By: Kamille Hernandez and Jennifer Walker

» Soft tissue mobilization technique that utilizes 6 stainless steel instruments » Can be applied across fibers in multiple directions, with venous drainage, and against venous drainage » The technique causes the skin temperature to increase allowing for the break down of collagen crosslinking which will stretch the tissue and fibers » Increases blood flow and cellular activity to the area and also allows for the reorganization of collagen after treatment

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» Allows the PT to detect large adhesions, scar tissue, and other tissue restrictions with ease (better mechanics for the therapist) » Instrument breaks up the scar tissue and adhesions with in a few sessions of 3- 5 minutes » Patients see tremendous benefits after 1-2 sessions » PT should allow appropriate time in between sessions for recovery

» The treatment will only be effective if the instrument is used correctly one can not just rub where it hurts and expect an outcome » Expensive tools » Bruising » Patients may feel better after one treatment and think they do not need to come back » Must be performed alongside an exercise program

» Instrument-Assisted Cross-Fiber Massage Accelerates Knee Ligament Healing ˃Graston technique is highly beneficial in early acute ligament healing, but does not significantly effect the long-term outcome of healing »Graston Instrument Soft Tissue Mobilization And Home Stretching For The Management Of Plantar Heel Pain: A Case Series ˃70% of patients experienced a positive outcome after treatment showing improvement with pain and overall gait function

» Carpal Tunnel Syndrome ˃After 5 treatments report of minimal symptoms- numbness and tingling » Trigger Finger ˃After six treatments (three weeks) 100% improvement occurred with no catching, weakness or feeling of tension » Rotator Cuff Tendinitis ˃ After 7 th treatment 90% improvement

» A precise method of manipulating the myofascia TimeInterventionNeutralSatisfiedVery Satisfied ImmediateGISTM STM 0% 10% 25% 50% 75% 40% 3 monthsGISTM STM 0% 20% 58% 40% 42% 40% Patient Satisfaction TimeGITSM patientsSTM patients Baseline61.5± ( ) 60.5± ( ) Immediate post9.8± ( ) 15.4± ( ) 3 months9.2± ( ) 33.7± ( ) VAS (mm)

1.Prentice W. Therapeutic Modalities and Rehabilitation. China: McGraw Hill Co; Loghmani MT, Warden SJ. Instrument-Assisted Cross-Fiber Massage Accelerates Knee Ligament Healing. Journal of Orthopaedic & Sports Physical Therapy. July 2009; 39(7): Looney B, Srokose T, Cleland JA et al. Graston Instrument Soft Tissue Mobilization and Home Stretching for the Management of Plantar Heel Pain: A Case Series. Journal of Manipulative and Physiological Therapeutics. February 2011; 34(2): Martinez R. Graston Instrument-Assisted Soft Tissue Mobilization (GITSM) Available at: rumentAssistedSoftTissueMobilization_IntegrativeMedicine_Martinez_2003.pdf. Accessed on April 21, Instraments.jpg 6.Burke, J, Buchbery DJ, Carey-Loghmani T et al. A Pilot Study Comparing Two Manual Therapy Interventions for Carpal Tunnel Syndrome. Journal of Manipulative and Physiological Therapeutics. January 2007: 30(1):50-61.