Graston and IASTM: what is instrument soft tissue therapy for?

Graston and other IASTM methods are an adjunct soft tissue technique used to make movement easier. They become meaningful when used together with exercise.

IASTM stands for "instrument-assisted soft tissue mobilisation". The physiotherapist applies stainless steel instruments with specially shaped edges over the skin to muscles, tendons and surrounding tissues, using controlled pressure. Graston Technique is one of the well-known branded systems of this approach.

When is it used?

It can be used as an adjunct method in muscle–tendon problems, movement restrictions and soft tissue sensitivity. For example, it may be chosen for pain on the outer side of the elbow (tennis elbow), for problems around the Achilles tendon and heel, or to make movement easier in an area that has been immobile for a long time. The decision to use it is made after an examination.

How does it work?

It used to be thought that IASTM "breaks down adhesions" in the tissue. Today we know this is not a conclusively demonstrated mechanism. A more likely explanation is that the instrument stimulates nerve endings in the skin and tissue, briefly changing how pain and tension are perceived in the area and so making movement more comfortable.

That is why I use IASTM with the same thinking as in dry needling: the aim is not to "scrape" the tissue but to help a tense area relax and make movement easier. The window this opens is then used straight away with exercise.

What does the research say?

There are many studies on IASTM, but the quality of the evidence is low. A meta-analysis published in 2024 reported that IASTM can increase range of motion, but that the certainty of this result is low. A comprehensive 2023 review of 46 studies, meanwhile, highlighted that adding IASTM to other treatments made no meaningful difference to pain and function, and that exercise and physical activity have stronger evidence behind them.

For us, the meaning is clear: IASTM is not a treatment on its own. It is an aid used to make movement easier and to prepare for exercise; at the heart of treatment are exercise and appropriately managed loading.

What does it feel like?

During treatment there is a sensation of pressure and friction. Afterwards, temporary redness or mild tenderness may occur. Causing bruising is not the aim of the treatment; if marked bruising or excessive tenderness occurs, the treatment dose is reassessed.

It is not applied to an area with an open wound, active skin infection or a recent injury. If you take blood thinners or bruise easily, tell us beforehand.

More information: Graston · IASTM · Exercise therapy

Sources

• Nazari G et al. Effectiveness of instrument-assisted soft tissue mobilization for the management of upper body, lower body, and spinal conditions. An updated systematic review with meta-analyses. Disability and Rehabilitation, 2023.
• Tang S et al. The effectiveness of instrument-assisted soft tissue mobilization on range of motion: a meta-analysis. BMC Musculoskeletal Disorders, 2024.