Tools of The Trade: The Graston Technique

Staten Island Advance (NY)
February 11, 2008
STATEN ISLAND, N.Y. - Over the last four weeks, Jacqueline Friscia has gained strength and mobility in her right arm. Equally important, she no longer has back and neck pain.
A 10-minute treatment called the Graston Technique is helping the 21-year- old School of Visual Arts student get on with her life after breaking her right shoulder on New Year's Day 2007 when a friend fell onto her.
The "silly" accident, as the Randall Manor woman describes it, caused her shoulder and arm to be immobilized for about five months. Scar tissue and adhesions formed around the injured area, limiting her range of motion and making movements painful.
To remedy the pain, Friscia opted to try the Graston Technique - which can be used on back pain, tennis elbow, carpal tunnel syndrome, hamstring pulls and other soft-tissue injuries - offered by Dongan Hills chiropractor Dr. Frank Mandarino.
"I go to art school, so I'm on my feet a lot. Because of that my back starts to tense up," explains Friscia. "Since I've been treated, I can stand for longer hours and use my arm more freely." Using a curiously-shaped stainless steel instrument - one of six such devices in his kit - Mandarino can work on the affected area horizontally, vertically, and diagonally. The different shapes of each tool accommodate different areas of the body.
BEVELED EDGES
Similar to massage therapy, the movement brings an increase in blood flow and nutrients to Friscia's shoulder and cervical spine. But the Graston Technique allows the cross fiber massage to penetrate further. The tools' single- and double-beveled edges break down and separate scar tissue, which is absorbed by the body.
A lotion applied to Friscia's neck and shoulder prior to treatment allows the instrument to glide over skin without pulling or irritating it. Mandarino grasps the tool with his left hand and sets to work. At first, the tool in his hand smoothly sweeps over Friscia's shoulder. As the tool's edge goes over an area of adhesions, it reverberates with a gravel-like grittiness. Both Mandarino and Friscia can feel he's hit a problem spot.
The chiropractor continues to comb over the band of fibrotic tissue. After about two minutes, the area reddens and he moves on to another spot.
"I couldn't have done with my hands what this technique can do to soft tissue," says Mandarino. "I'm goading this tissue. Ultimately, the idea is to break up these adhesions and realign the tissue."
Next, Mandarino has Friscia do some lateral arm raises with a 3-pound dumbbell. This introduces functional movement into the treatment mix. "When a person is in a static position you can only get so far," says Mandarino, as he maneuvers the tool onto her upper right arm. "When they are causing the muscles to contract, it allows the technique to go even deeper."
And it's working for Friscia. Her treatment also includes using moist heat pads, or doing some cardio prior to the Graston Technique, followed by applying cold to the treated area and stretching.
"I'm feeling so fantastic now," says Friscia. "I'm not tense anymore. I'm not sore. I'm not asking my dad all the time to rub my back."
HOW IT BEGAN
The technique was developed in the early 1990s by machinist and competitive water skier David Graston, who suffered a serious knee injury that failed to respond to surgery and traditional therapies.
Frustrated, Graston began to rehab himself using a cross friction massage technique that a therapist had taught him. The constant self-massaging tired his hands and he developed tools to do the work instead.
Today, more than 3,500 clinicians worldwide - including athletic trainers, chiropractors and physical therapists - use his namesake technique. Mandarino, a diplomate of the American Chiropractic Board of Sports Physicians, who also has practices in Brooklyn, Queens and the Bronx, became interested in the technique to help with many of his clients' sports- related injuries, including those of professional athletes.
According to Chris Richey, marketing manager for the Graston Technique, Mandarino is the only provider of the registered and trademarked treatment on Staten Island. The Gras ton Technique is owned by Indianapolis, Ind.- based TherapyCare Resources Inc. It was co-founded by Graston, who left the company to start Carpal Therapy Inc., which uses a similar soft-tissue treatment.

Dr. Mandarino Uses Special Technique

By - Rob M. Errara
May 8 - May 14 2008
Home Reporter and Sunset News - P.62
Dr. Frank J. Mandarino has been a practicing chiropractor since 1991 and has since opened an office in four of the New York's five boroughs. His Bay Ridge office was originally located on 83rd Street but is now located at 7601 Fifth Ave. due to the need for a larger space.
Not content with using traditional methods to treat the aching joints of his patients, Mandarino has taken up the Graston Technique, a soft tissue treatment the focuses on the area of the pain's rigination instead f only the area of pain.
"I don't believe in treating a patient, knowing they'll never get better", said Mandarino. "With the Graston Technique I can treat the source of the problems."
Mandarino and colleague Dr. Dominic Rubino are the only doctors in the area who practice the Graston technique. This chiropractic method treats the soft tissue connected to the painful area and is used by more than 3000 clinicians including athletic trainers, chiropractors, hand therapists and occupational and physical therapists.
"Patients come in for anything softtissue related, but I will also treat people with extremity problems," said Mandarino.
The Graston Technique uses spedial metal instruments that are curved in a conve/concave manner, mimicking the contours of various portions of the body. In this way, the Graston tools break up soft tissue adhesions and allow maximum tissue penetration.
The instruments resonate in the clinicians hands similarly to the way a tuning fork for would, allowinf the clinician to isolate adhesions and cosntrictions. Once isolated the problem can be treated precisely as the instruments amplify what the hands can feel - similar to the way a stethoscope amplifies hearing.
Most importantly, the procedure eliminates pain.
"Most symptoms that we havd do not necessarily come from the specific area of involvement," Mandarino said "If someonehas knee pain, it can be coming from the thigh muscles or the hip. What makes Graston so unique is that by addressing the soft tissue we are able to alleviate a lot of patient's problems."
There are only three other Graston practicing doctors in Brooklyn, located in Bergen Beach, Coney Island, and Park Slope. Mandarino is also the only practioner of the Graston Technique in Staten Island, where he has an office on Richmons Road.
Mandarino's practice treats a variety of acute and chronic pain, including headaches, neck pain, back pain, Carpal Tunnel Syndrome, Golfer's Elbow, Fibromyalgia, scar tissue and more. "I treat a number of athletes and wanted to further enhance my skills as well as treating standalone skeletal injuries," he said.
One woman Mandarino recently treated - a nurse - had fallen in December of last year. The nurse who used to walk four miles a day hurt her foot so badly that she could not walk at all. "I feel so much better now," said the nurse, during her fourh session.
After only three Graston Technique treatments as Mandario's Bay Ridge office, the woman had regained full motion in her ankle and could put pressure on the foot.
Though the treatment is different for each person, the nurses Graston treatment lasts 15 minutes on average, not including prepping time.
Before a Graston session the patiient is first prepped with a laser therapy treatment. This can take between 5 and 15 minutes and includes careful placement of superficial light superluminescent diodes(SLD) and phototherapy on the pained area. Phototherapy uses a cold laser to directly stimulate the cells and promote healing, though this part of the treatment is not used on cancer patients or patients who had cancer less than 5 years prior to the visit, pregnant women, or on open wounds. Dr. Frank Mandarino is available at his Bay Ridge off ice on Mondays. To make an appointment with Mandarino or Rubino call 718-748-9624. Most insurances are accepted and immediate appointments are available. For more information on the technique and for other locations, visit www.mandarinochiropractic.com

Ready! Set! Tape!

By: Andrea Boyarsky
Staten Island Advance (NY)
August 25, 2008
Over the last two-and-half weeks, American TV viewers have noticed a curious-looking black marking on beach volleyball star Kerry Walsh's right shoulder.
Is it a tatoo? Some kind of symbol representing team spirit? A really strange bandage?
As she spiked balls and returned shots with partner Misty May-Treanor, the two time Gold Medalist wore Kinesio Tex Tape.
For Walsh who had rotator cuff injury that resulted in surgery, the trademarked tape aids with blood flow and muscle support in her shoulder. The Albuquerque, N.M.-based Kinesio Taping Association (KTA) has been working with Walsh's trainers for about two years, according to director John Jarvis.
"She went into surgery in November for her shoulder and uses it [Kinesio Tape] now for rehabilitative purposes", Jarvis explained. "She would find after a match she had swelling and the tape decreases swelling."
Kinesio Tape has been around for about 27 years in Japan and nine in the United States.
The method was founded by Dr. Kenzo Kase of Japan who believed the body could heal itself if correctly positioned.
Kinesio Tex Tape is made of 100 percent cotton and is 140 percent elastic, offering the same flexibility as human skin, the KTA states. It contains no medicine and stays on for three to four days. The tape comes in black, nude, pink, and blue based on preference.
The tape lifts the skin's top layer and massages it as it moves with the body, increasing blood and lymph flow and decreasing discoloration and inflammation.
A thumb print like pattern on the back side of the tape aids in circulation to the area.
"It has a wave-like impression [on the back side] that mimics your hands giving a massage", said Jarvis. "Your body is in constant movement, the tape elongates and retracts in accordance." Prior to the Olympics, the KTA's Web site recieved around 1500 new hits per day. The day after Walsh wore it, the site logged more than 78,000 hits. Orders for the tape Walsh uses jumped from 300 a month to 2800.
Other Olympic athletes including Latvian beach volleyball player Martins Plavins have been seen wearing Kinesio Tape throughout the summer games. Athletes Lance Armstrong, Serena Williams and David Bekham also have been spotted wearing the tape.
"What athletes really like especially the high profile ones, is that it does not effect biomechanics", Jarvis noted. "If they can't go through the same motions each time, it will affect their performance."
But athlettes are actually the smallest population of users, said Jarvis. The biggest (48 percent) is pediatrics, where it's used to help treat a number of disorders, including those that affect muscle function like cerebral palsy.
Jarvis added that there are 1,100 Kinesio Taping applications that benefit different age groups and body parts. It is used by a variety of medical practitioners, including physical and occupational therapists, chiropractors, medical doctors and plastic surgeons.
Expert Taping While the tape is available online for purchace, KTA experts advise against trying to use the tape without consulting a certified Kinesio Taping practitioner. Muscular pain needs to be assessed to determine its origin, they say, which then determines where the tape is positioned for correct muscle support.
Dr. Frank Mandarino, a Dongan Hills chiropractor, became a certified Kinesio Taping practitioner in May. He ususally uses the tape in conjunction with the Graston Technique, a soft tissue treatment using instruments that correct muscle, tendon and ligament problems.
"Kinesio helps with muscular weakness, by giving it support," Dr. Mandarino said. "It's a nice adjutant [to Graston] that provides ultimate care".
Fran Galok of Oakwood has been undergoing Kinesio Taping with Dr. Mandarino on her lower back and neck. The treatments also help with her shoulder pain.
The 57 year old nurse injured her left shoulder about 33 years ago when a lift she was using to transport a patient broke and fell on her. For years, her shoulder would hurt whenever she was sick or tired. Throwing her back out more than 20 years ago only added to her suffering.
"Like the shoulder, it became nagging, constant discomfort, she said. "Between the two sites, I was like 'I can't take it. I have to do something."
Ms. Galok comes twice weekly for Graston and Kinesio Taping and also recieves acupuncture. Immediately after taping she feels muscle support, which she believes prolongs the effects of the other treatments.
For Daniel Colacrai of Graniteville, 26 years as an elevator mechanic left him with pain in his left shoulder from carrying heavy materials. Colacrai, 56, couldn't lift his left arm above his head, put his hand in his pocket or enjoy recreational sports.
In addition he is a liver and kidney transplant recipient, having recieved the life saving organs two years ago. Before he became sick, he was around 230 pounds and muscular. Afterward he whittled down to about 80 and his muscles were severely weakened.
"I'm free again," he said. "My golf swing is good. I bowl great. They did a great job."

A master at connective tissue issues

By Majorie Hack
June 2, 2010
ALL SHORESSTATEN ISLAND, N.Y. — Just 18 years old, he was living in Long Island, when Mother Nature dumped a nice heavy topcoat on his family’s home. Armed with shovels, Dr. Mandarino, along with his brother and father, headed out to clear the driveway and sidewalks.It didn’t take long, said Dr. Mandarino, before “I killed my back.”He was taken to a chiropractor who, almost magically, got him back on his feet, free of pain, in a jiffy. After that, all thoughts of becoming an eye surgeon went out the window. Dr. Mandarino wanted to follow in his healer’s footsteps.Dr. Mandarino sees some 300-400 patients a week, many of whom come with sports injuries and problems following a surgery.He earned a bachelor’s degree from Nassau Community College, as part of a special program for pre-med and pre-chiropractic students, then went on to future study in Iowa, followed by a preceptorship, a type of mentoring by a certified professional.There are thousands of people on Staten Island who swear by their chiropractor; there are also many who steer clear of these specialists, saddled as they are with the sights and sounds of back-cracking and electrical stimulation. Dr. Mandarino, who recently moved into an expansive new treatment facility at 2052 Richmond Rd. in Grant City, believes those who are leery of the specialty still associate it with old school theories like these that were rooted in the belief that biomechanical deficits with the joints were at the root of many movement problems."There are still chiropractors who subscribe to this,” said Dr. Mandarino, but he doesn’t.“It’s not the joint; it’s the connective tissue” that’s usually the problem, he said. That’s because connective tissue is encased in something called fascia, basically a webbing that enables muscles to glide over each other.When there’s a problem with the tissue, said Dr. Mandarino, a patient might say, “My knee hurts, but it could be your quadricep” where the problem is really rooted.Dr. Mandarino, who sees some 300-400 patients a week, many of whom come with sports injuries and problems following a surgery, is a big believer in something called the Graston Technique, a specialized kind of soft tissue manipulation that was five years in development and first began to be taught to clinicians in 1999.The technique is a patented form of instrument-assisted soft tissue manipulation that breaks down scar tissue and fascial restrictions. Specially designed stainless steel instruments are used to detect and treat diseased or inflamed areas. About 7,500 practitioners worldwide now offer the therapy“The results are amazing,” said Dr. Mandarino.He’s also incorporated physical therapy into his practice — hence, the new, all-in-one treatment facility that was once an old funeral home. Today, the space includes exam rooms, offices, a massage room, complete with fountain, and a gym. It’s a far cry from his 100 square-foot home office, where he started.Dr. Mandarino said he sees patients at all ends of the spectrum — from the very active, who develop problems because of too much repetitive activity, to the couch potato who experiences pain or discomfort with even the slightest movement.Many people show up with a strike against them that can be easily corrected: Bad posture due to “weak core muscles,” said Dr. Mandarino.People with perfect posture can stand against a wall and everything lines up against that wall. They can maintain the line even while walking forward. Those with weak core muscles, however, may be able to line up properly but as they begin to move forward, they tend to lose the straight line and bend forward, said Dr. Mandarino.Working with devices called Body Blades isolates the smaller muscle groups responsible for this slump and strengthens them.Dr. Mandarino is a Diplomate of the American Chiropractic Board of Sports Physicians — one of just 220 worldwide. He sees and treats a lot of athletes — among them players on the New York Yankees and the Miami Dolphins, though he was reluctant to release names without permission.Locally, Dr. Mandarino treats the weekend warrior and those seriously in the hunt for athletic glory who dedicate a part of every day to training; he treats the young and the older — all of whom can experience pain and discomfort because of poor biomechanics. This, in turn, can lead to adhesions and connective tissue dysfunction, he said.In other words, if you didn’t learn how to throw a baseball the correct way as a child, or perform correctly from the get-go on the balance beam in gymnastics, you’re more likely than someone who learned properly to end up with a connective tissue problem.Advice and instruction by a certified trainer can nip a lot of problems in the bud, said Dr. Mandarino, and he employs some on his staff. He also practices what he preaches — not just with his patients on Staten Island but at home in New Jersey with himself and his children —14- and 8-year-old boys, who play sports, and his 3-year-old son and 5-year-old daughter.Dr. Mandarino is in practice with Dr. Jason Brattner. Their office is at 2052 Richmond Rd. Call 718-667-2190. The Web site is www.mandarinochiropractic.com.

Dr. Frank J. Mandarino’s chiropractic practice raise the bar with a newly relocated facility, state-of-the-art therapies.

By Barry Horowitz – Relevant Public Relations
We are living in a wondrous age filled with invention: Solar energy, Apple iPads, the Internet - and Dr. Frank J. Mandarino. An award-wining chiropractor, Dr. Mandarino is noted for incorporating state-of-the-art therapies into the vibrant practice he launched nearly two decades ago. Dr. Mandarino’s widespread reputation for healing patients and ridding them of acute or chronic pain has resulted in four successful offices, including locations in the Bronx, Queens and Brooklyn, and his newly relocated ultra-modern Staten Island facility at 2052 Richmond Rd., Grant City Dr. Mandarino’s long time embrace of highly advanced therapies grew from concern over his patients, many of whom are athletes. “I felt more needed to be done to resolve their pain issues,” he said. Dissatisfied with the results of traditional treatment for some patients, Dr. Mandarino broadened the range of his therapies by earning certifications in the Graston and Active Release Techniques — which address soft-tissue and movement problems associated with back pain, tennis elbow, carpal tunnel syndrome and other conditions and Kinesio and Spider Tech therapeutic taping, which help to reduce strain on affected muscles and improve circulation. “Adjusting the spine is just one component of a remedy; if you don’t treat the soft tissue and connective tissue, you’re not going to get the patient better,” said Dr. Mandarino, who teaches the Graston Technique to health-care professionals throughout the Northeast. Dr. Mandarino’s successful health-care approach has earned him the prestigious U.S. Commerce Association’s Best of Staten Island Award, in the Chiropractors category for the second consecutive year. According to the organization, only one in 70, or 1.4 percent, of its award recipients in 2009 qualified as a two- time winner. Dr. Mandarino’s revolutionary treatments are a dream-come-true for some pain-weary patients whose previous visits to physicians, physical therapists, massage therapists, and even other chiropractors, had failed to provide relief. “My greatest reward is sharing in the happiness of a patient who, before being treated in my office, feared having to cope with pain for a life- time,” Dr. Mandarino said. Although Dr. Mandarino treats numerous athletes, you don’t need to be a golfer, football player or track star to benefit from his high level of care. “I treat standard problems, such as neck and back pain, with the same state-of-the art procedures, and obtain great results,” he said. If the anticipation of feeling better isn’t enough to inspire a visit to Dr. Mandarmno’s Grant City practice, the environment itself may contribute, at least in small part, to your recovery. The 3,500-square-foot office looks and feels more like a luxury spa than a medical facility. Everything about the location makes visitors feel relaxed, welcome and pampered, from ample onsite parking to a posh reception area, variety of treatment rooms — including one dedicated to mass age therapy and a modern gym. And, of course, there is Dr. Mandairno’s friendly and accommodating support staff. The beautifully renovated multi-tenant office building is a Staten Island treasure, with a history that dates back to 1920s, when the borough was a summertime vacation destination. For additional information, or to schedule an appointment, Dr. Mandarino’s Grant City office may be reached at 718-667-2190 or t:jmdc@aol.com. Barton Horowitz is the presid ent of Relevant Public. Relations, LLC. He may be reached at 718-682-1509, at BHorowitz@RelevantpR.com or on the Web at www.RelevantPR.com.