How the Graston Technique can Assist With Pain Management

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Graston technique is the best known of the methods for instrument-assisted soft tissue manipulation.   The tools, known as Graston tools are handcrafted from stainless steel and are anatomically shaped to contour to different parts of the body during treatment for maximum effectiveness. Graston was developed over many years in university sports departments, hospitals as well as in doctors' offices and many studies have shown this evidence-based approach to treatment is highly effective.   The chiropractic profession took to it quickly since it solved many of the problems treated by sports chiropractors.  Physical Therapists also liked the tools as well. The idea's behind the technique were not original, since Dr. James Cyriax explored the idea using trained practitioners treating tendons years ago for problems such as tendonosis.  Dr. Cyriax's method of friction massage was used by our office many years ago.  While effective, it was also quite painful and difficult to apply for both the healthcare practitioner as well as the patient being treated.  Graston or Instrument assisted soft tissue (IASTM) improved on the idea because the tools allowed for much broader areas to be treated and applying the therapy to broad areas of restricted tissue, not just tendons. Dr. Cyriax was also an early adopter of the idea of active evaluation and used treat-test-treat protocols to evaluate the effectiveness of his treatments, an evidence-based approach many offices such as ours have adopted to assure that the treatment we apply is effective and accomplishes what we believe it should for that visit.  As with most pioneers, he was treated as an outsider by his profession, even though history has shown that his approach was effective and groundbreaking. There are many types of myofascial treatments available to address dysfunctional soft tissues.  Graston is an effective and efficient way to break up soft tissue adhesion that limits movement and affects movement patterns that develop as we accommodate to gravity, our own body styles and many of the activities we do.  The myofascia will form according to the forces we place upon it.  If those forces are uneven, the tightened fascia will reinforce poor movement patterns and will affect the way we walk and move. There are many models that are well-revered as to how the fascia affects movement which include Myer's Anatomy Trains and Stecco who explain from their own points of view what fascia does, how it affects movement, and how it should be treated.  Any number of treatment methods can be used to affect fascia, and Graston Technique and its tools can be especially effective on resolving chronic problems. The myofascia controls movement and muscular coordination during walking, eating, running as well as other activities of daily living.    The fascia has been shown to have its own neurologic system as well and many painful syndromes are linked to the flexibility of the myofascia including back and neck pain. While there are methods that are effective in improving how fascia functions including myofascial release, instrument-assisted soft tissue methods such as Graston can effectively remove fascial restrictions so we can retrain those tissues and remodel the fascia for improved mobility and efficiency in how we move.   An emollient is used on the skin as a lubricant for the tool.   The treatment is always done to tolerance. Looser and more flexible tissues can then be retrained to work more effectively and efficiently with appropriate exercises to help you resolve a painful and chronic condition. The tool is very sensitive to restriction and adhesion formation which can be felt through the tool, both by the patient and the practitioner, through a method called scanning.  The procedure is the scan, then treat, then scan.  Applying movement during the treatment improves the effect of the tool markedly on restrictions and adhesions. Graston excels with fibrous tissue, such as the IT band, tight heel chords, plantar fasciitis and most types of tendonosis.   It is extremely effective on tight legs, hamstrings and a very restricted core area that may have had numerous injuries over the years which is now restricting motion in the shoulders and even the neck region.  An area that is repeatedly injured or has repeated flare-ups may improve markedly as the soft tissues have been restored to a better level of flexibility.

The importance of understanding how and when to use Graston Technique

Patients often visit our office with a laundry list of what they have done to manage their problems and sometimes Graston was one of these techniques that were used.  The way the problem is evaluated and the understanding of the problem from the evaluation by the healthcare provider will determine how effective the tool is in relieving painful mechanical problems.   If the problem is poorly understood, and Graston is used inappropriately, the problem may not improve at all with the use of the tool.  An experienced healthcare practitioner is likely to get a better result. A detailed evaluation is essential with active evaluation methods to determine why the patient is in pain and then, by using treat-test-treat protocols, we can then see how the patient is responding immediately and how the intervention that day, which may include Graston Technique has improved functionally. Rather than look strictly at the pain, which is what most patients initially visit us for, we look at function first.  When function improves, pain is usually reduced.   Follow-up visits build on the success of each visit and functional tests as well as corrective exercises are used to help build on that improvement. Our office uses both Graston and Myofascial Release to maximum effect.   Graston on very fibrous tissue is preferred because it is more efficient and remodels the tissues so they can work more efficiently.   Stiff tendons are often problematic and can be painful, with conditions such as tendonosis.   Graston is most efficient with tissues such as these.   On follow-up visits, myofascial release can efficiently restore movement more completely, so the combination of using both of these methods is ideal to resolve many painful conditions. Over the years, our office has developed our own unique protocols for using movement to resolve hip pain, tendonosis, knee pain, lower back pain, neck pain, shoulder pain, and elbow and wrist pain.   Pain in the foot especially on the bottom, which is also known as plantar fasciitis can also respond well to the use of Graston Technique. The combination of a thorough active evaluation, treat - teat - treat protocols, exercises, manipulation of restricted joints and neurologic retraining protocols resolves many chronic pain problems that many methods alone cannot.  A multi-faceted approach using Graston Technique helps many people not just manage pain, but resolve it, and the mechanism behind why you hurt, without the use of drugs or surgery.