Graston Technique - Kansas Athletic Trainers Society

Heavy Metal Treatment:
Using Instruments for Soft
Tissue Mobilization
Phillip Vardiman, PhD, LAT, ATC
Assistant Professor
University of Kansas
Department of Health, Sport and Exercise Sciences
Applied Physiology Laboratory
IASTM
Background
• Assistant Professor University of
Kansas
• Graston Technique M1 Instructor to
KU Athletic Training Education
Program
• Graston Module 1 and 2
• No funding for research has been
provided by GT or other company
Overview
 What is Instrument Assisted Soft Tissue Mobilization (IASTM)
 History
 Clinical Indications
 Research Overview
 Clinical Applications
 Discussion
 Questions
Instrument Assisted Soft
Tissue Mobilization

A therapeutic modality and
manual therapy technique that
when combined with
rehabilitative exercises
improves musculoskeletal
function.
History of IASTM

Gua Sha-(Gwah Shah) Gau = Scrape,
Scratch and Sha= Sand(the reddening,
petechiae that occurs)
 A.K.A. Coining, Spooning, Scraping
 Cao Gio(Vietnam)- (ceow yah)
Catch the wind
 Kerokan(Indonesia)- coining,
spooning, scraping
 Traditional East-Asian Alternative
Medicine
 The use of an instrument to cause
friction at the skin surface
 Transitory Petechiae
 Ecchymosis
 Thought to bring the static blood,
“wind”, or bad spirit from the body
so that it can be carried away
IASTM
Techniques/ Types of IASTM
 Gua Sha
 Fascial Abrasion
Technique (FAT)
 Hawk Grips
 Graston Technique
 Fibroblaster
 Adhesion Breakers
 Ceramic Spoon
Clinical Indications
 Pain
 Soft Tissue Injury
 Small and Large Treatment
Areas
 Decreased Range of Motion
 Scar Tissue
 Restriction of motion
 Excessive Scarring (Keloid,
Hypertropic)
 Fascial Restrictions
 Unsuccessful Treatment With
Traditional Cross-Fiber
Massage or Therapeutic
Massage
Clinical Indications (Cont.)
 Tendinopathies
 Fascial Syndromes
 Lateral Epicondylosis
 Plantar fascitis
 Medial Epicondylosis
 ITB Syndrome
 Supraspinatus Tendinosis
 Compartment Syndromes
 Achilles Tendinosis
 Trigger Fingers
 Dequervains Syndrome
 Patellar Tendinosis
Relative Contraindications
 Cancer
 Burn Scars (Mature scars
9 months post-healing
 Kidney dysfunction
 Pregnancy
 Medications,
Anticoagulants, Steroids,
hormone replacements,
NSAIDS
 Rheumatoid arthritis
 Varicose veins
Absolute Contraindications

Open Wounds/ Unhealed suture sites/ sutures

Thrombophlebitis

Uncontrolled Hypertension

Inflammatory conditions due to infection

Contagious or infectious skin conditions

Hematoma/ Myositis Ossificans

Osteomyelitis

Unstable fractures
Research Overview

Butterfield (2008) MSSE



Rabbit Model
Cyclic Compression improved function, attenuated necrosis and
leukocyte infiltration following EEP
Haas et al. (2013) BJSM


Rabbit Model
Dose Dependent (N, Hz, Time) MLL aided recovery in active muscle
properties in rabbits

Loghmani and Warden 2009
 Rat MCL complete disruption.
 Found the IASTM accelerated healing

Davidson et al. 1995
 Functional assessment of rats after achilles tendon injury
 Found increased fibroblast proliferation with use of IASTM
1.
2.
Haas et al. Br J Sports Med 2013: 47:83-88
Cunningham and Butterfield; ASWEB.ORG
Research Overview
 Vardiman, Siedlik, Hawkins, Herda, Cooper, and
Gallagher (2013)
 Intramuscular Response to IASTM
 IASTM to Gastroc/Soleus Complex
 MTS, EMG, MMG, ROM, PT, PFAQ
 Take Home
 IL-6 and TNF-α(p>0.05) Inflammatory Intramuscular
Myokines
 Passive and Active Muscle Properties are still being
analyzed (Stay tuned……..)
IASTM vs NO IASTM
IL-6
TNF-α
0.9
0.8
TNF-α (Arbitrary Units)
IL-6 (Arbitrary Units)
0.85
0.75
0.7
0.65
0.6
Baseline
24 Hours
48 Hours
72 Hours
0.8
0.7
0.6
0.5
Baseline
24 Hours
48 Hours
72 Hours
Research Overview
 Vardiman, Andre, Maresh, Graham, Gallagher,
Moodie, and Moodie (2012)
 Functional Squat Test Pre/Post IASTM to
Functional Squat Test
 3-D Motion Capture Assessment (ROM) and
PFAQ
 Take Home
 No change in Functional Squat Performance
 No change in perception of functional abiltiy
IASTM, Functional Assessment,
Perception of Functional Ability
Research Overview

Vardiman, Graham, Siedlik, Herda, Moodie, & Gallagher
(2013)




IASTM following SL-EEP
Muscle Biopsies at 24 and 48 hours
ROM, SL-1RM, Pressure Tolerance
Found




SL1RM (P<0.001) PT (P=0.009)
ROM (P=0.003) Greater in TL vs. CL and was significantly
greater over time (P<0.001)
IL-6 and TNF-α (P>.05)
Take Home

IASTM attenuated the decrease in ROM following EEP
IASTM After Eccentric Exercise
Case studies have shown Graston
Technique® to relieve symptoms of….
 carpal tunnel syndrome (Baker, 1999; Burke, 2007)
 lateral epicondylitis (Haller, 1999)
 achilles tendonitis (Hammer, 2008)
 plantar fasciitis (Hammer, 2008)
Outcome data
 60 subjects (20 in each group)
 Hip adduction ROM increased
 25% in GISTM group
 15% in Gua Sha
Holtz BJ, Davey K, Engleman N, Kaeser C, Wood-Vossmer K, Bayliss AJ, Loghmani MT.

3 patients

Patients achieved a mean decrease in pain of 3/10 per the NPRS

Mean improvement of 11.2% LEFS

Score 0 Minimum Score

Score 80 Maximum score

Lower the score greater the disability

Minimal Clinically Important Difference = 9 scale points (11%)
Journal of Manipulative and Physiological Therapeutics (JMPT). 2011 Feb; 138-142.
10 patients
Numeric Pain Rating Scale - baseline to follow-up (p=.002)
Lower Extremity Functional Scale – baseline to follow-up (p=.017)
Global Rating of Change Score – 70% improved outcomes
 GISTM used in combination with Dynamic Balance
Training had the greatest effect on
 Foot and Ankle Ability Measure (FAAM),
 visual analog scale (VAS)
 ankle ROM in 4 directions
 Star Excursion Balance
 Indicates GISTM may be of benefit in treatment of CAI
APTA Combined Sections Meeting [poster presentation].
Chicago (IL). 2012 Feb.
 5 treatment sessions
 20% increase in LEFS
 Decreased “at worst” pain rating from 7/10 to 3/10
Case Study
 Warren, AJ. (2013) Effects of Graston
Technique IASTM in the Treatment of
Chronic Exertional Compartment Syndrome
of the Lower Leg: A Case Study.
 Found
Visual Analogue Pain Scale (100 mm)
 p = .013
30
25
20
Pre Tx
15
Post Tx
10
5
0
Treat 1
Treat 2
Treat 3
Short-Form McGill Pain
Questionnaire
 Questions 1-10 Sensory pain
 p = .05912
10
8
Pre Tx
6
Post Tx
4
2
0
Treat 1
Treat 2
Treat 3
Present Pain Index (PPI)
 p = .038
2.5
2
 5 = Excruciating
 4 = Horrible
 3 = Distressing
 2 = Discomforting
1.5
1
0.5
0
Treat 1
Treat 2
Treat 3
 1 = mild pain
 0 = no pain
Pre Tx
Post Tx
Global Rating of Change Scale
(GROC)
8
From the time you began treatment until
now

p = .03
7
6
5
Pre Tx
4
Post Tx
3
2
1
0
Treat 1
Treat 2
Treat 3
Perceived Functional Ability
Questionnaire (PFAQ)
 p = .42
Flexibility
 Flexibility rating out of 10 max
6.2
6
5.8
5.6
5.4
5.2
5
4.8
4.6
4.4
Pre Tx
Post Tx
Chart Title
Treat 1
5
6
Treat 2
6
6
Treat 3
5
5
Perceived Functional Ability
Questionnaire (PFAQ)
 Strength rating out of 10 max
Chart Title
8
7
6
Strength
 p = .42
5
4
3
2
1
0
Pre Tx
Post Tx
Treat 1
7
5
Treat 2
5
5
Treat 3
5
5
IASTM
 Musculotindinous Stiffness
 EMG / MMG
 Electromechanical Delay
 Rate of Force Development
 Slope of the torque-time curve (∆ torque / ∆ time)
 Rate of Velocity Development
 Slope of the velocity-time curve (∆ velocity / ∆ velocity)
Questions?