Do PTs today practice medieval therapy techniques? An ABC affiliate in San Francisco seems to think we use medieval tools, anyway. The technique reported on is the Graston Technique,® an aggressive form of soft tissue mobilization aimed at breaking up adhesions between fascia and muscle fibers using specialized tools. In theory, this treatment is essentially the same as aggressive STM; the difference lies in the use of the specialized tools.
So do the tools really make the technique more effective than traditional STM? The literature results are extremely limited. Only one study directly compared STM and the Graston Technique ®:
Burke et al. compared Graston Techniques ® to regular STM provided by the therapist’s hands for the treatment of Carpal Tunnel Syndrome. They resulted no clinical differences between the two groups, but did substantiate the clinical efficacy of conservative treatment for mild to moderate CTS.
Perhaps the effectiveness of the Graston Technique ® occurs from the ability to detect adhesions better than manual palpation alone. Users report feeling vibrations or hearing clicks as they move the tools over adhesions that were not detected by palpation. There are a few case studies that report solely on the effectiveness of the Graston technique.
Hammer reports on the ability of the Graston Technique ® user to both feel and target treatment on areas of degenerated tissues in three cases involving plantar fasciitis, Achilles tendonosis, and supraspinatus tendonosis.
Aspergren et al. effectively used thoracic (HVLAT) manipulation and the Graston Technique ® to treat a collegiate volleyball player with acute costochondritis. Although the authors did not compare to thoracic manipulation plus manual STM, pain and functional levels improved.
Other foreseeable benefits include the ability to really dig-in during STM and saving your own joints as a PT, benefits that may also be found in simple massage tools. The side effects include being too painful for many patients and causing bruising in some patients. In all, more research needs to be performed comparing the technique to regular STM by independent examiners.
Bottom line: for now, trust in your hands – they have been around since before medieval times, and are the most powerful tool a PT possesses.
1. Burke J, Buchberger DJ, Carey-Loghmani MT, et al. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther. 2007;30(1):50-61.
2. Hammer WI. The effect of mechanical load on degenerated soft tissue. J Bodyw Mov Ther. 2008;12(3):246-256.
3. Aspegren D, Hyde T, Miller M. Conservative treatment of a female collegiate volleyball player with costochondritis. J Manipulative Physiol Ther. 2007;30(4):321-325.
Graston Technique (aka Instrument Assisted Soft Tissue Mobilization) is incredibly more effective than typical hands on techniques such as manual trigger point, transverse friction, myofascial release, active release, etc. I’ve been doing soft tissue mobilization since beginning practice in 1991. The IASTM based treatments get results faster and with cases that are chronic where every other technique has been tried. It’s changed the way I practiced and has increased the rate of success for very difficult chronic soft tissue injuries.
Also very effective for post surgical adhesion/scar tissue pain such as in total hip replacements.
There’s nothing midievil about keeping people from having surgery…But, when you look at the tools, yeah, midievil does come to mind.
Dr. Todd Narson
Miami Beach, FL
A therapeutic technique used by many physiotherapists in order to therapeutically aid problems related to the skeletal, muscle, and soft tissue injuries, is known as Graston Technique.
Graston Technique is a patented method that has been successfully used by many chiropractors and physical therapists to manage cumulative trauma and chronic disorders.
It is a innovative patented technique and practitioners who have been granted a license by the licensing company, TherapyCare Resources Inc can only make use of the Graston Technique. This technique was founded by David Graston.
Adhesions that are present in the muscles and tendons can be identified and resolved by means of Graston instruments (collection of 6 stainless steel instruments of different shapes and sizes). This is done by the Graston Technique practitioners, by specific and targeted palpation of the body of a patient.
Colleagues, please come with open minds. You can sense more with the tools if you are trained to detect adhesions. I have been certified in Graston for 8 years. I am very skilled and well versed with soft tissue training. I am a PT with 20 years experience and this along with SASTM and ASTYM- are very helpful–these are instrumented-assisted techniques. Of course, accurate diagnosis and assessment are key. You absolutely need to be trained to use these or you can really hurt people. The instruments are extremeley helpful in clinical practice.
I have helped many with scar adherence, tendinopathies, myofascial adhesions and superficial fascial restrictions. Well worth the training and the research is very solid.
Contact me, I am very interested in helping others acheive the outcomes and success with these techniques.
I’ve been receiving Graston as a patient for about 6 weeks now in combination with myofascial release massage for both a left foot plantar fascitis problem (over one year and no prior relief) and for a bilateral flexor and extensor tendon injury in arms (arm injury for 15 months). Found these therapies through a chiropractor of all things. Had already gone through two podiatrists and three of the best Orhtopedic clinics in Houston for my hands/arms, with no releif. Had asked about myofascial release for the arms at the Ortopedic surgeon in December of 2009 and was scolded for asking about it. Didn’t know I had a big wad of scar tissue built up in the palm of my hand. The people in the chiro office felt it immediately and said – “Yeah we know what that is, we can fix that.” And they have. I am totally amazed at the progress in my body. Both arms and hands, and my foot in such a short time. I had read up on this and viewed it at a last resort. One article said Graston was snake oil. It and the myo has saved my life. It’s like the conventional doctors wanted to deny it existed. They wasted my time, money and ability to get back to work. I was getting depressed and on my way to the Mayo Clinic in Minnesota for one last effort when I came across a local web site.