Friday, July 10, 2009

Now this is great research

Instrument Assisted Cross Fiber Massage Accelerates Knee Ligament Healing- JOSPT 7-09.
The researchers did Graston Technique on 51 rats who's MCL's were surgically injured. 3X a week for 1 minute; 31 received 9 treatments, 20 received 30.
At the end of the treatments, the rats were sacrificed, and the MCL's were placed under an electron microscope for study. Then, mechanically strain tested also.
At 4 weeks out, the treated ligs were 43% stronger, 40% stiffer, and able to absorb 57% more energy. At 12 weeks out, both treated & untreated ligs were similar, with the exception of the treated ligs being 15% stiffer.
The authors hypothesize that the Graston Technique has an underlying effect on collagen, influencing the fibroblastic cells.
How do my blog readers feel about this? It was fast, and a hell of a lot cheaper than other popular tendon therapies (platelet rich plasma, stem cells etc). Would ASTYM work just as well? Or, how about good 'ole deep transverse friction massage, which doesn't cost a dime to learn (it is well described in Warren Hammer's book).

8 comments:

JH said...

JOe,

WHen I worked at Toyota in KY we used the IASTM technique and saw some very positive results where friction massage just didn't cut it. The idea was that with the instrument you could feel adhesion if they were present easier than with your fingers due to the rigidity of the tools. There was a protocol though which required IASTM, stretches immediately afterwards, then strengthening exercises after that and lastly ice. If I use the technique (which is rare) I just use the handle of a reflex hammer.

Joe Przytula said...

Yeah, friction massage is tough on the hands. A question- do you think following it up with ice is a good idea? Or, do you want to encourage the inflammatory response?

JH said...

Good Question - The idea behind icing is that it helps the inflammatory response to remain more localized to the effected tissues while minimizing the potential damage that could be caused to the surrounding healthy cells. However I think it depends on the dysfunction. In the industrial setting where someone may have lived with an overuse tendon injury for years I might skip the ice but for someone who has just developed an overuse injury more recently I would be more likely to use the ice. Not sur eif that's accurate protocol or if the research would back this us but that's my thoughts on it.
Good question though!

Brian said...

I would think ice would inhibit one of the proposed effects of TFM/IASTM. This type of manual therapy probably creates a localized inflammatory response. I would think you want that...It appears we're tip toeing around whether inflammation even exists in tendon tissue...!

drcieslak said...

Hi Joe;

I just came across this thread, and thought I'd chime in. I just recently addressed a similar topic during the NATA meeting. My presentation addressed the different soft tissue techniques, and how they compare/contrast, as well as research that has been generated. The Loghmani study was included, but was interesting in that it really did not change final healing outcome, although it did speed things up. One of the arguments for IASTM is that they improve the overall healing response, and decrease fibrosis. This study did not appear to support that assertion. As far as the tools, the general consensus of practitioners (even many of the "big names" in soft tissue rehab) is that they are all similarly effective, if used in the appropriate situation, and with the appropriate technique. Clinician skill is vital to outcome. As for my own opinion, I have found that the weight of the instrument does help with "feeling" the tissues. Although I often get by using inexpensive Gua Sha tools, and my trusty Shrimp Deveiner!!

Keep up the good work on your blog. I will try to make an effort to respond more often, as I like your topics, and challenges to conventional thinking.

Have a great summer!
Ken

drcieslak said...

Oops,

I also wanted to say that I believe heat would typically be the better option post treatment, and with IASTM protocols, you are trying to stimulate a fibroblastic response anyway, and that is essentially an inflammatory response. Additionally, heat can also play an analgesic role as well as ice.

Regards,
Ken

Joe Przytula said...

Thanks Brian and Doc Ken. Speaking of "energy medicine"(they are proponents of heat on a fresh injury), did anyone read Doc Oschman's article in the most recent issue of "Journal of BodyWork & Movement Therapies"? I still think this guy takes a good premise, then goes waaaayyy too far.

drcieslak said...

Hi Joe;

On an unassociated note, I would like to get a better understanding of the approaches Gary Gray uses in his assessment and rehab. I know you are well versed in this area. I noted on his website that they sell educational materials. Which ones would you suggest (tape titles, etc) I get to obtain a basic grasp of his approaches and methods (kind of like a Cliffs Notes summary of his approach). Any suggestions is greatly appreciated.
Ken