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1. D R . M . S U S A N G U Y E R , D P E , A T C , C S C S
E A T A S T U D E N T P R O G R A M
S U N D A Y J A N U A R Y 1 1 T H , 2 0 1 5
Instrument-Assisted Soft Tissue
Mobilization
2. Background
Graston Technique® is an instrument-assisted soft
tissue mobilization that effectively break down scar
tissue and fascial restrictions.
The technique detects and effectively treats areas
exhibiting soft tissue fibrosis or chronic
inflammation.
Graston Technique® is an interdisciplinary
treatment: GT = GIASTM + Exercise
3. Diagnostic Indications
GT is indicated for virtually any patient who would
benefit from soft tissue mobilization.
After evaluation, soft tissue mobilization is used to
release and lengthen tight, shortened, restricted
tissue with the goal of restoring musculoskeletal
balance and normalizing function.
5. For the Clinician
Provides improved diagnostic treatment.
Detects major and minor fibrotic changes.
Reduces manual stress; provides hand and joint
conservation.
6. For the Patient
Decreases overall time of treatment.
Fosters faster rehabilitation/recovery.
Resolves chronic conditions thought to be
permanent.
7. Good results with the following:
Medial epicondylitis/osis
Back pain
Plantar fasciitis/fasciosis
Patella Tendinitis/osis
Achilles Tendinitis/osis
Wrist Tendinitits/osis
De Quervain’s Syndrome
Post-surgical scars
Myofascial pain
IT Band Syndrome
Also:
Pre/post competition
Petrissage/Milking edema
9. Graston Technique Instrument
The instruments are contoured to facilitate
treatment around different body parts.
Concave instrument:
Equalizes or disperses pressure over a larger surface area
Useful for increasing comfort, especially with a pain-sensitive
patient
Convex instrument:
Maximize pressure in a small surface area
Allows clinician to pinpoint pressure accurately
11. Instruments
Treatment edge
Single-beveled edge
Double-beveled edge
Basic handholds
Guidelines
30-60 degrees
Treatment edge faces in
the direction the
instrument is moving
12. Treatment strokes
Direction of the stroke
Perpendicular, parallel or diagonal to tissue fibers
Amplitude of the stroke
Large/small, broad/narrow
Rate of the stroke
Rapid/slow
Pressure of the stroke
Superficial
Contact point
On the instrument with the body tissue
Angle of the instrument
45 degrees
14. GT 1
Purpose
To evaluate and treat
generalized restrictions.
Scan and prepare the
tissue for deeper
treatment.
Application
Good for large muscle
groups.
16. GT 2
Purpose
Deeper work, knobs may
be used for deeper
penetration in a specific,
localized area.
Application
Fits around convex soft
tissue and bony
landmarks
18. GT3
Purpose
Used for localizing
restrictions and treatment
to a small area.
Application
Commonly used during
most treatment sessions,
allows more specific
application of pressure.
20. GT4
Purpose
Versatile instrument, used
to scan and locate
restrictions during an
assessment.
Application
Generalized assessment of
the region to detect soft
tissue abnormalities.
22. GT5
Purpose
Used as a general
scanning instrument as
well as a treatment
instrument.
Application
More aggressive treatment
of muscle restrictions,
useful in releasing
restrictions between ribs.
24. GT6
Purpose
Originally designed for
treating carpal tunnel,
used to release fascial
restrictions in the hands
and wrist area.
Application
Between metacarpals,
metatarsals and
phalanges, thenar and
hypothenar eminences.
26. Treatment Duration
Active Warm up
3-5 minutes
GISTM session:
Usually around 8-10 minutes for treatment of an involved region
GISTM per lesion:
Approximately 30-60 seconds. This pertains to a specific lesion
within a specific tissue structure
GISTM per joint:
Approximately 3-5 minutes.
Duration:
The goal is 4-8 sessions
27. Basic components of the Gaston Techniques
• Increase blood flow and tissue heating
• Increase tissue plasticity
Cardiovascular
warm-up
• Break up soft tissue restrictions
GISTM
• Lengthen shortened structures
• Low-load, long duration stretches to
facilitate plastic changes
Specifically
Targeted
Stretches
28. Basic components of the Gaston Techniques
• Davis’ Law of Soft Tissue – Fatigue shortened
structures and change fascial compartment
dimension
• Early goal is not strength
High
Repetition, low
weight exercise
• SAID Principle, LTG – Strengthen weak or
lengthened structures
Low repetition,
high weight
exercise
• Minimize post-treatment inflammation , soreness
and bruising as indicated by mode of treatment
Cryotherapy
34. Research
Research conducted, found that the controlled micro
trauma induced through Graston Technique® protocol,
increased the amount of fibroblasts to the treated area.
Inflammation to the scar tissue helps initiate the healing
cascade.
The structure of the tissue is rearranged, and damaged
tissue is replaced by new tissue.
Graston Technique®, generally achieving better
outcomes when compared to traditional therapies, and
resolving injuries that have failed to respond to other
therapies.
36. Summary
Excellent technique for chronic pathologies.
Good outcomes when protocol is used.
Can keep a patient more active during the recovery
phase.