The Effects of Graston Treatment Time on the Quadriceps
Muscles’ Strength and Fatigue in Division III Football Players
Brandon Lorrig, Zach Bils, Mitch Olson
Faculty Mentors: Dr. Saori Braun
Department of Kinesiology, University of Wisconsin- Eau Claire
METHODS
ABSTRACT
Purpose: It is unclear whether or not Graston Technique (GT) treatment times
of 8 and 15 minutes cause physiological and psychological effects compared to
instances where no treatment is administered. It was hypothesized that with
longer bouts of GT, one would experience greater perceived fatigue (PF) and a
decrease in peak torque (PT) and work per repetition as a result of induced
physiological effects of GT. The purpose of this study was to investigate the
possible iatrogenic effect that GT could have on athletes when used prior to
physical activity. Methods: Ten Caucasian University of Wisconsin – Eau
Claire Division III football players (age 20.50 ± .50) in the off-season
volunteered as candidates for the single blind counter balanced study consisting
of no treatment, treatment of 8 minutes, and treatment of 15 minutes. Results:
Although analysis showed no significant relationship between GT treatment
time to peak torque (p=.329), Work per repetition (p=.274), and PF (p=.451),
there appears to be a trend developing between each variable. Peak torque and
work per repetition seems to increase with longer bouts of GT, while PF
increases at 8 minutes compared to baseline and declines at 15 minutes below
baseline values. Conclusion: It is suggested that with longer bouts of GT prior
to competition, an increase in peak torque and work per repetition may result. In
addition, bouts of 15 minutes of GT may decrease perceived fatigue after
physical exertion compared to receiving no treatment.
INTRODUCTION
GT is a soft tissue mobilization modality that is utilized to release scar
tissue adhesions that exist between muscle tissue and the overlying
fascia (Stow, 2011). Another use for this modality is to restart or initiate
an inflammatory response within the tissue to assist in the healing
process. This is done by increasing blood flow in the tissue by creating
microtrauma within the muscle (Hall, 2009).
Fig. 1: Graston Technique Instruments
GT 1
GT 4
PURPOSE AND HYPOTHESIS
STATISTICAL ANALYSIS
Subjects
 10 Male UW-Eau Claire Division III Football Players ages 20-21 years.
 Participants recruited via mass email as permission was granted by the head
football coach for participation approval.
 Exclusion criteria: current pathology involving the dominant lower limb in
addition to vascular disorders, open wounds, cancer, thrombophlebitis,
uncontrolled hypertension, hematoma, osteomyelitis, hemophilia, myositis
ossificans and skin diseases. No subject warranted exclusion due to pathologies.
 All subjects were able to participate and informed consent was gathered
according to IRB guidelines at UW-Eau Claire.
Table 1: Participant Characteristics
Age
Mean
20.50
Std. Deviation
.527
Height (in)
71.80
2.12
Weight (lbs)
222.60
54.40
2.40
.516
Years of Participation
Fig. 2: HUMAC-NORM Isokinetic Dynamometer
RESULTS
 The analysis showed no significant relationship between GT treatment time on
peak torque, work per repetition and VAS.
 There is a noticeable trend highlighting an increase in peak torque and work per
repetition with longer bouts of GT application.
 VAS scale saw an increase in PF from baseline (6.30 ± 1.36) to 8 minutes (6.55 ±
1.34) while PF at 15 minutes is lower than at baseline (6.10 ± 1.10).
Table 2
Instrumentation
F-Value
P-Value
Peak Torque (ft∙lb)
Wk/Rep (ft∙lb)
VAS (range: 1-10)
Table 3: Peak Torque (ft∙lb)
Peak Torque Baseline
PT 8 Minutes
PT 15 Minutes
Table 4: Wk/Rep (ft∙lb)
1.106
1.397
.743
Mean
160.00
165.10
173.90
Mean
.329
.27
.45
Std. Deviation
32.20
33.46
33.75
Std. Deviation
 Visual Analog Scale (VAS) was an assessment tool to measure perceived pain
(Bijur, Silver, Gallagher, 2008).
Wk/Rep Baseline
186.90
44.67
Wk/Rep 8 Minutes
195.00
34.57
 A wall height chart and standard body weight scale was administered by
researchers to provided accurate measurements for height (in) and weight (lbs).
This information was implemented within the HUMAC-NORM software to
assist in analyzing peak torque and work per repetition.
Wk/Rep 15 Minutes
Table 5: VAS (range: 1-10)
VAS Baseline
VAS 8 Min
VAS 15 Min
205.40
Mean
6.30
6.55
6.10
40.71
Std. Deviation
1.36
1.34
1.10
 The HUMAC NORM isokinetic dynamometer was utilized to assess peak
torque and work per repetition. According to McCleary and Anderson (1992),
the Biodex isokinetic dynamometer was found to be a reliable instrument when
assessing torque output in the quadriceps musculature. They found that there
was an intraclass correlation value of .88-.97 for the Biodex (McCleary, 1992).
This reliability carries over to the HUMAC-NORM since it has the same
mechanism as the Biodex by assessing quadriceps and hamstring force
production (Potash & Potash, 2009).
 Graston Technique instruments 1 and 4 were used to implement treatment
according to testing procedures after GT emollient was applied.
Testing Procedure
The purpose of this study is to examine the effects of Graston Technique on
the dominant quadriceps peak torque and work per repetition on the
HUMAC-NORM isokinetic dynamometer. In addition, this study is to
assess the potential for GT to induce perceived fatigue following physical
exertion in physically active individuals. It is hypothesized that longer
bouts of GT will decrease muscular function and increase perceived fatigue
when used prior to physical activity.
 Data analyzed using IBM SPSS version 19.0.
 Descriptive analysis was used to determine the mean and standard deviation
of baseline characteristics. This includes age, height, weight and years of
Division III football participation.
 One-way repeated measures ANOVA and paired samples t-test were used to
assess the significance of peak torque and work per repetition for both GT
isokinetic tests and baseline isokinetic test. Same statistical analysis was
conducted for VAS.
 Alpha level set at .05 to determine statistical significance.
 Data was collected over a 3-week period from 6:30 pm to 8:30 pm. GT
treatment was administered in the Athletic Training Treatment Center while
Isokinetic testing was conducted in lab 198 of the McPhee Physical Education
Building.
 Three participant groups were created via random number generator to create a
counter balance study. Groups consisted of baseline where no treatment was
administered (1), an 8 minute group (2) and 15 a minute group (3). Each
individual proceeded to the following group until all groups were completed.
 Isokinetic dynamometer was set to 60 deg/s on concentric-concentric for each
test as it represents the greatest torque production.
 To ensure intra testing reliability, each researcher implemented individual tasks
throughout the study. To reduce bias, a single blind study was conducted as the
Isokinetic tester was unaware of the treatment time administered. In addition,
the isokinetic dynamometer was calibrated prior to each testing day.
 Following 10 minutes of moderate physical activity on a stationary bicycle, GT
emollient was applied by a researcher who is qualified in implementing GT and
its products on participating volunteers.
 During 8 minutes of application, GT 4 was used to scan soft tissue for 1 minute
to identify adhesions and fascial restriction, followed by 3 minutes of treatment.
Once 4 minutes was met, GT 1 was applied for an additional 4 minutes.
 During the treatment of 15 minutes, GT 4 was applied for 1 minute to scan the
soft tissue followed by 6 minutes. Once 7 minutes were completed, 8 minutes
of GT 1 was applied for the remainder of the treatment.
SUMMARY AND CONCLUSIONS
 Although not significant, it is suspected that longer bouts of GT would benefit lower
extremity performance during physical activity due to the increase in peak torque and
work per repetition. This may be the result of reduced scar tissue adhesions, that has a
potential to increase performance as fascial restrictions on the muscle tissue is
released.
 There was a non-significant decrease in VAS after 15 minutes of GT when compared
to 8 minutes and baseline, suggesting the impact of gate control theory of pain. By
inducing microtrauma to the muscle tissue, the treatment may desensitize the patient
from pain. This is similar to other modalities such as electrical stimulation where the
patient is no longer sensitive to the electrical current (Starkey, 1999).
 Further research should be conducted to investigate both the therapeutic and possible
iatrogenic effects of Graston Technique that involves both males and females, larger
sample sizes and different sport populations.
ACKNOWLEDGMENTS
We would like to thank Dr. Saori Braun for her guidance and assistance in making this
a successful research project. We would also like to thank the Department of
Kinesiology: Athletic Training Education Program for allowing us the use of the
equipment needed for this study.
REFERENCES
Bijur, P.E., Silver. W, & Gallagher (2008). Reliability of the Visual Analog Scale for Measurement of Acute Pain. Academic Emergency Medicine, 8(12) 1153-1157.
Graston Technique. (n.d.). GT Products: GT Instrument Set. Retrieved from https://www.grastontechnique.com/CartCAN.html
Hall, H. (2009, December 29). The Graston Technique – Inducing microtrauma with instruments. Retrieved from http://www.sciencebasedmedicine.org/the-graston-technique-inducingmicrotrauma-with-instruments/
McCleary, R.W., & Anderson, J.C. (1992). Test Re-Test Reliability of Reciprocal Isokinetic Knee Extension and Flexion Peak Torque Measurements. Journal of Athletic Training, 27 (4) 362-365.
Potash, R., Potash, R. (2009) HUMAC-NORM testing and rehabilitation system solutions. Retrieved from http://www.csmisolutions.com/sites/default/files/English_humac_norm_brochure
Starkey, C. (1999). Therapeutic Modalities (2nd edition). Philadelphia: F. A. Davis Company.
Stow, R. (2011). Instrument assisted soft tissue mobilization. International Journal of Athletic Therapy and Training. 16(3), 5-8.