Instruments of Change

Feeling a little stiff after surgery? Suffering from a sports injury and need to get back in the game 10 minutes ago? The Graston Technique could be just the thing to untangle your tissue.

Graston tool

After knee-replacement surgery and multiple rounds of physical therapy, Roberta Gunderson, 53, was feeling like the Bionic Woman — that is, if the Bionic Woman had been left in the rain to rust. “I felt very stiff and robotic in the beginning,” says Gunderson of her recovery. “Like I was Frankenstein’s monster.”

Doctors told Gunderson, a biology professor at Wilbur Wright College in Chicago, that her postsurgery progress had plateaued and that her knee would likely not gain more than 106 degrees of flexion — far from the ideal 120 degrees. An avid cyclist, swimmer and golfer, Gunderson was determined to regain her former mobility, so she opted for a treatment called the Graston Technique (GT), a form of soft-tissue mobilization that detects and breaks up scar tissue that impedes normal function of muscles, fascia, tendons and ligaments. Clinicians rub stainless-steel instruments over the injured area, as if trying to iron out tangled tissue.

After four weeks and seven treatment sessions, Gunderson’s knee went from 106 degrees of flexion to 116 degrees. “I was amazed at how much I improved in only a month,” she says.

An Instrumental Change

GT is a type of cross-fiber massage — a noninvasive, drug-free procedure that uses ultraprecise stainless-steel instruments to break up restrictive scar tissue. These instruments can be far more effective than a clinician’s hands alone because they are able to concentrate force while giving excellent feedback to both the clinician and the patient. (It’s worth noting, however, that GT is often used in conjunction with other therapies that involve hands, foam rollers and knobs.)

GT is used to treat a wide range of soft-tissue ailments, from tennis elbow to plantar fasciitis, because clinicians can easily adapt the technique to the situation and zero in on the offending area. “We are now able to diagnose things that used to go undetected,” says Ted Forcum, DC, DACBSP, owner of Back In Motion Sports Injuries Clinic in Beaverton, Ore.

When the clinician runs an instrument over scar tissue, she can feel exactly what’s happening under the skin. “It’s like when you were a kid and you put a leaf underneath some paper and colored over it. But instead of an imprint of the leaf, you get a picture of the injury,” says Forcum, who used GT to treat U.S. Olympians in Beijing.

Smoothing Out the Edges

A lot of soft-tissue problems occur within the fascia, the web of connective tissue that supports muscles and organs and prevents us from melting into formless blobs. If you suffer an injury, however, the fascia tends to attempt to stabilize the area by binding to the muscles like poorly applied wallpaper, complete with air bubbles and clumsy adhesions. GT instruments smooth out those air bubbles.

If not addressed, these adhesions can cause an avalanche of kinetic chaos, because when a muscle or group of muscles becomes incapacitated, all the surrounding muscles, tendons and ligaments have to pick up the slack — which eventually causes them to become overworked and fatigued. Your only option: Break down the adhesions so you can rebuild a healthy balance.

The approach seems to be effective. “We’ve found that injured ligaments treated with GT showed accelerated healing in the short term and a clear increase in strength compared to injured ligaments that weren’t treated with GT,” says Terry Loghmani, PT, MS, MTC, associate clinical professor of physical therapy at Indiana University in Indianapolis.

Hurts So Good

Because GT involves direct manipulation of stuck tissue, patients can expect some discomfort during the procedure. “But it should never produce pain that’s intolerable,” says Richard E. Vincent, DC, who uses GT in his Falmouth, Mass., clinic. Patient and clinician should work together to figure out the appropriate intensity levels.

“With most patients, we will wait a day or two between treatments, but others — especially athletes — are accustomed to working through benign pain and use GT every day because they have to recover fast and perform,” says Valli Gambina, DC, a chiropractic sports physician in Venice, Fla.

After treatment, some soreness, bruising and swelling is actually desirable because it means the body is replacing adhesed tissue with healthy, linear tissue.

Smooth Operators

Sessions usually last about an hour, during which the clinician uses GT for only about five to eight minutes on each injured area. The rest of the time is dedicated to assessment, warming up, stretching and icing.

Unlike some other types of treatment, patients using GT can’t just kick back and let the practitioner do all the work. After treatment, patients must continue to stretch and strengthen the injured area. While it might seem counterintuitive to work an injured area, the immediate movement helps the tissue heal correctly.

Most patients will begin to notice positive results after three or four sessions, with treatment lasting about eight to 10 sessions. But some will experience results even faster. After her first session, Gunderson said she immediately felt looser and more flexible.

There are some people for whom GT isn’t right, such as those who have arthritis or who have recently undergone surgery or take blood thinners. But if you’re free of such contraindications and are suffering from soft-tissue issues, GT can offer relief — and improve the way you move.

Jenny Lui is a Chicago-based writer.

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