Graston Technique: How It Works and What the Evidence Says
What the Graston Technique is, where it came from, what a session involves, what the research on instrument-assisted soft tissue mobilization shows, side effects, and home alternatives.
Last verified November 2, 2026. Every grade and study figure on this page links to the source we checked. Where we couldn't confirm something, we say so.
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The short answer
The Graston Technique is a trademarked way of doing instrument-assisted soft tissue mobilization (IASTM): a trained clinician strokes stainless steel tools over the skin of a sore or stiff area, as one part of a session that also includes exercise. Early reviews of small trials looked positive.2 The largest and most recent review, 46 randomized trials, found that adding IASTM to other treatment made no meaningful difference to pain, function or range of motion, and rated the evidence as very low certainty.1 It is generally low risk, and some people like how it feels. Don't expect it to do more than the exercise and stretching it comes with.
What the Graston Technique is
IASTM means using a hand-held tool, rather than only the hands, to press and stroke over muscles, tendons and the tissue around them. The Graston Technique is one branded version, with its own instruments, courses and provider directory.4, 5 The same idea sold for home use is usually called muscle scraping, and the traditional Chinese practice it resembles is gua sha.
A session usually pairs the instrument work with an assessment, a warm-up, and stretching and strengthening exercises for the problem area. Most trials test it the same way, as an add-on to other treatment.1 The instrument part is only one piece of it.
The tools are stainless steel with bevelled edges, in different shapes and sizes for different parts of the body. Clinicians usually apply an emollient first so the tool glides; the company sells its own.5
Where it came from
According to a 2002 trade magazine profile, David Graston injured his knee water skiing in 1987 and was left with limited movement after surgery and rehab. Drawing on his background in the tool and die industry, he worked with Andre Hall to make the first instruments.6 Early work took place at Ball Memorial Hospital and Ball State University in Muncie, Indiana, and in 1994 the parent company, TherapyCare Resources, opened an outpatient clinic in Indianapolis to collect outcome data before shifting its focus to training clinicians.4, 6
Today the company says only licensed professionals who meet its requirements can take its courses.4 Its directory lists chiropractors, physical therapists, athletic trainers, occupational therapists and massage therapists at three training levels.5
What it is claimed to treat
The Graston provider directory lists neck and back pain, shoulder injuries, tendinopathies, kneecap (patellofemoral) pain, carpal tunnel syndrome, plantar fasciitis, trigger finger and IT band syndrome. It says the method is "backed by clinical research" and "used by professional sports teams", but doesn't cite studies or name teams.5 An older version of this page repeated a claim that two-thirds of NBA, NFL and MLB teams use it; we couldn't find a current source for that, so we removed it.
What the evidence says
A = consistent meta-analyses of randomized trials. B = a meta-analysis or several good trials with a moderate effect, in a narrower group. C = small effects, or small or few trials. D = too little evidence. X = tested, and the claimed effect did not show up.
Most trials test IASTM in general, often with Graston tools, rather than the full Graston protocol. These grades match the ones in our muscle scraping guide.
| Claim | Grade | What the best evidence found | Caveat |
|---|---|---|---|
| Less pain in muscle, tendon and joint conditions | C | A 2019 review of 12 trials found large effects on pain in injured people.2 The 2023 meta-analysis of 46 trials found no meaningful benefit when IASTM was added to other treatment, up to one year.1 | Very low certainty; high risk of bias |
| Better function | C | Positive in the earlier, smaller review;2 no meaningful added effect in the 2023 meta-analysis.1 | |
| More range of motion | C | Large effects in uninjured people in the 2019 review;2 no clinically meaningful change in the 2023 meta-analysis.1 | Mostly short-term measures |
| Plantar heel pain (Graston specifically) | D | A pilot trial of 11 people: both groups improved with stretching and exercise; adding Graston gave medium-to-large but unconfirmed between-group effects. The authors estimated at least 42 people would be needed to test it properly.3 | Pilot only |
| Breaks up scar tissue or "adhesions" | D | This is the usual explanation, but we found no human study showing it is why people improve. | |
| Faster recovery and fewer treatment sessions | D | We found no good trial testing this. |
Why the reviews disagree: the earlier reviews pooled a few small trials, often against no treatment. The 2023 review asked a stricter question, whether IASTM adds anything to the care people get anyway, and found it didn't. Its authors also warned that IASTM trials are increasingly published in suspected predatory journals, and suggested clinicians lean on exercise and physical activity instead.1
What a session feels like, and side effects
Expect firm pressure that can be uncomfortable, especially over sore spots. The skin usually goes red, and some people get small red spots or light bruising for a few days. Tell your clinician if it is sharply painful; it shouldn't be.
Side effects are poorly reported in the research. Only 10 of the 46 trials in the 2023 review reported adverse events at all.1 We found no standard contraindication list in the sources we read, so these are precautions:
- Tell your clinician if you take blood thinners, bruise easily or have a bleeding or clotting disorder.
- Avoid treatment over broken skin, rashes, burns, infections, varicose veins, recent fractures, or a hot, swollen area.
- Ask first if you have diabetes with reduced feeling in the skin, are pregnant, or have had recent surgery near the area.
Graston vs muscle scraping vs gua sha
| Graston Technique | Muscle scraping (home IASTM) | Gua sha | |
|---|---|---|---|
| Who does it | Licensed clinicians with Graston training | Anyone, or a clinician | Traditional practitioners, massage therapists, or yourself |
| Tools | Graston stainless steel instruments | Steel, plastic or stone scrapers | Smooth-edged tools of stone, horn, metal or a spoon |
| Goal of the strokes | Treat a specific problem as part of an exercise plan | Make a tight area feel looser | Usually to raise red spots (petechiae) |
| Best evidence | IASTM reviews: C | IASTM reviews: C | One small trial for neck pain: C7 |
| Our guide | This page | Muscle scraping | Gua sha |
Can you do Graston on yourself?
Not the Graston Technique itself: its training is open only to licensed clinicians.4 You can try the same basic idea at home with a scraping tool, gently, on muscles you can reach. Our muscle scraping guide explains how. A foam roller or massage gun does a similar job of putting pressure on a muscle; we found no good trial showing one beats another.
If you have pain that is severe, came on after an injury, or keeps getting worse, see a clinician rather than treating it yourself.
Finding a provider
Graston Technique runs a certified provider directory where you can search by city, state or ZIP code and filter by profession and training level.5 Training in one tool matters less than the clinician's overall plan: a good provider will explain the diagnosis, set an exercise program and tell you how long to try it before changing course.
FAQ
Does the Graston Technique work?
It may help some people feel better for a while, but the best current review found that adding IASTM to other treatment made no meaningful difference to pain, function or range of motion.1
Is Graston the same as IASTM?
Graston is one branded IASTM method with its own tools and training. Most research tests IASTM in general.
Does Graston break up scar tissue?
That is the common explanation, but it hasn't been shown in people.
Does Graston bruise?
It can. Redness is common, and some people get small spots or light bruising. Tell your clinician if you take blood thinners or bruise easily.
How many sessions does Graston take?
We found no good evidence on the right number. Ask your clinician how they will judge whether it is working and when they would stop.
Is Graston better than massage?
We found no good head-to-head trial. Both are hands-on treatments that work best as part of an exercise plan.
Related: muscle scraping, gua sha, foam rolling guide, which recovery tools have evidence, IT band injury guide.
References
- Nazari G, Bobos P, Lu S 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. Disabil Rehabil 2023;45(10):1608-1618. doi:10.1080/09638288.2022.2070288. Source
- Seffrin CB, Cattano NM, Reed MA, Gardiner-Shires AM. Instrument-assisted soft tissue mobilization: a systematic review and effect-size analysis. J Athl Train 2019;54(7):808-821 (PEDro record). Source
- Jones ER, Finley MA, Fruth SJ, McPoil TG. Instrument-assisted soft-tissue mobilization for the management of chronic plantar heel pain: a pilot study. J Am Podiatr Med Assoc 2019;109(3):193-200 (PEDro record). Source
- Graston Technique. About Graston Technique (accessed 2 Nov 2026). Source
- Graston Technique. Certified provider directory (accessed 2 Nov 2026). Source
- The American Chiropractor. The Graston Technique, 1 June 2002. Source
- Braun M, Schwickert M, Nielsen A et al. Effectiveness of traditional Chinese "gua sha" therapy in patients with chronic neck pain: a randomized controlled trial. Pain Med 2011;12(3):362-369. Source
