Appropriate Manual Therapy within the AT Scope of Practice

Dr. Kevin Christie, D.C.

A Little About Me

• Kevin Christie D.C. A.R.T.

• Chiropractic Physician- Boca Raton, FL

• Active Release Techniques® Full Body Certified

• Graston Techniques® Certified

• Kinesio® Taping Certified

• Board of Athletic Trainers for the state of Florida

• Clinical Director of XPE Sports NFL Combine Prep Program

Common Manual Therapy Techniques

Within the Athletic Trainer’s Scope • Active Release Techniques®

• Graston Technique®

• Fascial Distortion Model™

• FAKTR-PM

I = Insult to TissuesN = Number of RepetitionsF = Force of each RepetitionA = Amplitude of each RepR = Relaxation time b/n Reps

Law of Repetitive MotionI=NF/AR

The Cumulative Injury Cycle

Tendinosis vs Tendonitis

• Chronic tendon injuries are degenerative in nature and NOT inflammatory.

• Anti-inflammatory medications (NSAID’s) and/or corticosteroid injections can actually accelerate the degenerative process and make the tendon more susceptible to further injury, longer recovery time and may increase likelihood of rupture.

• Heavy load eccentric strength training helps to increase the tensile strength of the tendon, increase the amount of Type I collagen and decrease the amount of ground substance thereby reducing tendon volume and helping restore the tendon to a healthy state.

• Treatment for this condition must first attempt to stop the degenerative cycle and then to restore proper collagen synthesis, strength and function.

Resolving TendinopathyTheories Regarding the Healing of Tendinosis

Increase of blood flow to the area decreasing the hypoxic state and aiding in healing response and collagen remodeling.

Reversing the Tendinosis Cycle

Mechanically mobilizes the scar tissue, loosening it from surrounding healthy tissue.

Reinitiates the inflammatory process by introducing a small amount of trauma to the tendon scar.

Re-inflammation starts the healing process again by increasing blood, nutrients, and fibroblasts to region.

Common areas for Tendonosis

Medial and Lateral Epicondylosis

Patellar Tendonosis

Achilles Tendonosis

Supraspinatus Tendonosis

Soft Tissue Changes after Injury

• Inflamed: 24 Hours-72 Hours

• Stringy: 2 Days- 2 Weeks

• Lumpy: 2 Weeks- 3 Months

• Leathery: 3 Months Plus

The ART® Process

• Patient presents with symptoms/history

• Match to symptom pattern chart

• List of treatment protocols

• Treat and evaluate tissues

• Related protocols and antagonists

• Re-evaluate for further treatment.

A.R.T. Palpation and Performing

• Diagnosing the Soft Tissue Lesion• Nature of lesion (tear, adhesion, crush)

• Exact Tissue (i.e. Pronator Teres, Median Nerve, Joint Capsule)

• Syndrome (Peripheral Nerve Entrapment, Myofascitis)

• Performing an ART Protocol • Shorten the affected tissue

• Place contact and apply tension

• Lengthen the tissue/cause relative motion

• Release the tissue by using contact tension

Key aspects of ART Effectiveness

• Avoiding Tissue Injury

• Soft Contact

• Start with longitudinal Direction

• Active Motion when possible

• Patient tolerance

• Tissue tolerance

• Lymphatic and veinous flow

• Treatment frequency

Key aspects of ART Effectiveness

• Maximizing Treatment Effectiveness

• Use tension and minimal compression

• Finish patient motion and contact tension

• Use internal vs external glide- Penetrate through skin to proper structure then draw tension. (Avoid skin pulling).

Becoming A.R.T® Certified

• After completion of an authorized ART® course, passing the practical examination and maintaining your certification allows you to:

• Use the ART® Treatment System and Protocols

• Use the terms ART® and Active Release Techniques®

• Participate in ART® Events and Programs

The Graston Technique® For the clinician:

• Provides improved diagnostic treatment• Detects major and minor fibrotic changes• Reduces manual stress; provides hand and joint conservation• Increases patient satisfaction by achieving notably better outcomes

For the patient:

•Decreases overall time of treatment•Fosters faster rehabilitation/recovery•Reduces need for anti-inflammatory medication•Resolves chronic conditions thought to be permanent

Becoming Certified in Graston Technique®

M1 Course Objectives

• The primary objective of M1 is to develop an understanding of GT and how to apply it into the full spectrum of musculoskeletal treatment approaches. By the end of the training, you will be able to

• Demonstrate a working knowledge of the GT instruments, GT treatments, potential effects and benefits.

• Identify and discuss the indications, contraindications (relative and absolute) of theGraston Technique®.

• Review and develop a better understanding of soft tissue injury, healing and potential reactivity to instrument-assisted soft tissue mobilization (therapeutic and adverse).

• Develop skill and competence in the GT application of IASTM to the major regions of the spine and extremities.

Graston Technique® Recommended Care

• Soft Tissue Warm-Up

• Graston Technique Applied

• Stretching

• Rehabilitative Exercises

• High Rep/Low Load

• Cryotherapy

Who is Using Graston Technique?

• Professional Sports Teams

• Major Universities

• Large Corporations

• Physical Therapy, Chiropractic, Sports Medicine Facilities

• Athletic Training Master’s Degree

• U.S. Olympic Training Centers

Universities and Pro TeamsUtilized in Athletic Training Room

NBA

Atlanta Hawks

Boston Celtics

Charlotte Bobcats

Cleveland Cavaliers

Denver Nuggets

Miami Heat

Milwaukee Bucks

Minnesota Timberwolves

New York Knicks

Philadelphia 76ers

San Antonio Spurs

NFLAtlanta FalconsCleveland BrownsHouston TexansIndianapolis ColtsJacksonville JaguarsMinnesota VikingsNew England PatriotsNew York GiantsSan Francisco 49ersSt. Louis RamsTennessee TitansWashington Redskins

MLBChicago White SoxCincinnati RedsCleveland IndiansKansas City RoyalsMilwaukee BrewersNew York MetsSeattle MarinersSt. Louis CardinalsTexas RangersToronto Blue JaysWashington Nationals

Athletic TrainingMasters Program

Barry University

Concordia University - Wisconsin

Culver-Stockton College

Georgia Southern University

Gustavus Aldolphus College

Illinois State University

Indiana University

Indiana State University

Kent State University

Louisiana State University

Old Dominion UniversitySaint Louis UniversityStephen F. Austin State UniversityTexas State UniversityUniversity of Kansas (undergraduate)University of North CarolinaUniversity of OregonUniversity of South CarolinaUniversity of Wisconsin West Virginia University

Graston Testimonial

•"GT has been an integral and largely beneficial application in our care

and treatment of the acute and chronic conditions that affect professional baseball players. Our efforts at edema reduction in acute ankle sprains and contusions (hit by pitch, foul tips) have been more successful as a direct result of implementing GT in our protocols. We have seen tremendous outcome results in chronic conditions such as tendinosis, scar tissue impediments and fascial pain syndromes. Our athletes often present to the athletic training room requesting GT. " 

Lonnie Soloff, ATC, PTHead Athletic Trainer, Cleveland Indians

FAKTR-PMFunctional and Kinetic Treatment with Rehabilitation, Provocation and Motion

Functional: Treating patients during functional mvmnt.

Kinetic: Assess the Kinetic Chain for injury cause.

Treatment: Graston Technique, A.R.T, Nimmo, PIR, Etc.

Rehabilitation: Low tech rehab during manual therapy

Provocation: Treat in position of provocation of symptoms

Motion: If pain is worse with motion, treat with motion?

Fascial Distortion Model™

• It’s called a ‘model’ because it isn’t a technique.

• Soft tissue injuries and/or musculoskeletal complaints.

• Viewed through 1 or more of the 6 different types of alterations to the body’s connective tissues.

• FDM has no protocols to memorize.

• FDM contains a detailed physical assessment, which leads to a specific diagnosis, and provides objective outcomes.

• The patient’s verbal and physical descriptions, coupled with the mechanism of injury and relevant orthopedic tests, will lead the practitioner to the proper form of soft tissue treatment.

Fascial Distortion Model™

• Treatment - This clinical assessment is followed by hands-on soft tissue and joint mobilization to help with the healing of the painful areas and their surrounding damaged tissues. If necessary you might be prescribed personalized stretching regiments and exercises.

Integrating Manual Therapy for the AT

• Common Injuries Successfully treated with manual therapy

• Tendonopathies

• Fascial Syndromes

• Myofascial Pain Syndromes

• Entrapment Syndromes

• Scar Tissue/Adhesions

• Ligaments Sprains

Research & References

www.grastontechnique.com- Preferred Provider Database

Graston Technique Module 2 Training Manual

FAKTR-PM Training Manual

The Effects of a Randomized Four-Week Graston Instrumented-Assisted Soft Tissue Mobilization (GISTM) Dynamic Balancing-Training Program on Individuals with Chronic Ankle Instability

Graston Technique for Athletic Injuries

Treating an Unresolved Hamstring Injury with GT

A Guide to Preventing and Managing Golf Injuries

Achilles Tendinpathies in Runners Causes Treatment and Prevention

The Pathology & Healing of Tendinosis

Shoulder Impingement Syndrome in Olympian

Any Questions?

www.Healthfitchiro.comDrkchristie@gmail.com