physical therapy and self stretching (Dommerholt and Gerwin, 2006).

Universal precautions are always followed when utilizing dry needling in patient care. During the procedure, a solid filament needle is inserted into the skin and muscle directly at the myofascial trigger point. The trigger point is penetrated with straight in and out motions of the needle. The needle can be drawn back to the level of the skin and redirected to treat other parts of the trigger point not reached in the first pass (Dommerholt and Gerwin, 2006). During this procedure, it is essential to elicit twitch responses in the muscle. The local twitch response (LTR) is an involuntary spinal reflex contraction of muscle fibers within a taut band during needling. Research shows that biochemical changes occur after a LTR, which correlate with a clinically observed decrease in pain and tenderness after MTrP release by dry needling (Shah and Gilliams, 2008).

Trigger Point Dry Needling for Lateral Epicondylitis

Trigger point dry needling is an effective treatment modality for numerous acute and chronic musculoskeletal issues. One condition that responds favorably to dry needling is lateral epicondylitis. Therapists know that this problem has usually become chronic by the time the patient seeks treatment, and progress is usually frustratingly slow for both the patient and the therapist.

When dry needling is incorporated into the treatment plan, results are often seen after 2 or 3 visits. The entire forearm is easily treated with the patient supine on the treatment table, and multiple TrP’s can be treated in a matter of minutes. After a thorough history and physical exam, the therapist assesses the forearm for taut bands and trigger points. Muscles commonly involved in symptoms of lateral epicondylitis include: triceps, brachioradialis, extensor carpi radialis longus (and sometimes brevis), extensor digitorum, anconeus, and supinator. As always, the therapist should screen the neck and shoulder region for MTrP’s. Muscles that may refer pain to the lateral epicondyle include: supraspinatus, infraspinatus, teres major and scalenes.

The needling treatment is completed when all LTR’s are eliminated or the patient requests to stop the treatment. The needle is discarded in a sharps container and hemostasis is applied to the area to decrease bruising. The therapist provides manual therapy with a local stretch to the taut band, myofascial release and therapeutic stretch. The patient is taught a self stretch for home, and the treatment can be concluded with ice or heat to the area. The patient is instructed to stretch the area throughout the day and apply heat/ice as needed. It is not unusual to have some increased soreness at the needling site that may last for up to 48 hours. After 48 hours, most patients report a significant decrease in pain, increase in range of motion and some return of strength.

In conclusion, trigger point dry needling can be used in conjunction with other interventions to treat myofascial pain. At the current time, each state has made its own ruling with regard to the physical therapist’s ability to utilize dry needling. The therapist would be best served by reading the State Practice Act for the state in which they practice to determine their ability to use this modality. I went through 100 hours of classroom and practical training in dry needling and successfully passed both a written and practical exam to become a Certified Myofascial Trigger Point Therapist through Myopain Seminars. I highly recommend this course and I find dry needling to be a very effective part of my practice.

Mike’s Thoughts

Great article Ann, thanks.  Dry needling is something I have been exploring and integrating into my practice.  I’d love to hear form others about their experiences as well, so please comment below.  What works?  What technique do you use?  What diagnoses respond best?

Here is a video from Youtube for the extensor pollicis brevis.  This technique is more aggressive in nature, utilizing and “in and out” pattern of needling rather than just different needles.  Different groups teach it differently:

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Dry NeedlingAnn is a graduate of Myopain Seminars program, which is great, but I also recommend Dr. Ma’s Integrated Dry Needling approach.  They are both different models.  Myopain is based on the trigger point theories of Janet Travell.   Dr. Ma’s Integrative Dry Needling, Orthopedic Approach™ is a contemporary dry needling therapy developed by Dr Yun-tao Ma and based on the works of Dr Janet Travell, Dr Chan Gunn, clinical evidence, evidence-based research and Dr Ma’s own 40 years of clinical and research experience and neuroscience training.

Click the below links for more information:


  • Dommerholt, J. and Gerwin, R., Trigger Point Needling Course Manual, The Janet Travell, MD Seminar Series, 2006
  • Shah JP, Gilliams EA. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther. Oct 2008;12(4):371-384
  • Simons, D.G., Travell, J.G., Simons, L., 1999. Myofascial Pain and Dysfunction: The Trigger Point Manual. Williams & Wilkins, Baltimore.

About the Author

Ann Wendel, PT, ATC, CMTPT holds a B.S. in P.E. Studies with a concentration in Athletic Training from the University of Delaware, and a Masters in Physical Therapy from the University of Maryland, Baltimore. She is a Certified Athletic Trainer (ATC) licensed in Virginia, a Licensed Physical Therapist, and a Certified Myofascial Trigger Point Therapist (CMTPT). Ann received her CMTPT through Myopain Seminars and utilizes Trigger Point Dry Needling as a treatment modality for many pathologies, including lateral epicondylitis.


Isometric Contractions, Trigger Points, and Muscle Energy Techniques

Leon Chaitow recently posted a great article on his website discussing the use of isometric contractions in pain management.  In this post he discusses many topics including trigger points and muscle energy techniques.  This is a must read article to truly get the most out of your trigger point work and muscle energy techniques.

I was going to include this article in last week’s stuff you should read article, but I really thought this was worth it’s own post.

Here are some tidbits of info that I really liked:

  • Long, low level isometric contractions are best at reducing pain – Leon tells you a few possible mechanisms as to why this works
  • All techniques, included isometric contractions and other methods of trigger point release, should be followed up with gentle stretching to lengthen the muscle
  • This has many implications for trigger point releases and muscle energy techniques
  • Combining everything Leon discuss, muscle energy techniques are simple and potentially very effective treatments to perform.  This makes muscle energy a no-brainer to include in your tool belt – potentially large bank for your buck with minimal investment

Read the full article on Isometric Contractions in Pain Management from Leon’s site, but more importantly, take a deeper look at Leon’s book on Muscle Energy Techniques.  This is one of the books that are including in my Essential Reading List and one that I recommend to everyone wishing to improve their manual therapy skills.  Check it out:

Muscle Energy Techniques


The Fibroblaster IASTM Tool

[box type=”note” icon=”none”]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 tool options and information on how to learn how to use IASTM.[/box]


Over the past several months there has been much discussion about instrument assisted soft tissue mobilization (IASTM) techniques and IASTM tools on this website.  I was pleasantly surprised at the amount of people using IASTM.  For those that know me, you know that I am constantly striving to improve and find the best product to use for IASTM.  I have tried almost all of the products on the market and have shared my past thoughts on IASTM tools in a previous post and discussion.

There was a lot of discussion regarding my previous post on the Graston Technique and during the discussion, I was lucky enough to receive a post from Jacob Fey.  Jacob is a physical therapy student at the University of Buffalo and has started to make a pretty good IASTM tool called the Fibroblaster.  Before we talk about the tool, I asked Jacob to write me a brief background into the development of the Fibroblaster, below is Jacob’s story.



How and Why the Fibroblaster Started

IASTM ToolDuring undergrad I first heard of IASTM, from a friend and former classmate that was attending chiropractic college; he talked about Gua Sha, Graston and SASTM.  He went into their use and cost (how he was going to try to even pay for it).  He sparked my curiosity and I started to look into IASTM, particularly the major marketers (Graston, SASTM, and ASTYM) and how it was theorized to work.  Also, during my extremities orthopedic class in DPT, an adjunct clinical professor showed us a tool that he had been using.  This was my first hands on exposure to an instrument.  He also talked about some of the IASTM tools on the market.  Most of us were interested in the tools but not the price.  I joked to a couple of classmates that day in class that I could make them less expensively and they said they would buy one if I could pull it off.

I started talking with the Machine Shop staff in the Engineering Department at the University at Buffalo.  Since I was a student I had access to the university’s facilities to do the project at a substantial savings.  I learned to use CAD software to save money by doing the designing and prototyping myself.  Once I had the design, I also figured out the whole machining process and related costs.  It was pitched to my current and former classmates getting enough interest to move forward.  About 75% of the class pre-ordered to fund the project and the first run of Fibroblasters was made in late Fall ’09 (entire project was not-for-profit).

Over the following year, there was enough interest to pursue another run of Fibroblasters with an updated design. This time the entire project was done off campus with a local company to assist with manufacturing (Made in the USA).  After I collected the pre-orders and borrowed some startup money, I completed the necessary paperwork to form Fibroblaster LLC.  Tools were completed and Fibroblaster sales began Nov. 1st, 2010.

As with all good stories, I have to give a shout out for my mom.  She went online to be the first to purchase a Fibroblaster from the website, at retail price no less.  She proudly displays it next to the clay knickknacks that were made in elementary school.  For the financially strapped graduate student, there is a student discount for those willing to supply me with their advisor’s name, email, contact number, school name and grad date.  Once status is verified, they receive a discount via email.  Since the start sales have been steady and there has been lot of positive feedback from those who have purchased.  The goal of Fibroblaster is to make a quality soft tissue mobilization instrument without the high price tag that is associated with other stainless steel IASTM tools on the market.


My Thoughts on the Fibroblaster IASTM Tool

[box type=”note” icon=”none”]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 tool options and information on how to learn how to use IASTM.[/box]

I thought that was a good story to share and that the product was worthy to promote to my readers (I have no financial interest). I have been using the tool for a couple of weeks now and must say that it is definitely worth looking into.  The design and materials, being stainless steel, are of top quality.

The tool has a great weight to it and resonates well, again thanks to the stainless steel.  The holes in the tool make it real easy to grip, especially when things get a little slippery.  And the sides have good concave and convex edges to them.  It has a single beveled edge but I found that you could using it in either direction to get a slightly different feel that was adequate.  I’m also trying to talk Jacob into working on a second Fibroblaster IASTM tool for more intricate areas of the body like the hand, forearm, foot, and ankle.

Fibroblaster Fibroblaster

I would still advocate that if you are interested in IASTM but worried about cost, that you start with simple Gua Sha tools made of horn, jade, or even bian stone.  I would rather see more people using IASTM with less expensive tools if cost is prohibitive to some.  But if you are ready to make the jump to a more expensive IASTM tool, stainless steel is definitely the way to go.

I have tried almost all of the tools on the market and the Fibroblaster ranks pretty high among them, I would recommend you try it first.  The Fibroblaster is relatively affordable for a stainless steel tool at $125, especially with the huge student discount that Jacob is offering at $75, and you have to respect Jacob’s approach and background story.  Kudos to him for trying to bring a quality IASTM tool to the market without excessive pricing!

For more info visit


Do You Have Interest in Learning More About IASTM?

My new online educational program will teach you everything you need to know to start using IASTM today!  IASTM does not have to be complicated to learn or expensive to start using.  Learn everything about IASTM including the history, efficacy, tool options, different stroke patterns, basic techniques, advanced techniques, and how to integrate IASTM into your current manual therapy skills and treatment programs!

Learn more about how to perform IASTM today!


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

[box type=”note” icon=”none”]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.[/box]

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


Mike’s Thoughts

[box type=”note” icon=”none”]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.[/box]

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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