IASTM & Graston Technique™
Instrument-Assisted Soft Tissue Mobilization at Alleviate Physiotherapy
Stubborn pain, restricted movement, and chronic soft tissue problems often need more than hands alone. IASTM and the Graston Technique give our therapists a precision advantage — treating tissue at a depth and specificity that manual therapy alone cannot always reach.
Instrument Assisted Soft Tissue Mobilization (IASTM) and the patented Graston Technique™ are now available at Alleviate Physiotherapy across our Etobicoke, Mississauga, and Clarkson/Oakville clinics. Our therapists hold certified training in these techniques — bringing effective, evidence-based soft tissue treatment to patients dealing with everything from chronic tendon pain and sports injuries to post-surgical scar tissue and stubborn trigger points.
What is IASTM?
IASTM stands for Instrument Assisted Soft Tissue Mobilization. It uses specially designed hand-held instruments — most commonly stainless steel — to assess and treat restrictions, adhesions, and scar tissue in muscles, tendons, ligaments, fascia, and nerves.
The instruments extend what a therapist's hands can detect and apply. Their weight and material transmit subtle vibrations back to the clinician, making it possible to feel tissue irregularities — including fibrosis, adhesions, and restricted fascia — that hands alone may miss. Once located, the therapist applies controlled pressure to begin breaking down those restrictions and stimulating the body's natural healing response.
IASTM is an Umbrella Term — Graston Technique™ is the Gold Standard Within It
Several instrument-assisted techniques exist, including HawkGrips, RockTape, and ASTYM. The Graston Technique™ is widely considered the gold standard — distinguished by its medical-grade stainless steel instruments, rigorous clinical training requirements, and structured treatment protocol. At Alleviate Physiotherapy, we use multiple IASTM techniques, including Graston Technique™, selecting the right approach for your specific condition.
What is the Graston Technique™?
The Graston Technique™ uses a set of stainless steel instruments with convex and concave shapes. Each instrument contour fits different anatomical areas, allowing for deeper, more targeted manual therapy than hands alone can provide.
The technique works in two related ways. First, the therapist runs the instruments over the skin to detect areas of scar tissue, muscle knots, and trigger points — reading the tissue through the instrument's vibration. Second, targeted strokes apply controlled microtrauma to restricted tissue. This stimulates a local inflammatory response, which initiates reabsorption of excessive scar tissue and drives the body's natural repair process.
"Graston Technique includes added tools that clinicians use between their hands to diagnose irregularities in the tissue and even identify fibrosis... It is not just a soft-tissue healing technique but also a tool that enables clinicians to identify and treat tissue damage."
— Mike Ploski, Graston Technique Clinician and Instructor
Why Instruments Outperform Hands Alone for Certain Tissue Problems
Stainless steel instruments provide a firmer, more precise edge than hands can replicate. They allow deeper penetration into dense scar tissue and fascial restrictions. The material resonance helps the therapist detect subtle changes in tissue quality — identifying the exact location and extent of a restriction before treating it.
Cross-friction massage is one key technique used within IASTM. The instrument strokes work against the grain of scarred or restricted tissue. This deliberately increases local blood flow and stimulates fibroblast activity — the cellular process responsible for remodelling and replacing disorganised scar tissue with healthy, functional collagen.
💡 Fun Fact
IASTM has roots in Gua Sha — a traditional Chinese medicine technique that uses smooth-edged instruments to stimulate tissue and blood flow. Modern IASTM evolved this concept with medical-grade instruments, clinical protocols, and a rigorous evidence base focused on musculoskeletal rehabilitation.
Conditions IASTM and Graston Technique™ Can Help
IASTM is particularly effective for conditions involving scar tissue, tendinopathy, fascial restriction, chronic muscle tightness, or post-surgical adhesions. Our therapists assess each patient individually before recommending IASTM as part of a treatment plan. Common conditions that respond well include:
IASTM Works Best as Part of a Comprehensive Plan
IASTM cannot work in isolation. Clinical evidence consistently shows that it must combine with movement, stretching, and a progressive strengthening programme to achieve lasting tissue remodelling. At Alleviate Physiotherapy, IASTM always forms part of a broader, therapist-directed treatment plan — never a standalone session.
What Does a Graston / IASTM Session Look Like?
Every IASTM session follows a structured protocol. Your therapist tailors each component to your specific condition, tissue findings, and tolerance on the day.
Assess
Your therapist examines the area, identifies tissue restrictions, and confirms IASTM is appropriate for your current presentation before treatment begins.
Treat
Instruments scan and treat the restricted tissue — 30 to 60 seconds per area — with pressure adjusted to your feedback throughout.
Reinforce
Post-treatment stretching, strengthening, and movement work consolidates the tissue changes made during the session.
The Treatment Protocol — Step by Step
Warm-Up
A 10 to 15 minute warm-up using light movement, cycling, or an upper body ergometer prepares the tissue. Warmed tissue responds better to instrument-assisted work — it is more pliable and the therapist can detect restrictions more accurately.
Tissue Scanning and Detection
The therapist runs the instrument over the treatment area at a specific angle (typically 30 to 60 degrees) to detect areas of altered tissue quality. The instrument transmits vibration and resistance back to the clinician — making fibrosis, adhesions, and trigger points identifiable by feel before treatment begins.
Instrument-Assisted Treatment
Targeted strokes address the identified restrictions, applying controlled microtrauma to stimulate tissue remodelling. Convex instrument faces treat larger surface areas; concave faces focus on smaller, more defined areas of restriction. Treatment lasts 30 to 60 seconds per zone. Your therapist adjusts pressure throughout based on your real-time feedback.
Post-Treatment Stretching
Immediately after instrument work, targeted stretching of the treated area reinforces the mobility gains achieved during treatment. Skipping this step reduces the durability of the tissue changes made during the session.
Strengthening and Movement Integration
Therapeutic exercise follows stretching to load the newly mobilised tissue progressively. This drives proper collagen remodelling and builds functional strength in the treated area. IASTM without subsequent loading exercise produces limited long-term change.
Ice (Where Indicated)
Ice application after treatment helps manage any local inflammatory response in subacute presentations. Your therapist advises whether this is appropriate for your stage of healing.
Why IASTM Works — The Science
IASTM produces its effects through two primary mechanisms. The first is mechanical — controlled microtrauma to restricted or fibrotic tissue initiates a local inflammatory response. This drives fibroblast proliferation, collagen synthesis, and remodelling of disorganised scar tissue into healthy, functional tissue aligned along normal stress lines.
The second is neurophysiological. The instruments stimulate mechanosensitive neurons in the skin and underlying tissue. These mechanoreceptors respond to compression and shear forces — influencing pain perception, improving proprioception, and enhancing neuromuscular control in the treated area.
treatment cycles typically needed to see meaningful improvement in chronic soft tissue conditions
rate of mobility improvement and pain relief — both tend to improve together throughout the treatment course
pressure produces equivalent outcomes to moderate or strong pressure — more intensity is not always better
Who Can Benefit From IASTM?
IASTM suits a wide range of patients — from competitive athletes managing sports injuries to office workers with chronic neck and back tension, to post-surgical patients working through scar tissue adhesions. It is particularly well-matched to presentations involving:
- Chronic tendinopathy: Where scar tissue and fascial restriction have built up over months or years of repetitive load.
- Acute muscle strain or sprain: Where early controlled stimulation of the healing response can reduce recovery time.
- Post-surgical or post-traumatic scarring: Where adhesions restrict normal tissue movement and limit rehabilitation progress.
- Persistent joint stiffness: Where soft tissue restriction around a joint limits range of motion despite other treatment.
- Sports performance and injury prevention: Where myofascial restrictions reduce movement efficiency or increase injury risk.
- Trigger points and chronic myofascial pain: Where muscle knots produce localised pain and referred discomfort.
⚠ IASTM Requires Certified, Trained Therapists
The Graston Technique™ requires formal certification to administer safely. Improper technique, incorrect instrument selection, or inappropriate pressure can cause excessive bruising, inflammation, or tissue damage. At Alleviate Physiotherapy, our therapists hold certified training in IASTM techniques. If you have seen IASTM offered without evidence of specific training, it is worth asking about the clinician's certification before proceeding.
Your Questions Answered
These are the questions patients most often ask before their first IASTM session. Click any question to read the answer.
Most patients experience mild discomfort during IASTM — not sharp pain. You may notice some temporary redness or sensitivity in the treated area. This is normal and signals increased circulation to the tissue.
Our therapists continuously monitor your comfort level and adjust pressure throughout the session. Research shows that light pressure produces equivalent outcomes to moderate or strong pressure. More intensity is not always more effective — and your therapist will never push beyond your limit. If something feels wrong, say so. Adjustments happen immediately.
During treatment, most patients feel mild tenderness, warmth, or a deep pressure sensation in the area being worked on. Some patients notice the instrument "catching" or vibrating slightly over restricted areas — this is the therapist detecting tissue irregularities.
After treatment, it is common to experience temporary redness, mild soreness, or minor skin discolouration (petechiae — small red spots caused by increased surface circulation). These effects typically resolve within one to two days. They are part of the healing process, not a sign of damage. If soreness persists beyond two to three days or worsens significantly, contact your therapist.
IASTM treatment adapts to you on multiple levels. Your therapist selects instrument shapes based on the anatomy of the area being treated — convex faces for broad surface areas, concave faces for more targeted work on specific restrictions.
Pressure adjusts to your tolerance and the stage of your healing. In earlier or more acute presentations, lighter pressure achieves the treatment goal without unnecessary discomfort. As tissue responds and tolerance builds, the therapist progresses accordingly. Every session begins with a brief assessment of how you responded to the previous treatment — your feedback directly shapes what happens in the next one.
Most patients begin to notice meaningful improvement within 6 to 12 treatment cycles. Chronic conditions with established scar tissue or long-standing restriction typically require more sessions than acute presentations.
The number of sessions depends on your specific condition, how long it has been present, how well the tissue responds to treatment, and how consistently you complete the prescribed stretching and strengthening programme between sessions. Your therapist reviews progress regularly and adjusts the treatment plan accordingly.
Yes — and it generally should be. IASTM produces the best outcomes when it forms part of a broader treatment plan that includes manual therapy, therapeutic exercise, and where relevant, other modalities such as acupuncture, dry needling, or shockwave therapy.
At Alleviate Physiotherapy, IASTM is never offered as a standalone treatment. Your therapist integrates it into a comprehensive plan tailored to your condition and recovery goals. The combination of tissue mobilisation through IASTM and progressive loading through exercise is what drives lasting change.
IASTM suits most patients, but certain situations require caution or mean it is not appropriate. Your therapist screens for contraindications before treatment begins.
IASTM is generally not appropriate over open wounds, fractures, areas with active infection or thrombosis, or in patients on blood-thinning medications where bruising risk is elevated. Patients with cancer in the treatment area, those who are pregnant (over certain areas), or those with certain skin conditions also require individual assessment. If you have concerns about whether IASTM is right for you, your therapist will discuss these during your initial assessment.
When Should You Ask About IASTM?
IASTM is not right for every condition or every stage of recovery. Your physiotherapist will assess whether it is appropriate during your initial assessment. Consider asking about IASTM if any of the following apply:
- You have a chronic tendon problem — such as Achilles tendinosis, tennis elbow, or rotator cuff tendinosis — that has not responded fully to standard physiotherapy.
- Your range of motion remains restricted despite manual therapy and exercise.
- You have post-surgical or post-traumatic scar tissue limiting your rehabilitation progress.
- You have chronic trigger points or myofascial pain that keep returning after massage or dry needling.
- You are an athlete managing recurring soft tissue restrictions that affect performance or increase injury risk.
Not Sure if IASTM is Right for You?
That is exactly what your initial assessment is for. Book a consultation with one of our therapists. They will assess your presentation, explain whether IASTM is appropriate for your condition and stage of healing, and outline what a full treatment plan would look like — before any treatment begins.
Ready to Tackle the Root of Your Soft Tissue Problem?
Whether you are dealing with a long-standing tendon issue, post-surgical restriction, or a stubborn sports injury, our certified IASTM therapists will assess your tissue, identify the restriction, and build a plan to fix it — not just manage it.
Available across four GTA locations — Etobicoke, Mississauga, Clarkson/Oakville.
References: Cheatham, S.W. et al. (2016). The Efficacy of Instrument Assisted Soft Tissue Mobilization: A Systematic Review. Journal of the Canadian Chiropractic Association. | Graston Technique LLC (2024). Clinical Training and Instrument Standards. | Copyright © 2025 Alleviate Physiotherapy.
