Graston Technique M1 Course Review

http://www.sportsrehabexpert.com

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.

Something I did not pay as much attention to as I should have initially was the angle at which I held the instrument. 30-60 degrees is the recommendation based on some of the studies which use a 45 degree angle and showed some promising results. It comes down to this: the greater the angle, the deeper the penetration. I spent a lot of time working at or near 90 degrees with my GuaSha instruments and it is probably why it was more uncomfortable than it needed to be at times. Someone who is very sensitive definitely does better with a 30 degree angle than a 60 degree. But as they become accustomed to it, increase the angle and work deeper. Maybe that is just obvious to everyone else but was lost on me starting out.

A technique I liked a lot was attempting to lift the tissue around areas like the IT band, Achilles, and patella. Trying to work under the Achilles to free it from the underlying tissues, and scooping away the tissues from the patella not only felt great but seemed to make a quick improvement with my mobility. I could also see how relieving some the compression on the patella would be useful with patellofemoral arthritis. Separating the IT band from the lateral hamstrings and quads did not feel so great but I've had good success with this technique so far.

I do want to continue with treatment of the IT band for a moment here:

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.

In the case of IT band syndrome, or any related issue, I do also use the foam roller as a soft tissue adjunct especially for home use and even as a warm-up in the clinic. Again, do not try to roll out the band so much as get the interfaces between the band and hamstrings/quad and also hit the hip musculature.

Another area I really liked using the instruments that I hadn't really worked before was through the thoracic spine. In the past I've done a lot of mobilization and muscle energy to go with corrective exercises, but the #3 GT instrument is great for carving out through the laminar groove. I'm literally thinking about pulling the soft tissues away from the bone. I've seen some nice improvements in mobility again using GT first, then my mobilization and muscle energy techniques, and then working through the correctives. The point is to keep the mobility you've gained in the clinic, and this is just one more tool to make that improvement carry over.

Finally, one other area I felt using the GT could make a big difference was deep in the groin. This is one of those hard to get into areas, but one that definitely needs to be addressed with groin injuries, sports hernia, etc. Mike Boyle wrote a great series of articles on the Sports Hernia in which he addressed the need for soft tissue work in that area. Here is a link to that article for a more in-depth discussion. Again, the shape of the tools allowed for deeper work and to pull back the soft tissues from the ramus. The position Jackie had us use was also effective as the patients hip and knee were flexed and resting against the therapist. Having the patient gently press out into you creates relaxation in the adductors and a more effective release.

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.