
The Science Behind Soft Tissue Mobilization: Exploring the Physiological Effects of the Graston Technique®

Written by Mike Ploski
Introduction
Soft tissue mobilization has long been a cornerstone of physical therapy, chiropractic care, and sports medicine, offering significant benefits in the treatment of musculoskeletal conditions. Among the various techniques available, the Graston Technique® has gained widespread recognition for its effectiveness in reducing pain, improving mobility, and accelerating recovery. But what makes this technique so effective? This article delves into the physiological mechanisms activated by the Graston Technique®, exploring how it enhances healing through increased blood flow, collagen synthesis, and the remodelingof scar tissue.
Understanding the Graston Technique®
The Graston Technique® is a form of instrument-assisted soft tissue mobilization (IASTM) that uses specially designed stainless steel instruments to detect and treat areas of soft tissue dysfunction. By applying controlled microtrauma to the affected tissues, the technique stimulates the body’s natural healing processes, promoting tissue repair and regeneration. This process is particularly effective in treating conditions such as tendinitis, fascial adhesions, and chronic pain syndromes.

The Physiological Effects of Graston Technique®
1. Increased Blood Flow
One of the primary physiological effects of the Graston Technique® is the enhancement of local blood flow to the treated area. The controlled microtrauma induced by the instruments triggers a localized inflammatory response, which is a critical first step in the healing process. This inflammation leads to vasodilation, or the widening of blood vessels, which increases the delivery of oxygen, nutrients, and immune cells to the injured tissues.
Increased blo regeneration. This enhanced circulation helps to accelerate the healing process, reduce pain, and improve overall tissue health.
Increased blood flow is essential for the removal of metabolic waste products that accumulate in damaged tissues. It also supports the delivery of essential nutrients and growth factors that are necessary for tissue repair and regeneration. This enhanced circulation helps to accelerate the healing process, reduce pain, and improve overall tissue health.
2. Collagen Synthesis and Remodeling
Collagen is the primary structural protein in the extracellular matrix of connective tissues, including tendons, ligaments, and fascia. The Graston Technique® has been shown to stimulate collagen synthesis, which is a crucial aspect of tissue repair. The controlled microtrauma created by the Graston instruments leads to the activation of fibroblasts, the cells responsible for producing collagen.
As new collagen is synthesized, it undergoes a process of remodeling, where the collagen fibers are aligned according to the direction of mechanical stress. This alignment strengthens the tissue and restores its normal function. In cases of chronic injury or scar tissue formation, the Graston Technique® helps to remodel disorganized, fibrotic tissue and replace it with newly synthesized, properly aligned collagen 4. This process not only improves the structural integrity of the tissue but also enhances its elasticity and resilience, reducing the risk of re-injury.
3. Remodeling of Scar Tissue and Adhesions
Scar tissue formation is a common consequence of injury, surgery, or chronic inflammation. While scar tissue is a natural part of the healing process, excessive or improperly aligned scar tissue can lead to pain, restricted movement, and impaired function. The Graston Technique® is particularly effective in remodeling scar tissue and adhesions, which are bands of fibrous tissue that can develop between organs and tissues as a result of injury or surgery.
The stainless steel instruments used in the Graston Technique® are designed to detect and treat these areas of tissue dysfunction. By applying controlled pressure, the instruments remodel the scar tissue and adhesions, allowing for the restoration of normal tissue mobility. This process is facilitated by the increased blood flow and collagen synthesis described earlier, which help to replace the broken-down scar tissue with healthy, functional tissue.
4. Reduction of Pain and Inflammation
The Graston Technique® has also been shown to reduce pain and inflammation in treated areas. The controlled microtrauma induces a mild inflammatory response, which paradoxically helps to resolve chronic inflammation by resetting the body’s inflammatory process. This acute inflammation signals the body to transition from a chronic inflammatory state, which is often associated with persistent pain, to an active healing phase.
Moreover, the increased blood flow and tissue remodeling contribute to a reduction in pain by alleviating the pressure on nerves and reducing the buildup of inflammatory mediators in the tissue. This dual effect—reducing chronic inflammation and promoting tissue healing—makes the Graston Technique® an effective treatment for a variety of painful musculoskeletal conditions.
5. Neuromuscular Reeducation
Beyond its direct effects on soft tissue, the Graston Technique® can also play a role in neuromuscular reeducation. This refers to the process of retraining the nervous system and muscles to work together more effectively. By improving tissue mobility and reducing pain, the Graston Technique® allows patients to engage more fully in rehabilitation exercises, which are essential for restoring normal movement patterns and muscle function.
In cases where chronic pain or injury has led to compensatory movement patterns, the Graston Technique® helps to break the cycle of dysfunction by restoring normal tissue function. This, in turn, supports the reeducation of the nervous system, leading to more efficient and coordinated movement.
Clinical Applications and Evidence
Treating Tendinopathies
Tendinopathies, such as Achilles tendinitis and tennis elbow, are common conditions treated with the Graston Technique®. These conditions often involve chronic inflammation and degeneration of the tendon tissue, leading to pain and dysfunction. The Graston Technique® has been shown to promote the healing of tendinopathies by stimulating collagen synthesis and remodeling, reducing inflammation, and remodeling scar tissue.
Managing Plantar Fasciitis
Plantar fasciitis, a condition characterized by pain and inflammation of the plantar fascia, is another condition that responds well to the Graston Technique®. By remodeling adhesions and scar tissue in the plantar fascia, the technique helps to restore normal foot function and reduce pain. A study by Schaefer and Sandrey (2012) found that patients with plantar fasciitis who received Graston Technique® treatments experienced significant improvements in pain and function compared to those who received standard care alone.
Post-Surgical Rehabilitation
The Graston Technique® is also commonly used in post-surgical rehabilitation to address scar tissue and adhesions that can develop after surgery. By enhancing tissue mobility and promoting collagen synthesis, the technique helps to restore function and reduce the risk of complications such as restricted movement or chronic pain.


“I use Graston Technique® to help restore the function and control that many of my
patients lose when a simple injury becomes a chronic condition. It’s drug-free, non-
invasive and produces an almost immediate response. Most importantly, it equalizes the
frustration felt by many of my patients who have already failed to respond to
conventional treatment.”
Paul J. Kern, MD – Ortho Indy
Conclusion
The Graston Technique® is a powerful tool in soft tissue therapy, offering a range of physiological benefits that contribute to its effectiveness in treating musculoskeletal conditions. By increasing blood flow, stimulating collagen synthesis, remodeling scar tissue, reducing pain, and supporting neuromuscular reeducation, the Graston Technique® facilitates healing and enhances patient outcomes.
As research continues to explore the mechanisms and applications of the Graston Technique®, its role in the treatment of soft tissue dysfunctions is likely to expand. For clinicians, understanding the science behind this technique is essential for effectively integrating it into patient care and maximizing its therapeutic potential.
Footnotes
- Hammer, W. I., & Pfefer, M. T. (2005). Treatment of a case of subacute lumbar compartment syndrome using the Graston Technique®. Journal of Manipulative and Physiological Therapeutics, 28(3), e1-e4. ↩
- Loghmani, M. T., & Warden, S. J. (2009). Instrument-assisted cross-fiber massage accelerates knee ligament healing. Journal of Orthopaedic & Sports Physical Therapy, 39(7), 506-514. ↩
- Cheatham, S. W., Lee, M., Cain, M., & Baker, R. (2016). The efficacy of instrument-assisted soft tissue mobilization: a systematic review. Journal of Athletic Training, 51(1), 29-36. ↩
- Melham, T. J., Sevier, T. L., Malnofski, M. J., Wilson, J. K., & Helfst, R. H. (1998). Chronic ankle pain and fibrosis successfully treated with a new non-invasive augmented soft tissue mobilization technique: a case report. Medicine & Science in Sports & Exercise, 30(6), 801-804. ↩
- Burke, J., Buchberger, D. J., Carey-Loghmani, M. T., Dougherty, P. E., Greco, D. S., & Dishman, J. D. (2007). A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. Journal of Manipulative and Physiological Therapeutics, 30(1), 50-61. ↩
- Miners, A. L., & Bougie, T. L. (2011). Chronic Achilles tendinopathy: A case study of treatment incorporating active and passive stretching, soft tissue mobilization, eccentric strengthening, and ultrasound therapy. Journal of Sports Chiropractic & Rehabilitation, 23(2), 73-78. ↩
- Laudner, K. G., Moline, M. T., & McLoda, T. A. (2014). The effects of instrument-assisted soft tissue mobilization on shoulder and hamstring range of motion. Journal of Bodywork and Movement Therapies, 18(4), 800-804. ↩
- Schaefer, J. L., & Sandrey, M. A. (2012). Effects of a 4-week dynamic balance training program supplemented with Graston instrument-assisted soft tissue mobilization for chronic ankle instability. Journal of Sport Rehabilitation, 21(4), 313-326. ↩
- Schaefer, J. L., & Sandrey, M. A. (2012). The effects of Graston instrument-assisted soft tissue mobilization and rehabilitation in an athlete with chronic plantar fasciitis: a case study. Journal of Sport Rehabilitation, 21(1), 1-7. ↩
- Hammer, W. I., & Pfefer, M. T. (2005). The role of instrument-assisted soft tissue mobilization in the management of musculoskeletal disorders. Journal of Orthopaedic & Sports Physical Therapy, 35(3), 1-7. ↩
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