The Graston Technique® is a common treatment that combines a warm-up, Instrument Assisted Soft Tissue Mobilization (IASTM), stretching, and strengthening protocols. The treatment is commonly chosen by clinicians to treat musculoskeletal injuries. The purpose of this study was to determine how the Graston Technique® is used in clinical practice by certified athletic trainers to compare to recommendations made by the Graston Technique®. Factors such as time, expense, lack of training in the Graston Technique®, availability of resources, and an overall lack of evidence-based recommendations may have influenced inconsistencies in clinical practice. Although the technique is not always performed according to recommendations, these findings suggest both clinicians and patients report objective and subjective improvements when treating musculoskeletal pathologies regardless of the techniques used.

Indiana University-Purdue University Indianapolis (IUPUI) / Soft tissue manipulation is a widely used practice by manual therapists from a variety of healthcare disciplines to evaluate and treat neuromusculoskeletal impairments using mechanical stimulation either by hand massage or specially-designed tools. The practice of a specific approach of targeted pressure application using distinguished rigid mechanical tools to breakdown adhesions, scar tissues and improve range of motion for affected joints is called Instrument-Assisted Soft Tissue Manipulation (IASTM). The efficacy of IASTM has been demonstrated as a means to improve mobility of joints, reduce pain, enhance flexibility and restore function. However, unlike the techniques of ultrasound, traction, electrical stimulation, etc. the practice of IASTM doesn't involve any standard to objectively characterize massage with physical parameters. Thus, most IASTM treatments are subjective to practitioner or patient subjective feedback, which essentially addresses a need to quantify therapeutic massage or IASTM treatment with adequate treatment parameters to document, better analyze, compare and validate STM treatment as an established, state-of-the-art practice. This thesis focuses on the development and implementation of Quantifiable Soft Tissue Manipulation (QSTM™) Technology by designing an ergonomic, portable and miniaturized wired localized pressure applicator medical device (Q1), for characterizing soft tissue manipulation. Dose-load response in terms of forces in Newtons; pitch angle of the device ; stroke frequency of massage measured within stipulated time of treatment; all in real-time has been captured to characterize a QSTM session. A QSTM PC software (Q-WARE©) featuring a Treatment Record System subjective to individual patients to save and retrieve treatment diagnostics and a real-time graphical visual monitoring system has been developed from scratch on WINDOWS platform to successfully implement the technology. This quantitative analysis of STM treatment without visual monitoring has demonstrated inter-reliability and intra-reliability inconsistencies by clinicians in STM force application. While improved consistency of treatment application has been found when using visual monitoring from the QSTM feedback system. This system has also discriminated variabilities in application of high, medium and low dose-loads and stroke frequency analysis during targeted treatment sessions. / 2023-04-26

<div>Soft tissue manipulation is a widely used practice by manual therapists from a variety of healthcare disciplines to evaluate and treat neuromusculoskeletal impairments using mechanical stimulation either by hand massage or specially-designed tools. The practice of a specific approach of targeted pressure application using distinguished rigid mechanical tools to breakdown adhesions, scar tissues and improve range of motion for affected joints is called Instrument-Assisted Soft Tissue Manipulation (IASTM). The efficacy of IASTM has been demonstrated as a means to improve mobility of joints, reduce pain, enhance flexibility and restore function. However, unlike the techniques of ultrasound, traction, electrical stimulation, etc. the practice of IASTM doesn't involve any standard to objectively characterize massage with physical parameters. Thus, most IASTM treatments are subjective to practitioner or patient subjective feedback, which essentially addresses a need to quantify therapeutic massage or IASTM treatment with adequate treatment parameters to document, better analyze, compare and validate STM treatment as an established, state-of-the-art practice.</div><div><br></div><div>This thesis focuses on the development and implementation of Quantifiable Soft Tissue Manipulation (QSTM™) Technology by designing an ergonomic, portable and miniaturized wired localized pressure applicator medical device (Q1), for characterizing soft tissue manipulation. Dose-load response in terms of forces in Newtons; pitch angle of the device with respect to treatment plane; stroke frequency of massage measured within stipulated time of treatment; all in real-time has been captured to characterize a QSTM session. A QSTM PC software (Q-WARE©) featuring a Treatment Record System subjective to individual patients to save and retrieve treatment diagnostics and a real-time graphical visual monitoring system has been developed from scratch on WINDOWS platform to successfully implement the technology. This quantitative analysis of STM treatment without visual monitoring has demonstrated inter-reliability and intra-reliability inconsistencies by clinicians in STM force application. While improved consistency of treatment application has been found when using visual monitoring from the QSTM feedback system. This system has also discriminated variabilities in application of high, medium and low dose-loads and stroke frequency analysis during targeted treatment sessions.</div>

Indiana University-Purdue University Indianapolis (IUPUI) / Instrument assisted soft tissue mobilization (IASTM) is a form of massage using rigid manufactured or cast devices. The delivered force, which is a critical parameter in massage during IASTM, has not been measured or standardized for most clinical practices. In addition to the force, the angle of treatment and frequency play an important role during IASTM. As a result, there is a strong need to characterize the delivered force to a patient, angle of treatment, and stroke frequency. This thesis proposes two novel mechatronic designs for a specific instrument from Graston Technique(Model GT3), which is a frequently used tool to clinically deliver localize pressure to the soft tissue. The first design is based on compression load cells, where 4-load cells are used to measure the force components in three-dimensional space. The second design uses a 3D load cell, which can measure all three force components force simultaneously. Both designs are implemented with IMUduino microcontroller chips which can also measure tool orientation angles and provide computed stroke frequency. Both designs, which were created using Creo CAD platform, were also analyzed thorough strength and integrity using the finite element analysis package ANSYS. Once the static analysis was completed, a dynamic model was created for the first design to simulate IASTM practice using the GT-3 tool. The deformation and stress on skin were measured after applying force with the GT-3 tool. Additionally, the relationship between skin stress and the load cell measurements has been investigated. The second design of the mechatronic IASTM tool was validated for force measurements using an electronic plate scale that provided the baseline force values to compare with the applied force values measured by the tool. The load cell measurements and the scale readings were found to be in agreement within the expected degree of accuracy. The stroke frequency was computed using the force data and determining the peaks during force application. The orientation angles were obtained from the built-in sensors in the microchip.