To understand this technique, it is necessary to understand the normal healing cycle that is activated by the Graston technique or ASTR mechanism.

Normal Healing Cycle

The normal healing cycle is completed in three stages namely inflammation, proliferation, and maturation. The inflammation stage includes increased temperature, swelling, redness, and soreness at the site of injury to attract the white blood cells that take part in the healing process. The second stage of proliferation is the primary healing stage of cascade events of scar tissue formation, trigger point release, muscle spasm, and fascia restriction. This stage is then followed by the maturation stage during which scar tissue release and fascia release take place to complete the healing cycle [1].

History of Graston Technique

The Graston technique is proposed by David Graston (1994) that is intended for breaking of soft tissues fibrosis and lower down the inflammation at the specific site of the injury. Graston technique, stainless steel tools are used to apply deep and rhythmic pressure in the painful area. The principle of the Graston technique is to break down the adhesions in the muscle tissues. So that the inflammation can be brought back to the injured site because it triggers the healing cycle. While the healing process, new micro-traumas are also commonly found in the area. While healing the new micro-traumas, healing of originally injured tissue will also be healed through the process due to the increased inflammation [2].   

Graston Technique (GT) is a unique form of treatment intervention that utilizes instruments or gadgets for tissue mobilization. This allows the clinicians to effectively addressing of soft tissues, lesions, and family restrictions due to the enhanced patents outcomes. The function and effectiveness of the tools will be evident by Journal of Sport Rehabilitation stating that the instruments are combined with appropriate therapeutic interventions to restore pain-free movement and function [3].

There are several potential benefits of Graston Therapy as the human body is made up primarily of muscles, fascia, tendons, and ligaments. These soft tissue injuries play an important role in the pain and deformities associated with various problems. Even if it didn’t look like a serious injury but contracting a torn muscle or ligament can also cause severe pain and difficulty in moving. Several studies have proved that Graston technology has several benefits for patients such that it reduces the total treatment time, promotes faster recovery, reduces the need for anti-inflammatory drugs, and eliminates chronic diseases that are considered permanent [3].

Graston Tool Design Comparison

This technique utilizes specially designed tools and instruments that are made up of steel. Most of these tools are sharp-edged as well as some of the tools are heavy, sleek, and large. Most chiropractors and physiotherapists suggest these tools only when the pain is linked with soft tissues. However, ASTR tools are more ergonomic and effective as they are made up of plastic and designed ergonomically. It has also been observed by the researchers that the use of tools of Graston technology leaves large red spots and people feel itching and inflammation due to either the inappropriate design or inappropriate application of the instruments for pain relief. On the other hand, ASTR tools are light weighted, plastic, and effective for the treatment of pain in soft tissues [4].

Graston Tools Vs Laser Technique

When comparing the Graston technique with other treatment options, Lindsey Mathews, a Chiropractor says that laser-based treatment may involve redness, bruises, or soreness during the following days of the laser treatment. Similarly, the Graston technique also hurts during the process leaving behind tenderness and bruises at the targeted area. This represents that both the laser and Graston stimulate the inflammation stage of the healing cycle as The Journal of the Canadian Chiropractic Association explained that the inflammation stage includes redness, bruises, swelling, and tenderness [4].

Research Studies

A randomized controlled trial titled “the efficacy of instrument-assisted soft tissue mobilization (IASTM): A systematic review” supported that IASTM is not much effective for certain pathologies related to the musculoskeletal system whereas there is weaker efficacy of IASTM to increase lower extremity joint only for a short time [4].

Another systematic review titled ”Evaluating the effectiveness of treatment options for pain: A literature review” reviewed 50 systematic reviews, 2 literature reviews, 4 RCTs, and 1 non-RCT. It has been found that the single models that provide pain reduction for short-term pain include opioids, NSAIDS, massage, manual therapy of soft tissue mobilization, IASTM, myofascial release, acupuncture, dry needle, trigger point injections, joint manipulation, active release technique, strain counterstrain, stretching, and Mackenzie method. On the other hand, the biopsychosocial model is effective for long-term pain reduction which included a multidisciplinary approach, cognitive-behavioral rehabilitation, and Advanced Soft Tissue Release (ASTR). This represents that the biopsychosocial model is more effective for long-term pain relief [4].

Journal of the American Podiatric Medical Association explained that ASTR can be referred to as a biopsychosocial model that is based on the utilization of unique ASTR instruments, theories, maneuvers, and methodologies. Therefore, ASTR treatment includes various treatment interventions such as scar tissue, fascia restriction, trigger points, muscle spasm, ergonomics, gait pattern, nutrition, stress management, inflammation, and behavior modification [5].

The biopsychosocial model reflects that the ASTR technique is based on three components i.e. biology, psychology, and social aspects of a person. The biological components of this model may include nutrition, musculoskeletal and neuromuscular injuries through the fascia, trigger points, fibrosis, and muscle spasm, etc. The psychological components may include lifestyle analysis, past experiences, and stress management. The social component included lifestyle analysis, education, and social support to an individual and a combination of all these stages predict the health of a person [6].

Bottom line

Graston technique is not effective for the treatment of pain in the soft tissues as it triggers the inflammation stage of the healing cycle. Several studies and literary evidence have proved the efficiency of ASTR to treat pain.

References 

1. Stanek J, Sullivan T, Davis S. Comparison of compressive myofascial release and the Graston Technique for improving ankle-dorsiflexion range of motion. Journal of athletic training. 2018 Feb;53(2):160-7.

https://pubmed.ncbi.nlm.nih.gov/29373060/

2. Lee JH, Lee DK, Oh JS. The effect of Graston technique on the pain and range of motion in patients with chronic low back pain. Journal of physical therapy science. 2016;28(6):1852-5.

https://pubmed.ncbi.nlm.nih.gov/27390432/

3. Bush HM, Stanek JM, Wooldridge JD, Stephens SL, Barrack JS. Comparison of the Graston Technique® With Instrument-Assisted Soft Tissue Mobilization for Increasing Dorsiflexion Range of Motion. Journal of Sport Rehabilitation. 2020 Nov 25;30(4):587-94.

https://pubmed.ncbi.nlm.nih.gov/33238244/

4. Cheatham SW, Lee M, Cain M, Baker R. The efficacy of instrument assisted soft tissue mobilization: a systematic review. The Journal of the Canadian Chiropractic Association. 2016 Sep;60(3):200.

https://pubmed.ncbi.nlm.nih.gov/27713575/

5. Jones ER, Finley MA, Fruth SJ, McPoil TG. Instrument-Assisted Soft-Tissue Mobilization for the Management of Chronic Plantar Heel Pain: A Pilot Study. Journal of the American Podiatric Medical Association. 2019 May;109(3):193-200.

https://pubmed.ncbi.nlm.nih.gov/30916579/

6. Ikeda N, Otsuka S, Kawanishi Y, Kawakami Y. Effects of instrument-assisted soft tissue mobilization on musculoskeletal properties. Medicine and science in sports and exercise. 2019 Oct;51(10):2166.

https://pubmed.ncbi.nlm.nih.gov/31083046/