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Any of you PTs use this and if so what are its indications and more importantly does it work??
Hello. I am the Education Coordinator with Graston Technique. I work daily with DPT's, ATC's, OT's and DC's and regularly get questions regarding research on GT. Please follow the link below for published research using Graston Technique.
http://www.grastontechnique.com/Research.html
Just being recently researched. It'll take a few years to get RCTs, then high-quality RCTs, then a bit longer for systematic review/meta-analyses.
I think this bandwagon of praising Graston technique based on anecdotal experiences is ludicrous. If you read the research objectively, there is nothing remotely convincing enough to convince a medical professional to use the treatment. It is irresponsible to use a treatment approach without sufficient evidence of safety and efficacy. The treatment may not work, in which case you are foregoing other treatments that would be helping the patient, and wasting time and money. The treatment may also be harmful, in which case you are actively causing damage to the patient. Or, the treatment could be effective: well constructed clinical trials would demonstrate this. You cannot just assume a fancy treatment works for any reason. Doing so, in my opinion, is morally wrong and unfair to your patients.
I think this bandwagon of praising Graston technique based on anecdotal experiences is ludicrous. If you read the research objectively, there is nothing remotely convincing enough to convince a medical professional to use the treatment. It is irresponsible to use a treatment approach without sufficient evidence of safety and efficacy. The treatment may not work, in which case you are foregoing other treatments that would be helping the patient, and wasting time and money. The treatment may also be harmful, in which case you are actively causing damage to the patient. Or, the treatment could be effective: well constructed clinical trials would demonstrate this. You cannot just assume a fancy treatment works for any reason. Doing so, in my opinion, is morally wrong and unfair to your patients.
Here is a short article by a physician on the evidence for Graston
Here is another article on tissue provocation in general that also discusses Graston
Yeah. Opiods, muscle relaxers, NSAID's, x-rays and MRI's are the way to go in addition to the "wait and see approach." Percocet is the number one prescribed medication in the US is it not? Please enlighten me about the relative safety of "graston" vs NSAID's and opiods, and cite me some evidence that justifies their excessive use. Enlighten me how boob jobs are ok. How about lumbar fusions, tell me about that as well. Oh, and how about you fork over a few billion dollars that goes into the research for the interventions that you use. It's not exactly easy to do exaustive research to the level that everyone will smile about when there isn't millions of dollars left and right like there is in medicine.
I am not going to "tell you about" all the research supporting treatment strategies for different ailments for different conditions. Do a quick literature search yourself, there is a lot out there. But your examples illustrate a key point: drugs like NSAIDs and opiates undergo extensive double-blinded clinical testing to assess efficacy and safety for specific conditions (pain, inflammation, etc).
There's about 30k deaths/year from opiods, and about 3500/year from NSAIDs. Vicodin alone is prescribed 150 million times per year in the US alone and is the #1 prescription. That is not justified. Canada and the UK do not have a single opiod on the top ten prescription medications, so I'm guessing it's really not necessary Sure they have their place, but the utilization of them is excessive. .
There are volumes of research on many aspects of x-rays, MRI, etc., as there should be. This is what should happen for all treatments.
There's lots of research showing the over utilization of x-rays and MRi's as well for NMSK conditions. This equates to increast cost and delayed appropriate care. These have their place as well, but they're not indicated as much as they're utilized.
Surely you're not implying that painkillers like percocet aren't effective at reducing pain? That is their intended use, and at proper dosages under appropriate circumstances they are incredibly effective. This is unrelated to the fact that many physicians overprescribe them in inappropriate circumstances.
Prescribing in inappropriate circumstances, when there's guidelines and clear danger and strong research/evidence, is far worse than using a benign intervention (i.e. Graston) when it's a form of commonly used intervention anyway.
Just because a treatment is not pharmaceutical in nature does not mean it is without risks. For a patient and caregiver to do an appropriate cost-benefit analysis you need adequate research. Are you suggesting that treatments should be employed without assessing safety and efficacy??
In a perfect world every intervention utilized by healthcare providers would have exhaustive research. Sadly, the world is not perfect, let alone healthcare, let alone healthcare in the US. Use of conservative measures such as Graston as indicated despite lack of research to the satisfaction of physician's who are accustomed to FDA regulated and Pharmaceutical sponsored research does not make it inappropriate or suspect of danger. There's a reason why medications are held to such high standards and strict study, because even after all that they can kill people left and right. And there's a reason why it's not required to study many conservative measures for NMSK conditions, because there's little to no danger.
Keep in mind that Graston/ASTYM are performed on patient's who are often non medicated, non sedated, non anesthatized. There's feedback between the clinician and patient prn. They can feel what's going on. It's not done on peripheral neuropathy, or quadriplegics. If it was dangerous, it would be better regulated.
That is ridiculous and irresponsible. You don't necessarily need exhaustive research, but adequate enough to demonstrate a clear benefit, yes of course. Well designed clinical trials with a technique like Graston would not be very expensive to conduct, so I'm not sure what you're getting at there. Have you read the supporting research for this treatment? It is woefully inadequate. There is essentially a plausible biological mechanism demonstrated in one small mouse study and some very unconvincing case studies.
Looks like ASTYM has done 1 RCT.
http://www.astym.com/Content/documents/ASTYM Research Summary.pdf
Lots of pilot studies, case reports, case series, histological studies on rats. Is there any evidence, even at the lowest level, of danger? Not beyond minor temporary side effects (i.e. bruising, swelling, tenderness). The above "studies" do indeed show benefit. Should we go off what we have, or dismiss it until 100 years from now when the research is to everyone's satisfaction?
What do boob jobs have to do with this? Do you not think research went into determining the proper procedures and safety precautions of breast enhancement/reduction? I do not understand your argument at all. I think we have a fundamental misunderstanding in that you don't seem to believe treatments need evidence before being employed, which is a strange position to take in a profession that should be about treating problems in the safest and most effective manner possible.
I don't believe the cost of the equipment is worth it, but I've spoken with a good number of colleagues that have had success with Graston. I recently purchased an IASTM tool and will be attending a Graston educational course for ceus this weekend.
Years ago when Graston was just getting rolling, a friend of mine had registered for their course, which was advertised for a particular price. When he told them he wouldn't be needing to purchase tools because his practice partner already had them, he said they jacked up the price of the seminar on him!
I can definitely tell you this is not true today... I took the Graston course in December and was charged the same price as those who were buying the instruments.