Graston Technique M1 Course Review
Joe Heiler PT, CSCS
I really have nothing but good things to say about the GT M1 course I took last weekend. In part because I've been playing around with GuaSha for the better part of the last year and a half so handling the instruments was nothing new. And SportsRehabExpert.com member Jackie Shakar was teaching the course so I know what to expect on that end to. I'm sure the other instructors are great but Jackie is truly passionate about GT, and combines it with her knowledge of the SFMA/FMS to produce some great results. I realize with our small group we probably had some advantages over a 'normal' course when it came to applying the technique and looking for its influence on patterns of movement. So all in all I felt like a got some great information out of the course, and have been seeing some nice results back in the clinic as well.
One thing I heard a lot about ahead of time, and was somewhat skeptical about, was that the instruments are very sensitive when it comes to detecting soft tissue lesions. Almost immediately I could tell quite a difference between the stainless steel and the plastic instruments I was using previously. As a matter of fact, one of the biggest benefits of the technique I think is using the larger instruments to 'scan' an area of interest and really narrow things down quickly. Then I can go in with the smaller instruments and work a little deeper based on that quick assessment. I think I could still do some good things with the GuaSha instruments, especially knowing what I know now, but the stainless steel, and shapes of the instruments, really do make a difference.
One thing in general I wanted to mention was treatment time. I know with the GuaSha I had a tendency to overdo it and really beat up the tissues. Creating petechiae is important in that technique. With the Graston Technique, the protocol was to treat a lesion 30-60 seconds and that was it. Attack it from at least 4 different angles and move on. That's enough to create the pro-inflammatory response, but not to overdo it. An entire region like the shoulder may take 8-10 minutes total. To see some redness is normal and maybe even a few petechiae develop, but definitely not going for the full blown nearly bleeding look or bruising. This seems to be more in line with what Thomas Myers teaches about not injuring the soft tissues.
So what I want to do with the rest of the article is to give some basic tips for those of you just starting out with instrumented techniques, and some advanced tips for those of you who have been using some form or another. If you haven't tried any form of instrument assisted STM yet, I would suggest you try it at some point. Not only are the results impressive, but it saves your hands and thumbs big time. And if you are concerned about not using your hands, there are still deeper areas that are quite difficult to reach, or maybe even not appropriate for the instruments, like the psoas and diaphragm.
We've talked about it on here before that it's not really about treating the IT band itself, but what attaches to it and creates aberrant forces along the band especially at the hip and knee. When you look at the picture above, you realize how many large muscles attach to the IT band along its entire length, and that it follows right into the lateral retinaculum of the patella. The emphasis on treatment of the IT band was to create separation of the band from the quad and hamstrings, and to address any soft tissue lesions/Trigger points in the glutes and TFL. Using the GT instruments is was quite easy to 'carve' out and release the tissues around the IT band, greater trochanter, and patella. In the clinic, I then go right into addressing mobility per the most dysfunctional non-painful pattern of the SFMA.
All in all it was a great course, and I really have a better understanding of how to use the instruments and techniques to get the best soft tissue release possible. The stainless steel instruments do make a big difference in feel, and just having more options when it comes to trickier areas and achieving the desired depth. Could you take the course and stick with your old instruments? Yes and you would be a better clinician for attending. However, for me, I felt the instruments made enough of a difference that I am going to give them a shot.
Big thanks to Jackie Shakar for putting on the course! Here is the link back to Graston Technique for more information.