This document discusses the Graston Technique, an instrument-assisted soft tissue mobilization used to treat musculoskeletal conditions. It breaks down scar tissue and fascial restrictions using specialized instruments. The technique aims to restore balance and function by releasing tight or shortened tissues. It provides benefits for both clinicians and patients by improving diagnosis, reducing treatment time, and resolving chronic conditions. Various instruments are used to apply targeted strokes to specific areas. Treatment is followed by stretches and rehabilitation exercises. Research shows the technique improves tissue healing by increasing fibroblasts and initiating the healing cascade. It often achieves better outcomes than traditional therapies for injuries like Achilles tendinitis, plantar fasciitis, and low back pain.

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.

4. Addressing Shortened Muscles

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

8. Red Flags – Absolute Yellow Flags – Relative
 Open wound
 Unhealed fractures
 Thrombophlebitis
 Uncontrolled
hypertension
 Hypersensitivity
 Hematoma
 Osteomyelitis
 Myositis ossificans
 Medications (anti-coagulants,
steroids, hormone replacement
therapy and NSAID)
 Cancer
 Varicose veins
 Burn scars
 Acute inflammatory conditions
 Kidney dysfunction
 Lymphedma
 Infection
 Rheumatoid arthritis
 Pregnancy
 Osteoporosis
 Hemophilia family history
 Polyneuropathies
Contraindications

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

10. Instrument Contact

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

13. Strokes
 Sweep
 Fan
 Brush
 Strum
 J-Stokes
 Swivel
 Scoop
 Framing

14. GT 1
 Purpose
 To evaluate and treat
generalized restrictions.
Scan and prepare the
tissue for deeper
treatment.
 Application
 Good for large muscle
groups.

15. Sweep Fan
Middle and Upper Trapezius

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

17. Framing Brushing
Patella

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.

19. Patella

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.

21. Plantar Fascia

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.

23. Gastrocnemius

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.

25. Sweep and Swivel

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

29. Warm-up

30. Treatment

31. Stretch

32. Rehabilitation

33. Cryo-therapy

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.

35. Injury
Average
# of Treatments
Complete
100%
Excellent
90%+
Good
80%+
Fair
70%+
Unchanged
less than 70%
Success Rate
Achilles Tendinitis 8 4 73 15 0 8 92
Ankle Sprain 8 6 52 24 6 12 82
Plantar Fasciitis 7 2 44 24 11 19 70
Patella Femoral Syndrome 11 5 42 24 24 5 71
Cervical Pain 11 4 49 29 13 5 82
Low Back Pain 11 8 44 35 6 7 87
Fibromyalgia 10 6 31 44 6 13 81
Hip Pain 9 8 30 50 4 8 88
Hamstring Strain 8 12 58 12 12 6 82
ITB Tendinitis 7 0 64 18 9 9 82
Lat Epicondylitis 10 15 44 31 4 6 90
Med Epicondylitis 8 13 27 20 7 33 60
Rotator Cuff Tendinitis 9 14 40 38 3 5 92
Adhesive Capsulitis 15 0 18 55 18 9 73
Carpal Tunnel Syndrome 8 5 60 21 9 5 86
Wrist Tendinitis 7 13 46 33 4 4 92
Scar Pain 9 0 46 8 38 8 54
* = Median # of treatments
Success Rate: Percentage of Resolution equates to attaining the patient/clinician goals of
1) increase in function

36. Summary
 Excellent technique for chronic pathologies.
 Good outcomes when protocol is used.
 Can keep a patient more active during the recovery
phase.