A study on efficacy of graston soft tissue mobilization technique on hamstring muscle in college level football players
Corresponding Author(s) : Pratheesh Das. K.P
pratheeshdaskp@gmail.com
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 9 No. 3 (2021): 2021 Volume - 9 Issue - 3
Abstract
Background
In a football competition there is greater number of tackles, heading, kicking and higher percentage of the game is performed in maximum speed. Hamstring has major role on football players not only for preventing injuries, but also for improving performance level. Short hamstrings have been related to various lower limb injuries in football. Graston technique is an instrumental assisted soft tissue mobilization technique (GIASTM), uses a set of six stainless steel instruments to assists in manipulating tissues. The Graston instruments assist in fitting the shape of the body in order to scan, locate, and treat myofascial trigger points and adhesions in the soft tissue. GIASTM is a time-saving, useful modality and safe method for soft tissue restrictions and injury in sports.
Aim
Study to find out the efficacy of Graston instrumented assisted soft tissue mobilizations on Hamstring flexibility, Agility, and 20m Sprint in college level football players.
Methodology
Thirty College level footballers aged between 18-22 were assessed and selected for the study who satisfies the inclusion criteria were assigned into two groups of 15 subjects each: Group A- Experimental Group underwent a protocol with Graston instrumented assisted soft tissue mobilization technique along with Conventional exercises and Group B- Control Group was treated with only Conventional exercises and performed it for 3 weeks (3days/week). The outcome measures used were Sit and Reach test, BALSOM Agility Test (BAT), 20 m sprint run test. Using these outcome measures pre-test and post-test values were obtained.
Result
The results were analysed using student t-test. Paired t-test was used to compare the results within the group and unpaired t-test to compare results between the groups. Significance level kept p<0.05. In 20m Sprint test, since the t-value2.395, shows p- value <0.05, there is a significant difference in post-test 20m Sprint test scores between the experimental and the control groups. The difference 0.15 is the difference between mean in two groups (3.38&3.53). Although both groups showed improvement, the scores in the experimental group is significantly higher than that in control group.In the flexibility, since the t-value 0.969, shows p value 0.341, there is no significant difference in post-test flexibility score between the experimental and the control group.
The difference (1.66) shows the difference between mean in two groups (35.33&33.67). Although both group showed improvement, the scores in the experimental group is significantly higher than that in control group.In the BALSOM Agility test, since the t-value 1.035, shows p-value 0.309, there is no significant differences in post-test BALSOM Agility run score between the experimental and the control groups. The differences (0.16) show the difference between mean in two groups (12.21&12.37). So, the experimental group shows more significant improvement in the Agility.
Conclusion
The Graston instrumented assisted soft tissue mobilization on Hamstring muscle is effective in sprint performance. Since reducing the fatigue of hamstring muscle, improve quickness, and enhancing the sprinting activities on football event. Therefore GIASTM on Hamstring muscle is effective and improves the performance level on highly sprinting demanded player’s in football and other sporting events. GIASTM technique is simple and cost effective and can be given adjunct to physiotherapy treatment.
Keywords
Graston instrumented assisted soft tissue mobilization (GIASTM)
Hamstring flexibility
Agility
Sprint
1.
Pratheesh Das. K.P, Arun Thachil. A study on efficacy of graston soft tissue mobilization technique on hamstring muscle in college level football players. Int. J. of Allied Med. Sci. and Clin. Res. [Internet]. 2021 Sep. 13 [cited 2025 Jul. 13];9(3):588-95. Available from: https://ijamscr.com/ijamscr/article/view/1076
Download Citation
Endnote/Zotero/Mendeley (RIS)BibTeX
References
-
[1]. Requena B, González-Badillo JJ, de Villareal ES, Ereline J, García I, GapeyevaH, Pääsuke M. Functional performance, maximal strength, and power characteristics in isometric and dynamic actions of lower extremities in soccer players. The Journal of Strength & Conditioning Research. 2009 Aug 1;23(5):1391-401.
[2]. García-Pinillos F, Ruiz-Ariza A, Moreno del Castillo R, Latorre-Román PÁ. Impact of limited hamstring flexibility on vertical jump, kicking speed, sprint, and agility in young football players. Journal of sports sciences. 2015 Jul 21;33(12):1293-7.
[3]. Russell M, Benton D, Kingsley M. The effects of fatigue on soccer skills performed during a soccer match simulation. International journal of sports physiology and performance. 2011 Jun 1;6(2):221-233.
[4]. Mendes B, ERCIN T, UZUN K. Examination of flexibility and sprint performance values of adolescent footballers. Turkish Journal of Sport and Exercise. 2015;17(3):16-20.
[5]. Lehance, Cédric, Johnny Binet, Thierry Bury, and Jean-Louis Croisier. "Muscular strength, functional performances and injury risk in professional and junior elite soccer players." Scandinavian journal of medicine & science in sports 19, no. 2 (2009): 243-251.
[6]. Askling, Carl, TönöSaartok, and Alf Thorstensson. "Type of acute hamstring strain affects flexibility, strength, and time to return to pre-injury level." British journal of sportsmedicine 40, no. 1 (2006): 40-44.
[7]. Little T, Williams A. Specificity of acceleration, maximum speed and agility in professional soccer players. . Journal of Strength and Conditioning Research. 2005; 19(1): 76-78.
[8]. Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. journal of orthopaedic& sports physical therapy. 2010 Feb;40(2):67-81.
[9]. BARCELONA EA. Hamstring injuries in football: Applying scientific knowledge to daily on-field practice.– Written by Luis Til et al, Spain
[10]. Bhosale N, Yeole U, Chogle A, Khatri S. Assessment of Lower Extremity Flexibility in Recreational Football Players. International Journal of Research and Analytical Reviews. 2019 june;6(2):2348 –1269.
[11]. Cheatham SW, Lee M, Cain M, Baker R. The efficacy of instrument assisted soft tissue mobilization: a systematic review. The Journal of the Canadian Chiropractic Association. 2016 Sep;60(3):200.
[12]. Hammer WI. The effect of mechanical load on degenerated soft tissue. Journal of Bodywork and Movement Therapies. 2008 Jul 1;12(3):246-56.
[13]. Baker RT, Nasypany A, Seegmiller JG, Baker JG. Instrument-assisted soft tissue mobilization treatment for tissue extensibility dysfunction. International Journal of Athletic Therapy and Training. 2013 Sep 1;18(5):16-21.
[14]. Carey-Longmani, MT, Hammer. WI. GrastonTechniqueâ In: Hammer, WI, ed. Functional Soft-Tissue Examination and Treatment by Manual Methods. Boston, MA: Jones and Bartlett lerning; 2007: 589-625
[15]. Stow R. Instrument-assisted soft tissue mobilization. International journal of athletic therapy and training. 2011 May 1;16(3):5-8.
[16]. Laudner K, Compton BD, McLoda TA, Walters CM. Acute effects of instrument assisted soft tissue mobilization for improving posterior shoulder range of motion in collegiate baseball players. International journal of sports physical therapy. 2014 Feb;9(1):1.
[17]. Baker RT, Nasypany A, Seegmiller JG, Baker JG. Instrument-assisted soft tissue mobilization treatment for tissue extensibility dysfunction. International Journal of Athletic Therapy and Training. 2013 Sep 1;18(5):16-21.
[18]. Nejo Y. The Graston Technique increases hamstring flexibility. The Grston technique increases HmstringflexibilityA Thesis Submitted to the Graduate Faculty of the North Dakota State University of Agriculture and Applied ScienceBy ,Advanced Athletic Training May 2014
[19]. Kim J, Yim J. Instrument-assisted soft tissue mobilization improves physical performance of young male soccer players. International journal of sports medicine. 2018 Nov;39(12):936-943.
[20]. Moon JH, Jung JH, Won YS, Cho HY. Immediate effects of Graston Technique on hamstring muscle extensibility and pain intensity in patients with nonspecific low back pain. Journal of physical therapy science. 2017;29(2):224-7.
[21]. D. Kim. Effects of soft tissue mobilization techniques on neuromotor control and stiffness in hamstring shortness (Doctoral dissertation, Graduate School, Yonsei University).2013.
[22]. García-Pinillos F, Martínez-Amat A, Hita-Contreras F, Martínez-López EJ, Latorre-Román PA. Effects of a contrast training program without external load on vertical jump, kicking speed, sprint, and agility of young soccer players. The Journal of Strength & Conditioning Research. 2014 Sep 1;28(9):2452-60.
[23]. Black DW. Treatment of knee arthrofibrosis and quadriceps insufficiency after patellar tendon repair: a case report including use of the graston technique. International journal of therapeutic massage & bodywork. 2010;3(2):14.
[24]. Miners AL, Bougie TL. Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique, ART, eccentricexercise, and cryotherapy. The Journal of the Canadian Chiropractic Association. 2011 Dec;55(4):269.
[25]. Odunaiya NA, Hamzat TK, Ajayi OF. The effects of static stretch duration on the flexibility of hamstring muscles. African journal of biomedical research. 2005;8(2):79-82.
[26]. Hammer WI. The effect of mechanical load on degenerated soft tissue. Journal of Bodywork and Movement Therapies. 2008 Jul 1;12(3):246-56.
[27]. Bourne M, Williams M, Pizzari T, Shield A. A functional MRI exploration of hamstring activation during the supine bridge exercise. International journal of sports medicine. 2018 Feb;39(02):104-9
[28]. Howitt S, Wong J, Zabukovec S. The conservative treatment of trigger thumb using graston techniques and active release Techniques®. The Journal of the Canadian Chiropractic Association. 2006 Dec;50(4):249.
[29]. Ananias BM, Braghiroli FL, Prudêncio DA, da Silveira CB, Sanada LS, Okubo R. Therapeutic heat and cryotherapy increases knee range of movement on hamstring muscles of healthy volunteers. International Journal of Therapy And Rehabilitation. 2017 Dec 2;24(12):528-33.
[30]. Loghmani MT, Fuller EM, Handt R, Neff B, Seasly L, Swartz C, Witted M, March KL. Instrument-assisted soft tissue mobilization in healthy young adult males mobilizes tissue-resident mesenchymal stem cells into circulation. J Orthop Sports Phys Ther 2016; 46: A107
[31]. Romero D. Effects of Instrument-assisted Soft Tissue Mobilization on Isokinetic Knee Extensor Strength and Fatigue (Doctoral dissertation, Oklahoma State University).2014
[32]. Markovic G. Acute effects of instrument assisted soft tissue mobilization vs. foam rolling on knee and hip range of motion in soccer players. Journal of bodywork and movement therapies. 2015 Oct 1;19(4):690-6.
[33]. Vardiman JP, Siedlik JA, Herda TJ, Hawkins WC, Cooper MA, Graham ZA, Deckert JA, Gallagher PM. Instrument-assisted soft tissue mobilization: effects on the properties of human plantar flexors.2014 interntionljournl of sports medicine 2014 Oct 36(03).
[34]. Hoffmeier NJ. Effects of a Single Session Graston Technique on Hamstring Flexibility and Muscle Stiffness of Recreationally Active Individuals (Doctoral dissertation, Oklahoma State University).2014
[35]. Boyer S, Novack J, Madsen LP, Kingma JJ, Schrader JW, Docherty CL. The Immediate Effects of Graston Technique© on Hamstring Flexibility Compared to a Control. Journal of Athletic Training. 2017 Jun 1;52(6):S94.
References
[1]. Requena B, González-Badillo JJ, de Villareal ES, Ereline J, García I, GapeyevaH, Pääsuke M. Functional performance, maximal strength, and power characteristics in isometric and dynamic actions of lower extremities in soccer players. The Journal of Strength & Conditioning Research. 2009 Aug 1;23(5):1391-401.
[2]. García-Pinillos F, Ruiz-Ariza A, Moreno del Castillo R, Latorre-Román PÁ. Impact of limited hamstring flexibility on vertical jump, kicking speed, sprint, and agility in young football players. Journal of sports sciences. 2015 Jul 21;33(12):1293-7.
[3]. Russell M, Benton D, Kingsley M. The effects of fatigue on soccer skills performed during a soccer match simulation. International journal of sports physiology and performance. 2011 Jun 1;6(2):221-233.
[4]. Mendes B, ERCIN T, UZUN K. Examination of flexibility and sprint performance values of adolescent footballers. Turkish Journal of Sport and Exercise. 2015;17(3):16-20.
[5]. Lehance, Cédric, Johnny Binet, Thierry Bury, and Jean-Louis Croisier. "Muscular strength, functional performances and injury risk in professional and junior elite soccer players." Scandinavian journal of medicine & science in sports 19, no. 2 (2009): 243-251.
[6]. Askling, Carl, TönöSaartok, and Alf Thorstensson. "Type of acute hamstring strain affects flexibility, strength, and time to return to pre-injury level." British journal of sportsmedicine 40, no. 1 (2006): 40-44.
[7]. Little T, Williams A. Specificity of acceleration, maximum speed and agility in professional soccer players. . Journal of Strength and Conditioning Research. 2005; 19(1): 76-78.
[8]. Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. journal of orthopaedic& sports physical therapy. 2010 Feb;40(2):67-81.
[9]. BARCELONA EA. Hamstring injuries in football: Applying scientific knowledge to daily on-field practice.– Written by Luis Til et al, Spain
[10]. Bhosale N, Yeole U, Chogle A, Khatri S. Assessment of Lower Extremity Flexibility in Recreational Football Players. International Journal of Research and Analytical Reviews. 2019 june;6(2):2348 –1269.
[11]. Cheatham SW, Lee M, Cain M, Baker R. The efficacy of instrument assisted soft tissue mobilization: a systematic review. The Journal of the Canadian Chiropractic Association. 2016 Sep;60(3):200.
[12]. Hammer WI. The effect of mechanical load on degenerated soft tissue. Journal of Bodywork and Movement Therapies. 2008 Jul 1;12(3):246-56.
[13]. Baker RT, Nasypany A, Seegmiller JG, Baker JG. Instrument-assisted soft tissue mobilization treatment for tissue extensibility dysfunction. International Journal of Athletic Therapy and Training. 2013 Sep 1;18(5):16-21.
[14]. Carey-Longmani, MT, Hammer. WI. GrastonTechniqueâ In: Hammer, WI, ed. Functional Soft-Tissue Examination and Treatment by Manual Methods. Boston, MA: Jones and Bartlett lerning; 2007: 589-625
[15]. Stow R. Instrument-assisted soft tissue mobilization. International journal of athletic therapy and training. 2011 May 1;16(3):5-8.
[16]. Laudner K, Compton BD, McLoda TA, Walters CM. Acute effects of instrument assisted soft tissue mobilization for improving posterior shoulder range of motion in collegiate baseball players. International journal of sports physical therapy. 2014 Feb;9(1):1.
[17]. Baker RT, Nasypany A, Seegmiller JG, Baker JG. Instrument-assisted soft tissue mobilization treatment for tissue extensibility dysfunction. International Journal of Athletic Therapy and Training. 2013 Sep 1;18(5):16-21.
[18]. Nejo Y. The Graston Technique increases hamstring flexibility. The Grston technique increases HmstringflexibilityA Thesis Submitted to the Graduate Faculty of the North Dakota State University of Agriculture and Applied ScienceBy ,Advanced Athletic Training May 2014
[19]. Kim J, Yim J. Instrument-assisted soft tissue mobilization improves physical performance of young male soccer players. International journal of sports medicine. 2018 Nov;39(12):936-943.
[20]. Moon JH, Jung JH, Won YS, Cho HY. Immediate effects of Graston Technique on hamstring muscle extensibility and pain intensity in patients with nonspecific low back pain. Journal of physical therapy science. 2017;29(2):224-7.
[21]. D. Kim. Effects of soft tissue mobilization techniques on neuromotor control and stiffness in hamstring shortness (Doctoral dissertation, Graduate School, Yonsei University).2013.
[22]. García-Pinillos F, Martínez-Amat A, Hita-Contreras F, Martínez-López EJ, Latorre-Román PA. Effects of a contrast training program without external load on vertical jump, kicking speed, sprint, and agility of young soccer players. The Journal of Strength & Conditioning Research. 2014 Sep 1;28(9):2452-60.
[23]. Black DW. Treatment of knee arthrofibrosis and quadriceps insufficiency after patellar tendon repair: a case report including use of the graston technique. International journal of therapeutic massage & bodywork. 2010;3(2):14.
[24]. Miners AL, Bougie TL. Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique, ART, eccentricexercise, and cryotherapy. The Journal of the Canadian Chiropractic Association. 2011 Dec;55(4):269.
[25]. Odunaiya NA, Hamzat TK, Ajayi OF. The effects of static stretch duration on the flexibility of hamstring muscles. African journal of biomedical research. 2005;8(2):79-82.
[26]. Hammer WI. The effect of mechanical load on degenerated soft tissue. Journal of Bodywork and Movement Therapies. 2008 Jul 1;12(3):246-56.
[27]. Bourne M, Williams M, Pizzari T, Shield A. A functional MRI exploration of hamstring activation during the supine bridge exercise. International journal of sports medicine. 2018 Feb;39(02):104-9
[28]. Howitt S, Wong J, Zabukovec S. The conservative treatment of trigger thumb using graston techniques and active release Techniques®. The Journal of the Canadian Chiropractic Association. 2006 Dec;50(4):249.
[29]. Ananias BM, Braghiroli FL, Prudêncio DA, da Silveira CB, Sanada LS, Okubo R. Therapeutic heat and cryotherapy increases knee range of movement on hamstring muscles of healthy volunteers. International Journal of Therapy And Rehabilitation. 2017 Dec 2;24(12):528-33.
[30]. Loghmani MT, Fuller EM, Handt R, Neff B, Seasly L, Swartz C, Witted M, March KL. Instrument-assisted soft tissue mobilization in healthy young adult males mobilizes tissue-resident mesenchymal stem cells into circulation. J Orthop Sports Phys Ther 2016; 46: A107
[31]. Romero D. Effects of Instrument-assisted Soft Tissue Mobilization on Isokinetic Knee Extensor Strength and Fatigue (Doctoral dissertation, Oklahoma State University).2014
[32]. Markovic G. Acute effects of instrument assisted soft tissue mobilization vs. foam rolling on knee and hip range of motion in soccer players. Journal of bodywork and movement therapies. 2015 Oct 1;19(4):690-6.
[33]. Vardiman JP, Siedlik JA, Herda TJ, Hawkins WC, Cooper MA, Graham ZA, Deckert JA, Gallagher PM. Instrument-assisted soft tissue mobilization: effects on the properties of human plantar flexors.2014 interntionljournl of sports medicine 2014 Oct 36(03).
[34]. Hoffmeier NJ. Effects of a Single Session Graston Technique on Hamstring Flexibility and Muscle Stiffness of Recreationally Active Individuals (Doctoral dissertation, Oklahoma State University).2014
[35]. Boyer S, Novack J, Madsen LP, Kingma JJ, Schrader JW, Docherty CL. The Immediate Effects of Graston Technique© on Hamstring Flexibility Compared to a Control. Journal of Athletic Training. 2017 Jun 1;52(6):S94.
[2]. García-Pinillos F, Ruiz-Ariza A, Moreno del Castillo R, Latorre-Román PÁ. Impact of limited hamstring flexibility on vertical jump, kicking speed, sprint, and agility in young football players. Journal of sports sciences. 2015 Jul 21;33(12):1293-7.
[3]. Russell M, Benton D, Kingsley M. The effects of fatigue on soccer skills performed during a soccer match simulation. International journal of sports physiology and performance. 2011 Jun 1;6(2):221-233.
[4]. Mendes B, ERCIN T, UZUN K. Examination of flexibility and sprint performance values of adolescent footballers. Turkish Journal of Sport and Exercise. 2015;17(3):16-20.
[5]. Lehance, Cédric, Johnny Binet, Thierry Bury, and Jean-Louis Croisier. "Muscular strength, functional performances and injury risk in professional and junior elite soccer players." Scandinavian journal of medicine & science in sports 19, no. 2 (2009): 243-251.
[6]. Askling, Carl, TönöSaartok, and Alf Thorstensson. "Type of acute hamstring strain affects flexibility, strength, and time to return to pre-injury level." British journal of sportsmedicine 40, no. 1 (2006): 40-44.
[7]. Little T, Williams A. Specificity of acceleration, maximum speed and agility in professional soccer players. . Journal of Strength and Conditioning Research. 2005; 19(1): 76-78.
[8]. Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. journal of orthopaedic& sports physical therapy. 2010 Feb;40(2):67-81.
[9]. BARCELONA EA. Hamstring injuries in football: Applying scientific knowledge to daily on-field practice.– Written by Luis Til et al, Spain
[10]. Bhosale N, Yeole U, Chogle A, Khatri S. Assessment of Lower Extremity Flexibility in Recreational Football Players. International Journal of Research and Analytical Reviews. 2019 june;6(2):2348 –1269.
[11]. Cheatham SW, Lee M, Cain M, Baker R. The efficacy of instrument assisted soft tissue mobilization: a systematic review. The Journal of the Canadian Chiropractic Association. 2016 Sep;60(3):200.
[12]. Hammer WI. The effect of mechanical load on degenerated soft tissue. Journal of Bodywork and Movement Therapies. 2008 Jul 1;12(3):246-56.
[13]. Baker RT, Nasypany A, Seegmiller JG, Baker JG. Instrument-assisted soft tissue mobilization treatment for tissue extensibility dysfunction. International Journal of Athletic Therapy and Training. 2013 Sep 1;18(5):16-21.
[14]. Carey-Longmani, MT, Hammer. WI. GrastonTechniqueâ In: Hammer, WI, ed. Functional Soft-Tissue Examination and Treatment by Manual Methods. Boston, MA: Jones and Bartlett lerning; 2007: 589-625
[15]. Stow R. Instrument-assisted soft tissue mobilization. International journal of athletic therapy and training. 2011 May 1;16(3):5-8.
[16]. Laudner K, Compton BD, McLoda TA, Walters CM. Acute effects of instrument assisted soft tissue mobilization for improving posterior shoulder range of motion in collegiate baseball players. International journal of sports physical therapy. 2014 Feb;9(1):1.
[17]. Baker RT, Nasypany A, Seegmiller JG, Baker JG. Instrument-assisted soft tissue mobilization treatment for tissue extensibility dysfunction. International Journal of Athletic Therapy and Training. 2013 Sep 1;18(5):16-21.
[18]. Nejo Y. The Graston Technique increases hamstring flexibility. The Grston technique increases HmstringflexibilityA Thesis Submitted to the Graduate Faculty of the North Dakota State University of Agriculture and Applied ScienceBy ,Advanced Athletic Training May 2014
[19]. Kim J, Yim J. Instrument-assisted soft tissue mobilization improves physical performance of young male soccer players. International journal of sports medicine. 2018 Nov;39(12):936-943.
[20]. Moon JH, Jung JH, Won YS, Cho HY. Immediate effects of Graston Technique on hamstring muscle extensibility and pain intensity in patients with nonspecific low back pain. Journal of physical therapy science. 2017;29(2):224-7.
[21]. D. Kim. Effects of soft tissue mobilization techniques on neuromotor control and stiffness in hamstring shortness (Doctoral dissertation, Graduate School, Yonsei University).2013.
[22]. García-Pinillos F, Martínez-Amat A, Hita-Contreras F, Martínez-López EJ, Latorre-Román PA. Effects of a contrast training program without external load on vertical jump, kicking speed, sprint, and agility of young soccer players. The Journal of Strength & Conditioning Research. 2014 Sep 1;28(9):2452-60.
[23]. Black DW. Treatment of knee arthrofibrosis and quadriceps insufficiency after patellar tendon repair: a case report including use of the graston technique. International journal of therapeutic massage & bodywork. 2010;3(2):14.
[24]. Miners AL, Bougie TL. Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique, ART, eccentricexercise, and cryotherapy. The Journal of the Canadian Chiropractic Association. 2011 Dec;55(4):269.
[25]. Odunaiya NA, Hamzat TK, Ajayi OF. The effects of static stretch duration on the flexibility of hamstring muscles. African journal of biomedical research. 2005;8(2):79-82.
[26]. Hammer WI. The effect of mechanical load on degenerated soft tissue. Journal of Bodywork and Movement Therapies. 2008 Jul 1;12(3):246-56.
[27]. Bourne M, Williams M, Pizzari T, Shield A. A functional MRI exploration of hamstring activation during the supine bridge exercise. International journal of sports medicine. 2018 Feb;39(02):104-9
[28]. Howitt S, Wong J, Zabukovec S. The conservative treatment of trigger thumb using graston techniques and active release Techniques®. The Journal of the Canadian Chiropractic Association. 2006 Dec;50(4):249.
[29]. Ananias BM, Braghiroli FL, Prudêncio DA, da Silveira CB, Sanada LS, Okubo R. Therapeutic heat and cryotherapy increases knee range of movement on hamstring muscles of healthy volunteers. International Journal of Therapy And Rehabilitation. 2017 Dec 2;24(12):528-33.
[30]. Loghmani MT, Fuller EM, Handt R, Neff B, Seasly L, Swartz C, Witted M, March KL. Instrument-assisted soft tissue mobilization in healthy young adult males mobilizes tissue-resident mesenchymal stem cells into circulation. J Orthop Sports Phys Ther 2016; 46: A107
[31]. Romero D. Effects of Instrument-assisted Soft Tissue Mobilization on Isokinetic Knee Extensor Strength and Fatigue (Doctoral dissertation, Oklahoma State University).2014
[32]. Markovic G. Acute effects of instrument assisted soft tissue mobilization vs. foam rolling on knee and hip range of motion in soccer players. Journal of bodywork and movement therapies. 2015 Oct 1;19(4):690-6.
[33]. Vardiman JP, Siedlik JA, Herda TJ, Hawkins WC, Cooper MA, Graham ZA, Deckert JA, Gallagher PM. Instrument-assisted soft tissue mobilization: effects on the properties of human plantar flexors.2014 interntionljournl of sports medicine 2014 Oct 36(03).
[34]. Hoffmeier NJ. Effects of a Single Session Graston Technique on Hamstring Flexibility and Muscle Stiffness of Recreationally Active Individuals (Doctoral dissertation, Oklahoma State University).2014
[35]. Boyer S, Novack J, Madsen LP, Kingma JJ, Schrader JW, Docherty CL. The Immediate Effects of Graston Technique© on Hamstring Flexibility Compared to a Control. Journal of Athletic Training. 2017 Jun 1;52(6):S94.