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 OpenerPurpose- concave surfaces fit around the

convex soft tissue and bony landmarks

GT3- Tongue DepressorPurpose- 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