The Graston® Technique is a registered trademark technique that has been gaining popularity amongst medical clinicians over the past 10 years. (http://www.grastontechnique.com/AboutUs.html)
The site reports that there are over 16,000 clinicians worldwide practicing this technique as well as over 250 professional and amateur sports organizations. The technique is also used to help everyday people who are involved in rehabilitation or recovering from car accidents or reconstructive surgery.
So what is the Graston® Technique?
Graston® has made six expensive stainless steel tools that look like devices that you might see at a mechanic shop or even an operating table. The purpose of these tools is to assess and treat scar tissue that is built up through our connective tissue system. In particular, they focus on the fascial system which is comparable to the clear material you see when peeling the skin of a chicken breast.
As a manual therapist, I love that a company like this has done a great job looking beyond joints and misalignments of bones and targeted the connective tissue system which includes muscles, tendons, ligaments, and fascia.
Through excellent marketing and branding they have reached the far expanses of the universe. They have a number of certification classes to help clinicians learn how to treat their clientele.
Those allowed to practice the technique are:
Physical Therapist/Physiotherapist
Occupational Therapist
Chiropractor
Certified Athletic Trainer
Medical Physician
Dentist
Osteopath
Podiatrist
Selected Canadian Registered Massage Therapists*
The reason why this may be important to the general public is because SAFETY is my number one concern. There are some individuals that are not licensed medical providers who may be practicing these techniques in your area without the proper certification/training. The massage therapist down the street should not be advertising or performing these treatments. I believe it is not closely regulated and therapists often teach their unlicensed technicians to perform these techniques on patients for them. Be WARY!
The Upside
The fascial system has been undervalued in the medical profession for a long time and because of Graston, there is more emphasis on this system. The fascial system has been termed by Gratz in 1938 as a “Functional Joint” because it provides strength, structure, extensibility, and flexibility all in one! It weaves itself through muscles, ligaments and joints and not only that but also the nerves, head, brain, and organs.
After an injury heals (one that caused scar tissue), there is an unorganized cluster or matrix of tissues that become hard to the touch and are at times very sensitive. I like to tell patients to grab a hold of their skin at the stomach and pull it down with their left hand and raise their right arm up above their head (Ida Rolf). Try it! You’ll see that you may be restricted in your shoulder range of motion. Now you may understand the value in treating such areas after surgeries, especially mastectomies that can scar down and cause frozen shoulders, and hamstring strains and tears.
After getting your soft tissue mobilized and scar tissue freed up, you will likely feel an increase in range of motion of movements as well as decreased pain. A feeling of being light and even some strength gains are also present. However, often times these gains go away quickly, much like a prolonged stretch or a chiropractic adjustment. You may feel great and swear by it, but why do you have to keep going back to get it done?
The Downside
I believe athletes and the general public that are receiving these treatments are at risk of tendons failing and muscles rupturing. Further, I believe continuing to stretch in a new range without the proper strength or stability is creating these injury opportunities.
For the average person the Graston technique is helpful for breaking up scar tissue and most injuries will not likely occur. But for high-level athletes like Kobe Bryant (Basketball) and Matt Kemp (Baseball) who have to be running, twisting, jumping, and stopping on a dime are not strong enough in this new range. They are essentially unstable in this extra range with no one educating them to reintegrate the awareness of the new range back into their neuromuscular system.
I watched on Time Warner Cable Sportsnet—Backstage: Lakers the reality TV show for the 2012-13 season. On this show, the Laker’s physical therapist, Dr. Judy Seto, was performing the Graston technique on Kobe Bryant’s Achilles tendon before a game. Kobe probably felt looser during warm ups and games which gave him more confidence.
In my professional opinion, this could be one of a few reasons Kobe continued to have an irritated tendon that would lead to a possibly career ending injury. The tendon would create increased scar tissue and because he was unable to control this new range of motion over time he tore it, like a rubber band that continued to be overstretched.
Neuromuscular IS the Missing Link
Do you ever wonder why after you perform a stretch you have all this new springiness and flexibility, but by the next day, it all goes away? This is because you don’t OWN the new movement. Your brain does not realize that it has this new range. Your brain analyzes your body within minutes, and once it forgets, you go back to the same stiff body from before. In order to OWN this new movement you need to sustain the new movement with techniques and patterns that require resistance and holds done CORRECTLY. You will be sending signals back up the nervous system to the brain to recognize this new range and create a truly real connection. This is called Neuromuscular Re-education (NMR).
Functional Manual Therapy® (FMT) is the treatment approach that I would primarily utilize. In an FMT® paradigm (Gregory Johnson), NMR is an essential aspect of the treatment after every mobilization of connective tissues and joints that gains ranges of motion and stabilizes them.
Athletes are hurting themselves in great numbers because of this technique. As I mentioned above, there are great applications for it, but make sure a trained professional is reintegrating the body back to the brain so it is aware and stable. FMT® as mentioned above is a treatment that would work in conjunction with Graston for effective gains that stick. Most importantly, for athletes recovering from injuries, their body will be more capable of optimal and efficient sports performance.