The document discusses various manual therapy techniques, notably Active Release Techniques® (ART) and Graston Technique®, within the athletic trainer's scope, emphasizing their efficacy in treating chronic tendon injuries like tendinosis. It details the mechanisms behind tendinosis, management strategies to improve healing, and the importance of proper training and certification in these techniques. The content also highlights common areas for treatment, the stages of soft tissue recovery, and testimonials from professionals using these methods in sports settings.

1. Appropriate Manual Therapy
within the AT Scope of Practice
Dr. Kevin Christie, D.C.

2. A Little About Me
• Kevin Christie D.C. A.R.T.
• Chiropractic Physician- Boca Raton, FL
• Active Release Techniques® Full Body Certified
• Graston Techniques® Certified
• Kinesio® Taping Certified
• Board of Athletic Trainers for the state of Florida
• Clinical Director of XPE Sports NFL Combine Prep Program

3. Common Manual Therapy Techniques
Within the Athletic Trainer’s Scope
• Active Release Techniques®
• Graston Technique®
• Fascial Distortion Model™
• FAKTR-PM

4. I = Insult to Tissues
N = Number of Repetitions
F = Force of each Repetition
A = Amplitude of each Rep
R = Relaxation time b/n Reps
Law of Repetitive Motion
I=NF/AR

5. The Cumulative Injury Cycle

6. Tendinosis vs Tendonitis
• Chronic tendon injuries are degenerative in nature and NOT inflammatory.
• Anti-inflammatory medications (NSAID’s) and/or corticosteroid injections
can actually accelerate the degenerative process and make the tendon more
susceptible to further injury, longer recovery time and may increase
likelihood of rupture.
• Heavy load eccentric strength training helps to increase the tensile strength
of the tendon, increase the amount of Type I collagen and decrease the
amount of ground substance thereby reducing tendon volume and helping
restore the tendon to a healthy state.
• Treatment for this condition must first attempt to stop the degenerative cycle
and then to restore proper collagen synthesis, strength and function.

7. Resolving Tendinopathy
Theories Regarding the Healing of Tendinosis
Increase of blood flow to the area decreasing the hypoxic state and aiding in healing
response and collagen remodeling.
Reversing the Tendinosis Cycle
Mechanically mobilizes the scar tissue, loosening it from surrounding healthy tissue.
Reinitiates the inflammatory process by introducing a small amount of trauma to the tendon
scar.
Re-inflammation starts the healing process again by increasing blood, nutrients, and
fibroblasts to region.
Common areas for Tendonosis
Medial and Lateral Epicondylosis
Patellar Tendonosis
Achilles Tendonosis
Supraspinatus Tendonosis

8. Soft Tissue Changes after Injury
• Inflamed: 24 Hours-72
Hours
• Stringy: 2 Days- 2 Weeks
• Lumpy: 2 Weeks- 3 Months
• Leathery: 3 Months Plus

9. The ART® Process
• Patient presents with
symptoms/history
• Match to symptom pattern chart
• List of treatment protocols
• Treat and evaluate tissues
• Related protocols and antagonists
• Re-evaluate for further treatment.

10. A.R.T. Palpation and Performing
• Diagnosing the Soft Tissue Lesion
• Nature of lesion (tear, adhesion, crush)
• Exact Tissue (i.e. Pronator Teres, Median Nerve, Joint Capsule)
• Syndrome (Peripheral Nerve Entrapment, Myofascitis)
• Performing an ART Protocol
• Shorten the affected tissue
• Place contact and apply tension
• Lengthen the tissue/cause relative motion
• Release the tissue by using contact tension

11. Key aspects of ART Effectiveness
• Avoiding Tissue Injury
• Soft Contact
• Start with longitudinal Direction
• Active Motion when possible
• Patient tolerance
• Tissue tolerance
• Lymphatic and veinous flow
• Treatment frequency

12. Key aspects of ART Effectiveness
• Maximizing Treatment Effectiveness
• Use tension and minimal compression
• Finish patient motion and contact tension
• Use internal vs external glide- Penetrate through skin to
proper structure then draw tension. (Avoid skin pulling).

13. Becoming A.R.T® Certified
• After completion of an authorized ART® course, passing the practical
examination and maintaining your certification allows you to:
• Use the ART® Treatment System and Protocols
• Use the terms ART® and Active Release Techniques®
• Participate in ART® Events and Programs

14. The Graston Technique®
For the clinician:
• Provides improved diagnostic treatment
• Detects major and minor fibrotic changes
• Reduces manual stress; provides hand and joint conservation
• Increases patient satisfaction by achieving notably better outcomes
For the patient:
•Decreases overall time of treatment
•Fosters faster rehabilitation/recovery
•Reduces need for anti-inflammatory medication
•Resolves chronic conditions thought to be permanent

15. Becoming Certified in Graston Technique®
M1 Course Objectives
• The primary objective of M1 is to develop an understanding of GT and how to apply it
into the full spectrum of musculoskeletal treatment approaches. By the end of the
training, you will be able to
• Demonstrate a working knowledge of the GT instruments, GT treatments, potential
effects and benefits.
• Identify and discuss the indications, contraindications (relative and absolute) of the
Graston Technique®.
• Review and develop a better understanding of soft tissue injury, healing and potential
reactivity to instrument-assisted soft tissue mobilization (therapeutic and adverse).
• Develop skill and competence in the GT application of IASTM to the major regions of the
spine and extremities.

16. Graston Technique®
Recommended Care
• Soft Tissue Warm-Up
• Graston Technique Applied
• Stretching
• Rehabilitative Exercises
• High Rep/Low Load
• Cryotherapy

17. Who is Using Graston Technique?
• Professional Sports Teams
• Major Universities
• Large Corporations
• Physical Therapy, Chiropractic, Sports Medicine Facilities
• Athletic Training Master’s Degree
• U.S. Olympic Training Centers

18. Universities and Pro Teams
Utilized in Athletic Training Room
NBA
Atlanta Hawks
Boston Celtics
Charlotte Bobcats
Cleveland Cavaliers
Denver Nuggets
Miami Heat
Milwaukee Bucks
Minnesota Timberwolves
New York Knicks
Philadelphia 76ers
San Antonio Spurs
NFL
Atlanta Falcons
Cleveland Browns
Houston Texans
Indianapolis Colts
Jacksonville Jaguars
Minnesota Vikings
New England Patriots
New York Giants
San Francisco 49ers
St. Louis Rams
Tennessee Titans
Washington Redskins
MLB
Chicago White Sox
Cincinnati Reds
Cleveland Indians
Kansas City Royals
Milwaukee Brewers
New York Mets
Seattle Mariners
St. Louis Cardinals
Texas Rangers
Toronto Blue Jays
Washington Nationals

19. Athletic Training
Masters Program
Barry University
Concordia University - Wisconsin
Culver-Stockton College
Georgia Southern University
Gustavus Aldolphus College
Illinois State University
Indiana University
Indiana State University
Kent State University
Louisiana State University
Old Dominion University
Saint Louis University
Stephen F. Austin State
University
Texas State University
University of Kansas
(undergraduate)
University of North Carolina
University of Oregon
University of South Carolina
University of Wisconsin
West Virginia University

20. Graston Testimonial
•
"GT has been an integral and largely beneficial application in
our care and treatment of the acute and chronic conditions that
affect professional baseball players. Our efforts at edema
reduction in acute ankle sprains and contusions (hit by pitch,
foul tips) have been more successful as a direct result of
implementing GT in our protocols. We have seen tremendous
outcome results in chronic conditions such as tendinosis, scar
tissue impediments and fascial pain syndromes. Our athletes
often present to the athletic training room requesting GT. "
Lonnie Soloff, ATC, PT
Head Athletic Trainer, Cleveland Indians

21. FAKTR-PM
Functional and Kinetic Treatment with Rehabilitation,
Provocation and Motion
Functional: Treating patients during functional mvmnt.
Kinetic: Assess the Kinetic Chain for injury cause.
Treatment: Graston Technique, A.R.T, Nimmo, PIR, Etc.
Rehabilitation: Low tech rehab during manual therapy
Provocation: Treat in position of provocation of
symptoms
Motion: If pain is worse with motion, treat with
motion?

22. Fascial Distortion Model™
• It’s called a ‘model’ because it isn’t a technique.
• Soft tissue injuries and/or musculoskeletal complaints.
• Viewed through 1 or more of the 6 different types of alterations to the body’s connective
tissues.
• FDM has no protocols to memorize.
• FDM contains a detailed physical assessment, which leads to a specific diagnosis, and
provides objective outcomes.
• The patient’s verbal and physical descriptions, coupled with the mechanism of injury and
relevant orthopedic tests, will lead the practitioner to the proper form of soft tissue
treatment.

23. Fascial Distortion Model™
• Treatment - This clinical assessment is followed by hands-on soft tissue
and joint mobilization to help with the healing of the painful areas and
their surrounding damaged tissues. If necessary you might be
prescribed personalized stretching regiments and exercises.

24. Integrating Manual Therapy for the AT
• Common Injuries Successfully treated with manual therapy
• Tendonopathies
• Fascial Syndromes
• Myofascial Pain Syndromes
• Entrapment Syndromes
• Scar Tissue/Adhesions
• Ligaments Sprains

25. Research & References
www.grastontechnique.com- Preferred Provider Database
Graston Technique Module 2 Training Manual
FAKTR-PM Training Manual
The Effects of a Randomized Four-Week Graston Instrumented-
Assisted Soft Tissue Mobilization (GISTM) Dynamic Balancing-Training
Program on Individuals with Chronic Ankle Instability
Graston Technique for Athletic Injuries
Treating an Unresolved Hamstring Injury with GT
A Guide to Preventing and Managing Golf Injuries
Achilles Tendinpathies in Runners Causes Treatment and Prevention
The Pathology & Healing of Tendinosis
Shoulder Impingement Syndrome in Olympian

26. Any Questions?
www.Healthfitchiro.com
Drkchristie@gmail.com