The Graston Technique: a new manual therapy for back pain

By: Thomas E. Hyde, DC
August 5, 2003

There are many treatment options available for back pain caused by soft tissue problems, such as a back muscle strain. One method of treatment is soft tissue mobilization, which is a form of manual therapy designed to break down scar tissue and restrictions that are usually associated with some form of trauma to the soft tissue (such as a strained muscle, pulled ligament).

The Graston Technique is a relatively new form of soft tissue mobilization that uses specifically designed stainless steel instruments to help the practitioner identify and break down the scar tissue. The majority of practitioners specializing in this technique are chiropractors, athletic trainers, physical therapists and occupational therapists, and it is also available to medical doctors and registered nurses.

Soft tissue injuries and back pain

Most of the back is comprised of muscles, ligaments and tendons, and injuries to these soft tissues play a significant role in the pain and dysfunction associated with back problems. While it may not sound like a serious injury, a muscle strain or torn ligament in the back can cause excruciating pain and difficulty moving.

When an injury within the soft tissue occurs, the tissue repairs itself in a haphazard pattern, forming scar tissue. While the scar tissue itself isn’t painful, it does tend to limit range of motion, and the ongoing stiffness may contribute to back pain.

The Graston Technique

This form of manual therapy comprises soft tissue mobilization and incorporates the use of stainless-steel instruments. The goal of the therapy is to separate and break down the scar tissue, as well as stretch connective tissue and muscle fibers.

The Graston Technique uses the instruments with a specialized form of massage that is designed to help the practitioner identify areas of restriction and break up the scar tissue. The concave and convex stainless steel instruments are used to comb over and catch on injured fibrotic tissue.

Using a cross-friction massage, which involves brushing or rubbing against the grain of the scar tissue, the practitioner re-introduces small amounts of trauma to the affected area. This temporarily causes inflammation in the area, which in turn increases the rate and amount of blood flow in and around the area. The theory is that this process helps initiate and promote the healing process of the affected soft tissues.

Patients undergoing therapy with the Graston Technique can expect the following:

• Prior to an appointment with a practitioner, patients are advised to complete five minutes of cardiovascular activity (because it is easier to work on warm tissue), such as riding a stationery bike or walking on a treadmill

• At the clinician’s office, ultrasound or heat treatment may first be applied to the injured area to warm up the soft tissue

• The practitioner will utilize the appropriate Graston Technique instruments to scan, then treat the affected area of the back

• Treatment time is usually 30 to 60 seconds per area treated

• The typical course of treatments generally range from 6 to 10 visits

• After each treatment, the area is stretched, and ice may be applied if there is some local soreness

It is common to experience some discomfort during the procedure and possibly some bruising. Ice application following the treatment may ease the discomfort. No medications are required in conjunction with the treatment.

It is recommended that an exercise, stretching and strengthening program be used in conjunction with the technique to rehabilitate the back and help the injured tissues heal.

At the time of this article, there are no peer-reviewed published clinical studies of the effectiveness of the Graston Technique in relieving back pain. However, a number of practitioners report success with this technique both for patients with chronic pain and acute pain from soft tissue injuries.