Question from a Reader: ART vs. Graston Technique?

Hey Aleck

Well I just had confirmation of a partial (Grade II) hamstring tear with an MRI ordered by my orthopedic doc. It happened 3 months ago during my 11 mile long run. I didn’t hear/feel anything pop or snap. I felt a slight tight/stiffness in the belly of the hamstring at the 7th mile mark and tighten-up even more as I finished the rest of the 11 miles. I was able to finish my run, but the following short runs; I just didn’t have a full stride. I did my hamstring stretches. I have also been to physical therapy for past month (3x a week) that my orthopedic doc referred me. PT had me do a lot of balancing and strengthening exercises. Don’t get me wrong, overall my legs feel stronger. But I haven’t been able to run more than 5 miles before I feel the “tightness” in the belly of the hamstring. My marathon pace used to be a 7:30 pace. I can’t even do an 8 min pace on a 5 mile run.

Question for you – Do you think Graston or ART would help my hamstring? I’ve been told ART works well with Ironman ~ to encourage recovery or something like that? How many sessions of ART would you recommend to have? Does it deal with the inflammation as well?

Cheers,
Mike

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Hi Mike -

I'm sorry to hear of your injury. Good news is that you have a great chance of recovery and getting back to running full speed again. Better news is that the journey back to the land of running and competing in races doesn’t have to be as long and bumpy as you might think. We’ve all heard of the tragic stories of months of rest and out for a whole season with repeated hamstring pull and never getting back to the pre-injured status. But it doesn’t have to be like that.

The basic principle behind both A.R.T. (Active Release Technique®) and Graston Technique® is addressing and breaking up the scar tissues that have formed around a soft tissue injury. I've certainly worked on many hamstring "pulls" and tears successfully with both A.R.T and Graston Technique.

The body naturally produces scar tissues (collagen fibers) to “patch” up the tear. However, these collagen fibers are layered in a random fashion and they tend to be very sticky ~ resulting in limited flexibility within the muscle and adhesion formation to surround tissue, further limiting flexibility. This explains the tightness you described. Some could even feel a “knot” in the area of the scarred muscle.

Graston Technique tends to be more aggressive and is a better technique for thick/matted tissue, post-operative scar tissue and tendinopathy. This instrument-based soft tissue technique is a cut above other hands-on techniques for degenerative tendon (tendinosis) and post-surgical cases of all types. It’s designed to cause an inflammatory reaction in the tissue which stimulates the production of new collagen fiber – the basic building block of muscle and tendon fibers. The instruments allow the practitioner to gain a “vibration” sensation of the scar tissue with the instruments. The patient typically simultaneously experiences a noticeable tenderness while the tool goes over the injured area. The technique is designed to break cross-fiber links, splay fibers and increase fascial mobility. I prefer Graston Technique for chronic cases, where conventional forms of treatment have failed.

A.R.T. is not only an exceptional technique/treatment with the detailed oriented nature. Every soft tissue in the body (muscles, ligamnets, tendons & nerves) has at least one protocol to address it if it's involved in the injury. Its concept is to re-establish motion between fascial planes thus reducing fibrous adhesion and glide between layers of tissue. The technique is useful for acute, chronic, overuse; repetitive strain injuries and post-op cases . It’s a quite a dynamic technique ~ When A.R.T. is applied appropriately, it is far more forgiving to the patient and the injured tissues. The experience of the A.R.T. practitioner always plays a big part ~ understanding the nature of the injuries, experience working with athletes with similar condition. Beware of imitations ~ there are some practitioners who are familiar with A.R.T. and suggest they do a certain type of myofascial release technique that's similar to A.R.T. I do not doubt they treat soft tissue injuries. They just simply do not do A.R.T. (I digress.)

Given that both techniques work directly on the injured tissue, it is only right that the recipient would “feel” it. Sometimes a little; sometimes a lot. But it shouldn’t be painful (this is where it gets a bit subjective with differentiating good pain vs. bad pain.) If the patient is tensing up tremendously and biting down , most definitely, either technique is not applied appropriately.

I use A.R.T. on 99.9% of my patients and approximately 40% with Graston Technique. Depending on the patient and their condition on the day of the treatment, I may choose to add Graston with the treatment. So, it's hard for me to say if you should go with one or the other. I certainly have not shied away from using Graston on hamstring tears because of the bulk of the muscle, and the tenacious nature of hamstring tears.

I wouldn’t suggest you to take any anti-inflammatory medication for at least 48 hrs after either treatment since the techniques are meant to introduce the healing properties of the inflammatory cascade. You can take pain medication if needed though.

As for how many treatments you'll need, quite frankly ~ I don't know. For some injuries, the turn around time could be as quick as 2-3 treatments in a matter of 2 to 3 weeks. Some may take longer. It depends on the extensiveness of the tear, how much healing has taken place and how symptomatic you are during the treatment.

Thanks for sending in your questions and I hope this was helpful to you. Best of luck in your recovery.