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Graston Technique

The Graston Technique (GT) is an innovative form of instrument-aided tissue mobilization that lets a clinician effectively break down the fascial restrictions and scars in order to promote healing. Healing and recovery of fibrous or scarred tissues is rather slow. This is primarily due to low blood supply across the fibrous tissue. The aim of the Graston Technique is to create micro-traumas at the damaged tissue in enhance healing.

While this might seem counter-productive, it is not. The micro-trauma enhances inflammation – and thus, blood flow – to the area, and thereby helps the process of repair and remodelling.

This technique requires a specially designed stainless steel instrument that helps find and treat problem areas with chronic inflammation or soft tissue fibrosis.

How does the Graston Technique work?

GT separates and breaks the cross-linked collagen in scar tissue. This is usually accomplished by stretching and splaying the muscle fibers and connective tissue components.

To promote the natural healing process and remodelling of tissues, chiropractors slightly increase the temperature of skin, and GT increases the flow of blood to and from the affected tissues. GT increases the activity of cells in the region, which helps with tissue remodelling.

When would the Graston Technique help?

Research and clinical data indicate that the Graston Technique is effective in the management of following conditions:

  • Lower back muscle strain or sprain
  • Achilles tendinosis
  • Carpal tunnel syndrome
  • Abductor pollicis longus tendonitis
  • Plantar fasciitis
  • Shin splints
  • Tennis/golfer’s elbow
  • Rotator cuff tendinosis
  • Illiotibial Band Syndrome
  • Myofascial pain syndrome
  • Cervical sprain/strain

What are contraindications of Graston Technique?

There are some conditions for which the Graston Technique is not the preferred therapy. These include (2):

  • Open wounds or weeping ulcers
  • Uncontrolled or very high blood pressure
  • Active malignancy or tumor (also depends on the location and type of tumor)
  • Active Pregnancy or immediately after childbirth
  • Compound fractures, or any healing fracture
  • Hemophilia
  • Osteomyelitis
  • Muscle disorders such as myositis ossificans
  • Certain renal conditions
  • Use of blood-thinning medications

Why is scar tissue problematic?

Scarring in musculoskeletal tissues is associated with:

  • Limiting the overall range of motion and flexibility of tissues.
  • Pain and discomfort on activity.
  • Higher risk of future injuries due to aggravated pressure and load on functional muscle fibers.
  • High risk of stiffness.
  • More than higher risk of developing premature osteoarthritis and other dysfunctional joint injuries.

What is the difference between scar tissue and other tissues?

Normal tissues appear as regular elongated, dense fibers running in similar directions like ligaments and tendons. Due to symmetrical alignment, the strength, power, and overall capacity of muscle component increases significantly.

Damaged or scarred tissues, in contrast, have a haphazard arrangement of muscle fibers along with non-contractile elements in between the contractile components. All these factors can directly compromise the strength and power of muscles, overall flexibility, and range of motion.

How is the instrument used?

The stainless steel instrument is used by skilled practitioner to identify the area of involvement. Next, the practitioner uses knowledge of musculoskeletal tissue anatomy and physiology to break up scar tissue, fibrous cords and realign muscle fibers, which enhances functional independence.

There may be some degree of discomfort during the procedure that should resolve spontaneously within a few days. Some patients may develop mild bruising, which is normal and resolves on its own.

How can you enhance the quality of results with Graston Technique?

Graston Technique is often employed with a variety of other intense therapeutic protocols, such as Active Release Technique, Ultrasound, and stretching exercises. A practitioner may initiate the therapy with a short warm-up exercise, followed by stretching and strengthening exercises. After the procedure, patients are advised to maintain mild physical activity to enhance healing and optimal recovery. Cold compresses or ice massage can help for pain relief.

Most patients respond to 3-4 sessions of therapy (over 2 or more weeks), though this varies depending upon the findings of an initial examination, response to therapy, and other features. Extreme cases may require additional sessions of therapy, though most patients report improvement in symptoms after first few sessions.

According to a study conducted by Hansen and associates (1), 100% of patients reported improvement in symptoms after first two sessions. Another study (2) examining the efficacy of this technique in managing trigger point myofascial pain, investigators found that, “Graston technique does decrease the amount of pain felt by the patient in a given myofascial trigger point and the amount of pressure required to elicit pain.”

Research has also found that the positive effects of Graston Technique can be enhanced using a multi-modal approach. For example, according to recent research published in the Journal of the Canadian Chiropractic Association (4), investigators reported that using warm compresses, application of ice/ cold compresses, stretching, eccentric exercises, cryotherapy, and soft tissue mobilization along with Graston Technique can enhance the quality of results several folds.

References:

  1. Hansen, R., Phillips, D., & Tosh, J. (2012). Effects of Graston Technique on Iliotibial Band Syndrome.
  2. Roberts, M., Rupp, K., Dill, K. & Murray Q. (2012). Graston Technique and Its Effect on Trigger Points in the Upper Trapezius Muscle. October 2012.
  3. Looney, B., Srokose, T., Fernández-de-las-Peñas, C., & Cleland, J. A. (2011). Graston instrument soft tissue mobilization and home stretching for the management of plantar heel pain: a case series. Journal of Manipulative and Physiological Therapeutics, 34(2), 138-142.
  4. Miners, A. L., & Bougie, T. L. (2011). Chronic Achilles Tendinopathy: A case study of treatment incorporating active and passive tissue warm-up, Graston Technique®, ART®, eccentric exercise, and cryotherapy. The Journal of the Canadian Chiropractic Association, 55(4), 269.

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