What Is IASTM in Physical Therapy?

Using Stainless Steel Tools for Myofascial Release

Physiotherapist massaging woman's leg using tools
izusek / Getty Images

If you have an injury or illness, you may benefit from physical therapy to help you move better and feel better. Your physical therapist (PT) will assess your condition and use various treatments and techniques as part of your rehab program.

One such treatment is massage and myofascial release of tissues, or a hands-on soft tissue technique. PTs often use multiple types of massage, and one such type is known as instrument-assisted, soft tissue mobilization (IASTM).

Commonly known as the Graston technique, it is a specialized, myofascial release and massage technique. It is a relatively newer treatment that involves using metal or plastic tools to improve soft tissue mobility in the body. These ergonomically shaped tools help a PT massage and mobilize muscles, fascia (the collagen covering the muscles), and tendons. This is thought to reduce pain and improve movement.

This article explains why physical therapists include massage in their treatment plans, how IASTM is different, and why it works. It also describes what to expect from a treatment, as well as its benefits, risks, and effectiveness.

Massage and Myofascial Release

Some physical therapists include massage in their rehab programs. The benefits can include:

  • Better soft tissue mobility
  • Elimination of restrictions in tight fascia
  • Fewer muscle spasms
  • Improved flexibility
  • Increased circulation and blood flow to the tissues
  • Less pain

Sometimes, after an injury, you may develop tissue tightness or restrictions in muscles and fascia. These soft tissue restrictions can limit your range of motion (ROM) and may trigger pain.

Your physical therapist may use various myofascial release and soft tissue mobilization techniques to free these restrictions to help you move better and feel better. Myofascial release with IASTM may be one way your PT treats these restrictions.

There is some debate in the PT and rehab field as to whether soft tissue restrictions really cause pain or can even be accurately identified by a PT. (Take this point one step further: If you cannot identify tight tissue, then how can you treat it?)

Still, some PTs believe they can pinpoint scar tissue and soft tissue restrictions and apply massage and myofascial techniques to help improve motion and decrease pain. And many patients confirm the benefits of myofascial release and massage as a treatment for their pain.

History of IASTM

The Graston technique of IASTM was developed in the 1990s by an athlete who created his own instruments to treat a soft tissue injury. Since then, with input from researchers and clinicians, it has grown in popularity.

Physical therapists may use different types of tools to perform IASTM. Many of these blades, scrapers, and sharp, pointy objects look scary. Some of these tools are specifically designed by the Graston company, and many other companies offer their own version of metal or plastic scraping and rubbing tools for IASTM.

The goal of using these tools during IASTM is consistent: To help free soft tissue and myofascial restrictions to improve the way someone moves.

How IASTM Is Different

During standard massage techniques, PTs use their hands so that there is direct, skin-to-skin contact. During an IASTM treatment, a physical therapist uses a metal or plastic tool to provide soft tissue massage and mobilization.

This tool is gently (or vigorously) scraped and rubbed over the skin. The rubbing of the instrument is used to locate and release tightness in the fascial system—the collagen covering the muscles.

How IASTM Works

When your PT uses an IASTM tool during your treatment, they will initially be searching for areas of fascial and muscle restrictions. These areas will feel crumbly or craggy as the tool passes over them. Once restrictions are found in the fascia, your PT can home in on them, using the IASTM tool to scrape at them.

So what happens as your PT uses the IASTM tool to scrape at fascial restrictions? It's theorized that scraping your tissues causes microtrauma to the affected area, thus sparking your body's natural inflammatory response.

The body then works to reabsorb the excess scar tissue that is causing the restriction. The PT can then stretch adhesions of scar tissue to help improve overall pain-free mobility.

When IASTM Is Used

IASTM treatment is not for every patient and circumstance. But certain conditions respond well to it, including:

Similarly, certain injuries and medical conditions can be treated with ASTM techniques. They include:

What to Expect

During a PT session that includes IASTM, your PT will expose the body part to be worked on. They will then rub an ergonomically shaped metal tool over your skin. The PT should start gently, exploring the area around your injury with the IASTM tool.

During this time, you will likely feel gentle scraping sensations. And you may feel a slight gravelly sensation as the tool passes over tight areas of the fascia. Your PT may then focus on an area that needs more work, scraping the tool more vigorously over your skin.

During the session, you may feel some discomfort. Be sure to tell your PT if you cannot tolerate the discomfort. Your therapist should stop performing IASTM if it is too uncomfortable or you tell them to stop.

After the treatment, the affected skin will probably be red. In some cases, slight bruising may occur, especially if the IASTM treatment was performed vigorously. After an IASTM session, your therapist will likely have you perform active motions or stretches to improve your mobility. This can help keep scar tissue or fascia restrictions from reforming.

Recap

You will be aware that the IASTM treatment is taking place. At first, you will likely feel gentle scraping sensations. Then you may feel a slight gravelly sensation as the tool passes over tight areas of your fascia.

Benefits and Risks

Benefits of IASTM include:

  • Better range of motion
  • Greater tissue extensibility
  • Improved cellular activity near the site of injury
  • Less pain
  • Less scar tissue formation

While these benefits sound enticing, many have not been subjected to rigorous scientific study. Many studies about IASTM are case reports of one specific patient or studies done on non-human tendons and fascia. The results of such studies may not be relatable to your specific condition, so if your PT recommends IASTM, be sure to ask about the expected benefits.

In addition to a lack of research support, the risks of IASTM may include:

  • Bruising
  • Ineffectiveness
  • Redness of the skin where the treatment took place
  • Worsening of the pain

Effectiveness

Whenever your PT applies any treatment to your body during rehab, you should question the efficacy of that treatment. Is it supported by rigorous scientific research? Are there alternatives to treatments that may be more beneficial or safer?

If your PT believes that myofascial restrictions are part of the cause of your pain, injury, or movement dysfunction, they may use IASTM to help free these restrictions. Many PTs who use IASTM believe that it's an effective treatment for movement loss, pain, and myofascial restrictions.

What the Research Shows

One review of studies compared the use of hands-on myofascial release to the use of instrument myofascial release, like IASTM, for chronic low back pain. It found little difference in the two techniques for reducing pain. The IASTM technique did provide greater improvements in disability when compared to hands-on myofascial techniques.

Another review compared IASTM to other techniques for treating pain and lack of function. The authors concluded that IASTM may have a positive effect on blood flow and tissue flexibility while reducing pain.

Another study examined the use of IASTM, sham (fake) ultrasound, and spinal manipulation for patients with thoracic (upper back) pain. The researchers found no significant difference in pain or disability with any of the treatments. All groups improved over time, and no significant negative events occurred. The researchers concluded that IASTM is no more (or less) effective than spinal manipulation or fake ultrasound for thoracic pain.

Interpreting the Research

While it's true that these studies raised no red flags, they didn't end with a hearty endorsement of IASTM, either. So will IASTM work for you? Maybe, maybe not. Everyone and every case is different, and your specific condition may respond its own way—different from someone else's.

The best course of action: Understand what treatments your PT is using for your condition and have a reasonable expectation of the outcome. And if you have any questions about IASTM—or any other treatment—ask your physical therapist.

Summary

Instrument-assisted, soft tissue mobilization (IASTM) is commonly known as the Graston technique. It's a myofascial release and massage technique used during physical therapy.

To perform IASTM, physical therapists use a metal or plastic tool to provide soft tissue massage and mobilization. The tool is gently (or vigorously) scraped and rubbed over the skin. The rubbing of the instrument is used to locate and release tightness in the fascial system—the collagen covering the muscles. The technique carries some risks, but the benefits may outweigh them.

A Word From Verywell

The prospect of being pain-free can make anyone giddy with relief. But it's important to gather as much information as possible before proceeding with this technique (or any other). If you can, talk to people who have undergone the treatment. They can provide detail to enhance what a healthcare provider and physical therapist can tell you.

Was this page helpful?
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Kamali F, Panahi F, Ebrahimi S, Abbasi L. Comparison between massage and routine physical therapy in women with subacute and chronic nonspecific low back pain. J Back Musculoskelet Rehabil. 2014;27(4):475-80. doi:10.3233/BMR-140468.

  2. Kim J, Sung DJ, Lee J. Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: Mechanisms and practical application. J Exerc Rehabil. 2017;13(1):12-22. doi:10.12965/jer.1732824.412.

  3. Williams M. Comparing pain and disability outcomes of instrumental versus hands-on myofascial release in individuals with chronic low back pain: a meta-analysis. Doctoral dissertation, California State University, Fresno.

  4. Lambert M, Hitchcock R, Lavallee K, et al. The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: A systematic reviewPhys Ther Rev. 2017;22(1-2):76-85. doi:10.1080/10833196.2017.1304184

  5. Crothers AL, French SD, Hebert JJ, Walker BF. Erratum to: Spinal manipulative therapy, Graston technique® and placebo for non-specific thoracic spine pain: A randomised controlled trial. Chiropr Man Therap. 2016;24:31. doi:10.1186/s12998-016-0111-1

Additional Reading