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The Effectiveness of Graston Technique® In Treating Musculoskeletal Injuries has attracted a lot of attention by scholars across the globe in the current era.  This is due to the fact that most of the chiropractic practice doctors have associated its use with great success and efficiency. As well, it has been argued by scholars that the technique has contributed to a great growth and development in the chiropractic practice. So to speak, the topic under study seeks to exclusively review the current literature regarding the usefulness of this technique in chiropractic practice. In particular, the literature review will be directed towards establishing the Effectiveness of Graston Technique® In Treating Musculoskeletal Injuries. Given to this point, it is the fact that many chiropractors have turned to a wide and increasing use of the technique in the treatment of Musculoskeletal Injuries among others as such.

So to speak, various sources of information will be used to solicit information on the effectiveness of Graston Technique® In Treating Musculoskeletal Injuries. Besides this point, it is important to bring into view that chiropractic practice is the health care professional as well as the discipline which deals with identification, management and in the larger perspective the preventions of all mechanical disorders related to musculoskeletal system like spine since it is presumed that such disorders are closely linked to the nervous system. In line with this point, most important chiropractic treatment techniques comprise of the manual therapy which takes in manipulation of the spine, soft tissues, and other joints.

In addition, Physical exercise, counseling, and healthy lifestyles are part of the treatment process which has been highly employed in the past. Following this point, Graston Technique® has been introduced in the practice so as to help Treating Musculoskeletal Injuries. Graston Technique® is actually a scientifically advanced form of instrument-assisted tissue mobilization abbreviated ISTM. More to this point, it makes the use of patented, contoured stainless steel devices. These devises are precisely used to carry out an examination as well as the treatment of soft tissue. Further in this context, Hyde & Gengenbach  (2007), asserts that the technique is meant to assist the hands of the clinicians and it is not by any way replacing it. As well, these instruments serve as rigid levers to complement manual theory by means of magnifying what the hands can feel together with what can be palpated (p.300).

In this context, the topic of study deals with the usefulness of the Graston Technique® in Treating Musculoskeletal Injuries. Being a technique that was developed in 1990s by two athletes to massage sustained knee injuries, its results have been realized in the clinical practice. The reason for it being used by Chiropractics in practice is embedded in the fact that at its inception, it proved to work in as an effective mobilization of the resultant tissue, strengthening, functioning and the aspect of gaining the range of motion of an individual.  In essence, Graston Technique® was introduced to Chiropractors in November, 2001. In response to the introduction, the technique has been associated with enthusiastic response as it has been pointed out to offer practicable and innovative approach in the area of soft tissue treatment (Sayler, & Siegel, 2005). 


Researchers and scholars have carried out numerous researches on different ways of treating musculoskeletal injuries. Their findings reveal that different techniques have been identified so far, among them Graston Technique®. To begin with, Graston Technique® is a patented technique which is used as a therapy in treatment of all problems that are associated with skeletal muscle and soft tissue. According to Sweere (2004), Graston instrument technique is a highly effective means of releasing adhesions found in fascia, joint muscles, and tendons (p.130). In line with this, the application of this technique in the treatment of musculoskeletal injuries has been found as one of the most appropriate approach towards treating these disorders.

In reference to Miners & deGraauw (2010), Trigenics® and Graston Technique® are the two least utilized named or specific protocol soft tissue/myoneural treatment techniques used by sports fellows (p.289). Arguably, it is possible that their lack of use to affect performance may simply be a reflection of their less common utilization in general or limited exposure to practicing sports fellows (p.289). In other words, the unpopularity of this technique among the sportsmen, who are vulnerable to musculoskeletal injuries, is not as a result of the ineffectiveness of this technique, but rather it is as a result of lack of exposure to this technique.

The researches that have been carried out in the past have often focused on comparing different techniques of musculoskeletal treatment with Graston Technique®. Cothers, Walker & French (2008) argues that soft tissue or massage therapy is a very popular method for the treatment of low back pain in a general population (p.2). In line with this, Graston Technique® is used effectively in administering soft tissue therapy as a way of treating Musculoskeletal Injuries. It has been argued that Graston Technique® improved nerve conduction, wrist strength and wrist motion (p.8). In this respect, Graston Technique® was utilized as an appropriate method in the treatment of musculoskeletal injuries. Note that the research and studies which have been carried out in the past indicate that the use of Graston Technique Assisted Soft Tissue Mobilization (GISTM) does not impart pressure on the affected area as compared to pads. Note that the promoters of Graston Technique claimed that the metal surface of the instruments do not compress the tissues, as do the fat pads of the finger, so that deeper restrictions can be accessed and treated (Weintraub, Mamtani & Micozzi, 2008, p.192).

Furthermore, it is important for one to understand that the identification of the tissues and body areas was among the most important factor in the treatment of musculoskeletal injuries (Burke et al., 2007). Therefore, using a specific technique implied that the therapist was supposed to be in a position to identify the injured tissues and then administer the therapy. In other words, the effectiveness of a particular technique was examined on the basis of whether the treatment approach was effective. In this regard, it was found out the Graston Technique® had an increased ability to identify specific tissue in the body as compared to other techniques which are used in the treatment of musculoskeletal injuries. In reference to Aspegren, Hyde & Miller (2007), use of the GT instruments break down existing scar tissue in patients with chronic pain and begins the formation of new scar tissue activity with the fibroblast laying down new scar tissue in parallel, as opposed to laying down of this tissue in random (p.324). Thus, the use of GT approach reflected an increased efficacy in the treatment of musculoskeletal injuries.

Arguably, the topic under study is a worthy studying topic since it is directed towards establishing the value of Graston Technique®, and reinforces more needed skills to either make it more effective or seek other alternative in case its success and effectiveness is invalidated. Note that the use of Graston Technique® in musculoskeletal treatment is a new treatment method irrespective of the fact that it had gained popularity in the United States and in some other parts of the globe. As a result of this, the study of this topic raised important concerns which needed to be addressed. To begin with, there was a need to train as many people as possible in order to increase its awareness in the medical arena. Such understanding would increase the effectiveness of using this method by medical practitioners with the specifics of chiropractic (Miners, & deGraauw, 2010). Furthermore, the topic raised questions on whether to develop new equipments that are currently used or to adopt the existing equipments.

Concept behind Graston Technique®

Sweere (2004) argues that Graston Instrument Technique is a highly effective means of releasing adhesions found in fascia, joint, muscles, and tendons (p.130). In line with this, there are different aspects of this technique that have been integrated in its approach to musculoskeletal treatment. Note that apart from ensuring that the patient is comfortable, it also increases the chances of getting well more quickly as compared to other treatment methods which are used currently. Importantly, the aspects that inspired the development of this technique were based on the fact that there was an increasing need to develop a therapeutic technique that would enhance musculoskeletal healing process as compared to the existing techniques.

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In this regard, it is important at this point to explore the theoretical or conceptual base on which the technique is build. Arguably, the technique has been integrated in the typical practice among the chiropractors, physical therapists, athletic trainers, occupational therapists and osteopathic physician altogether. Under this circumstance, the instruments used in the technique are made use of during the palpation exam which is meant to detect abnormalities in soft tissues. Needless to say, this is the actual neuromusculoskeletal evaluation and when the injury is located, the instruments are used in the context.

As such, they are made use of so as to mobilize, lengthen the tight, release, shorten and restrict the tissue with the sole aim of normal movement and postural alignment restoration. Generally, the technique works together with neuromusculoskeltal evaluation, soft tissue mobilization, inflammation control, mobilization of the joints, exercises for strengthening and stretching exercises, postural re-education, neuromuscular re-education, and progression in the aspect of progression, proprioception training along with the home exercise program abbreviated HEP.

As it has been highlighted earlier in the text, the technique was developed in the early1990s by two athletes who made it for cross-friction massage of the often sustained knee injuries. Nowadays, the technique has been incorporated in the mainstream practice by clinicians almost in every state in the nation and as such, it has gone even to the international level. Again in this context, it is important to bring into view that the practice as well has been incorporated in the major universities and colleges as a part of the curriculum. More to this, amateur team of sports along with the related professionalism, have made use of the technique in the management of injuries with the main goal of developing the general performance.

There are several components of the Graston Technique® and as such, there is the examination as well as re-examination involving the use of manual and instrument-assisted exam in palpation. Moreover, Graston Technique® Intrument-Assisted Soft Tissue Mobilization (GISTM), has the ability to mechanically manipulate the soft tissue. This is done so as to release restrictions, reduce per-articular edema, promote healing, and in the larger perception enhancing repair. Stretching exercise has as well been incorporated in the components of the technique. They are actually meant to lengthen the structures which may happen to be shortened. In this respect, they bring about improvement in the alignment of collagen fiber together with the remodeling of injured tissues. 

Besides the component of stretching exercises, there are also the strengthening exercises that follow. In relation to this point, the exercises are meant to heat and fatigue the shortened structures which give room for changes in the connective tissue. They also bring about the proper realignment of the collagen fiber and the aspect of the tissue remodeling. Uncalled for to say, the endurance and stability of the muscle is brought about by the strengthening exercises. Additionally, GISTM minimizes the discomfort and the bruising which come as a result of post-treatment. According to Cothers, Walker & French (2008), the instruments are much like tuning forks as they reportedly resonate in the clinician's hands allowing the clinician to isolate adhesions and restrictions, and treat them very precisely. This precision in identifying adhesions and restrictions reduced the discomfort which could be experienced if the treatment was not precise.

The development of the Graston Technique is also based on the concept of pain reduction among the patients who had been affected by musculoskeletal injuries (Howitt, 2006). Graston Technique helped to increase range of motion and decrease pain in affected joints after injury or surgery (Indianapolis Monthly, 1995, p.69). In other words, this technique employed an approach that could allow the patient to have an increased mobility irrespective of the fact that he or she had been injured as well as reducing the pain that he or she experienced during that period. Hammer asserts that not only do the instruments assist in identifying areas in need of treatment, which formerly were not apparent, but also in directing the clinician in the precise treatment (p.2). Notably, this is an important factor that has increased the efficiency of clinicians in administering the treatment therapies among patients who have been affected by injuries. The accuracy of the treatment process is facilitated by the fact that the instruments which are used in this process provide a precise guideline that when followed by the medical practitioner; they increase the healing capacity of the patients.

In addition to this, Graston Technique employs both the diagnosis approach as well as treatment approach. In line with this, the technique has the capability to diagnose different tissue areas which has been affected by the injury. This is based on accurate analysis of the area to ensure that the analysis results are accurate as possible. In reference to Hammer (2003), although the Graston Technique instruments do not reveal the skin temperature, moisture and tissue layers as can the hand, they have been found to significantly magnify what one is able to feel (p.2). Therefore, these instruments can be used effectively in the diagnosis and treatment process of musculoskeletal injuries instead of using the hands. This is one of the concepts of this technique that has increased its effectiveness in the treatment of musculoskeletal treatment. Importantly, the ability to accurately identify the specific part that needs treatment has also been found to increase the efficacy of this technique in the sense that the instruments leave no doubt in my mind, or that of the patient's, that a significant area needs treatment (Hammer, 2003, p.2).

Limitations of Graston Technique® In Treating Musculoskeletal Injuries

The use of Graston Technique in treating musculoskeletal injuries has been on the increase in the recent time. In this regard, there has been an increased confidence in the use of this technique in the treatment of musculoskeletal injuries. With this in mind, one of the limitations of this technique is embedded in the fact that there has been a heightened confidence in the use of the technique. As a result of this, there is a tendency to rely heavily on it without considering the fact that it is not a replacement of the clinician's hands but rather a complement. This in most cases would result in the inability of the medical practitioners to identify important flaws in the technique that could help in further development of the technique.

There have also been increasing resistances from a section of researchers and scholars who oppose the use of this method in the treatment process. One of the reasons that have been cited for this resistance is embedded in the fact that there is no scientific backing on the technique in the treatment of musculoskeletal injuries. According to Crothers, Walker & French (2008), at present, limited research has been undertaken to determine the effectiveness of GT (p.2). Note that the use of this technique involves people's health and as a result, backing research is necessary in every technique that is used in the treatment process.

The use of this technique with other available techniques is limited. It is important to understand that there is limited research which has been carried out on how the technique could be used together with other available techniques to treat musculoskeletal injuries. Note that the medical world has been characterized with the use of different treatment techniques as a complementary of each other. Using different treatment techniques as complementary of each other enhances the treatment and recovery process of patients. However, current research and studies are limited in that they provide limited information and data on how Graston Technique could be used to supplement other techniques.

The effectiveness of Graston Technique® in treating musculoskeletal injuries is an important subject of study in the medical world. Therefore, the process of acquiring information and data was vital in this research. In this respect, this research was based on important aspects and elements of data collection in research. To begin with, the research relied on researches which have studied the Graston technique since its inception in the 1990s. This included carrying out an analysis of scholarly articles, books and websites, with a focus on areas that had analyzed Graston Technique. In other words, books, scholarly articles and websites were critically analyzed as vital sources in the research. More importantly, this research was mainly based on secondary sources that had analyzed the use of Graston Technique in treating musculoskeletal injuries.

After gathering the information and data that was needed in this research, it was analyzed and presented in the trendiest way using vital scientific presentations method. This analysis was meant to identify contradictions and areas that that authors of these sources agreed on. More so, the analysis examined the weaknesses of these sources and eliminated those that had superficial information as a way of eliminating errors. On the other hand, the information and data that was collected was presented in a systematic manner to make this research to be coherent. Therefore, most issues that emerged during the research were handled from the general perspective and narrowed down to specific issues.

The feasibility (practicability) of the Project

Some have questioned the practicability of the Graston Technique® in the chiropractic practice; however, it is evident from research that it actually works.  This is not to mean that it is the only way for treatment bur rather, there are other means of treatment. According to Whiting & Zernicke, (2008), low back pain being one of the worst musculoskeletal injuries, affects over 80 percent of the world population. In relation to this point, conservative treatment which makes use of ice, rest and gentle activity has been used in the past. Again in this context, manipulative therapies have been made use of together with the therapeutic exercise interventions. However, these treatments have been associated with limited efficiency in the treatment.

Following this point, the treatment of such injuries has been open to debate and further research. Subsequently, the use of Graston technique came into play. According to Hyde & Gengenbach  (2007), the technique revealed some good and as well excellent outcomes in several aspects. Given to this point, it has worked in the past for the treatment of Achilles tardiness and back pain (Morris, 2005, p.638-639). Along with this, chronic and acute strains or sprains together with the illotibial band tendinosis, post-surgical scars, writs tendinosis, scars of trauma, rotator cuff tendinosis, neck pain, lateral epicondylosis, medical epicondylosis, carpel tunnel syndrome, de Quervain syndrome and plantar fasciitis have also demonstrated positive outcomes through the technique (p.301). Moreover, there also the nonacute bursitis which has showed positive results with the use of the technique in its treatment.

From a general point of view Hyde & Gengenbach  (2007) has pointed out to some of the benefits associated with the Graston Technique® instrument-assisted soft tissue mobilization (GISTM) as it is applied in the rehab program. Relative to its use by patients, the technique has proved useful in the improvement of the levels of functional outcome as well as the improvement of the life quality. Enhanced patience independence has been cited as a benefit since there is a main focus on the education of the patient and the use of home programs of exercise. Another thing to note is that the technique has been noted for the development of participation of the patients as well as compliance while being treatment.

In the same line of thought, patients have revealed that the use of the technique can as well increase the aspect of confidence of the patients in the health care provider. This comes into play as a result of the patient being able to feel the soft tissue abnormalities during the exam as well as with the treatment while making use of the instruments. As a matter of fact, it also adds confidence of the patient to the care provider owing to the fact that the patient is able to see that the clinician has been able to particularly and precisely diagnose the sites involved (Coulter, 1999).  

On the other hand, the clinicians have greatly benefited from the technique by means of having decreased fatigue along with an aspect of conserving energy. Notably, mechanical advantage is realized in regard to the force been directed into the tissues rather. Again in this context, it has been noted that the technique brings about improvement in time consumption in the sense that short time is employed. So to speak, the technique is equipped with a superior aspect of specificity and localization of the injury during the exam and treatment process and as a result, this saves time and energy. The technique has also been associated with improved satisfaction of work resulting from the improved patient care.

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