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"

Shoulder Pain Facts


Shoulder pain is a common ailment that affects 10% of the population at some time in their lives. Shoulder stability requires proper function of the rotator cuff and surrounding muscles which attach the arm to the torso. A properly functioning shoulder allows for excellent movement and proper stability when pushing, pulling or reaching overhead. Injury to the shoulder joint may limit movement and/or cause pain with activities. Since there is the capability for so much movement of the shoulder, problems can occur, leading to rotator cuff tendonitis or tears, shoulder impingement syndrome (pain while reaching overhead), shoulder bursitis, or complete loss of the shoulder’s range of motion (frozen shoulder or adhesive capsulitis). While many shoulder problems are frustrating and may take several months to heal, many spontaneously get better on their own. As much as 50% of all people with shoulder pain do not seek treatment at all with as many as 23% of the cases getting better in one month and 44% of the case getting better by three months. Trauma to the shoulder or recurring shoulder pain may be an indicator that there is a more serious problem and additional investigation may be required.


When should I see a doctor?

You should see a doctor when you can no longer cope with the pain or you can no longer perform activities which are important to you.

You should see a doctor when:

•When the pain is too much for you to cope with and there are specific activities important to you that you are having difficulty undertaking.

•When you have sharp pain shooting into the shoulder with or without numbness.

•You notice a shrinking (atrophy) of the shoulder and/or arm muscles or an increased weakness in the hand or arm as a result of the shoulder dysfunction.

•The shoulder pain is non-mechanical. It is painful and symptomatic when you are not moving it or it seems to arise from other areas of the body (i.e. chest).

Shoulder pain is very common and most people are fine coping with the pain as the condition slowly gets better. The chance there is serious disease causing the pain is rare, but it is important you tell your healthcare provider of any fears or concerns you may have or difficulties you may be experiencing at your workplace. It is normal to have feelings of worry. Often times there are ways to control the pain and ways of modifying your activities that help you get on with your life.


What can I do for myself ?

Keep in mind that by staying active with your normal activities is one of the best things you can do for yourself. If your job requires movements that aggravate your shoulder, try to modify the task or activity. You may have to speak with your supervisor to see if there are ways to modify the job or activity to let the shoulder heal. Often reaching or lifting overhead will aggravate shoulder problems. Workstations may have to be changed to limit the cumulative tension in shoulders.

•Remember to try to move the shoulder in the pain free range

•Move before the shoulder stiffens up.

•Do not stay in one position too long.

•Take “mini” stretch breaks while doing repetitive tasks (computer work, desk work, etc.) ·

•Don’t stop doing things, just change the way you do them.


Ways to increase your activity.

First ask what is it that I want to do? Is it reaching into a cabinet, washing your hair, carrying a jug of milk, putting on a coat, etc.? Find out how long you can perform this activity without “flaring-up” your condition or making you worse off than when you started. This is individual to you. Reduce the amount or time of activity by 20% so you’re able to perform the activity, but it does not take you to the “flare up” point. Having a little discomfort is ok, though the duration of the activity should not make you worse off than before. Gradually increase the activity little by little, as not to reach the “flare-up” state. Slowly you will notice you’re able to do the activity longer without “flaring-up” the condition. Don’t be too upset if you have a “flare-up,” just reassess your activity level and continue on. If you unable perform the activity at all, try to change the way you use the shoulder. You may have to use a step stool to reach the cabinet, or bring your head closer to your hands while washing your hair, or carry a jug of milk with two hands rather than one. Find out how to modify your activity so you are able to complete the task that’s important to you. It’s normal to have good days and bad days. It takes some patience, but it works.


Ways to Modify Your Activities

The computer workstation
Make sure your shoulders are relaxed as you work. You may have to lower your keyboard or raise your seat. Take frequent microbreaks before tension builds in the shoulder. Structure your desk equipment so you do not have to reach too far for it.

Putting on a shirt or coat
Place the bad shoulder in the sleeve first. Then use your good shoulder/arm to place the shirt overhead or the coat around your body. You may have to twist your body a bit.

Washing/styling hair
Stoop and bring your head down to your hands. You may have to change your hairstyle until your shoulder function improves.

Reaching into a cabinet
Use a stepstool so you do not have to reach overhead.

Carrying
Use two hands when carrying, even if the object is small.

Fastening your seatbelt
Use two hands to control reaching and fastening the seatbelt. You may have to twist your body a bit.

Driving
Take frequent rest breaks so you can get out of the car and move your shoulder. You may have to modify where you rest your arm in the car.

Sleep
You may have to try different positions or support your shoulder with a pillow.


Rehabilitation

If there are specific activities which you are having difficulty with, a rehabilitation specialist can help. Once serious causes are ruled out and the pain is under control, the rehab specialist examines where the dysfunction lies. Often muscle and joint dysfunction leads to faulty movement patterns of the shoulder. This may lead to specific tissues and shoulder muscles getting “beaten up” by continually being reaggravated. First identify specific goals or limitations you wish to overcome that are agreed upon by both the practitioner and you.

The rehab specialist will perform a functional evaluation to determine what you are able to do and what areas may be causing some trouble. Bridging the gap between what you are able to do and what you want to do is the essence of rehabilitation. This may consist of specific exercises prescription that helps improve areas where you are having some difficulty. Sometimes manual therapy, soft-tissue therapy, medication, injection therapy and other modalities may also be used to further you towards your outcome goals.

Make sure and voice your thoughts and concerns with your healthcare provider. Pain and “flare-ups” may happen from time to time. This is normal and should not be the focus in care. Rather, try to focus on the exercises that are bridging the gap to your goals and what activities you want to do. Some shoulder conditions may require surgery. This is usually after non-surgical remedies have failed and the individual is unable to cope with the pain or dysfunction. Your thoughts and fears are important. Make your healthcare provider aware of any worries you may have with any procedure.


All 4's Rock




A simple exercise for frozen shoulder and shoulder impingement syndrome is the “All – 4’s Rock”. In this exercise start on all 4’s and push your back away from the floor without rounding it. Hold your back flat and rock side to side 8-10 times. You can repeat this for 3 sets. This exercise targets the deep “inner” shoulder blade muscles – in particular, the serratus anterior muscle – that are responsible for stabilizing your shoulder.



Brügger Relief Position

Another exercise for frozen shoulder and shoulder impingement syndrome is is the Brügger relief position. This exercise improves both shoulder and upper back posture. It erases the slump position and helps take pressure off the ball and socket shoulder joints. Perform this throughout the day as a “micro-break” to improve your posture when you have been sitting or working at a desk for long periods of time. One or two repetitions for every 20-30 minutes of sitting is ideal.

Source from : clinicalrehabspecialists.com