Graston techechnique

Soft-Tissue Injuries: Better, Faster Healing

Beyond “hands only”The early Chinese may have been the first to promote health through using “instruments” on the soft tissues of the body. Those first devices were made of buffalo horn and jade.

Interest in instruments to extend the “reach” of chiropractors, massage therapists, and others got a boost in the ’80s when David Graston suffered a debilitating sports injury. Graston’s disappointment with the rehabilitation methods of the day caused him to create several stainless steel instruments with various shapes and angled surfaces. These instruments were designed to augment hands-only approaches to healing.

Chiropractors and massage therapists have always worked their fingers into injured soft tissue to increase blood flow and break up restrictions. But fingers alone cannot detect restrictions at deeper levels, nor can they match the ability of the right instruments to treat the full range of restrictions.

Today, several companies produce hand-held devices used to perform what’s known as instrument-assisted soft-tissue mobilization (IASTM).


What do the instruments look like?

Most instruments are stainless steel. Others are made of aluminum or polymer.


Which parts of the body can develop soft-tissue injuries?

Soft-tissue injuries, such as strains and sprains, often affect the extremities—the legs or arms. Because “soft tissue” refers to anything that isn’t bone, neck and back injuries fall into this category, as well.

How do soft tissues become injured?

Athletes who suffer a traumatic injury will often need soft-tissue-specific rehabilitation to get back full range of pain-free motion. Many soft-tissue injuries, however, are the result of repetitive motion.

People who may suffer from such injuries include:

Assembly-line workers

Golfers and other athletes

People who spend long hours at a computer without regular stretch breaks

Mothers who hold their babies only on one hip

Students who overfill backpacks or who hang heavy backpacks over one shoulder

Sedentary people who allow their muscles to atrophy


Where do soft-tissue injuries originate?

A soft-tissue injury can occur anywhere that ligaments, tendons, muscles, or myofascia are found. Ligaments connect two or more bones and help stabilize the joints. Tendons attach muscles to bones. Ligaments, tendons, and muscles provide a natural brace to protect the bony skeleton from injury. A ligament can be injured, for example, by making a movement that would take a joint outside of its normal range.

What is a “healing cascade”?

When the body is injured, it works to repair itself through a three-phase “healing cascade” process of inflammation, proliferation, and maturation.
In the inflammatory (“acute”) phase, the body releases chemicals that start the healing process. This process continues through the proliferative phase, during which the body migrates materials it needs to create scar tissue at the site of injury.
During the maturation phase of healing, scar tissue forms in the soft-tissue injury site. In this phase, the injury becomes chronic. Scar tissue helps the body form a “patch” at the site of an open wound or internal injury. Scar tissue, however, is much less flexible than normal tissue. It restricts movement, leading to pain when, for example, an athlete with a sprained ankle tries to return to running.

Why is a second healing cascade important?

Most patients with soft-tissue injuries come to a doctor of chiropractic after injuries have become chronic (weeks, months, or even years post-injury). By that point, the body has completed most if not all of the healing tasks of the original healing cascade. A second healing cascade is needed to restart the healing process, bringing to the site, among other things, oxygen and nutrients.

How is a second healing cascade created?

Although healthy soft tissue is longitudinal (laid out all in the same direction) and flexible, the body lays out scar tissue in a haphazard fashion. Scar tissue is fairly rigid. Pain results when movement stresses scar tissue. The doctor of chiropractic presses his instruments into damaged tissue to help release restrictions created by scar tissue and get a chemical healing cascade started. The goal is the normalization of the tissue. “Normalization” probably does not mean that the instruments force the underlying tissue to re-form longitudinally. It refers instead to the release of restrictions. Treatment, which includes stretching out muscles, helps patients build flexibility and strength in the area.

What is a treatment like?

When doctors of chiropractic trained in IASTM use the instruments, they first spread a light gel film over the patient’s skin. Then, they press into and move the instrument around the site to locate restrictions. Treatment breaks down scar tissue and encourages the body to remodel the underlying tissue. During treatment, smaller capillaries in the area are broken. Bruising is a normal response, signifying that a healing cascade is underway.

How does treatment feel?

IASTM can cause minor discomfort. You may wish to arrange a signal that will tell your chiropractor that the degree of pressure has become too uncomfortable. Treatments are typically short—often just three to five minutes.
The level of discomfort typically is reduced with repeated treatments. Chronic soft-tissue injuries are not healed overnight, but your willingness to perform home stretches and exercises as prescribed by your chiropractor will hasten the process.

What side effects can I expect?

Redness of the skin, followed by bruising, is common. These side effects show that your practitioner has been working to get at troublesome areas and help start the healing process. You may also be asked to apply ice as part of your at-home treatment.
Doctors of chiropractic are trained to effectively address your musculoskeletal complaints. If you have further questions about soft-tissue injuries, your doctor can help.

Sources from "www.acatoday.org"

What is ‘whiplash’?


‘Whiplash’ is what happens when someone’s head moves forwards and then backwards quickly. This quick back and forth movement may cause injury to the neck. This whiplash movement often happens in car crashes. People who have been in a crash often complain of neck pain and stiffness afterwards, sometimes even a few days after the accident. For most people the pain is mild, does not interfere with their normal activities and gradually gets better. Research indicates that people who carry on with their normal activities recover faster than people who stay at home and reduce their activities.

Some people have more severe neck pain. They may also experience:
• headaches
• pain in the shoulders and arms
• dizziness or altered sensation
• weakness in the arms.

These people should see a doctor immediately since they may have a Whiplash-Associated Disorder, or WAD as it also known.

What is WAD?

The term WAD stands for Whiplash-Associated Disorders. It covers a range of neck problems resulting from the whiplash motion of the accident. These can range from no discomfort at all to very severe injuries.

To help the doctor work out how serious your injury is and the most appropriate treatment, the neck problems from a whiplash have been grouped into four ‘grades’ of WAD.

Grade 0 no pain or discomfort. No physical signs of injury.

Grade 1 neck pain, stiffness or tenderness. No physical signs of injury.

Grade 2 neck pain, stiffness or tenderness and some physical signs of injury such as point
tenderness or trouble turning the head.
Grade 3 pain, stiffness or tenderness and neurological signs of injury, such as changes to
reflexes or weakness.
Grade 4 pain and fracture or dislocation of the neck.


When should I seek medical advice?

You should seek medical advice after an accident if you have:

• medium to severe pain in your neck
• neck pain plus stiffness (you have problems turning your head)
• arm numbness or weakness
• drowsiness, nausea, vomiting, confusion
• any complaints that are not getting better or are getting worse.

These symptoms may mean you have WAD.
It is important that you see your GP for a medical assessment.
A registered health professional such as your GP, physiotherapist or chiropractor is the best person to advise you about how to manage your whiplash injury.

It is also important that you tell your GP of other professionals who may be treating you.

How long will it take me to get better?

This will depend on the extent of your injury. Every injury is different.
Most people will be able to continue with their normal activities, but it may take weeks, or even months, for the discomfort to go away completely.
If you have had to reduce your normal activities, you should be able to return to them within weeks.
It may seem that it is taking a long time for you to recover. If you are worried about this, or if your pain gets worse, see your doctor immediately.


Treatments that are recommended

Act as usual: you may have pain but maintaining your normal activities is an important factor in getting better.

Exercise: specific exercises to restore muscle control and support your neck should improve postural control and prevent unnecessary postural strain. General exercise and activity are also important.

Pain relieving medication: pain relieving medication such as paracetamol can be prescribed. For more severe cases, anti-inflammatories can be prescribed in the short term to reduce pain and swelling. Use of medication should be limited as it may have side effects.


Treatments that may be used

Advice about posture: advice about how to sit and stand correctly can be helpful in addition to maintaining usual activities and exercising.

Joint Mobilisation: a therapist gently and repetitively moves the joints in the neck region to reduce pain and restore normal movement in the neck. This can be used if it reduces your
symptoms. It is important that your therapist is registered, qualified and trained to do mobilisation.

Spinal Manipulation: a therapist applies a gentle quick single thrust to the joint to the limit of its range of movement. This produces a clicking sound. The manipulation aims to reduce pain
and restore motion. It can be used if it reduces your symptoms. You should check that your health provider (medical practitioner, chiropractor, osteopath or physiotherapist) is registered, qualified and trained to do manipulation. Complications from manipulation are rare but include stroke and death.

Combination of Treatments: a combination of treatments such as exercise and mobilisation can be used. Traction: a machine gently stretches the neck. Traction can be used with other treatments. There is no evidence that traction works for WAD, so it should only be used if it reduces your symptoms.

Acupuncture: fine needles are inserted into specific points on the body. There is no evidence that acupuncture works for WAD; it should only be used if it reduces your symptoms.

Improving your environment: learning about the structure of your neck and how it works can be helpful. Improving your work practices can lessen unnecessary strain and allow you to function well in your normal daily activity. For example, the chair you sit on at work may need adjusting. It may also help to stand up for a break or change position every 20 minutes. If you have learnt relaxation techniques these may be helpful in managing pain associated with WAD.

TENS, heat, ice, massage, ultrasound, laser, short-wave diathermy: TENS (Transcutaneous Electrical Nerve Stimulation) is a low frequency, painless electric current sent through the skin to reduce pain.
This and other passive treatments/electrotherapies, if administered by trained professionals, are additional treatment options during the first three weeks. They are used with manual and physical therapies and exercise to help you return as soon as possible to your usual activity.

Rest: a period of bed rest is not recommended for people with WAD Grade 1. People with WAD Grades 2 and 3 should not have bed rest for more than four days.

Surgical Treatment: in almost all cases of WAD Grades 1 to 3 surgery is not required.

Collars: the use of a collar, sometimes called a neck brace, is not recommended for WAD Grade 1. If prescribed for WAD Grades 2 and 3, a collar should not be used for more than three days as it may slow your recovery.

Exercises that might help The following exercises should help to heal your neck.* Perform all exercises in a slow and controlled manner. The exercises are designed to restore the movement and muscle control around your neck and to reduce unnecessary postural strain and muscle pain.


When you are performing the exercises, stop and contact your doctor or therapist if you notice:

• dizziness, light headedness, blurred vision, fainting or disorientation
• sudden pain shooting down your arm, or numbness or weakness in your arm or hand
• unusually severe neck pain
• exercises consistently producing a headache, which persists.

For each exercise:
• move smoothly and slowly, without sudden jerks. The key is precision and control.
• keep your mouth and jaw relaxed. Keep lips together, teeth slightly apart and let your tongue rest on the roof of your mouth.
• gently hold your shoulders back and down so that they are relaxed while doing all exercises.
• in movement exercises, try to move the same distance to each side. If one side is stiffer, move gently into the stiffness. Move to that direction a little more often.
• expect some discomfort, but remember exercises should not cause severe pain.

Lie down with a soft pillow under your neck, and with your knees bent up.

The chin nod exercise

Gently and slowly nod your head forward as if to say ‘yes’. Feel the
muscles at the front of your neck.
Stop the nodding action just before you feel the front muscles hardening.
Hold the nod position for five seconds and then relax. Gently move your head back to the normal start position. Repeat up to 10 times.

Head rotation

Gently turn your head from one side to the other. Look where you are going. Progressively aim to turn your head far enough so your chin is in line with your shoulder and you can see the wall in line with your shoulder. Repeat 10 times to each side.


Correct postural position

Correct your posture regularly by gently straightening up your lower back and pelvis. Now gently draw your shoulder blades back and down (women towards their bra clip). Hold the position with ease for at least 10 seconds.

This position will prevent and ease muscle pain and tension in your neck and shoulder muscles. Repeat the correction regularly, every half hour during the day. You can do this exercise at work, in the car, train or bus and sitting at home.

Neck isometric (no movement) exercise

Sit in the correct postural position as described above. Make sure your chin is relaxed and slightly down. Place your right hand on your right cheek. Gently try to turn your head into your fingers to look over your right shoulder but allow no movement. Hold the contraction for
five seconds. Use a 10% to 20% effort, no more! Repeat with the left hand on the left cheek. Do five repetitions of the holding exercise to each side.

Sit in the correct postural position. Repeat all exercises below 10 times to each side.

Rotation: gently turn your head from one side to the other. Look where you are going, progressively aim to see the wall in line with your shoulder. This exercise is similar to the one you did lying down. This time you do it sitting.

Side bending: gently tilt your head towards your shoulder and feel the gentle stretch in the muscles on the side of your neck. Perform the movement to both sides.

Bending and extension: gently bend your head towards your chest. Lead the movement with our chin. Moving the chin first, bring your head back to the upright position and gently roll it back to look up towards the ceiling. Leading with your chin, return your head to the to the upright position.

Where else can I get help?

Specialist health professionals
Your GP can refer you to health professionals who are experts in treating WAD. These may include a GP who sees a lot of WAD patients, specialists, physiotherapists and chiropractors.

Pain management clinics
You would normally be sent to a pain management clinic only if your injury and/or pain is severe and long lasting.

Community resources
Evening and community colleges run classes in relaxation and stress management, but see your doctor before starting one of these. For the phone number of your nearest college look under
‘Evening & Community Colleges’ in the White Pages phone book.

Local hospitals may also run relaxation classes.
Web site The MAA web site www.maa.nsw.gov.au has general information on rehabilitation and other publications on Whiplash-Associated Disorders.

Claims Advisory Service
For information or assistance on a CTP claim contact the Motor Accidents Authority Claims Advisory Service on 1300 656 919.

Source from "clinicalrehabspecialists.com"