Technique Talk

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 Technique Talk: Where clinicians can gather and share what works

3 thoughts on “Technique Talk”

  1. ASTYM, IASTM, TASTM, or tool-based soft tissue mobilization is gaining popularity, and rightfully so. We’re certified in ASTYM (2004)…(Augmented Soft Tissue Mobilization), the “y” was put in to simply make it a word. Our results are excellent to say the least. Let’s do a comparison of what’s out there.

    ASTYM: astym instrumentIt is a patented method that requires membership and annual payments. You don’t own the instruments, you lease them and make yearly payments for each clinician you have certified. There is a certification process that is fairly rigorous. The instruments are made of a polymer-type plastic and have a nice ergonomic design with good gripping. The technique is specific in terms of # of strokes, the amount of pressure applied, the angle at which the chosen instrument is applied, and the speed of the strokes. Excellent patient and clinician feedback is noted, and it can be objective tracked. The entire kinetic chain of an affected area is addressed…not just the affected area. Specific exercise and stretches follow based on where the problem is. Exercise is for assisting in the remodeling of the tissue in terms of restoring tensile strength and length. The pressure is consistent, and the intent is to stimulate healing, not to breakdown the tissue. Feels good to some, and not so good to others. Although developed by a physician and a group of PT’s, this method was originally offered only to PT’s. Now I believe it is open to PT’s, PTA’s, and OT’s. Bruising only occurs occasionally where there is abnormal tissue. Petechia is not usually expected. Comfort improves and tissue improves and this is noted both subjectively by the patient and objectively by the clinician. Pain and function improve in the first few sessions. If there is no improvement after the 3rd session, typically, this approach is abandoned. For more of their info, http://www.astym.com.

    Graston: graston instrumentComing from the same family as the ASTYM guys, actually, graston came first. It is a straight forward approach using special metallic instruments to address a specific problem. Nice ergonomic designs. We looked at doing this, but this procedure seemed a little too agressive for our patient population, and their science wasn’t as good as ASTYM’s. Basically, you are “working” the problem area and associated structures with these instruments in order to break down adhesions, cross-linked fibers, in the tissue. This is after a little warm up. Then a modality is applied along with light exercise to assist in new scar formation. I’m not certified in this method, but there is a certification process before you can buy the instruments. Classes run about 2-3K and instruments are included. There is a higher level of certification you can go through also for functional graston technique. This method is most popular with chiropractors, and it is offered to physicians and trainers as well. There are PT’s that use this as well. You can also buy instruments online that are very similar to Graston instruments. Bruising is not intended, but there appears to be some training issues where clinicians are inconsistent with their techniques and misuse these instruments. You don’t see this too much with ASTYM. For more of their info, http://www.grastontechnique.com.

    Then there is Gua Sha, a very old Chinese method of using an instrument to create healing of various disorders, not just neuromusculoskeletal. They use this to treat fever, systemic problems, and physical injuries and disorders. The intent is to create “Sha” or petechia – a reaction that allows the problem being addressed to heal. There is a methodology used by acupuncturists, but this technique is purported to be known as a lay method found in many Chinese households. gua shaInstruments are typically made out of water buffalo horn, but a nice soup spoon can also be used! Anything to create “Sha.” The working theory is that of counteraction meaning that only one disease can prevail at a time. So, in creating Sha, the underlying problem must go away. The problem is that of the appearance of the tissue after treatment. Looks like you’ve been really beat up. It’s a little tender, but the underlying pain is usually much less. There is no intent to breakdown tissue or scar. The petechia usually resides in a few days. Not very scientific, but it’s gaining popularity. There is no certification unless you are Chinese and your parents have some proficiency test for you 😉

    So, you like the concepts of instrument-based soft tissue mobilization, but you don’t want to take the time and fork out the dough to achieve instrument certification, you can buy a variety of instruments online. We’re currently experimenting with a variety of models, and we’ll soon be reporting our results.iastm tools It’s unfortunate that such a valuable treatment method remains “owned” by a select few, and it is not taught in physical therapy schools. It should be.

    Instrument assisted soft tissue mobilization has many advantages: enhanced healing and accelerated recovery (especially with chronic problems), identification of fibrosis or abnormal tissue integrity, and applicator joint conservation to name a few.

    The key in using instrumentation to facilitate healing and recovery is to be well educated on the stages of wound healing and be precise in what your objectives are in the application process. You must also have a mastery of anatomy and associated pathologies. To go digging around indiscriminately with an instrument, hoping for the best, will potentially cause harm to a patient as well as put the clinician at risk for legal action and loss of clientele. This is where the certification methods prevail, and this is why I chose ASTYM.

  2. Our Chief PT in Louisville, Mary Margaret Crowson, PT, DPT is certified in the first level of Kinesiotape Application. kinesiotapeOur results to date are fairly remarkable. We had one recalcitrant thoracic pain that had been treated previously with chiropractic, the husband was “taught how to manipulate it!” by the chiro – temporary results. Always came back. With one application of KT, the relief was greater than the patient had previously experience, and it lasted!

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