1. GRASTON TECHNIQUE

2. 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.

3. 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

4. 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

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

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

7. 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

8. 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

9. 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

10. 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

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

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

13. 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

14. 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

15. 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

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

17. 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

18. 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)

19. 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

20. 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

21. 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

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

23. Frequency/Amplitude/ Direction
Frequency- no more than 2x wk, at least 2 day rest and no longer than 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

24. 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

25. 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

26. 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

27. 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

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

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