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Cupping vs. Graston/IASTM: How They Differ in Pain Relief and Tissue Healing

11 minutes ago3 min read

At River Forest Health and Wellness, we employ various soft tissue techniques to assist patients in recovering from pain, injuries, and mobility restrictions. Two notable methods—cupping therapy and instrument-assisted soft tissue mobilization (IASTM), including the Graston Technique—offer unique approaches to enhancing tissue health and function. While both therapies aim to alleviate musculoskeletal pain, they operate through distinct mechanisms at the cellular level.

Understanding the histological effects of these therapies can guide patients and practitioners in selecting the most appropriate treatment for individual needs.

Cupping Therapy: Decompression for Fascia and Blood Flow

Cupping therapy River Forest Physical Therapy

Cupping therapy is an ancient technique that has been utilized in Eastern medicine for centuries. Unlike most manual therapies that compress soft tissues, cupping employs negative pressure (decompression) to lift the skin and underlying fascia.

Histological Effects of Cupping:

1. Increase in Blood Flow and Microvascular Permeability

The suction created by the cup expands capillaries and induces localized hyperemia (increased blood flow).
This influx of oxygen-rich blood delivers nutrients to the tissues and removes metabolic waste, accelerating healing.

2. Stimulation of Fibroblasts and Myofibroblasts

Fibroblasts are crucial for collagen production and tissue repair.
Cupping’s negative pressure stimulates fibroblast activation, enhancing fascia elasticity and aiding recovery from chronic tension.

3. Reduction of Fascial Adhesions

Over time, fascia can become densely bound due to injuries, overuse, or chronic inflammation.
Cupping separates fascial layers by lifting and stretching the tissue, promoting better gliding movement between structures.

4. Trigger Point and Lymphatic Drainage Effects

Cupping helps to decrease myofascial trigger points by altering pressure within the tissues.
It also improves lymphatic circulation, reducing fluid retention and inflammation in affected areas.

A study examining the clinical and histological skin changes after cupping therapy reported immediate effects such as erythema, swelling, and bruising, which are indicative of increased blood flow and localized inflammation—key components in the healing process.

Best for: Chronic tightness, myofascial pain, postural tension, circulatory issues, and recovery from soft tissue overuse injuries.

Graston Technique & IASTM: Controlled Microtrauma for Tissue Remodeling

IASTM Graston River Forest Physical therapy

Instrument-assisted soft tissue mobilization (IASTM), including the Graston Technique, utilizes specialized metal or plastic tools to scrape or glide over soft tissues. Unlike cupping, which decompresses tissues, IASTM provides mechanical stimulation through controlled microtrauma to initiate a healing response.

Histological Effects of Graston/IASTM:

1. Breakdown of Scar Tissue and Adhesions

The mechanical force applied by IASTM tools creates microtrauma within pathological collagen fibers.
This stimulates phagocytosis, where the body breaks down and resorbs dysfunctional scar tissue.

2. Induction of Fibroblast Proliferation

IASTM increases fibroblast activity through mechanical stimulation.
The microtrauma signals fibroblasts to lay down new collagen in a more organized, functional pattern to replace rigid scar tissue.

3. Stimulation of Mechanoreceptors for Pain Reduction

Graston and IASTM activate Ruffini and Pacinian corpuscles, which help regulate proprioception and pain perception.
This process, known as mechanotransduction, reduces pain by altering sensory input from affected tissues to the nervous system.

4. Increased Vascular Response and Cellular Repair

IASTM stimulates angiogenesis (formation of new capillaries), improving tissue oxygenation.
The localized inflammatory response leads to macrophage activation, which helps clear damaged cellular debris and promotes healing.
A systematic review of IASTM reported improvements in range of motion, pain reduction, and patient-reported function, supporting its efficacy in treating various musculoskeletal conditions.

Best for: Chronic tendinopathies, post-surgical adhesions, plantar fasciitis, carpal tunnel syndrome, and conditions requiring scar tissue remodeling.

	Cupping	IASTM
Mechanism	Decompression & negative pressure	Controlled microtrauma & mechanical stimulation
Primary Goal	Increase blood flow, separate fascia, reduce tension	Break down adhesions, stimulate fibroblast proliferation, improve collagen remodeling
Histological Effect	Expands capillaries, increases fibroblast activity, reduces fascial tightness	Induces controlled microtrauma, increases phagocytosis of scar tissue, improves cellular repair
Pain Reduction	Improves circulation, reduces myofascial tension, stimulates lymphatic drainage	Alters pain perception through mechanoreceptor activation, stimulates localized inflammation for repair
Best for	Myofascial pain, chronic tightness, postural tension	Chronic tendinopathy, adhesions, scar tissue remodeling, limited mobility due to fibrosis

Which Treatment Is Right for You?

Both cupping and Graston/IASTM provide significant pain relief and soft tissue remodeling, but they work in different ways.

If you’re experiencing tightness, restricted blood flow, or fascial stiffness, cupping is a great choice to improve circulation and decompression.
If you have scar tissue, chronic tendinitis, or restrictions from past injuries, Graston/IASTM can help break down adhesions and restore tissue mobility.