Graston technique is a form of instrument-assisted soft tissue mobilization, in other words, it is a technique used to treat soft tissue injuries. The Graston are stainless steel tools which glide across the skin to stimulate a desired response, such as soft tissue reorganization and pain reduction. This post will discuss how instrument-assisted soft tissue mobilization (IASTM) works and which conditions respond well with this kind of treatment.
Instrument-assisted soft tissue mobilization is used for the treatment of soft tissue injuries. Soft tissue injuries are injuries to muscles, ligaments, tendons, or fascia. Muscle strains, rotator cuff tendinopathy, Achilles tendinopathy, and ankle sprains are all common conditions that are treated with the use of Graston.
When there is damage to soft tissues, there are two main objectives to treatment. The first is to decrease the pain. The stimulation of mechanoreceptors has an inhibitory effect on nociceptor activity (receptors that are responsible for pain), thereby decreasing pain. This would be similar to when you hit your funny bone then rub on it.
The second is to facilitate proper healing of the tissue. For the tissues to heal correctly, they need to receive the proper building blocks. By facilitating local fluid dynamics, Instrument-assisted soft tissue mobilization helps increase the healing process. Instrument-assisted soft tissue mobilization has also been shown to increase the strength of injured ligaments. A study in Medicine and Science in Sports and Exercise demonstrated an increase in fibroblast activity (cells that produce collagen) in rats, which would be most beneficial for ligament sprains and degenerated tendinopathies.
While it is important to treat the injured area, it is also important to assess the rest of the kinetic chain. Work by Thomas Myers has demonstrated that fascia creates a interconnected network of soft tissue throughout the musculoskeletal system. For example, the superficial back line connects the plantar fascia through the calf and hamstrings all the way up to the back muscles.
It was first proposed that IASTM was used to break up scar tissue adhesions. While this makes sense with what is experienced (decreased tissue tightness, improved range of motion, and decreased pain), recent research does not support this theory. A study in the Journal of the American Osteopathic Association concluded that the forces needed to deform tissues were “far outside the human physiologic range.” Instead, it appears that IASTM stimulates mechanoreceptors (receptors that respond to mechanical stimulation) which causes decreased pain and tissue adaptation.
There are two mechanoreceptors that are responsible for the benefits of IASTM, Ruffini and interstitial receptors. Ruffini and interstitial receptors can stimulate the central nervous system (the brain and spinal cord) to directly alter tissue tone. These receptors can also influence the autonomic nervous system and local fluid dynamics. The autonomic system (consisting of the sympathetic and parasympathetic systems) controls the global muscle tone. The sympathetic system is often thought of as your fight or flight system, causing you to tighten your muscles; whereas the parasympathetic system is known as your rest and digest system, leading to a decreased activation of your muscles. Decreasing sympathetic activity and increasing parasympathetic activity will lead to decreased global muscle tone. Altering your local dynamics allows your tissues to receive the proper nutrients through the blood stream, which will also decrease tissue tone.
In conclusion, instrument-assisted soft tissue mobilization is a great conservative treatment option for the treatment of soft tissue disorders. Even though the mechanism may not involve breaking up scar tissue, the stimulation of mechanoreceptors still produces the desired effects of decreasing pain and muscle tone. If you are suffering from a soft tissue disorder such as tendinopathy or a sprain/strain, IASTM should be included in your comprehensive treatment program.