IASTM Advantage?
Is IASTM, also known as “scraping”, an effective means of soft tissue work? The use of tools to treat soft tissue dates back thousands of years. In Traditional Chinese Medicine, the practice of “gua sha” (scraping the skin with a smooth-edged tool) has been documented for over 2,000 years. Gua sha was believed to promote circulation, release “stagnant energy,” and reduce pain. Though gua sha was not developed from a Western biomedical framework, its core principle (using instruments to mobilize tissue) directly influenced later techniques like IASTM.
IASTM, as it’s known today, emerged in the U.S. The most recognized early system was the Graston Technique, developed in the 1990s by athlete David Graston, who was recovering from a knee injury. He adapted stainless steel tools to help treat scar tissue and fascial adhesions when his rehabilitation plateaued. Around the same time, clinicians and researchers began experimenting with different instrument shapes and materials, refining the approach toward biomechanical and rehabilitative goals rather than traditional energetic frameworks. IASTM began spreading beyond physical therapy and athletic training into chiropractic, massage therapy, and occupational therapy. Additional branded systems (e.g., ASTYM, HawkGrips, Functional and Kinetic Treatment with Rehab [FAKTR]) emerged, each with variations in tools and application methods.
A growing body of scientific research investigated IASTM’s effects, suggesting mechanisms such as stimulating fibroblast activity, promoting collagen remodeling, breaking down scar tissue, and improving blood flow. Clinical studies expanded its use to conditions like tendinopathies, chronic neck pain, low back pain, and post-surgical adhesions.
IASTM is most supported in research as a safe pain-relieving modality for musculoskeletal pain. Let's explore some of the evidence:
A 2024 randomized controlled trial (Bostan et al.) found that IASTM combined with exercise therapy produced greater reductions in neck pain than exercise therapy alone in people with chronic neck pain.
Another comparative study between IASTM and therapeutic exercise vs. myofascial release (MFR) and therapeutic exercise showed that both improved pain, posture, and neck function, but IASTM had a slight edge in pain relief (Palekar et al, 2025).
A recent meta-analysis by Tang et al. reported moderate–certainty evidence that IASTM significantly reduces patient-reported pain in musculoskeletal disorders, including chronic neck pain and cervicogenic headache (Tang et al., 2025).
On a physiological level, we only have animal studies to pull from in terms of what may be happening at a tissue level.
It may stimulate connective tissue remodeling, help in the breakdown of fibrosis, and promote collagen repair (alignment, maturation) (Cheatham et al., 2016).
IASTM has been linked to increased fibroblast proliferation in animal models, improved vascular perfusion, etc. These processes may underlie improvements in tissue pliability, mobility, and reduced pain (Cheatham et al., 2016; Tang et al., 2025).
Caveats and What the Evidence Doesn’t Fully Show
To present a balanced view, let's discuss some of the limitations in research so far with IASTM.
Although there is good evidence of functional improvements with IASTM (i.e., increased range of motion), its superiority over other interventions has yet to be proven. An honest critique is that your hands are just as sufficient in functional outcomes, and therefore, using IASTM really just comes down to practitioner and client preferences.
Optimal "dosing" of IASTM has yet to be established. Studies are all over the place in terms of how exactly IASTM is applied. Variations in durations, pressure, and tools in studies make it difficult to come up with a standard operating procedure, which affects how IASTM is taught.
Mostly short-term effects have been studied; long-term follow-ups are less common. We have a pretty good idea of what happens in the moment, but have very little understanding of how these effects last (or don't last), if frequency of treatment matters at all, and if the effects compound over several sessions.
Research shows that IASTM can reduce pain, improve range of motion, and decrease trigger point sensitivity, all of which are highly relevant for clients struggling with dysfunction or postural strain. By knowing that these outcomes are supported by scholarly evidence, practitioners can integrate IASTM more confidently into treatment plans, explain its value to clients, and make informed decisions when choosing between different manual therapy techniques. This not only elevates the quality of care but also strengthens the credibility of the profession by grounding practice in scientific research.
So, is IASTM superior to other manual modalities? In my opinion, probably not that much. If there’s superiority to be proven, it’ll be in IASTM’s ability to increase fibroblast activity, given its unique shear stress stimulus. Whether or not practitioners should use IASTM really comes down to comfort, confidence with the tools, personal preference, and client preferences.
References:
Bostan, A., & Kaya, P. (2024). Effect of instrument-assisted soft tissue mobilization combined with exercise therapy on pain and muscle endurance in patients with chronic neck pain: a randomized controlled study. The Journal of manual & manipulative therapy, 32(2), 131–140. https://doi.org/10.1080/10669817.2023.2213989
Cheatham, S. W., Lee, M., Cain, M., & Baker, R. (2016). The efficacy of instrument assisted soft tissue mobilization: a systematic review. The Journal of the Canadian Chiropractic Association, 60(3), 200–211.
Palekar, . T. J. ., Tandon, V. ., Tandon, V. ., Mulchandani, K. ., Belekar, K. ., & Basu, S. . (2025). A Comparative Study of Instrument Assisted Soft Tissue Mobilization Versus Myofascial Release for the Treatment of Mechanical Neck Pain in Dentists. Journal of Neonatal Surgery, 14(27S), 363–375. Retrieved from https://www.jneonatalsurg.com/index.php/jns/article/view/6443
Tang, S., Sheng, L., Wei, X., Liang, M., Xia, J., & Chen, J. (2025). The effectiveness of instrument-assisted soft tissue mobilization on pain and function in patients with musculoskeletal disorders: a systematic review and meta-analysis. BMC Musculoskeletal Disorders, 26(1), 257.