Approximately 5 years ago, I was introduced to the Graston Technique (GT) when my wife was treated with the instruments for a stiff neck. I had sustained a career-ending hand and wrist injury in November 1996, and I was unable to adjust her. She felt immediate relief and insisted I learn the technique.

Training for GT consists of 2, 12-hour modules. The first module contains approximately 2 hours of didactic materials covering the indications, contraindications, basic physiology, and research. The remaining 10 hours is all hands-on, with those attending pairing up to work on specific body parts, including pretty much the entire body. The second module delves more into condition-specific treatment and diagnostic workup. The instruments are included in the total package, which also includes a listing on the GT Web site for one year. Total cost of the package is $3,595.

Treatment with the Graston instruments occurs in the direction of the beveled edge at a 30° to 60° angle.

The Instruments

There are six patented instruments made of 515 stainless steel, which is a very hard steel mixed with alloys. This creates a very durable product that contains no pores to house pathogens, and also allows great feedback into the DC's hands as he or she runs the instruments over the skin. Scar tissue or other soft-tissue lesions are felt through the instruments and feel like a gritty, crunchy sensation that is transmitted from the instrument back into the DC's hands. Each instrument is designed to treat different parts of the body, and as such, they have convex and concave surfaces. Some have knobs, a hook, and either single- or double-beveled edges. You can use the instruments with one hand, except the largest instrument, which must be used with two hands. These instruments are passed over various parts of the body depending on where a patient's complaints are located.

For example, if someone has pain over the lateral epicondyle, the instrument chosen by the clinician will be used to assess for adhesions located around the epicondyle in the soft tissues, especially the fascia. The treatment is always administered in the direction of the beveled edge and in multiple directions, much like going around the face of a clock. As the instrument is passed over the treatment site, a notation is made of where a "gritty, lumpy, grizzle" type of sensation is detected. The clinician can actually feel these sensations through the instruments better than with the hands or fingers. This is often a difficult thing for many DCs to admit initially, but in essence, the instrument acts as a stethoscope and magnifies what lies under the skin. The treatment takes place at a 30° to 60° angle. Each area is treated for approximately 1 to 2 minutes.

The clinician uses GT instrument No. 5 over the thoracic spine. In this case, the clinician demonstrates a two-hand grip rather than a single-hand grip of the instrument.

According to the early research that took place at Ball State Memorial Hospital and Ball State University, several things happen when the instruments are passed over the so-called lesion.^1-4 First, old fibroblasts are broken down. The instruments begin the healing process and bring in new fibroblasts that are now laid down in parallel and not random. There is an increase in phagocyte production and mast cells. The technique was built around Transverse Friction Massage as developed by English orthopedist James Cyriax.⁵ The instruments can save your hands and wrists, and allow the DC to get into nooks and crannies around the body that are otherwise difficult to reach.

During treatment with the instruments, both the DC and patient will actually feel the "gritty" sensation when the DC runs the instrument over the site of a lesion. The treatment is quick and effective, with occasional bruising, soreness, or formation of petechea.

Success Story

DCs have reported a number of success stories with the use of these instruments, but one comes to mind that demonstrates how effective the instruments can be.

A young male football player sustained a back injury, and after a complete year of being unable to run or practice, he received GT treatment. During that year, he had received physical therapy, treatment by the athletic trainers, manipulation by the chiropractor, and medications. His diagnosis was lumbar compartment syndrome. A fascial release had been discussed, but the treating chiropractor contacted John Triano, DC, PhD, at the Texas Back Institute. Triano advised them to give GT a try.

The player upon examination exhibited approximately 30° of lumbar flexion with very rigid muscles over the left lower back. He presented with pain, numbness, and tingling over the same area without radiation. He was treated for approximately 15 minutes with GT over the lower back bilaterally, the gluteal muscles bilaterally, the piriformis muscles bilaterally, and the left psosas. Upon completion of treatment, his lumbar range of motion was greater than 90°. He received three treatments and was able to return to practice and run. Following his sixth treatment, he was able to play in the game and continued to play for the remainder of that season. He is now playing in the NFL.

While the vast majority of patients treated with GT obtain excellent results, a few do not respond. Many questions remain to be answered related to the exact mechanisms involved. We also know there is a neurological component that occurs when the instruments are used. Very much like massage, when the instruments are passed over the skin, a slight numbness can occur. At this time, we do not clearly understand all the mechanisms related to how GT works.

GT is an incredible technique that serves as a diagnostic tool and a form of treatment. While many techniques focus on the treatment of soft-tissue lesions, GT is the easiest and least labor-intensive of all the techniques I have personally learned over the years. This is not to say that many of those techniques are not effective, just that they require abnormal stress on the hands, fingers, and joints while GT does not. For those clinicians who wish to lengthen their time treating patients, GT offers the best solution.

Without hesitation, I highly recommend that every chiropractor or any health care provider learn GT. Although it might be just one more tool in your toolbox, this is the premier tool to have at your disposal. DCs say they have experienced more referrals from patients since they began offering GT. Some have actually created GT-only practices due to the ease of utilization, effectiveness, and the demand from patients. This technique can be used on elderly patients or others whose cervical spine you might otherwise not wish to manipulate. The instruments allow the easiest way to address so many soft-tissue injuries that typically offer headaches for the practitioner.

Education

Each class size generally does not exceed 40 people. Instructors have 10 to 12 attendees in class, so there is an incredible amount of personal attention to each attendee.

These instruments should be able to last forever. They will not wear out. GT also has a 60-day return policy. If you purchase the instruments and decide they are not for you, you are allowed to return them up to 60 days after purchase for a very small restocking fee.

The GT Web site offers information about the instructors, dates, and locations of the programs; educational and research materials; and a provider directory. I look forward to seeing you in a class very soon.

Thomas E. Hyde, DC, DACBSP, is a Graston Technique instructor. He graduated from Logan College in 1977 and practiced in Miami. He served as the team chiropractor for the Miami Dolphins for 7 years, and served as the chiropractor for the 1987 Pan American Games. Contact him at .

References

1. Davidson CJ, Ganion L, Gehlsen GM, Verhoestra B, Roepke JE, Sevier TL. Rat tendon morphologic and functional changes resulting from soft tissue mobilization. Med Sci Sports Exerc. 1997;29(3):313–319.
2. Haller KH, Helfst RH, Wilson JK, Sevier TL. Treatment of chronic elbow pain. Physical Therapy Case Reports. 1999;2(5):195–200. .
3. Gehlsen GM, Ganion LR, Helfst RH. Fibroblast responses to variation in soft tissue mobilization pressure. Med Sci Sports Exerc. 1999;31(4):531–535.
4. Melham TJ, Sevier TL, Malnofski MJ, Wilson JK, Helfst RH. Chronic ankle pain and fibrosis successfully treated with a new non-invasive Augmented Soft Tissue Mobilization (ASTM): A case report. Med Sci Sports Exerc. 1998;30(6):801–804.
5. Cyriax J, Coldham M. Treatment by Manipulation, Massage and Injection. In: Textbook of Orthopaedic Medicine, Volume E. 11th ed. London: Bailliere Tindall; 1984.