Soft-tissue therapies (ART, Graston, cupping)
Evidence: weak
Active Release Techniques, instrument-assisted soft-tissue mobilisation (Graston) and cupping are branded soft-tissue treatments with weak, inconsistent evidence. Where any benefit shows, it is short-term and looks like the general comfort effect of massage, not something the specific method or trademark adds.
Not medical advice
This is a general knowledge base, not medical or dietary advice. If you are injured, unwell or weighing up a supplement or a change to your diet, speak to a doctor, physiotherapist or registered dietitian who knows your situation.
Why this page exists
The evidence for these treatments is genuinely thin, and this page exists so a reader finds an honest account of that rather than the marketing. None of them is a fix for a running injury. They are grouped together because they share the same shape: a branded soft-tissue technique whose felt benefit is short-term, perceptual and hard to separate from ordinary massage.
Three popular treatments wrap a brand or a tool around generic soft-tissue work and claim something more specific. The evidence does not bear the claims out.
Active Release Techniques (ART)
ART is a trademarked system of manual soft-tissue treatment, in which a therapist applies pressure to a muscle while moving the limb through a range, on the theory of breaking down adhesions between tissues. The controlled evidence is scarce and concentrated on one narrow outcome: small studies, mostly in healthy people, support an acute, short-term increase in hamstring flexibility after a single session, but head-to-head trials find ART no better than, and sometimes worse than, comparators such as PNF stretching or dynamic soft-tissue work (ART hamstring evidence). So the evidence is for an immediate flexibility change in the uninjured, not for treating a running injury, and it does not show ART doing anything its generic soft-tissue comparators do not. The wider evidence for hands-on soft-tissue work, including massage, points the same way: short-term relief — small improvements in flexibility and perceived soreness — with no meaningful performance or structural benefit (Davis et al. 2020). The ‘releasing adhesions’ mechanism is best read as a loose metaphor, the same caution the massage page applies to ‘knots’.
Instrument-assisted soft-tissue mobilisation (Graston, IASTM)
IASTM uses metal or plastic tools to scrape and rub the skin and underlying tissue; Graston is the best-known branded version. A systematic review and effect-size analysis found large effect sizes for pain and patient-reported function in injured participants and for range of motion in uninjured participants, concluding that moderate evidence supports IASTM for those outcomes (IASTM review 2019). The studies were heterogeneous, no firm recommendation on dosage or instrument could be drawn, and IASTM showed no consistent benefit for strength.
Cupping
Cupping applies suction cups to the skin, leaving the circular marks sometimes seen on athletes. A systematic review of its use in musculoskeletal and sports rehabilitation found mostly low-quality, high-risk-of-bias trials; cupping beat doing nothing or usual care, but performed similarly to acupuncture, and the evidence was insufficient to recommend it for athletes (cupping review 2022). Adverse effects (skin marking, occasional haematoma or increased pain) are minor. The picture is of a largely non-specific effect on a weak evidence base.
The common thread
All three sit at the same place as the rest of the passive therapies: real but short-term relief, much of it non-specific, with little to show that the named technique adds anything over plain hands-on work. They are reasonable enough as comfort, poor value as a cure, and not a substitute for the loading and strength work that treats the injury. The branding is a good example of the marketing playbook: a proprietary name and a mechanism story attached to a modest, generic effect.