presentation-guyer.pdf
- 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
- 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
- 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
- 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.