Graston Technique Review
An honest review for manual therapy clinicians.
Before I start, let me say that this is an informal and clinical Graston Technique Review review, not a scientific review. That means n=1 (“n” is number of clinicians, “1” being me). If you want to review the research, I would suggest starting at the Graston Technique Research Page. In light of keeping this down to earth, I will keep this to a Q & A format:
Q: How does it compare to other soft tissue treatments, such as Active Release Technique?
In a word, well.
I have been fortunate enough to have experienced many forms of soft-tissue treatment techniques, including Active Release Technique, DMS, HMT, Gua Sha, Tecnica Gavilan, Dry Needling/IMS, Massage, Fascial Stretch Therapy, AIS, Trigger Point Therapy, and many more. To this day, my top three are as such: 1 = Graston, 2 = ART, 3 = FST/AIS.
As a practitioner, it is much easier on the hands than most manual techniques (ART, HMT, massage, manips, etc). For my own comfort (and for that of the patient), I tend to use Graston for superficial, fibrous and/or small structures (if you look at their presented research, I think this makes the most sense). For instance, I will use it for fascial slings, the forearms, the suboccipitals, tendinitis’, shoulders, feet, and superficial muscles like the levator scapulae. I will lean more towards Active Release Technique over Graston Technique for more aggressive approaches or deeper structures, such as psoas, lumbar paraspinals, piriformis, pec minor, popliteus, etc.
Q: Does it work?
In a word, usually.
Obviously the problem and the solution must match, but if you are a manual practitioner who finds himself always dealing with a soft tissue injury, such as tendinopathies, trigger points, hypertonicity, and myofascial pain, then you are on the right track with Graston Technique. I have had particular success in treating headaches, epicondylitis, ankle sprains, SC/AC joint dysfunctions, and SI Joints. I have, however, found other thing to work better for rotator cuff, thoracic spine, and femoroacetabular issues.
Q: What do patients think of the treatment?
In a phrase, love-hate relationship.
Many of my patients feel ripped off if I don’t use them because they say it “hurts so good”, even though it is not usually painful treatment. Almost everyone I use the Graston tools on feels intrinsically as if they are making a difference in their soft tissue quality. There is just something about how they feel when applied to the myofascial system that seems to tell patients “this is making a difference“. Athletes with sports injuries really seem to gravitate towards Graston. *Caveat: if you just haul out a medieval looking stainless steel tool and don’t explain what’s going on, expect some weird looks. A good clinician explains what they’re doing and helps the patient understand their pain as well as their treatment.
Q: Where does soft tissue treatment (Graston Technique) fit into your clinical “flow”?
In a word, early.
Personally, Graston usually comes out near the start of a treatment. It usually goes something like this:
- Re-test previous findings, potentially adding new tests
- +/- Graston
- +/- ART-ish treatments
- +/- Adjust
- +/- Assisted Stretch or Motor Control Assist (SFMA based, usually)
- +/- Self- Corrective Movements (SFMA baseline, again)
- Home work explained
Q: What does the research say?
In a phrase, a reasonable amount.
Honestly, there are very few interventions that have a lot of RCTs, systematic reviews, and hold-strong fire-proof evidence. As a clinician, this is the world I live in. Clinical judgement reigns supreme, so you best be educating yourself in as many realms as you can. HOWEVER, Graston Technique brings in evidence form all sorts of Instrument Assisted Soft Tissue Treatments to create a soup flavored with all sorts of favorable savors. One thing I particularly appreciate about Graston is that they are trying. You’re hard pressed to find many techniques or tools out there that have their research, both good and bad, presented on their website. They want to be evidence based, and they are doing a pretty good job as far a manual therapy goes.
Q: Is it worth the price?
In a word, abso-freaking-lutely.
I can’t count the number of practices I shadowed before I became a doc myself. Nearly ALL of the sports guys and hands-on guys were trying to get their hands off of people because their bodies couldn’t take decades of soft tissue treatment. Save your thumbs from their own soft tissue injury. Get some tools already. Your future is worth more than a few thousand bucks, especially if you’re the type to drop the 2K on an Active Release Technique course.
Q: Is there an alternative to Graston Tools?
In a word, sort-of.
I have used a few other tools and can honestly say that Graston Tools work the best for me. However, at lower price points, there are cheaper options that seem nearly as good. I would venture to say that you should check out FAKTR (as per Tom Hyde and Gregory Doerr), Erson Religioso’s the EDGE Tool, IAM Tools, the F.A.T. Tools, and surely some others. Gua Sha is not the same as the tools are sharper and the premise is entirely different.
I want to hear your experiences. Have you read or produced your own Graston Techique Review? What has your experience been? I’d love to hear about it in the comments.