Summer 2010

CASE REPORTSpeedskater’s Tensor Fascia Lata Improved with GTBy Eric St. Pierre, DC, DACBSP, CSCS, South Pointe Medical Center, Lafayette, CO Page 1

Vincent Leaves ‘Footprint, Legacy’Page 1

Shakar Named GT Clinical AdvisorPage 1

CASE REPORTIASTM Used for Treatment of Finger Joint SprainBy Evelina Gundeck, DPT, Amy Bayliss, DPT and M. Terry Loghmani, PT, PhD, Department of Physical Therapy, IU, Indianapolis, INPage 4

CASE REPORT25-Year Post-Traumatic Achilles Tendon Injury Has Excellent ResponseBy Larry Smith, BPE, DC, Parksville, British ColumbiaPage 5

Instructor Cites Importance of Adhering to GT PrinciplesBy John W. Schrader, HSD, ATC/L, Clinical Professor, Departments of Kinesiology and Athletics, Indiana University and GT Instructor, Bloomington, INPage 6

CASE REPORTAdhesive Capsulitis Treatment Gets ResultsBy C.J. Kleene, DC, Back in Line Family Chiropractic & Wellness, Hiawatha, IAPage 7

Marketing HelpNew Customizable GT AdsPage 8

In This Issue

CLINICAL INFORMATION FOR THE GT PROFESSIONAL

GrastonTechnique.com

History: A male short-track speedskater presented with right lateral hip tightness after crashing in practice a week prior. The mechanism was described as his skate “breaking out” from the ice at the apex of a left turning corner at roughly 30 mph. A 20-foot, supine slide resulted in pelvic impact into a break-away padding system, with his legs extended in the air. The athlete had completed all ice- and land-based training since the crash, but was experiencing progressively worsening symptoms. He described minor tightness and ache to the right tensor fascia lata (TFL) while at rest,

with moderate cramping in a skating position, worse when loaded onto the right leg. Pain, paresthesia, popping, clicking, locking and instability of the extremity were all denied. Also denied was previous diagnosis of spinal, orthopedic and/or neurological injury and surgery.

Examination:Initial examination generally found minor tenderness and moderate hypertonicity of both hip complexes and lumbar spine. The right TFL exhibited moderate tenderness and hypertonicity without visual signs of

Continued on page 2

CASE REPORT

Speedskater’s Tensor Fascia Lata Improved with GT By Eric St. Pierre, DC, DACBSP, CSCS, South Pointe Medical Center, Lafayette, CO

Jacqueline (Jackie) J. Shakar, DPT, MS, ATC, has been named clinical advisor for Graston Technique®. Shakar, who has 27 years of clinical experience, started her position June 1.

Shakar, 50, has been using GT in a clinical setting since 2003 and has been a GT

instructor since late 2004. She is employed by Central Mass Physical Therapy & Wellness in Worcester, MA, and also is a professor in the physical therapist assistant program at Mount Wachusett Community College in Gardner, MA. She teaches kinesiology, orthopedic content and manual therapy.

Professional and Academic Background Cited

Shakar Named GT Clinical Advisor

Dr. Richard E. Vincent, the professional face of Graston Technique® since 2001, has stepped down from the position of clinical advisor. Vincent, a nationally respected chiropractor, in March announced his intention to leave GT in the spring to pursue private business opportunities.

Vincent, 81, is president of Integrative Health Care Practice Resources (IHCPR), a web-based business that he co-founded in 2006.

“Dick Vincent has left his footprint and his legacy on Graston Technique®,” said Michael I. Arnolt, GT president. “It is in large part because of Dick’s vision, professional standing, leadership and enthusiasm that we have reached a position of prominence in the world of soft

Vincent Leaves ‘Footprint, Legacy’

Continued on page 3

Continued on page 3

Richard E. Vincent

Page 2The EDGE

injury or palpable defect. Postural analysis presented an ectomorph somatotype in sway-back form with anterior pelvic tilt. High fascial tension was noted of the abdominal cavity and right anterior-lateral hip in supine and seated positions, with marked increases in tension during passive hip extension and horizontal adduction. Both hip capsules exhibited multi-directional restriction and moderate deficits into internal rotation and extension. Active pelvic tilting found rigid control and limitation into extension. Neurologic and orthopedic examination of the extremity and spine were unremarkable.

Standardized functional assessment confirmed poor coordinated movement between the spine, hips and pelvis, with asymmetry in rotational spinal stability, compromised balance, recruitment of accessory musculature and a dependency on breath. During power and strength training maneuvers, a “sloppy” pelvis and “breaking” core were identified, often producing the chief complaint. During right-sided “push-off” while skating, minimal hip extension, excessive lumbar extension and rotation of the pelvis were identified. At high speeds and pressures associated with the corner’s apex, the athlete’s pelvis would close in toward the right hip rather than stay firm and level which dampened the transfer of energy, compromising his control of pressure, maintenance of speed and proper lean to ideally exit out of the turn.

Diagnosis:Myofascial pain centralized around the right TFL.

Findings:Compromised inter-spinal, pelvic and extremity stability; multi-directional femoral-acetabular capsular restriction; multi-planar myofascial restriction and dysfunctional breathing patterns.

Treatment:The treatment goal was to decrease discomfort in the skating position, while complementing a high-volume training block so the athlete could peak at the end of a quadrennial training program and essentially his most important competition. Graston Technique,® in combination with movement rehabilitation and manual

therapies, was essential to the recovery and preventative process. GT was used on different muscle groups and incorporated into the treatment schedule up to four times a week. Because the competition was so close, the objective was to address the quality and maintenance of motion already available, rather than promote large changes in ROM and symmetry. However, the athlete quickly found great relief and improvement in his skating technique with large gains in ROM and aggressive myofascial work.

In the mornings, a sport-specific warm-up was used with the athlete participating in a guided routine of spinal and pelvic self-mobilizations, active muscular lengthening, passive hip mobilizations and quick, light soft tissue work to rigid musculature. GT1, GT4 and GT5 were used often across large fascial areas, using light, linear strokes or quick, short, multi-directional attention to adhesions along multiple planes. Different ranges of motion and tensions along the most objectively and subjectively restricted planes were exploited, without producing ecchymosis. After completion of the day’s training, GT generally was used with greater intensity, with more attention paid to symptomatic tissue. An ice bath was required often because of the volume of training executed 6 days a week. All end-of-day treatment sessions included an extensive self-mobilization routine to ensure quantity and quality of motion.

The athlete quickly experienced a decreased “lock-down” effect when in the skating position and felt “smooth” control of the pelvis and hip. The TFL also felt less “swollen” when in position. A common approach consisted of GT3 and GT4 to the abdominal fascia, along the anterior hip and quadriceps in changing hip ranges and tensions (neutral, lengthened, concentric, eccentric, bridge, lunge, etc.) in conjunction with spino-pelvic self-mobilization progressions and a regrooving of squat and lunge progressions. Significant improvements were discovered in a kneeling upright lunge position within a

Speedskater’s TFL Improved with GTContinued from page 1

ABC TV News Spotlights GT

Continued on page 8

Page 3The EDGE

tissue treatment.” Arnolt credits Vincent with successfully melding professional clinicians from many disciplines—particularly, athletic trainers, chiropractors, occupational therapists and physical therapists—toward the common goal of using Graston Technique® to provide the finest of soft tissue treatment.

He also is responsible for the entry of GT into the educational offering of numerous chiropractic colleges. “It is because of the respect the top administrators have for Dick Vincent that they were willing to listen and see the value of adding a brand new component to treatment to their curriculum,” Arnolt said. GT is a requirement or elective in 16 chiropractic colleges, the first two of which were added in 2002.

Vincent, long an outspoken advocate of chiropractic, gained a large level of acclaim when Massachusetts in 1966, after years of effort, passed a law to license chiropractic. From 1950 to 1966, he practiced his profession in defiance of the Medical Practice Act. His presence and influence gained national attention as a board member with the Federation of Chiropractic Licensing Boards and the National Board of Chiropractic Examiners.

Vincent and his wife, Carla, reside in Falmouth, MA. She continues to provide a cross-section of services, including training and continuing education, for Graston Technique®. They jointly own and operate Vincent Management Inc., a consulting firm.

Shakar has a doctorate in physical therapy (DPT) from MGH Institute (2010), a master’s degree (MS) in physical therapy from Boston University (1983) and an undergraduate degree (MA) in psychology, with a minor in sports medicine, from Worcester State College (1981).

“The breadth of professional experience, her skills as an instructor and ability to communicate made Jackie an excellent choice,” said Michael I. Arnolt, GT president. The selection of Shakar was lauded by Richard E. Vincent, DC, previous clinical director for GT.

“Jackie is an excellent appointment as clinical advisor,” Vincent said. “Her combination of clinical and academic experiences make her well qualified for the position. She will work very well with the established inter-professional culture of Graston Technique®.”

In making the announcement, Arnolt added, “Dick and I agree Jackie is a professional and educator with respect throughout the GT organization. I am very pleased she accepted the position.”

Shakar, who will continue as a GT instructor in M1 and M2, will be the liaison with GT’s instructors, as well as clinicians in the field. Additionally, she will work with the administrative, education and research components of GT. Among her goals is to provide “clinicians and patients with the most accurate and evidence-based solutions to their questions.” Shakar also will guide the continued development of the Graston Technique® as it emerges as

the premier method to deliver instrument-assisted soft tissue mobilization.

Instructor Base to ExpandOne of Shakar’s priorities will be to create a regionalized base of instructors, across all disciplines, to handle the increasing load of scheduled courses and on-site trainings.

“We have extraordinary instructors, and I believe it is important for us to be keenly aware of the importance of providing them with every opportunity to instruct, while being cognizant of their desire to balance their professional and personal lives. Seeking new instructors to complement our trained staff is a key to our continued success,” Shakar said. She is counting on recommendations from current instructors, along with other trained clinicians who have an interest in being instructors, to contact her concerning staff expansion.

Shakar, who resides in Sutton, MA, has the distinction of being trained in and using ASTYM for nearly three years before being trained in GT. Her clinic was one of the first two in the nation to switch from the ASTYM system to the Graston Technique®.

Vincent Leaves FootprintContinued from page 1

Shakar Named Clinical AdvisorContinued from page 1

Shakar Discusses GT in Podcasts

Jackie Shakar

Page 4The EDGE

CASE REPORT

IASTM Used for Treatment of Finger Joint SprainBy Evelina Gundeck, DPT, Amy Bayliss, DPT and M. Terry Loghmani, PT, PhD, Department of Physical Therapy, IU, Indianapolis, IN

Introduction:A guitarist with a chronic finger sprain was treated with instrument-assisted soft tissue mobilization (IASTM), i.e. the Graston Technique.® The purpose of the study was to illustrate how the IASTM multifaceted approach may improve the therapeutic outcomes of a musician with a chronic index finger joint sprain and meet the treatment goals in an efficient and cost-effective manner.

History:A 55-year-old male guitarist presented with pain in the left index finger, primarily along the proximal interphalangeal (PIP) joint line due to a fall 6 months prior. He had not received any other treatment interventions. X-rays were negative for fracture. Before and after treatment pictures are depicted in Figure 1.

Treatment Protocol:The initial assessment, treatment and reassessment were performed by a single GT experienced physical therapist. He was seen during a 6-week period for a total of 6 treatment sessions. Significant admit and final findings are summarized in Table 1. Each treatment session lasted approximately 30 minutes and consisted of IASTM (10 min) (Figure 2), joint mobilization, therapeutic exercise and ice massage (5 min). His home program included cross-friction massage, joint ROM, ice and compression wrapping as needed.

Clinical Outcome:Significant gains in decreased pain, improved function and PIP ROM in a performing artist were achieved using an IASTM treatment approach. Most notably, the patient was able to play the guitar with minimal to no pain. Demonstrated changes were likely due to treatment, since the patient had pain and limitation for 6 months prior to treatment.

The most significant limitation of the case study was the inability to isolate the effect of IASTM. Nonetheless, IASTM may offer a deeper, more specific treatment to the involved structures, while providing a mechanical advantage to the clinician.

Given the prevalence of upper extremity overuse syndromes and related postural dysfunction in musicians, the use of IASTM provides a promising treatment option. IASTM applications in the performing arts patient population warrants future exploration.

Figure 1. Initial (A) and discharge (B) hook grip of left index finger are displayed. Discharge (B) demonstrates significant gain in ROM to near normal.

Figure 2. The tip of GT6 can be used for cross fiber massage to the PIP joint.

Table 1. Summary of significant subjective and objective findings from initial and final assessments. Decreased pain and increased ROM were demonstrated, along with improved function, especially when playing a guitar.

Initial Assessment

Final Assessment

Subje

ctive Pain rating

(scale 0-10) Average: 4/10 Average: 1/10

DASH score4 75% disability 6.3% disability

Objec

tive

Active/Passive (L) ROM: PIP

Flex: 80˚/85˚ slight pain

Ext: -20˚/-15˚

Flex: 95˚/100˚ no pain

Ext: -5˚/0˚

Strength: Hook Grip

Lateral Key Grip(R) 85 lbs (L) 60 lbs(R) 15 lbs (L) 11 lbs

(R)85 lbs (L)78 lbs (R)13 lbs (L)13 lbs

Palpation

Medium-sized fibrotic, painful nodules on forearm flexor surface. Marked tenderness at PIP joint line.

Minimal fibrotic, non-painful nodules on forearm flexor surface. Minimal tenderness at PIP joint line.

FINDINGS

REFERENCES1. Loghmani MT, Warden SJ. Instrument-assisted cross fiber massage accelerates knee ligament healing. JOSPT. 39(7): 2009.2. Davidson CJ, Ganion L, Gehlsen G, Roepke J, Verhoestra B, Sevier TL: Morphologic and functional changes in rat achilles tendon following collagenase injury and GASTM. Journal of the American College of Sports Medicine 27(5): 1995.3. Sevier TL, Gehlsen GM, Wilson JK, Stover SA, and Helfst RH: Traditional physical therapy vs. Graston Technique® Augmented Soft Tissue Mobilization in treatment of lateral epicondylitis. Journal of the American College of Sports Medicine. 27(5): 1995. 4. DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001 Apr-Jun;14(2):128-46.

Page 5The EDGE

CASE REPORT

25-Year Post-Traumatic Achilles Tendon Injury Has Excellent ResponseBy Larry Smith, BPE, DC, Parksville, British Columbia

History: A 47-year-old male marina worker initially presented with temporal headaches of a very severe nature.

After the headaches resolved through traditional chiropractic treatments, the patient inquired about receiving Graston Technique® for a left Achilles tendon injury. He suffered a complete rupture in the left Achilles tendon 25 years earlier and required immediate surgical repair. Twelve years later, he stated that he sustained another injury to the same ankle and it had been totally “crushed.”

Previous treatment during the past 25 years included medications such as Tylenol #3, NSAIDS, ultrasound and laser therapy. He also completed a work-conditioning program. None of these treatments seemed to decrease his pain level or increase ankle function. He complained of having very little movement in the ankle, was extremely sensitive to touch and had considerable difficulty bearing weight.

Exam Findings:Relevant physical examination findings included pelvic asymmetry with the left iliac crest measuring 2 cm lower than its right counterpart. There was also a major fixation of the left sacroiliac joint and a minor fixation of the right sacroiliac joint. Active and passive range of motion demonstrated moderate to severe decrease of dorsiflexion, plantarflexion, eversion and inversion of the left ankle as compared to the right. Joint mobility testing showed a moderate to severe decrease in talocrural mobility on the left. There was a healed surgical scar located on the medial aspect of the Achilles tendon with prominent hypertrophy of the entire tendonous sheath. The patient walked with an obvious limp favoring the left ankle and was unable to perform even one bilateral calf raise (flat feet to toes via plantar flexion). GT examination revealed very “gritty” dense scar tissue of the entire Achilles tendon and surrounding sheath and the Gastrocnemius-Soleus complex.

Treatment Goals:The two major treatment goals were to increase mobility and function of the left ankle joint and to decrease the pain intensity.

Treatment Protocol: With the patient in a prone position, GT4 was used to sweep the plantar fascia and also sweep the Achilles tendon, Gastrocnemius-Soleus complex right to the top of the knee. The foot was placed in static plantar flexion, dorsi flexion, inversion and eversion. Once adhesions were isolated, GT3, GT2 and GT6 were used to break up the restrictions. In addition to the above, GT2 was used to mobilize the soft tissue around the talocrural joint, distal tibiofibular joint and tissues surrounding the medial and lateral malleolus. The GT treatment was followed by stretching in all ranges of motion. The patient was instructed to perform these stretches at home, followed by icing.

After the first 2 treatments, the patient stated that he had a mild increase of dorsi flexion, plantar flexion, eversion and inversion. He also experienced mild to moderate pain and bruising of the left lateral head of gastrocnemius just proximal to his post-surgical scar.

After a phone consultation, it was decided to perform the same GT protocol with added active and passive ankle motion. After the 4th treatment, the patient noticed great improvement. He experienced pain relief and was able to move his foot and ankle without discomfort.

The next 5 treatments involved the above protocol plus the addition of standing on a chair next to the wall and performing dorsi and plantar flexion. The patient could only perform 2-3 repetitions initially, but was able to perform 5-6 repetitions within a few weeks. He also was instructed to perform resisted stretching at home with surgical tubing followed by icing.

After 10 treatments, a full re-examination was performed. Objectively, there was a 60-70% increase in all foot and ankle ROM and the patient could now perform 6 calf raises without pain. The tissue and musculature surrounding the post-surgical scar was no longer tender

Continued on page 6

Page 6The EDGE

Handholds, knob/bevel, angle, rate, patient position …

After completing the training modules on Graston Technique,® each clinician begins to incorporate the treatment modality into his/her practice. With time, memory can fade and we begin to develop habits related to use of GT implements that vary from “textbook technique.”

Very frequently, individuals “stylize” the Technique to suit their wishes, or perhaps the Technique was not adequately grasped during the educational modules. In any circumstance, deviation from the established Technique, when based on sound professional judgment, may be appropriate. However, changing the established Technique because of lack of attention, rushing or laziness is not acceptable.

I recently observed a clinician treating an elbow using GT3. He proceeded to use the instrument at roughly an 80° angle, with large amplitude strokes at a very high rate. The translation of this treatment equated to INTENSE (high rate = increased intensity), UNCOMFORTABLE (large amplitude = more uncomfortable) and DEEP PENETRATION (angle above 30-60º) of tissue.

In my opinion, deviating from the well-established

Technique becomes an open opportunity for a poor result. If GT is not properly applied, there is no justifiable rationale for its use. It reverts to a freelance exercise like those still attempting to treat patients with reflex hammers or scissor handles.

The objective of treatment with GT is to initiate controlled microtrauma in specifically targeted tissues. Keep in mind that pressure/depth, rate, edge, amplitude, direction and length of treatment are essential components to a successful treatment session. The amount of discomfort experienced by a patient should be minimized to what is deemed appropriate/necessary for that body part and the soft tissue restrictions identified. Interacting with the patient and using your “stop” signal should never be forgotten. Anything beyond these tolerable limits becomes the fault of the clinician and can compromise both progress and outcome.

Adherence to instrument application principles yields more effective treatments, better patient tolerance and pays the dividend of better outcomes.

Schrader has integrated GT in the graduate kinesiology course for athletic trainers since 2000 and has been a GT clinician since 1996.

When Changing Treatment, Speed Doesn’t Pay DividendsInstructor Cites Importance of Adhering to GT Principles

By John W. Schrader, HSD, ATC/L, Clinical Professor, Departments of Kinesiology and Athletics, Indiana University and GT Instructor, Bloomington, IN

to palpation and demonstrated healthy vascularity. Subjectively, the patient stated he greatly reduced his usage of medication. In fact, he took 60 fewer pills of Tylenol #3 per month. He was able to stand on his toes and even run for short distances. The patient said, “This is the 1st time I have had mobility in my left ankle in 25 years!”

Discussion: The above patient demonstrated an excellent response to a 25-year-old post-traumatic Achilles tendon injury via GT. In this case, the key to breaking up the scar tissue was the addition of motion to the GT treatment protocol.

Successful Achilles Tendon TreatmentContinued from page 5

Before treating edema patients with Graston Technique,® put the instruments

in the freezer long enough to get them cold. The cold temperature will help reduce swelling and bruising

occasionally caused during treatment.

TECHNICAL tip

Page 7The EDGE

CASE REPORT

Adhesive Capsulitis Treatment Gets ResultsBy C.J. Kleene, DC, Back in Line Family Chiropractic & Wellness, Hiawatha, IA

History:A 47-year-old active female presented with a 12-month history of primary adhesive capsulitis. Previous orthopedic evaluation and management included the option of steroid injections and manipulation under anesthesia. After opting for chiropractic care, it was determined subjective complaints were not being relieved by adjustments alone. Patient was referred for GT and manipulative therapy. The patient had no other significant health concerns.

Exam Findings:The patient had limited active ROM during Apley’s scratch test. The test was positive for severe decrease of motion in essentially all directions: internal, external and abduction. It elicited pain upon movement. Essentially, all functional orthopedic exams could not be performed due to pain and restricted range of motion. Patient could only perform forward flexion of the humerus to 50 degrees. Palpation over subacromial brusa caused severe pain over the anterior deltoid.

Examination revealed active and passive glenohumeral (GH) ROM significantly diminished in all directions. See Table 1 for initial ROM findings. Quick Dash outcome measure was scored at 63.9. Visual assessment showed high right shoulder, decreased thoracic extension and anterior head carriage with head sway to the left. Taut and tender fibers bilateral along the cervical paraspinals were present also. Serratus, biceps, triceps and pectoralis musculature was graded 4/5. Compensatory, overactive and hypertonic trapezius, scalenes, subscapularis, supraspinatus and levators were noted bilaterally with moderate to severe spasms on the right scapulo-thoracic junction and shoulder girdle. The anterior deltoid showed signs of edema, increase in temperature and was painful

to the touch. All upper extremity deep tendon reflexes were graded 2+ bilaterally. Palpation revealed moderate hypertonicity of the cervical and thoracic paraspinal musculature; and decreased left lateral bend was noted in the cervical spine. Thoracic extension was decreased T2-T12 with taut and tender fibers bilaterally.

Treatment Protocol:GT was applied to the soft tissue lesions identified for a total treatment time of 5-8 minutes using both static and dynamic techniques including: GT2 and GT4 to the deltoid (medial aspect) while the patient abducted and adducted her shoulder; GT2 to the anterior deltoid without movement, but positioned to allow cross friction to adhered tissues; scanning to pectoralis major/minor, coracoacromial and coracoclavicular ligaments and subacromial tissues while the patient adducted and externally rotated her shoulder; and myofascial rerelease to the subscapularis (axillary entry) with simultaneous active and passive internal/external rotation. During some active ROMs for the deltoid and supraspinatus, patient held a 5-lb. weight in order to increase muscle tension and raise superficial fibers. Based on MRI findings, stagnant synovial fluid created increased inflammation and pain (possibly creating majority of the motion dysfunction). GT instruments predominately focused medial to lateral for most of the treatment to flush the synovial fluid, aiding reduction of pain and increase of GH motion.

Based on patient presentation, motion palpation, tissue changes and joint dysfunction, adjustments were administered at C1, C2, C5, T2, T6, T9 and left illium using diversifed short lever adjustments delivered while the patient was seated in a chair for the cervical region, prone for the thoracic region, and side posture for the illium.

During the second visit conducted three days later, motion and static palpation of the right shoulder demonstrated evidence of GH misalignment. Traction was performed while the patient was seated using the humerus as a lever while pressure was applied lateral to medial at the distal end. On the second visit, ultrasound was used on a continuous setting, 1.5w/cm2 at 1 MHz, for 10 minutes. Palpation and decreased

Table 1 Passive ROM details

ROM AbductionForward Flexion

Internal Rotation

External Rotation

Initial 30° 50° 45° NA

After 1 treatment 90° 80° 50° 90°

After 2 treatments 120° 160° 90° 90°

After 3 treatments 180° 170° 90° 90°

Continued on page 8

Page 8The EDGE

motion revealed a slight humeral subluxation inferior.

Additional myofascial release was performed on the teres major, subscapularis, infraspinatus, teres minor, supraspinatus, trapezius, rhomboids, scalenes with levator scapulae, triceps, biceps, deltoid, posterior pectoralis major and latissimus dorsi.

Clinical Outcome:There are numerous methods for treating AC with the overall goal of restoring function and decreasing or eliminating pain. Graston Technique® along with thoracic and cervical adjustments showed remarkable results within 3 office visits within a 7-day period for this particular case. Chiropractic manipulative therapy (CMT) alone was not alleviating the condition, so it was essential to look to the connecting structures. Joints and soft tissues move together, making it significant to use both CMT and GT to treat AC injuries.

Adhesive Capsulitis Treatment Continued from page 7

New For Preferred Providers

Customize Graston Technique® Ads for Your Clinic or PracticeHave you wanted to run an ad in a neighborhood publication or create a flyer, but don’t know where to start? Turn to the Preferred Provider section on GrastonTechnique.com, where you have access to GT logos, photos and ads that can play a vital role in your marketing efforts.

Choose from nine ads that can be customized to run in your local newspaper, newsletter or health publication. We’ll place your clinic or

practice information in our template, add your logo, resize the ad to your pub’s specifications and email the final PDF to you or your vendor! Choose black and white or color designs. The cost is $85 for the first ad; $40 for each ad thereafter.

Use your personal login and password to access the Preferred Provider section. If you have difficulty entering the section or you have questions, contact us at info@grastontechnique.com.

Get Back in the Game.[Name of Your Clinic or Practice] uses Graston Technique® to treat soft tissue injuries.Graston Technique® effectively breaks down scar tissue and reduces inflammation that causes pain, loss of motion and stiffness.

Using stainless steel instruments, the Technique irons out the tangled tissue that’s causing the dysfunction. Along with warming up, stretching, strengthening and ice, clinicians can rebuild the soft tissue injury into healthy functioning tissue again.

Graston Technique® speeds rehabilitation and recovery, reduces the need for anti-inflammatory medication and allows the patient to continue everyday activities.

For more information about GT, contact

[Name of Clinician][Name of Clinic or Practice]

[Address] [Phone] • [Website]

Heal Better. Recover Faster.

GT has been clinically proven to achieve quicker and better

outcomes in treating:Achilles Tendinitis (ankle pain)

Carpal Tunnel Syndrome (wrist pain)Cervical Sprain/Strain (neck pain)

FibromyalgiaLateral Epicondylitis (tennis elbow)Lumbar Sprain / Strain (back pain)

Medial Epicondylitis (golfer’s elbow)Patellofemoral Disorders (knee pain)

Plantar Fasciitis (foot pain)Rotator Cuff Tendinitis (shoulder pain)

Scar TissueShin Splints

Trigger FingerWomen’s Health (post-mastectomy

and Caesarean scarring)

Note: Gray border will not appear in final artwork. Ad can be resized to your publication’s similar specifications. (Current actual size: 8 x 5.̋ )

Click any ad to go to the Preferred Provider section. After logging in, choose ‘Download Marketing Materials.’

[Name of Your Clinic or Practice] uses Graston Technique® to treat soft tissue injuries.Graston Technique® effectively breaks down scar tissue and reduces inflammation that causes pain, loss of motion and stiffness.

Using stainless steel instruments, the Technique irons out the tangled tissue that’s causing the dysfunction. Along with warming up, stretching, strengthening and ice, clinicians can rebuild the soft tissue injury into healthy functioning tissue again.

Graston Technique® speeds rehabilitation and recovery, reduces the need for anti-inflammatory medicationand allows the patient to continue everyday activities.

For more information about GT, contact

[Name of Clinician][Name of Clinic or Practice]

[Address] [Phone] • [Website]

Heal Better. Recover Faster.

Enjoy Life Again.GT has been clinically proven to achieve quicker and better

outcomes in treating:

Achilles Tendinitis (ankle pain)Carpal Tunnel Syndrome (wrist pain)Cervical Sprain/Strain (neck pain)

FibromyalgiaLateral Epicondylitis (tennis elbow)Lumbar Sprain / Strain (back pain)

Medial Epicondylitis (golfer’s elbow)Patellofemoral Disorders (knee pain)

Plantar Fasciitis (foot pain)Rotator Cuff Tendinitis (shoulder pain)

Scar TissueShin Splints

Trigger FingerWomen’s Health (post-mastectomy

and Caesarean scarring)

Note: Gray border will not appear in final artwork. Ad can be resized to your publication’s similar specifications. (Current actual size: 5 x 7.̋ )

[Name of Your Clinic or Practice] uses Graston Technique® to treat soft tissue injuries.Graston Technique® effectively breaks down scar tissue and reduces inflammation that causes pain, loss of motion and stiffness.

Using stainless steel instruments, the Technique irons out the tangled tissue that’s causing the dysfunction. Along with warming up, stretching, strengthening and ice, clinicians can rebuild the soft tissue injury into healthy functioning tissue again.

Graston Technique® speeds rehabilitation and recovery, reduces the need for anti-inflammatory medicationand allows the patient to continue everyday activities.

For more information about GT, contact

[Name of Clinician][Name of Clinic or Practice]

[Address] [Phone] • [Website]

Heal Better. Recover Faster.

Get Back in the Race.

GT has been clinically proven to achieve quicker and better

outcomes in treating:

Achilles Tendinitis (ankle pain)Carpal Tunnel Syndrome (wrist pain)Cervical Sprain/Strain (neck pain)

FibromyalgiaLateral Epicondylitis (tennis elbow)Lumbar Sprain / Strain (back pain)

Medial Epicondylitis (golfer’s elbow)Patellofemoral Disorders (knee pain)

Plantar Fasciitis (foot pain)Rotator Cuff Tendinitis (shoulder pain)

Scar TissueShin Splints

Trigger FingerWomen’s Health (post-mastectomy

and Caesarean scarring)

Note: Gray border will not appear in final artwork. Ad can be resized to your publication’s similar specifications. (Current actual size: 5 x 7.̋ )

Speedskater’s TFL Improved with GTContinued from page 2

light stretch, using GT3 to the abdomen and anterior hip/TFL while the athlete progressively tilted, rocked and rolled the pelvis at low-moderate tensions, using independent breath and upright posture.

Outcome:The athlete experienced immediate relief of his symptoms with the strategies incorporated, and he continued to make gains in the quality of movement on and off the ice throughout the remainder of the season. The most subjective improvements were in the quality of the athlete’s pelvic control and in his technical capabilities while skating, aside from increased comfort. The coaching staff acknowledged initial improvements in the athlete’s technique and continued gains thereafter. The practitioner noted general improvements in the quality of soft tissue during an exceptionally high-volume training regimen, and large gains in the coordinative relationship of the spine, pelvis and hip. During the final four months of the season, exacerbations to the TFL were limited to two mild occurrences with similar mechanisms that subsided in short time with similar management.

Copyright © 2010 THE EDGE, published quarterly by TherapyCare Resources, Inc., corporate entity for Graston Technique®.