Graston technique is not dangerous for most people when performed by a trained practitioner. It involves scraping the skin with stainless steel instruments to break up scar tissue and adhesions, and while the treatment causes temporary discomfort, soreness, and sometimes bruising, serious injuries are rare. That said, there are specific medical conditions where the technique is genuinely unsafe, and the intensity of a session matters.
What Happens During Treatment
Graston technique works by introducing controlled microtrauma to soft tissue. A clinician uses specially shaped metal instruments to apply firm, repetitive strokes over muscles, tendons, and fascia. This triggers the body’s inflammatory healing response, which over time encourages the breakdown of scar tissue and the realignment of collagen fibers. Sessions on a given area typically last 30 to 60 seconds, and most patients experience discomfort during the procedure.
The key word is “controlled.” The instruments only scrape the surface of the skin. They aren’t penetrating tissue or reaching deep structures. The microtrauma is intentional and limited, designed to restart a healing process in tissue that has become fibrotic or restricted.
Normal Side Effects vs. Warning Signs
Some redness, soreness, and mild bruising after a session are completely normal. Your skin will likely look flushed or pink in the treated area, a reaction called erythema. This is expected and typically fades within a day or two.
Petechiae, tiny red or purple dots that appear on the skin, are a more important signal. These dots indicate that small blood vessels near the surface have broken. While patients are often told petechiae are a normal part of treatment, clinical guidance actually treats them as a sign that the practitioner should reduce pressure, adjust their stroke technique, or shorten the session. If you’re seeing heavy petechiae or significant bruising after every appointment, that’s not a sign the treatment is “working.” It means the technique is being applied too aggressively.
After a session, drinking water, doing gentle movement as directed, and applying ice to the area can help manage soreness. Most post-treatment discomfort resolves within a day or two.
When Graston Technique Is Unsafe
An international expert consensus study using a modified Delphi method identified several conditions where Graston and similar instrument-assisted techniques should not be used at all. These contraindications had strong agreement among experts:
- Unhealed or unstable fractures: The mechanical pressure could worsen the injury.
- Blood clots or bone infections: Thrombophlebitis (vein inflammation with clotting) and osteomyelitis are absolute contraindications because of the risk of dislodging a clot or spreading infection.
- Open wounds, blisters, scrapes, or inflamed skin conditions: The scraping action would damage compromised skin further.
- Insect bites of unknown origin: These may indicate an underlying infection or allergic response.
- Metal, latex, or emollient allergies: The instruments are metal, gloves may contain latex, and lubricant is applied to the skin during treatment.
- Active infections or fever: Any systemic viral or bacterial illness rules out treatment.
- Pacemakers or insulin pumps: Treatment should not be performed near these devices.
Bleeding disorders like hemophilia and severe skin hypersensitivity also reached consensus as contraindications, though with slightly less agreement among the expert panel. If you take blood thinners or anticoagulants, this falls into the same risk category. The technique deliberately causes minor capillary disruption, and anything that impairs your blood’s ability to clot raises the chance of excessive bruising or bleeding under the skin.
Gray Areas That Need Clinical Judgment
Some conditions didn’t reach clear consensus on whether they’re full contraindications or simply require extra caution. These include peripheral vascular disease, varicose veins, cancer, lupus, healing surgical scars, stress fractures that haven’t fully healed, and high-risk pregnancy. For these, the decision depends on the specifics of your situation and your practitioner’s clinical judgment.
Pregnant women should, at minimum, avoid Graston over the spine, pelvis, abdomen, and certain acupuncture points. And regardless of pregnancy status, direct pressure over the face, eyes, bony prominences, and areas where arteries, veins, or nerves sit close to the surface carries higher risk.
Practitioner Training Matters
One of the biggest factors in whether Graston technique is safe or risky is who’s performing it. Officially, only clinicians who complete the Graston Technique Basic training course are qualified to use the branded instruments. Training is available to physical therapists, chiropractors, athletic trainers, occupational therapists, acupuncturists, massage therapists, and several other licensed professionals. Beyond the basic course, practitioners can pursue advanced training and a credential exam.
The reality is that many practitioners use generic instrument-assisted soft tissue mobilization (IASTM) tools without Graston-specific certification. The technique itself isn’t complicated to learn at a basic level, but knowing how much pressure to apply, when to stop, and how to read the skin’s response takes training and experience. Too much pressure turns therapeutic microtrauma into unnecessary tissue damage. A practitioner who treats petechiae as a goal rather than a warning sign is applying the technique incorrectly.
If you’re considering Graston, ask your practitioner about their training and certification. A qualified provider will also screen you for contraindications before the first session, not just hand you an instrument consent form.
The Bottom Line on Risk
For a healthy person without the contraindications listed above, the risks of Graston technique are minor and temporary: soreness, redness, and possibly some bruising. The treatment does not cause deep tissue damage when performed correctly. The most common “danger” is simply overly aggressive application, which leads to unnecessary bruising and pain but not lasting injury. The conditions where Graston is genuinely dangerous are well defined, and a properly trained clinician will screen for them before treatment begins.