The Benefits of Instrument-assisted Soft-tissue Mobilization

Experts agree that a crucial component of healing is soft-tissue treatment. Indeed, since the works of British orthopedist James Cyriax, clinicians have routinely employed cross-friction massage as a means of breaking up the web of adhesions and restrictions that normally form after injury. However, it is my contention that our profession is insufficiently informed about the advantages of soft-tissue methods in the healing process with regard to both the spine and extremities. Many doctors have steered clear of soft-tissue mobilization due to lack of exposure in their education or out of frustration—too many techniques from which to choose and there is minimal information available about most techniques. Others avoid soft-tissue mobilization because they fail to see the need—they are already successful at helping patients, so why abandon what works?

No matter the reason, this avoidance of soft-tissue mobilization in general is unfortunate, especially if one bears in mind that a principal goal of soft tissue healing is to improve the function of soft tissue by changing its quality.  Quality changes come about by enhancing the proliferate invasion of vascular elements and fibroblasts.1 Fibroblasts, of course, are essential in the inflammatory process necessary for repairing and healing tissue. These specialized cells produce needed collagen which—through deposition and ultimate maturation—supports and strengthens tissue, while also producing the surrounding proteoglycan gel.2

Thus, a primary criterion of any manual loading system is its ability to change the quality of the tissue by encouraging production of collagen and proteoglycan gel. The sad fact of the matter is that rubbing and stretching of tissue achieve only minimal quality changes, far below what is possible with an easier and more versatile method—an approach known as instrument-assisted soft-tissue mobilization.

Studies have conclusively demonstrated that ISTM causes fibroblast proliferation.3 Moreover, ISTM easily removes restrictive adhesions, those that prevent normal tissue motion. It also can be employed to create microvascular trauma and capillary hemorrhage in order to initiate a localized inflammatory response that stimulates the body’s healing cascade and immune/reparative system.4 Further, tissue restrictions and the direction of tissue barriers can be identified with heretofore unattainable precision. Take epicondylopathy (tennis elbow), for instance. After a clinician performs functional passive and resistive tests that localize the sites of pain, ISTM is used to confirm that these sites of pain require treatment. ISTM is also used to detect abnormal tissue tension throughout the kinetic chain (wrist, arm, shoulder) of which the patient may be totally unaware.

It would be extremely difficult to identify such problems in adjoining areas if the only diagnostic tool available to the chiropractor was his or her hands. The pads of the fingers simply cannot compete with instruments in a contest of sensitivity.

In my opinion, ISTM offers a near-universal method to evaluate and treat soft-tissue problems, both for the spine and the extremities. It supercedes many of the myofascial-release and muscle-manipulation methods and products currently on the market. And, for some 1,500 clinicians across the U.S. and Canada, me included, the ISTM application that has proven most efficacious in the role of injury resolution is the Graston Technique®.

I’ve been a proponent of hands-on methods for more than 40 years. Even so, I must say that, in less than the three years since its formal introduction to the chiropractic profession, it is nothing less than remarkable that Graston Technique has already found its way into the curriculum of seven chiropractic colleges.  To my knowledge, there hasn’t been another technique so widely embraced in so short a time in all of chiropractic history.

The Graston Technique system of instrument-assisted soft-tissue mobilization entails the use of six specially designed stainless steel instruments. However, to wield them properly, one must first be trained in their use. The company that owns the rights to GT provides such instruction, typically spread over two weekends.  However, there is a minimum of a two-month span between the 12-hour courses to allow the acquired basic skills to become second nature through daily usage before other, higher-level skills are taught.

In conclusion, soft-tissue mobilization should be looked upon for what it is—an important adjunctive to chiropractic care. And ISTM should be seen for what it is—a viable means of achieving greater success with the acute and chronically injured patient, faster and easier than ever before possible.


1. Nirschl RP, Ashman ES. Elbow tendinopathy: tennis elbow. Clin Sports Med 22(4);2003:813-836.

2. Davidson CJ, Ganion LR, Gehlsen GM, et al. Rat tendon morphologic and functional changes resulting from soft tissue changes  resulting from soft tissue mobilization. Med Sci Sports Exe;29(31997):313-319.

3. Gehlsen GM, Ganion LR, Helfst R. Fibroblast responses to variation in soft tissue mobilization pressure. Med Sci Sports Exer 1999;31(4):531-535.

4. Gross MT. Chronic tendonitis: Pathomechanics of injury factors affecting the healing response and treatment. J Orthop Sports Phys Ther 16(2):248-261.

Warren Hammer, DC, MS, DABCO, is the owner of Hands On Therapeutics in Norwalk, CT. He is the author of a widely used textbook, Functional Soft Tissue Examination and Treatment by Manual Methods, New Perspectives, soon to be released in its third edition.  For more information about ISTM and a GT training seminar near you, visit or call 866-926-2828.

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