Active Release Technique Versus Graston Technique for Rotator Cuff Tendinopathy: A Narrative Review

Abstract

Background: Rotator cuff tendinopathy is a common cause of shoulder pain, reduced range of motion, sleep disturbance, and functional limitation. Exercise-based rehabilitation remains the foundation of conservative care, but soft-tissue interventions such as Active Release Technique and Graston Technique are frequently used as adjuncts to reduce pain and improve movement tolerance. Objective: This narrative review aimed to compare the available evidence on Active Release Technique and Graston Technique for rotator cuff tendinopathy and related shoulder rehabilitation conditions, with emphasis on pain, range of motion, disability, function, and clinical applicability. Methods: A structured narrative synthesis was conducted using recent and clinically relevant literature on Active Release Technique, Graston Technique, instrument-assisted soft tissue mobilization, rotator cuff tendinopathy, rotator cuff-related shoulder pain, subacromial pain syndrome, supraspinatus tendinopathy, and shoulder rehabilitation. Evidence from randomized trials, systematic reviews, clinical studies, and related rehabilitation literature was synthesized descriptively because direct head-to-head evidence was limited and study populations, interventions, comparators, and outcomes were heterogeneous. Results: Both Active Release Technique and Graston Technique may improve short-term pain, movement tolerance, and function when combined with therapeutic exercise. Active Release Technique appears most applicable for localized movement-related soft-tissue sensitivity, whereas Graston Technique and broader instrument-assisted soft tissue mobilization have a wider evidence base in shoulder rehabilitation, including supraspinatus tendinopathy and post-operative rotator cuff repair contexts. However, much of the evidence remains indirect for non-surgical rotator cuff tendinopathy. Conclusion: Neither technique should replace progressive exercise-based rehabilitation. Current evidence does not establish clear superiority of one intervention over the other. Technique selection should depend on clinical presentation, patient tolerance, movement limitation, and rehabilitation goals.