Scraping Past Injury With the Graston® Technique
Physical Therapy and the Graston® Technique
Have you ever noticed a physical therapist using a small silver tool to scrape along a patient’s skin and wondered, “what the heck is that for?” It’s likely that you witnessed the therapist using a technique called the Graston® Technique. Graston is a type of instrument assisted soft tissue mobilization (IASTM) that therapists can use to promote healing and sensory changes in chronically or acutely injured or irritated tissues. This is just one tool that therapists have in their toolbox to address musculoskeletal injuries and in this article you will learn more about the technique, why it is used and the proposed effects.
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Like many great inventions, the Graston Technique evolved out of the desire to solve a problem.
This technique was first imagined by an amateur athlete who designed a set of tools to help him heal a knee injury. After having success treating his own injury, this athlete sought the help of medical and research professionals at Ball Memorial Hospital and Ball State University in Muncie to create a set of tools that would be adopted by the technique. In 1994 a clinic was opened in Indianapolis where clinicians gathered data on the success of these tools on a wide variety of acute and chronic injuries and five years later began offering training and education to outside clinicians on how to use these tools effectively in their own practices.
Now that you know where it came from let’s talk about what it is. Graston tools are made of stainless steel and designed with special edges and bevels to maximize their contours and effectiveness. Each instrument fits in the hand of a clinician and is used to mobilize soft tissues, ie., instrument assisted soft tissue mobilization. These tools were designed to address restrictions in the fascia and lesions in soft tissue that may be contributing to musculoskeletal injury or dysfunction. Through deep pressure and a scraping motion along the tissue, researchers at Graston Technique state that empirical and anecdotal evidence exists for several physiologic changes in the tissues. According to their website, the use of the Graston Technique can:
Separate and break down collagen cross links
Splay and stretch connective tissue & muscle fibers
Inhibit abnormal muscle tone and guarding which can lead to pain reduction
Increase the rate and amount of blood flow to/from the area
Increase cellular activity in the area
These effects can all contribute to a reduction in pain, a normalization of tissue alignment and an inflammatory response that can result in a completed healing cycle. The goal in using this technique is to combine it with individually prescribed therapeutic exercises to help reduce pain, restore normal range of motion and improve function.
Only clinicians trained by Graston instructors can claim to be using the Graston Technique. At this time there are other brands of IASTM tools that may train their clinicians differently, however, in this article we are focusing only on Graston. Graston Technique trained clinicians have made a considerable contribution of their time and finances to gain their credentialing and a sound knowledge of the safe application of the technique.
WHO CAN BENEFIT FROM THE GRASTON® TECHNIQUE?
As noted above, this technique has been historically used to treat a wide variety of acute and chronic injuries. Soft tissues are the primary focus of the Graston technique and these include tissue layers such as fascia, tendons and ligaments. Fascia is a thin casing of connective tissue that courses through the body and encapsulates every organ, muscle, nerve, blood vessel and fiber. Inflammation and trauma can affect the fascia causing pain and impeding movement both locally and further away in the body.
Injuries can lead to scar tissue, facial restrictions and soft tissue impairments which can restrict movement but also have larger effects on the nervous system. They alter sensory perception in the tissue which can induce a cycle of centralized pain in the body. In many of these cases the presence of pain does not actually signal the presence of injury but the nervous system becomes stuck in a cycle of perceived pain which then alters the body's movement and motor output. The use of the Graston instruments are intended to alter the abnormal sensory input and interrupt the pain cycle to allow the person to restore normal movement.
A simple example of how deep pressure or scraping can alter sensory input is to think of a time when you bumped your elbow hard against something. Pain quickly explodes in the area and you immediately place your hand over that spot and apply pressure. Because the nerves that carry pressure information transmit faster than the pain-carrying nerves, the pressure alters the sensory input and lessens the pain.
While Graston Techniques are not always indicated or needed, your therapist may opt to use the Graston instruments where they feel the soft tissue or fascia is affected or restricted. Tendonitis or tendinopathy, for example tennis elbow or achilles tendonitis, might benefit from the use of the tools on the involved tendon. Plantar fasciitis is another condition that may respond well to these techniques. Treating scar tissue after a surgery, low back or neck pain, patellofemoral disorders or even myofascial pain syndromes like Fibromyalgia are all examples of times when the Graston Technique may be applied.
Though Graston is a great tool, don’t worry if your therapist is not trained in this technique. There are many different ways to reduce pain, improve range of motion and function and our team of therapists at Evolve Physical Therapy have been trained in many effective treatment techniques. If you are dealing with an acute or chronic injury, however, it’s time to call the experts. We are here to help you get on the road to healing. Call to schedule an evaluation today.
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