Graston Technique®, ASTYM, FAKTR, SASTM, Gua Sha - A Brief Explanation & Commentary

The (now patented) Narson Body Mechanic N6

Graston Technique®, ASTYM, FAKTR, SASTM, Gua Sha are all forms of IASTM (Instrument Assisted Soft Tissue Mobilization). The purpose of which is to break down scar tissue and adhesions that are causing multi-layered soft tissue restriction and adversely affecting the dynamic function of the underlying muscles, tendons, fascia & fascial planes, ligaments, etc. These restrictive scars and adhesions can be from old injuries, surgeries, repetitive strain (like carpal tunnel), mis-use or improper use of your body when working, playing, doing sports or just from the day-to-day activities of your normal life. They happen from car accident, sitting in front of a computer too much for too long or from childhood bumps and bruises that were never really attended too properly. 

 There are some minor difference between the techniques I mentioned above however ultimately, all are very effective for the right conditions. However effectiveness doesn't depend so much on the original coursework or specific technique, but the experience of the practitioner and the accuracy of their diagnosis coupled with proper application of the technique. 

 One thing I want to "get off my chest" is that Graston Technique® & ASTYM aren't new techniques. Your doctor or therapist may have just learned it and is all excited about it, but these techniques have been around for over 20 years with the original research being done at Ball State University. Gua Sha actually dates back to the 5th &; 7th centuries (roughly 700-BC to 500-AD). FAKTR & SASTM have been around since the mid to late 2000 respectively

IASTM techniques are not simply the use of instruments to loosen or remove adhesions and provoke an acute inflammatory response, but it’s the follow up treatment, stretching, therapies, resistance, rehab & anti-inflammatory nutrition that completes the techniques and is equally as important. Otherwise, you're simply doing Gua-Sha/Instrument Massage and without the proper follow-up, you can expect the symptoms and condition to return. Sometimes, they’ll return with a vengeance. This is why you want a fully trained (and experienced) practitioner performing this on you or your athletes.

Having become certified in Graston Technique® M1 & M2 in 2002 and several years ago, trained in FAKTR-PM (now known simply as FAKTR), 11 years of the last 20 years using IASTM full time in my practice, weekend excursions as a member of the sports medicine team at local sporting events, a 10 day rotation at the 2006 Central American & All Caribbean Games and 10 days at the 2011 Pan American Games, all gives me a unique experience and perspective in the practical application of IASTM. You’ll find many others with varied but similar experience. 

Some of the most important factors for providing good IASTM are: 

1. A good physical exam 

2. Sports specific examination of their injury 

3. Creativity -Thinking outside the box (and sometimes outside the walls of your clinic) 

As a result of my experience with Graston Technique®, FAKTR and IASTM in general, I developed my own instrument design known as the Narson Body Mechanic N6. The design is patented in Canada and I’m very proud to announce that it has been awarded a US Patent as well (just received the certificate today!!). The reason I designed this instrument was out of my constant need to be more efficient with IASTM. The design affords me the ability to carry all of the most useful IASTM instruments with me in one convenient tool. No longer do I have to carry a kit of tools with me. No longer do I have to clean multiple instruments between patients. I have everything in one hand at all times. The design includes a non-slip gripping surface which reduces tool slippage and reduces practitioner finger & hand fatigue which, the longer you do IASTM with real highly polished stainless steel instruments, you’ll come to appreciate. The other thing most of us in the USA can appreciate is that it’s the only useful “multi-tool” for IASTM that is made from 100% U.S. steel and made 100% by hand right here in the U.S.A., although I have seen some copycats popping up here and there.

When it comes to giving effective IASTM, the most important thing to remember is after a good base education, it’s the wealth of experience along with the doctor’s (or therapist) ability to be creative. From my experience, it's thinking outside the box that matters most, coupled with a good nutrition plan, rehab and anti-inflammatory therapies and the results will astound. It’s very possible with IASTM to take long time chronic injuries-treat them with IASTM and have the athlete back out playing the same day or the next day. 

This year I have helped a multitude triathletes get back into their training to complete in the full Ironman triathlon. Others are back training to complete 26.2 distance marathons and half marathons and some people are back into their workout routine because of the proper application of IASTM. Often you’ll find me at the pool, the track, with a cyclist on an indoor trainer or running on the sidewalk with a patient working with them while they do their sport. For me, putting a person in the exact environment that produces their symptoms is the only way to resolve the problem. Just like anything else in life, experience matters and creative matters. Even with IASTM.

'nuff said 

 Dr. T 

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 Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.

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Graston Technique(r), FAKTR & Narson Body Mechanic

I've been certified in Graston Technique(r) since 2002/2003. It's a phenomenal method at treating chronic sports injuries and some acute injuries as well. The technique uses 6 stainless steel instruments (pictured to the right) that are used to treat scar tissue and adhesions that prevent the function of normal tissue dynamics typically seen after an improperly healed injury.

Since becoming certified and practicing this technique on thousands of patients over the years I began to notice that I would get the best results when I treated patients in a position of provocation. In other words, when a patient said, "it hurts when I do this" I would treat the condition with my Graston Technique(r) instruments while they were in the position where they complained provoked their pain. My rate of success increased even more.

I began having people hold dumbbell weights, pull on resistance bands or exercise tubing or simply go through the motions of their sport while I administered the treatment. I would follow this more active/function version of Graston Technique(r) with stretching, ice and electric stimulation and pulsed ultrasound. The results were outstanding. You should also know that Graston Technique(r) isn't just treating patients with their instruments. It also involved evaluation of the patient and the administration of treatment afterward (stretching, therapies and home instructions for patient self care).

In 2006 I was picked to travel with a team of sports chiropractors to treat athletes at the 20th Central American & All Caribbean Sport Games. It's basically a mini-Olympics where the winners of these events go on to the Pan American Games and then onto the Olympics.

In most circumstances, all I had was my reflex hammer, some athletic tape & and ACE bandage, my adjusting table and my set of Graston instruments. If I was lucky, there was some ice and plastic bags. I used both the standard Graston Technique(r) and also the more functional version I was slowly discovering. Being in an environment where you often didn't have electricity and certainly didn't have all the comforts of a modern chiropractic sports injury office, you had to so the best with what you had. I found that I was able to use these more functional treating techniques were extremely effective, more so than when treating statically. I helped quite a few athletes get back into their event pain free. I continued to use my modified methods when I finally returned home.

It wasn't too long after that I learned one of my sports medicine mentors, Dr. Tom Hyde along with one of my original Graston Technique (r) instructors, Dr. Greg Doerr had been developing a lot of this "functional" Instrument Soft Tissue Mobilization stuff. I believe they had been doing it for about 4 years at the point when I first caught onto it but had already taken it a lot further. Both being instructors & friends, they they continued to collaborate and add more and more to it. Dr. Hyde and Dr. Doerr continue to develop and add to this functional instrument based soft tissue technique and began teaching and adding to it. I took their class which was called FAKTR-PM (Functional And Kinetic Treatment with Rehab Provocation and Motion (...now shortened to just FAKTR). It was outstanding. The physicians, trainers and therapist that were in the classes were certainly the cream of the crop. I think people knew that they were on to something big.

The technique really developed and advanced, now getting the input of the many of the leading physicians, trainers and therapists from around the world. This FAKTR thing had developed into a very advanced Instrument Assisted Soft Tissue Mobilization method. It continues to evolve to this day and I'm sure will be better tomorrow than it was yesterday.

I think the Graston Technique(r) is an excellent base of knowledge and represents the foundation for this work. If you want to get into this kind of treatment, Graston Technique(r) is definitely the place to start. It represents the foundation of instrument based soft tissue treatment. In my opinion, you can't get very far without a good foundation. However, as you get more experienced with your technique, FAKTR is where you go from there. FAKTR is an ever evolving technique that incorporates current trends and research. I've seen where one seminar to the next will be different based on information that was published in a recent research journal. It's ever evolving for the right reasons.

What has made performing FAKTR so much easier was the N6 Narson Body Mechanic that I developed. I found that when treating a patient, I changed instruments at least twice, sometimes more. Now, I currently use only 1 stainless steel instrument that has the functionality of my 5 main GT instruments as well as other Gua Sha instruments on the market. It's like a Swiss Army Knife of Soft Tissue instruments. I've added a gripping surface to reduce finger and hand fatigue and now I only need to carry 1 instrument from patient to patient. I only clean 1 instrument and it's much easier to transport when traveling. That's probably considered a shameless plug, but it kind of like talking about baseball without mentioning the glove, ball or bat.

So combine your FAKTR Functional and Kinetic Treatment with Rehab Provocation and Motion with your Narson Body Mechanic N6 and you have a winning combination to treat athletes, difficult chronic sports injuries and more.

For more information on the techniques and instruments discussed above, please click on the following links:

FAKTR www.faktr.com
Narson Body Mechanic N6: www.NarsonBodyMechanic.com
Graston Technique: www.GrastonTechnique.com

Graston Technique(r), FAKTR and Narson Body Mechanic are separate and distinct companies. None of these companies endorses the other. The Narson Body Mechanic instrument should not be confused with Graston Technique(r) instruments. The Narson Body Mechanic is for use with Instrument Assisted Soft Tissue Mobilization while only Graston Technique(r) tools are for use with Graston Technique(r). Graston Technique(r) is owned by Therapy Care Resources, Inc.

Healthfully yours

DocT



Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.

What To Do About Those Old "Aches & Pains" That Keep Coming Back To Haunt

Graston Technique, FAKTR-PM, SASTM, AYSTM I’m sure you remember falling off your bike as a kid. Maybe a little accident on the monkey bars or on the ball field. A bump on the head, a bruised knee, a pulled groin or strained hamstring or maybe a sprained ankle or a sore shoulder from a multitude of childhood horsing & playing around. You went home, mom or dad put on a cold compress and the next day or the day after you’re up and running around again like nothing ever happened.

Ahhhh; but something did happen. Your little bump, bruise, strain or sprain started a little process. Yes it’s your body’s natural healing process but its how we ignore the process that presents the problem. Mom or dad puts an ice pack (if you were lucky) or a heating pad on it for a day or two and then off to the races you go. It doesn’t really matter if you go to a doctor or therapist for treatment of your injury, it will heal on its own regardless. But that doesn’t mean it will heel properly or optimally. That’s where we (the doctors, trainers & therapists) come in.

So, you have some contusion (deep muscle bruise) or strained a muscle that now needs to be fixed. The healing process starts by removing the damaged tissues then when that’s done, it starts bring in the new materials to start rebuilding. Inflammation happens, hopefully it subsides on its own, typically it doesn’t. So you put on some ice, take some over the counter pain killer and you feel fine again. Trust me on this, you’re not fine. You can ignore the pain, the slight change in function and get on with your little life. But the healing process ensues. Eventually, the damaged tissue heals with scar tissue and you’re all patched up. Now, here in lies the problem.

Scar tissue isn’t as good as the original tissue. Just look at any old cut on your arms or hand, or that spot where you skinned your knees as a kid and you can easily see it. Scar tissue has a haphazard matrix of fibers whereas the original tissues matrix is organized. It’s organized based on the specific function of the tissue for both strength and resiliency. Have you ever seen a car that had bad body work done on it? It’s just like that. Most scar tissues (adhesions) are simply a bad “patch job”. If you’re lucky enough to realize what’s going on in the beginning, applying ice compresses, doing light stretching and very light resistance exercise can help scar tissue heal optimally. If you just brushed it off, took a few over the counter pain killers and ignored it, (like most of us); as you get to your mid 30s or 40s all of a sudden you start getting these aches and pain out of nowhere. Then you are forced to deal with it as that once childhood bump, bruise or strain, comes back to Haunt You.

The problem lies in the transition area between the scar tissue and “normal” tissue. It’s a zone of weakness that is prone to re-injury. It’s not that neat organized “normal” flexible tissue you used to have prior to that old injury, and it’s not that thick inflexible scar. It’s the transition somewhere in-between. And it’s weaker!

So, how do you get rid of it?

In the past, we never realized that scar tissue and adhesions from old injuries were such a problem. The conditions were attributed to “old age” (what I call a cop-out), arthritis or the doctor would say something like “you probably twisted yourself in your sleep” or something the like. The approach was typically physical therapy, ice compresses, or heat compresses or stretching or massage, joint mobilization, adjustments to the joints etc. Which, are all good treatments, but never really addressed the primary problem. Now, through a lot of trial and error and some published research, reducing scar tissue and adhesions from old injuries seems to be solving many of the problems people have been told they simply have to “live with”.

Once scar tissues have formed they are pretty darn durable. Which is usually as good thing. But many scars attach to more than just the injured part and therein lies the problem. Muscles, ligaments, connective tissue, fascia etc are all layered on top of one another and they slide & glide on top of each other. When one tissue gets injured, the “stuff” that becomes a scar to heal the area solidified while attaching to a bunch of different tissues in the area bonding them together. But they weren’t made to work together like that, they should work independently. This causes restriction and pain and sometimes it could take years for it to develop as the scars become more mature as the years pass. (Think about lifting your pants leg up while it sticks to your sock or stocking with static cling; or taking a band-aid off a cut while the little white pad sticks to the scab)

You can’t massage them away, some more aggressive stretching works in some cases but is mostly temporary. Typical therapies just never really did the trick. However, over the past 8-10 years a new technology has emerged that directly addresses scar tissues and adhesions at their source. With high density stainless steel soft tissue mobilization tools, doctors and athletic trainers using Instrument Assisted Soft Tissue Mobilization(IASTM) have been able to detect both superficial and deep scars and adhesions, reduce and remove them and in combination with post IASTM treatment protocols, finally get rid of this nemesis that plagues us as we get older. I have great successes with rotator cuff problems, post surgical knees, chronic hip pain after hip replacement surgery, low back pain, TMJ disorders, neck pain deep contusions, ankle sprains, plantar fascitis just to name a few.

The IASTM technique has been wildly successful to the point where most Athletic Trainers for the NBA, NHL, NFL & MLB have become certified and use the techniques to treat their pro athletes. Sports medicine physicians, therapists and athletic trainers around the world are all learning this stuff now. Back in 2006, I had the privilege to travel to Cartegena Colombia to treat world class athletes along with some of my colleagues at the 2006 Central American & All Caribean Games; and after only a few days, those of us certified in IASTM techniques were getting a huge following amongst the athletes, their team physicians & trainers. Those physicians who weren’t certified, all inquired about signing up for the certification program. That's how powerful this is. Trust me, physicians are a skeptical bunch.

So, if your joints are starting to ache and you feel like you too are suffering from “old age”, maybe try a new approach. If you are an athlete and you feel things aren’t just right, maybe not like they use to be, then seek out a physician, therapist or trainer certified in IASTM and put those childhood bumps, strains and bruises back in the past where they belong.

More info on where to get IASTM instruments and education; click here


Healthfully yours

DocT

Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.