GRASTON TECHNIQUE

instrument assisted soft tissue mobilization an advanced form of instrument assisted mobilization, which is used to detect and to release scar tissue, adhesions and fascial restrictions.

Benefits: To the Patient: Quicker improved outcomes Focus on patient participation and education promotes feeling of control and management re: diagnosis/rehab process Improved quality of life

Benefits: To the Clinician: Decreased fatigue and energy conservation Decreased treatment time is possible Joint conservation Improved ability to locate soft tissue lesions with more precision, especially around bony prominences and at greater depths

Contraindications RED FLAGS Open wound Unhealed fractures Thrombophlebitis Uncontrolled hypertension Kidney dysfunction Patient intolerance/hypersensitivity Hematoma Osteomyelitis Myositis Ossificans

Contraindications Yellow Flags Anti-Coagulant Medications Cancer Varicose Veins Burn Scars Acute Inflammatory Conditions Inflammatory conditions secondary to infection Rheumatoid Arthritis

Diagnostic Indications Used virtually for 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 movement and posture

Distinguishing Characteristics Instrument assisted, combined with targeted stretching and strengthening exercises Stainless steel instruments can be likened to a tuning fork, when the instruments contact the fibrotic tissue, they reverberate sending information to the clinician

Distinguishing Characteristics Instruments serve as levers, help to increase the mechanical advantage and reduce effort of the clinician SHAPE- instruments contoured to facilitate treatment around different body parts

Convex instruments on concave body part Concave instrument on convex body part -Equalizes and disperses pressure over a larger surface area -Useful for increasing comfort in patient

Convex instrument on a convex body part -maximize pressure in a small surface area - Allows clinician to accurately pinpoint pressure

Treatment edge Single-Beveled Edge -Better tissue separation -Isolated pressure to specific areas -Allows deeper penetration with increasing pressure during treatment

Treatment edge Double-Beveled edge -limits amount of penetration, increases pressures ( linear relationship wrt to penetration N/A) -increases comfort on thin, sensitive soft tissue and around bone

Instruments GT1- Handlebars Purpose- Eval. and treat generalized restrictions -concave treatment edge used to scan and prepare tissue for deeper work -good for large muscles

Instruments GT2- Bottle Opener Purpose- concave surfaces fit around the convex soft tissue and bony landmarks GT3- Tongue Depressor Purpose- localizing restrictions and treatment to smaller areas -more specific application of pressure to more specific structures

Instruments GT4- Scanner Purpose- most commonly used, usually the first instrument used to scan GT5 –Boomerang Purpose- general scanning GT6-Little Bottle Opener

Rate Stroke velocity should be reduced over larger areas to improve patient comfort Pts can tolerate quicker, shorter strokes in smaller areas Reduce the rate with higher pain levels

Duration No longer than 1 min over a single trigger point Number of sessions depends on pts ability to sustain results (usually no longer than 4-8 sessions)

Treatment Intensity Matter of patient perception along with the amount and degree of tissue effected by the treatment Guided by patient tolerance and response Combination of the following factors: pressure, depth of penetration, session duration, rate, instrument

Pressure Force/area High force/small area= increased pressure delivered to tissues= increased intensity A smaller contact area requires less force to deliver the same pressure, thus deeper penetration

Depth Enough pressure to penetrate to the level of the lesion according to the patients tolerance Vary tissue tension by putting the soft tissue on stretch/slack Angle of application of ~60 degrees penetrates more deeply

Session duration/Rate/Instrument Session duration-longer sessions= increased intensity Rate= higher rates of application= increased intensity Instrument- double beveled edge is less intense

Frequency/Amplitude/ Direction Frequency- no more than 2x wk, at least 2 day rest and no longer than 10-14 days total Amplitude-length of stroke or stroke distance Large-broad areas, can be a little more uncomfortable Small- narrow body surfaces, treat deeper more isolated restrictions, increased comfort level Direction-multiple directions

Stroke Description SWEEP- Instruments- ALL Description- instrument contact points moving in one direction at the same rate in a linear or curvilinear path Purpose- Scanning, edema

Stroke Description Fanning Instruments-GT1, GT2, GT4, GT5 Description-instrument contact points moving at different rates in an arched path. One end of the instrument is stabilized, serving as the fulcrum of motion Purpose- Localized scanning

Stroke Description Brushing Instruments-GT3 Description-superficial, linear stroking motions, small amplitude, any direction. Brush in ONE direction, not back and forth Purpose-Mobilization of superficial fascia, desensitization

Stroke Description Strumming- Instruments- GT1, GT3, GT4 Description- Deep, linear stroking motions, small amplitude, perpendicular to fiber direction ( to enhance treatment specificity, joints are mobilized in one direction at a time) Purpose-Mobilization of specific restrictions

Special Note Brushing- superficial and mulidirectional Strumming- deep and perpendicular to fibers Always Brush PRIOR to Strumming

Stroke Description J-Stroke Instruments- GT3 Description- Superficial or deep stroke in a “J” shaped pattern Purpose- Mobilizing superficial or deep restrictions