Graston Technique is a therapeutic technique that is used by physical therapists so as to diagnose and treat all the problems that are related to the skeletal muscles and soft tissue. It is a patented method, which is used by therapists to control and manage chronic disorders. This technique can only be used by therapist who have undergone training on its use and have obtained a license from a licensing company or Therapy care resources Inc.David Graston is the main founder of this technique.
The adhesions present in the muscles and tendons can be identified and resolved by means of Graston instruments which comprises of a collection of six stainless steel instruments of various shapes and sizes (Destefano, 2009). This exercise is mainly performed by the Graston Technique practitioners through palpating the bodies of the patients. Graston technique is said to be an expensive and a very painful massage technique that uses mean looking curvilinear steel equipments to apply scarping pressure and hence achieve maximum tissue penetration. This technique claims to treat and stimulate healing process by first causing damage. For instance, it aims at breaking down scar tissue and facial restrictions and also targets tissues that are chronically inflamed, although there are risks taken in the entire process. However, evidence suggests that no concrete research has been conducted to establish the effectiveness of this method of treatment.
The major protocol of the Graston technique is the Graston instrument Assisted Soft Tissue Mobilization (GISTM) which has only been introduced into the chiropractic profession recently. This instrument is stainless steel made and designed and established specifically to act as an alternative to transverse friction massage (Donahue, 2008). Graston instrument is used as a supporting agent in the diagnosis and treatment of soft tissue dysfunction or pathology. It gives tactile diagnostic response to both the physician or the doctor and the patient since the instrument acts as a focused extension of the doctor's own hands while reducing wear and tear on the hands.
The Graston technique employs instruments that are with specialized form of massage designed to assist the practitioners to identify body parts of restriction and break up the scar tissue. The injured fibrotic tissue are combed and caught by the concave and convex stainless steel instruments. By the use of a cross friction massage that includes brushing or rubbing against the grain of the scar tissue, the doctor reintroduces small quantity of trauma to the affected area. This is aimed at causing inflammation in the area that in turn increases the rate and amount of blood flow in and around the area (Georgiou, 2006). But what is the effectiveness of this process and the outcome? Does its effectiveness depend on other factors such as the level of competency of the clinician, the nature of injury and the physiology of the patient?
Purpose of the project
The main purpose of this project proposal will be to determine the usefulness of the Graston technique in the practice of chiropractic practice. It will investigate if the effectiveness of this treatment technique is dependent on other external factors.
The results from this study will establish the value of Graston Technique, and reinforce more needed skills to either make it more effective or seek other alternative.
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Definition of terms
This involves a range of injuries which include muscles, bones, tendons, blood vessels, nerves, and other soft tissues. Every person who works in education who most of the time applies pressure on body parts, overloads some particular muscle group, maintains a fixed position, and performs repetitive movement of the limb is at risk of experiencing musculoskeletal injury. The severity of the injury varies from individual to individual and this may include frequent fatigue which starts after work and continues after work ceases and may result into inability to carry out daily duties (Haldeman, 2004).
This is a health care profession that promotes the diagnosis, treatment, and prevention of mechanical disorders of the musculoskeletal system particular the spine, since these injuries affect the general function of the body via the nervous system. Major chiropractic treatment technique includes the manual therapy which involves manipulation of the spine, soft tissues, and other joints. Physical exercise, counselling, and healthy lifestyles are part of the treatment process (Hammer, 2007).
The project has the assumption that the patient has to encounter some pain in the process of treatment. This pain may be from the bruises caused when the restrictions are released from healthy tissue and more bruises are likely to occur while dealing with chronic conditions. Also some body parts that have rich blood supply may produce more bruising though this will be controlled by the use of ice (Harwell, 2005).
The project limitation is based on the use of patient to assess their response. Graston technique is most likely to prove some reaction which is not good for the body. Just like inflammation is actively destructive to tissues, the immune cells will deliberately overreact and hence cause damage to healthy cells incase there might an infection. This kind of reaction is completely appropriate in open wounds, but more dangerous for all minor internal injuries such as the tendonitis (Hume, 1792). This will pause a major barrier for the success of the study process as it will need the consent of the patient and significant others. The technique involves risks and the doctors are not in any position to predict how the whole process may end. The process might work, not work, or even be more dangerous to some patients.
The main objective of this research proposal is to analyze the effectiveness of Graston Technique in treating musculoskeletal injuries, and also to determine the usefulness of this technique in the chiropractic practice (Hyde, 2007).
Sweere (2004) says that the Graston technique is highly efficient in releasing adhesions found in joints, muscle and tendons. Erin (2006) further supports this by saying that though one feels very painful during the treatment it is however very effective and he encourages therapists who use this method to continue. Even the former two time Olympic- Champion Debbie Fergusson was once quoted saying that this technique had shown instant results on his knee injury and had thus enabled him to continue with his training.
The Graston technique has been found to be quite effective in curing a variety of musculoskeletal problems and illnesses. According to a study by Pelham healing clinic, the Graston technique is both effective and advantageous to the patient in terms of the time spent during the treatment. For the patient they say that it decreases overall time of treatment and fosters faster recovery. It also reduces the need for anti- inflammatory medication and resolves chronic conditions that were initially thought to be incurable. This idea is also supported by the research carried out by My Healthy Living (reported in Wong, 2009). According to them the total amount of time spent on this treatment is comparatively less than the one spent on other methods. Research conducted by Graston Technique, found that the controlled micro trauma induced through Graston Technique and increased the amount of fibroblasts to the treated area. That amount of inflammation to the scar tissue helps initiate the healing cascade. On the other hand, West valley institute for health and Rehabilitation say that this technique cannot be used to cure all of today's ailments that people suffer from. He gives examples of open wounds, High blood pressure, Cancer (depending on the type and location), Pregnancy (pregnant women should avoid having the therapy done over the spine, pelvis, abdomen or along certain acupuncture points), Unhealed, complicated fractures as complications that should not be treated using the Graston technique as it might have disastrous results (Wong, 2009).
For the Clinician the technique provides an improved diagnostic treatment as well as detecting both major and minor fibrotic changes. Moreover, it reduces stress and provides hand and joint conservation. Most importantly, it increases patient satisfaction and thus increases the business' revenue (Hammer, 2003). A study by Donahue (2008) reveals that patients treated using the Graston technique enjoyed a longer period of healthy living than the ones that were treated using other methods like soft tissue mobilization (STM). My healthy living also conducted a research and found out that the treatment took only few weeks and the patient would be back on his/ her feet (Haldeman, 2004). However, the positive results are realized after the third and forth treatment. This directly implies that though it will require the patient to have several treatments, the end result will always be desirable.
Hyde (2007) in his research further found that using Graston technique alleviated pain, eliminated snapping and clicking of the thumb and improved the range of motion. My healthy leaving's research indicates that this technique can quickly cure chronic disorders (Haldeman, 2004). This thus means that the softer tissue disorders that people might have developed over the years can be easily and quickly managed. According to Pelham clinic, since the Graston Technique Instruments' perfectly fit in the clinician's hands it allows the clinician to isolate adhesions and thus treat very precisely Kinetics (Liebenson, 2006).
The technique is also effective in terms of time taken to heal. Research by Maartens (2005) found out that, since it only takes about four to five weeks for a patient to get well, the patient is able to develop self-confidence to carry out his/her daily activities the same way as before s/he contracted the disorder. Liebenson (2006) compared the relative effectiveness of this method and other methods currently in use. Patients treated by this method returned to functional sport activity at a faster rate (Liebenson, 2006). This thus indicates that the technique is efficient in terms of time taken to heal and hence allows patients to resume their work as quickly as possible.
Dr. Hegazi uses the Graston technique to effectively detect and treat stubborn muscular scar tissue and adhesions in restoring full strength to his patients (Morris, 2005). According to him this technique helps restore control and function that is commonly lost as a result of musculoskeletal injuries and disorders. Morris (2005) revealed that 85 - 90% of people who were treated by this technique fully recovered and were able to carry out their duties even more effectively. This means that they were able to resolve the functionality of the affected areas. This also means that this technique is actually very effectively and should actually be allowed to be used all over the world to treat patients with such like problems and disorders like Carpal tunnel Syndrome(wrist problem), scars, foot and arch pain, neck pain, lower back, ankle pain. Pohl (2009) says that he uses this technique to help restore the function and control that many of his patients lose when a simple injury turns out to be chronic. He goes ahead to say that it produces an almost immediate response, and thus it equalizes the frustration felt by those patients who have failed to respond to conventional forms of treatment.
In chronic conditions the Graston Technique can be used more aggressively to promote tissue mobility and to control the amount of tissue inflammation (Sweere, 2004, p.32). It is believed to bring about improved recovery, patient satisfaction and improved quality of life for the patient. It is able to provide enhanced patient care and ability to detect soft tissue lesions son the side of the clinician (Sweere, 2004, p.9). However, in order to critically evaluate the effect of this technique on a patient's ankle injury a placebo is necessary (Liebenson, 2006). Liebenson (2006) says that the outcome of placebo treatment could be high in about 40% of the participants and a poor outcome of about 30%. It is therefore not biased to either the excellent or the poor participants. Morris (2005) goes on to mention that the use of this technique in chiropractic research indicate that all healing methods involve a placebo effect. To this, Graston method is not an exception.
Hammer (2003) says that the Graston technique is a treatment that can be used in chronic ankle sprains. In his hypothesis he states that this technique enhances ones ability to detect and treat soft tissue lesions. He says that the treatment results in an induced yet controlled micro trauma hence causing fibroblastic proliferation. This initiates the healing cascade (Hammer, 2003, pg 1).
According to Living Well Medical, Graston technique is effective because it provides a controlled micro trauma to the affected soft tissue structures (Sayler, 2005). It thus stimulates a local inflammatory response that causes healing and repair of the damaged tissue or the affected areas. It thus allows doctors to accurately diagnose patients and be able to offer the appropriate medication. Since treatment by this technique involves a rehabilitation program, studies further conclude that it allows for flexibility, strengthening which are able to provide optimal results (McLaughlin, 2006; Hyde, 2007; Smith, 2010). This is so because it focuses on imbalances throughout the kinetic "chain" (Hyde, 2007). A medical report published in Hyde (2007) advises people suffering from conditions such as Shin Splints, Achilles Tendinitis (ankle pain), Plantar Fasciitis (foot and arch pain), Cervical Sprain/Strain (neck pain), Lumbar Sprain/Strain (lower back pain) and Trigger Points to use this method. The reason is that they respond well to this kind of treatment.
A pilot study by Burke et al. (cited in Smith, 2010) compared two manual therapy interventions for carpal tunnel syndrome. The results showed that use of Graston technique improved the nerve conduction latencies, wrist strength and motion (Smith, 2010). However, the improvements were detected by his subjective evaluations of signs and symptoms as well as customer satisfaction with the treatment outcomes, which provided additional evidence for the great efficacy of this technique (Smith, 2010). Since little evidence exists the findings by these researchers can be used to find the percentage efficacy of using this technique.
The Graston technique is not only effective to the patients, but the employers, third party payer as well as the healthcare industry. They stand a chance to benefit if they utilize this treatment technique. According to Pelham healing clinic, it allows patients to remain on their job, reduces need for splints, braces and job-site modifications, as well as contributing to reduction of labor and healthcare costs both direct and indirect. From the many researches cited there is no doubt whatsoever that the Graston technique is actually an effective technique that. The missing link is how other factors affect its usage. Factors such as the nature of injury, the physiology of the patients body and the level of competency of the medical staff, especially clinicians, could determine the level of competence.
The main purpose of this research is to gather quantitative data to assess the effectiveness of Graston technique. Evaluate how it has been used to heal numerous problems like carpal tunnel Syndrome. It can also reduce on the time spent by the practitioners on patients thus promoting faster rehabilitation. Through this method of treatment, even the internal infections can be treated. When the treatment has already been performed, the patient can quickly resume his normal duties of the day. The author will seek to administer questionnaires and one-on-one interviews with patients and practitioners who have the valid license that authorizes them to conduct the treatment. It is to the assumption that small scale survey will give a more accurate and useful information that would meet the expectations as regard to the purpose of this research. Factors such as age and health background history will be considered so as to determine how many times the patient has undergone such treatment. While the patient is still under treatment, it is advisable that he should take six glasses of water every day (Lardner, 1978).
To achieve this method, the paper seeks to identify the current number of patient who have adjusted themselves and agreed to start using this method. It will also research on the success stories of patients who have undergone this process. This will mean that patients will have to explain vividly on their experience while using this system. The method will be, however, compared with other method and find out the benefits of each method, and establish the most appropriate to be recommended for specific problem of musculoskeletal injury.
The data will be collected from 200 patients who have had an experience with Graston Techniques while they were trying to treat musculoskeletal injuries from different hospitals. Five hospitals randomly chosen will be used. The hospitals will be at the town center where most patients attend. The respondents herein meaning only and only if the patient has ever had an experience of Graston technique will be issued with questionnaire that will contain all the questions so as to ensure we reach research objective. Interpretation will be given to those who do not understand some scientific terms but the interpretation will be brief just to make sure you do not assist a patient to interpret the question as this may lead him to unbiased answer. The questions will range from closed questions to open questions and the respondents have the freedom to express themselves as much as possible. Qualitative method will be used to reduce on the probability error as the method allows the respondents to give all the information as per his knowledge. 200 people with thoracic pain that is not actually specified will be randomly picked and categorized in three groups; placebe, GT or SMT. Each group will be given treatment at Murdoch University and here the treatment outcomes will then be measured at baseline. One week later after the treatment has been rendered; there will be an analysis that will basically be statistical.
All the information will be collected and will be used to get the results. Socio- demographic variables will also be important here to determine which type of group for example is mostly affected or which group of people is mostly affected. Gender, ethnic, race, education, household income, marital status, and current income are some of the variables that will be put into consideration. General health of individuals will also be measured at baseline to determine the individual general health. The results are determined by the data collected. The data collected are analyzed to get the results.
If the analysis is wrong then it might lead to wrong result. The respondents will have to be randomly selected to avoid the error of probability. Basing on the population of only 200 people out of the whole population in America it limits the research and reduces the chances of error. This does not, however, mean that there will be no error in the research. It thus means that the errors will be minimized to come up with the best analysis for the research data. In this research, both quantitative and qualitative methods will be applied. This will just make sure that the weakness of one method is covered by the other method. Mixed method in this case will be incorporated, to ensure that all the data is acquired for good analysis of the data.
Analysis and Discussion
After the collection of data, the most sensitive part is the analysis of the information as it is this that will determine the result of the research. In this research, data will be collected using questioners and direct interview. All the information given by the respondents will be written down according to the way of format and according to the research question. Research conducted in one of the hospitals by Graston technique found out that, micro trauma that is normally induced through this technique normally increased the amount of fibroblasts to the treated area (Wong, 2009). Clinical experience has proved that this technique is very helpful when it comes to the management of large variety musculoskeletal disorders (Donahue, 2008b). During the data analysis, the patient information will be coded so as to ensure that the person involved with the data analysis does not know the treatment that the patient was given (Liebenson, 2006).This is just to ensure the privacy of the respondents. Statistical software will be used to analyze the quantitative data. Preferably, SPSS will be of greater help as it is more exhaustive and tested methods of data analysis. While checking the data, descriptive statistics will be used to check. To get the summary statistics, there will be need to outlier and this will lead to inconsistencies through recording and contacting the study participants. Analysis using the regression analysis will be the most preferred due to its beneficial statistical properties. No adjustment is to be made incase of double testing. A detailed statistical analysis will however be discussed on completion of trial (Maartens, 2005).
Implications, Summary, conclusion
The implication of this study will depend on the outcome of the research. It is expected that the outcome will either prove the numerous claims that Musculoskeletal Injuries can easily and effectively be treated by Graston technique for treatment. This paper outlines the designs and rationale of Graston technique. The graston instrument used to assist soft tissue in mobilizing technique, hence reduction and reorganization of fibroitic restriction that is mostly in the neuromusculoskeletal system. To utilize the instrument, a lubricant must be applied on the skin to allow the instrument to roll over the skin smoothly without necessarily causing friction or irritation (McLaughlin, 2006).
According to the research conducted at Ball memorial hospital, GISTM increases the number or the amount of fibroblasts leading to the depositing of collagen. Activation rate is equal to the force applied. Most of the clinical experiment has proved that, this technique is helpful in the treatment of carpal tunnel syndrome, and low back pains (Nichols, 1763).There have been more success stories of people who have used the method, and doctors now encourage people to go for the Graton technique because it has proved to be an easy solution to chronic problems. Most people believed that skeletal muscles could not be easily treated but with this technique in place, chronic disorders take no time to heal (Smollett, 1758).
The technique has reduced by almost half the time that was used on treatment. The time is quite less and the whole disorder is settled (Morris, 2005). The technique has helped practitioners to be in a position to identify those damages that were so deep to be identified. The combing style simply brings out the affected area and the needed medication is granted so fast. Because the treatment is quiet faster, Graston technique entails a stainless steel tool that is used to treat the affected area (Sweere, 2004).The system apart from allowing the patient to perform other activities just after the treatment, it allows them to go back to work so fast as it allows the patient to have self confidence within himself and hence perform duties just the same way he used to perform before treatment (Williams, 1985). If this technique is proved appropriate, then there will be a need to implement it in many hospitals and practitioners to be authorized to perform the method to patients. The side effects are minimal if not nil and therefore, the technique is a better option for the practitioners.