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.

New Soft Tissue Instrument for use with Graston Technique, FAKTR-PM, SASTM, ASTYM, Gua Sha or IASTM

Graston Technique®, FAKTR-PM, SASTM, ASTYM, Gua Sha and IASTM are the names being thrown around today in the arena of instrument assisted & augmented soft tissue mobilization methods.

Gua Sha (Chinese: 刮痧; pinyin: guā shā), literally "to scrape away fever" in Chinese, dates back sometime between the 5th & 7th centuries. Since then as you could imagine there's been some progress. Science has taken the reigns and nowadays we have Graston Technique®, ASTYM, SASTM and of course all the people running around with spoons and Whartenberg Pinwheels with tape over the pointy wheel doing some made up form of IASTM. The moral of this paragraph is that this ancient method of treatment has lasted the test of (a lot of ) time and has some solid research behind it (referenced below). The reason, quite simply put, it works really well.

No matter which technique you do, there are a lot of "instruments". Each system offers either stainless steel, ceramic or hard plastic tools and there seems to be one tool for each body part. Having been a certified Graston Technique® practitioner since 2002-2003, I've been using my instrument set numerous times daily when treating sports injuries, car accident injuries, chronic back and neck pain and post hip/knee replacement pain. However the more I use the tools, the more I had to carry with me. Tools became slippery from the emollient and when you added it all up, I ended up spending a lot of time changing between different instruments, cleaning and searching for the right tool for the particular tissue I was working on. Although quite effective, it was definitely a hassle that I thought could be streamlined. Greater efficiency with equal or greater effectiveness was what I was looking for.

So, After years of tools slipping from my hands, my hands and fingers getting fatigued as the tools became more slippery during treatments throughout the day, having to change tools during treatment of the same patient, washing, cleaning and transporting multiple tools to and from different treatment rooms. I also found that there were some parts of the existing tools that I never used or needed, so I had to find a something better. However everywhere I looked, nothing existed that fit my needs. Everyone I spoke to was “mostly content” with what was available and no one offered any solution. So with all the metal, wood and plastic soft tissue tools I accumulated over the years, I went to the drawing board and started designing.

After years of my testing different wood, metal & plastic tools available on the market, I started combining the best and most useful elements of the tools I obtained into various designs. During this time my father injured his right shoulder and was unable to abduct his right shoulder. He was diagnosed with a torn supraspinatus with 2.5mm of retraction at the myo-tendon junction, his orthopedic surgeon (as well as an orthopedic second opinion) told him he’d require surgery to repair the rotator cuff if he hoped to regain any function again. He called me and came in for an exam & treatment with his MRI in hand.

This was about the same time I finished my latest design of a new soft tissue instrument (of which there had been many). I had been playing with the design and had just finished refining the drawing the day he came in. As I was working on his shoulder, he was looking over my drawings and took a copy of the latest design back to his shop with him. Without my knowing it, he began taking my design and forging it into reality. He spent that week cutting, grinding and shaping it out of stainless steel. He brought it to me a week later and for the first time I held in my hands what I thought was the perfect soft tissue instrument. Over the next several months as we continued to treat his shoulder, we refined & improved the instrument until it worked as I dreamed it would. Today, I’m proud to say (and to his surgeon’s amazement) my father had a fully functional, pain free & strong rotator cuff, & we had developed an incredibly functional Soft Tissue Mobilization Instrument which we named the Narson Body Mechanic N6.

Now, for the first time, I didn’t have to change tools during treatment. I was able to seamlessly go from tissue to tissue changing techniques simply by turning the tool to the desired treatment edge. No longer did I have to clean multiple tools or stop treatment because tools became too slippery. It was faster, more efficient and everything I was looking for was finally right there in my hands. After cleaning, it easily slipped into my pants pocket to go with me from patient to patient. No longer did I have to carry multiple tools, or go back somewhere in my office to find the one tool I happened to forget to bring with me. Now I have them all with me all the time. No lugging a pouch or tray of tools with me anymore.  The N-6 was all I needed.

So now with “Patent Pending” we go forward with a new all-in-one tool for your soft tissue treatment 'tool belt'. I hope you like it as much as I do.

For Information on the Narson Body Mechanic N6, go to: www.NarsonBodyMechanic.com

References for Instrument Assisted Soft Tissue Mobilization:

1. Davidson C, Ganion L, Gehlsen G, Verhoestra B, Roepke J, Sevier T. Rat tendon morphologic and functional changes resulting from soft tissue mobilization. Med Sci Sports Exer. 1997;29(3):313-9.

2. Gehlsen GM, Ganion LR, Helfst R. Fibroblast responses to variation in soft tissue mobilization pressure. Med Sci Sports Exerc. 1999;31(4):531-5.

3. Melham TJ, Sevier TL, Malnofski MJ, Wilson JK, Helfst RH, Jr. Chronic ankle pain and fibrosis successfully treated with a new noninvasive augmented soft tissue mobilization technique (ASTM): a case report. Med Sci Sports Exerc. 1998;30(6):801-4.

4. Carey MT, Ploski M, Sweney L, editors. The Graston Technique of Soft Tissue Mobilization. APTA Combined Sections Meeting; 1999 February 3-7; Seattle, WA.

5. Sevier TL, Wilson JK. Treating lateral epicondylitis. Sports Med. 1999;28(5):375-80.

6. Earley BL, Carey MT, Hall A, editors. The Graston Technique of Instrument-assisted Soft Tissue Mobilization. AOTA Annual Conference and Exposition; 2000 March 30 - April 2; Seattle, WA.

7. Carey MT. The Graston Technique Instruction Manual. 2nd ed. Vincent RE, editor. Indianapolis, IN: TherapyCare Resources, Inc.; 2001.

8. Perle SM, Perry DG, Carey MT, editors. Effects of Graston Technique on Soft Tissue Conditions: A Prospective Case Series. WFC's 7th Biennial Congress; 2003; Orlando, FL: World Federation of Chiropractic.

9. Loghmani MT, Avin K, Burr D, Warden S, editors. Instrument-Assisted Cross Fiber Massage Accelerates Knee Ligament Healing. Combined Sections Meeting; 2006: American Physical Therapy Association.

10. Burke J, Buchberger DJ, Carey-Loghmani MT, Dougherty PE, Greco DS, Dishman JD. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther. 2007 Jan;30(1):50-61.

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 is a Diplomate of the American Chiropractic Sports Physician (DACBSP) and practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.

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