Magic steel massage tools that supposedly scrape the pain away, and “resonate” in the therapist’s hands
The eponymous Graston Technique® (GrastonTechnique.com) is a modality empire — a commercialized, trademarked therapy technique — with roughly 6000 practitioners world-wide, almost all of them chiropractors. Graston is an expensive and painful massage technique that employs mean-looking “curvilinear”1 steel tools to apply scraping pressure and achieve “maximum tissue penetration.” Although not always painful, it often is. It is a classic example of a hurts-so-bad-it-must-be-good therapy.
Graston Technique claims to cure and stimulate healing by doing damage first — breaking eggs to make an omelette. In particular, its goal is to “break down scar tissue and fascial restrictions,” and even targets issues that are chronically inflammed — which is not without risks. Graston therapists will firmly scrape an inflammed tendon, for instance.2
The science of Graston Technique?
The theoretical basis for Graston is speculative and debatable. It is not proven or significantly supported by any research that I am aware of. No good quality study3 of the therapeutic effectiveness of Graston Technique exists, nor is it ever likely to — it is too small a player in the world of manual therapy to attract any serious research attention. It has not done so in over twenty years so far. The state of the evidence is similarly impoverished for SASTM and ASTYM.
Only three studies are cited on the Graston Technique website, which isn’t many to start with. However, two of them are the same paper and another appears to be fictional!4 The only correct citation is barely relevant to Graston Technique: a tiny study of tendonitis for rats.5 Meanwhile, a few other scientific papers are not listed — probably because they make Graston look bad.
Didn’t the Davidson study provide some half-decent support for Graston Technique? I do not deny that the results of the study were positive: massage did indeed seem to have a positive effect on those rats! And that’s interesting. But suggestive data is a long way from proof.6
The Graston Technique’s idea of “supporting research” seems quite watered down to me. The situation is similar on the websites for the ASYTM® system,7 and Graston’s new SASTM® system.8
In theory
Is Graston technique based on a sound idea?
The basic rationale for Graston Technique may not be unreasonable — perhaps inflamed tissue really does “like” to be disturbed a little. There are other precedents for this kind of response in the body. There are several physiological contexts in which moderate stresses on our bodies really provoke a positive change: weight lifting jumps to mind as one of the most obvious examples. We are adaptation machines.
On the other hand, it’s also a well-known biological principle that too much stress is injurious.
And we also now know, thanks to the last 20 years of chronic pain science, that chronic pain is often a failure of nervous stem itself. Many people with serious chronic pain problems — the very same patients who might try something like Graston Technique — are actually pathologically oversensitive. What happens if you “stress” a nervous system in that condition? Simple: the problem gets worse, not better.
And, finally, brand new research has shown quite conclusively (and graphically, on video) that inflammation is actively destructive to tissues: like a gang of insane firefighters, immune cells deliberately over-react and destroy healthy cells just in case there might be an infection.9 This response is completely appropriate in open wounds, but dramatic overkill for all minor internal injuries — like tendonitis. Indeed, it may be a major reason for the stubbornness of conditions like tendonitis. Graston Technique unquestionably has the potential to provoke exactly this reaction.
I’m not saying that there’s no. I’m saying it’s not clear — that there are good mysteries here, good questions, good reasons why it might work, not work, or even be dangerous to some patients. The scientific knowledge simply does not exist to say how it will turn out in the end.
And yet it is being sold …
Overconfidence and safety
No potentially dangerous treatment should ever be sold to patients on the basis of such scant data: we’re talking about scraping inflammd tendons here. There is no reason to think that will necessarily go well, and I just spelled out at least two theoretical reasons it could go badly. What if, upon studying more rats, you found that some had a nasty reaction? What if all rats tolerate tendon scraping well … but one in a hundred humans is seriously injured?10
The safety of an aggressive treatment is something you simply have to test, thoroughly, before you can know that the rewards outweigh the risks. Yet Graston proponents cite that single rat study as the main justification not only for treating tendonitis, but essentially any other musculoskeletal condition. Different kinds of tendonitis won’t necessarily respond the same way to the same treatment, let alone completely different musculoskeletal conditions.
Patients should be extremely wary of such clinical overconfidence. Do you want to pay to be a guinea pig?
Are the Graston tools like magic dowsing rods?
They are priced like it. They currently go for about $2500–3500 … for tools about as hard to manufacture as cutlery.
But perhaps they are worth it. The Graston Technique website makes some interesting claims about those tools. Strangest of all, right on their “about” page — always one of the most-visited pages on a website — they climb right out on a marketing limb and describe their massage tools as having spooky powers:
The Graston Technique® Instruments, much like a tuning fork, resonate in the clinician's hands allowing the clinician to isolate adhesions and restrictions, and treat them very precisely. … Just as a stethoscope amplifies what the human ear can hear, so do the instruments increase significantly what the human hands can feel.
Graston makes a similar for his SASTM® tools:
The ergonomic design of these instruments provides the clinician with the ability to locate restrictions through sound waves.
These statements are not explained in any more detail. They are lobbed at the reader as-is.
Since it is non-controversial that other stainless steel objects do not vibrate in response to lesions, clearly the claim here is that the Graston tools have some other special property heretofore unknown to physics — magic tools, in other words. Presumably that’s why they cost so much?
One reader protested that the claim isn’t as odd as it sounds. I dispute that, however — I think the intent is clearly to imply some kind of special property.11 I do not believe in dowsing, and I do not believe that these tools are anything like dowsing rods. Even if I did believe in such things, I still wouldn’t go to a surgeon who claimed to use a magic scalpel.12
Summary
There may well be a kernel of truth in Graston Technique, and I would be interested in serious science looking for that kernel. I hope that Graston Technique will eventually be validated by new research — I would be delighted to endorse a new, proven method of treating stubborn pain problems. Three simple randomized controlled trials with at least 50 human subjects with clearly positive results would be sufficient to increase my confidence in Graston Technique® substantially.
However, I think it is unlikely that the results of such testing will be positive. Meanwhile, a vague and unsubstantiated theory is simply not adequate justification for such a severe approach to tissue — especially tissue that’s hurting to begin with.
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