










































MANUSCRIPT TYPE


DISABLEMENT MODEL CASE STUDY 

 

36 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 5 – Issue 1 – April 2022 
 

Graston Technique® Combined with Therapeutic Intervention as an 
Alternative Treatment for a Grade III UCL Thumb Sprain: A 
Disablement Model Case Study 
Raul Anaya Jr. LAT, ATC*; Kim Bacalla, DAT, MBA, LAT, ATC†; Annette D. Monk, DAT, LAT, ATC‡ 
*Lake Forest College, Lake Forest, IL, †Baptist Health South Florida, Coral Gables, FL ‡Trinity International University, Deerfield, IL 
  

 
ABSTRACT 
Nonoperative measures have been shown to have positive 
effects on thumb ulnar collateral ligament (UCL) sprains 
considered less than complete. This case presents evidence 
supporting Graston Technique® (GT) plus therapeutic 
exercise in order to decrease pain and stiffness in a 
collegiate football athlete who sustained a grade III UCL 
sprain. The results showed that there was a reduction in pain 
level above the minimal clinically importance difference, and 
ROM improved throughout the three-week intervention. The 
findings of this case study provide minimal support for an 
alternative treatment to reduce pain and stiffness in a grade 
III UCL sprain, with further research needed. 
 
Key Phrases 
College and university patient population, patient-reported 
outcomes, therapeutic exercise 
 
Correspondence 
Dr. Annette Monk, 2065 Half Day Road, Trinity 
International University, Department of Health Sciences 
Deerfield, IL, 60015 
E-mail: admonk@tiu.edu  
 
Full Citation 
Anaya R, Bacalla K, Monk AD. Graston technique 
combined with therapeutic intervention as an 
alternative treatment for a grade III UCL thumb sprain: 
A disablement model case study. Clin Pract Athl Train. 
2022;5(1): 36-45. 
https://doi.org/10.31622/2022/0005.01.6.    
 
Submitted: May 4, 2020 Accepted: May 4, 2021. 

 
INTRODUCTION 

The term Skier’s Thumb refers to the acute 
mechanism of injury associated with the ulnar 
collateral ligament (UCL) of the first 
metacarpophalangeal (MCP) joint.1,2 The term 
Gamekeeper’s thumb, similar in nature, is 
characterized by chronic repetitive stresses 
placed on the same joint.1,2 For this case study, 
Skier’s thumb is a more accurate representation of 
the injury in question. Injury to the thumb MCP joint 
is considered common in athletics.3 According to a 
study conducted by Werner et al, 63% of isolated 
UCL sprains examined on a single NFL 

team required surgical intervention. 3 Surgery 
is a common treatment method for grade III thumb 
UCL sprains while non-operative treatment is 
vastly accepted for grades I and II.4 Yet, 
a systematic review indicated that there is no 
consensus regarding surgical indications for thumb 
UCL injuries.5 A previous investigation of non-
operative intervention for UCL injuries has shown 
favorable results, including patient satisfaction 
and grip strength.6 Additionally, treatment of 
canine grade III ligamentous injury has suggested 
that conservative treatment with early 
mobilization has improved tensile 
strength compared to surgical treatment with 
immobilization.7  

Non-surgical conservative treatment of a 
UCL injury includes a recommended early 
immobilization of the injured MCP joint followed 
by therapeutic intervention.8 Early immobilization 
aims to protect the injured joint by restricting 
motion.9 The duration of immobilization is a fine 
balance between too long, which may lead to joint 
stiffness, and too short, which may not allow 
sufficient healing time.8 Although joint protection 
through immobilization is necessary, motion loss 
and/or muscle atrophy can occur at its 
expense.9 Suggested immobilization time ranges 
from 3 to 12 weeks, but the outcomes associated 
with such extended 
immobilization are unknown.8,10 The treatment 
principles which allow motion while concurrently 
avoiding additional injury are sought after 
because of its evidenced support in decreasing 
pain and inflammation throughout the healing 
process.9    

Instrument assisted soft tissue mobilization (IASTM) 
has been found to cause physiological changes 

mailto:admonk@tiu.edu
https://doi.org/10.31622/2022/0005.01.6


Graston Technique Combined with Therapeutic Intervention as an Alternative Treatment for a Grade III UCL Thumb Sprain: A 
Disablement Model Case Study 

 

 

37 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 5 – Issue 1 – April 2022 

and acts as an enhancement to the healing 
process of ligaments via significant increase in 
proportion of blood vessels and fibroblastic 
activity.11-13 It has also been shown to improve 
collagen formation in injured ligaments of rodent 
models.13 The current case study specifically 
addresses the proliferative phase of healing, 
where collagen formation occurs.  At 
approximately 3 days following an injury, 
injured soft tissue begins to repair and 
regenerate and continues over the next 3 to 6 
weeks.14 Over several weeks, angiogenesis, 
fibroplasia, generation of new epithelial tissue 
and wound contraction occur, as the damaged 
cells at the site of injury are replaced with scar 
tissue.14 As the new collagen tissue matrix is 
forming, the new blood supply is supporting the 
tissue with nutrients, resulting in the formation of a 
vascularized bulk of immature connective 
tissue.14 The developing tissue includes type I and 
type III collagen; type III being especially 
significant because of its power to form cross-links 
that provide stabilization to the healing 
tissue.14 Instrument assisted soft tissue mobilization 
can be considered controlled local microtrauma, 
causing local inflammation in the tissue in an effort 
to support the healing process. Multiple 
treatments of IASTM have been shown to increase 
tissue perfusion when initiated one week following 
injury of a ligament.12 Additionally, IASTM 
combined with rehabilitation exercises has been 
suggested as an alternative to surgical 
intervention.12,13 The Graston Technique ® (GT) is 
a form of IASTM and is widely used across 
medical rehabilitation professions such as athletic 
training, physical therapy, and occupational 
therapy. The Graston Technique® uses stainless 
steel instruments specifically designed to apply 
controlled forces to muscles, tendons, and 
ligaments of the body.12,13 The aim of 
completing GT and therapeutic exercise in the 
current case study was to improve the limitations 
reported in a grade III thumb UCL sprain. 

 

PATIENT INFORMATION  

The patient was an 18-year-old male NAIA 
collegiate football athlete who presented to the 
athletic training facility with pain and swelling in 
his right thumb. Mechanism of injury 
(MOI): the patient reached across his body to 
deflect an incoming pass, the football hit his open 
palm and hyper-abducted his first MCP joint of 
the right hand. Otherwise, the 
patient was considered healthy and free from 
injury. The uniqueness of this case has 
two parts. The first aspect of uniqueness 
is that the injury sustained was diagnosed as a 
grade III sprain, and surgery was not 
recommended by the referred hand 
specialist. Conservative rehabilitation for the 
injury immediately began and 
continued during the three weeks prior 
to seeing the hand specialist. Upon evaluation, the 
specialist recommended that all treatment 
be ceased, and the patient be placed in a 
thumb spica splint throughout the day and 
allowed to return to sport. A removable hard 
cast was provided for practice and game 
competition. The second portion of uniqueness 
concerns the treatment provided in this case study, 
as the use of GT combined conservative 
rehabilitation for treatment of a grade III thumb 
UCL sprain is the first report to our knowledge.  

DIFFERENTIAL DIAGNOSIS AND 
EVALUATION  

The patient was initially evaluated the same day 
of injury by the athletic training staff, which 
included the head athletic trainer and athletic 
training student. Upon inspection of the hand there 
was moderate swelling and mild bruising along 
the thenar eminence and point tenderness in the 
first MCP joint. There were no symptoms of 
numbness or tingling and no obvious deformities 
noted. The patient had no previous history of hand 
injuries. The patient reported that his thumb felt 
“stiff and as if it was throbbing.” A decrease in 
flexion, extension, and abduction due to pain was 



Graston Technique Combined with Therapeutic Intervention as an Alternative Treatment for a Grade III UCL Thumb Sprain: A 
Disablement Model Case Study 

 

 

38 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 5 – Issue 1 – April 2022 

observed of the patient’s active range of motion 
(AROM). The assessment of passive range of 
motion (PROM) showed a decrease in flexion and 
abduction. The strength deficits that 
were observed in grip, flexion, 
extension, abduction and adduction were 
observed and confirmed through subjective 
bilateral comparison. Manual muscle tests (MMTs) 
were attempted but unable to be completed due 
to pain. Joint laxity was discovered through a 
valgus stress test of the first 
metacarpophalangeal joint. Special tests 
exhibited negative results in tap/percussion test, 
tuning fork, and varus stress test. The patient was 
believed to have sustained a moderate to severe 
sprain of the UCL in the first MCP joint. The patient 
was placed in a wrist and thumb soft splint for 
immobilization for approximately 5 days until he 
was able to see the team physician. No 
rehabilitation took place during this time, other 
than the application of cold modalities via ice tub 
or ice bag. The recommendation to the patient 
was that the splint was only removed when 
necessary (i.e., showers and therapeutic 
treatment) but otherwise worn day and night. 
The patient was referred to the team physician 
who confirmed the findings of the athletic trainer 
and athletic training student. The team physician 
recommended that the patient continue with 
splinting and provided a referral to a hand 
specialist. The patient continued to wear the soft 
thumb splint until his appointment with the hand 
specialist. Sport participation had ceased 
since the time of initial evaluation by the athletic 
trainer. Non-steroidal anti-inflammatory 
drugs (ibuprofen) was suggested on an as-
needed basis for pain. During this time, there 
were no restrictions noted by the team physician 
for controlled rehabilitation of the hand.  

BODY STRUCTURE AND FUNCTION  

The patient identified as right hand dominant and 
reported limitation in activities of daily living 
(ADLs), social leisure, and sport participation. The 
patient reported severe difficulty turning 

doorknobs, opening jars, writing, gripping a 
toothbrush, lifting weights, gripping a video 
game controller, shaking someone’s hand, and 
catching a football. The impact of the injury on the 
patient is illustrated using the International 
Classification of Functioning, Disability and Health 
(ICF) Disablement Model15 in Figure 1.   

ACTIVITY AND PARTICIPATION  

The athletic training staff, team physician, and 
patient agreed that the patient would not 
engage in football practice until evaluated and 
cleared by the orthopedic hand specialist. 
Additionally, the patient was not participating in 
any other physical activity involving the use of his 
right hand. However, the patient was able 
to continue cardiovascular exercise in the athletic 
training facility and allowed to participate in 
conditioning with his team. At school, he reported 
and inability to write legibly and effectively type 
notes on his computer without restriction or pain. 
The patient explained on multiple occasions that 
he did not feel as if he could function properly in 
everyday life because anything involving his right 
hand was limited.  

Socially, there were moments 
where the patient felt excluded from leisure 
activities because he could not participate with his 
friends. During rehabilitation, the athletic training 
staff would ask about the patient’s life outside of 
football. He admitted there were moments he 
felt dispirited while hanging with friends 
because it often revolved around 
playing videogames. Given the injury to his 
thumb, holding a console controller 
was difficult. The athletic training staff saw the 
importance of treating 
the whole person and assisted the patient with 
psychosocial coping strategies of conversation 
and positive affirmation. The athletic training staff 
and patient began to use daily tasks/results as an 
opportunity to help discover and appreciate the 
small victories of rehabilitation (i.e., decrease in 
pain, stiffness).  



Graston Technique Combined with Therapeutic Intervention as an Alternative Treatment for a Grade III UCL Thumb Sprain: A 
Disablement Model Case Study 

 

 

39 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 5 – Issue 1 – April 2022 

Figure 1: Disablement model: Impact of Injury 

  

Health Condition: Right Thumb Grade III UCL 
Sprain

Body Function & Structure:

- Throbbing pain, swelling, stiffness 
- Weakness
- Uncomfortable during sleep
- Grip weakness
- Decreased AROM & PROM

Participation:

- Limited in videogaming
- Limited sport participation

Activities:

- Limiting ADLs
- Difficulty writing, grabbing, lifting
pushing doors, turning door knobs,  
opening tight jars, brushing teeth,
holding groceries, preparing food,
etc.

Environmental & Personal Factors

Environmental:

- School duties
- Pressure from coaches/teammates
- Feeling of abandonment from coaches
and teammates

Personal:

- Lack of motivation
- Age (maturity)
- Positive attitude turn around
- Obliging to social norms (i.e. opening

doors for others)



Graston Technique Combined with Therapeutic Intervention as an Alternative Treatment for a Grade III UCL Thumb Sprain: A 
Disablement Model Case Study 

 

 

40 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 5 – Issue 1 – April 2022 

ENVIRONMENTAL AND PERSONAL 
FACTORS  

Regarding psychosocial considerations of the 
injury, the patient had reported that he felt 
indirect pressure and feelings of abandonment 
from his  

coaches and teammates because he could no 
longer actively participate in practices or 
games. There was a lack of motivation because he 
felt his worth was dependent on 
football. Since the patient was without football 
and was limited in daily activities, he 
was hesitant to begin rehabilitation. After 
completing one full week of treatment, the 
patient’s perceived pain improved. These results 
gave the patient hope, as he reported that he felt 
more motivated to continue the process and work 
hard in rehabilitation. This psychosocial finding 
was similar to a systematic review which noted 
that patient compliance may improve with 
decreased pain achieved through IASTM.16 The 
patient began to slowly participate in everyday 
activities and noted feeling less extrinsic 
pressures.   

INTERVENTION  

The treatment for the 
first week included immobilization and 
cryotherapy to manage pain and swelling until he 
was seen by the team physician. Once evaluated 
by the team physician, the patient was 
allowed to begin conservative hand therapy until 
he was seen by the hand 
specialist, approximately three weeks later. Duri
ng this time, the patient reported to the athletic 
training facility five days per week. The 
intervention included GT and therapeutic 
interventions to address ROM and strength 
deficits. The Graston Technique® was selected as 
an intervention based on previous work 
which demonstrated improved range of motion of 
the thumb after eight sessions 
of combined GT and active release 

therapy during immobilization.17 In the current 
case, GT was administered by two providers 
certified in GT (head athletic trainer and athletic 
training student) two times per week with at 
least 48 hours in between application, and 
therapeutic exercise was performed at every 
appointment. This method of combining daily 
exercise with GT twice per week is consistent 
with a previous reported case of subacute lumbar 
injury.18    

The Graston Technique® requires the treatment 
area be heated with either a modality or with 
a warm-up of the soft tissue before application of 
the technique, followed by treatment with 
therapeutic exercises after treatment.19 For this 
treatment, the patient performed 10 minutes of 
heating (paraffin bath: in an extended position, 
his hand was dipped 7 times with a 3 second hold 
in wax before the next dip) prior to GT. The 
intervention was administered for 10 
minutes, using the GT2 and GT6 instruments. The 
treatment time selected is consistent with previous 
work where GT was applied to an acute ankle 
injury for 10 minutes.20 There are several strokes 
that require distinctive techniques; in the 
present case, brushing and scooping were the two 
strokes that were used. Brushing requires a brush 
stroke motion up and down, similar to the stroke 
of painting. Scooping requires a motion in a U-
shaped pattern, similar to scooping ice 
cream. Following GT, therapeutic exercises were 
instructed and performed. The patient began with 
soft putty for 10 minutes (hand motions included 
pinching, squeezing, pulling, rolling, and 
smashing) in order to restore abductor 
pollicis longus, abductor pollicis brevis, and flexor 
pollicis brevis strength, followed 
by an additional 15 minutes of wrist and 
hand strengthening exercises (grip, finger flexion, 
finger extension, wrist flexion, wrist extension, 
ulnar deviation, and radial deviation). The same 
exercises were completed on days when GT was 
not performed in order to continue 
strengthening the wrist and hand.  



Graston Technique Combined with Therapeutic Intervention as an Alternative Treatment for a Grade III UCL Thumb Sprain: A 
Disablement Model Case Study 

 

 

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All rights reserved. ISSN Online 2577-8188                                                                              Volume 5 – Issue 1 – April 2022 

Approximately three weeks after seeing the team 
physician and completing the intervention of GT 
and therapeutic exercise, the patient was 
evaluated by the hand specialist who determined 
that the soft thumb splint was not rigid enough for 
immobilization during ADL’s. The 
recommended plan of care was that 
the patient continuously wears a rigid splint for 
immobilization and rehabilitation should 
cease. The specialist created a different rigid 
removable cast for football activities, and the 
patient was allowed to participate in football 
activities contingent upon wearing the removeable 
cast during practice and game competition.  

OUTCOMES  

Throughout the treatment process, the chief 
complaints were pain and stiffness of the right 
thumb. The patient’s pain was monitored using the 
Numeric Pain Rating Scale (NPRS).21,22 The 
tool has been found valid (r = 0.94, 95% CI = 
0.93-0.95) in assessing acute pain.23 The rating of 
stiffness, although subjective in nature, was 
attempted to be captured through ROM 
testing. Given the patient’s concerns with 
his ability to function, the outcome measure 
of Quick Disabilities of Arm, Shoulder, and 
Hand (QuickDASH) was completed by the 
patient. The QuickDASH is an assessment tool used 
to measure functional ability and symptoms in 
individuals with any musculoskeletal disorder of 
the upper extremity.24 No other patient-reported 
outcome measures were used by the athletic 
training staff.  

NPRS: Pain was measured weekly using the NPRS. 
The patient was asked to rate his current, best, 
and worse state of pain within a 24-hour period 
on a scale from 0 (no pain) to 10 (worst pain 

imaginable). The three numbers were added 
together, and an average was calculated (sum of 
pain rating divided by number of ratings).21,22 For 
example, in the initial evaluation the patient 
reported a current pain rating of 6, best pain 
rating of 0, and a worse pain rating of 8 within a 
24-hour period; 6 + 0 + 8 divided by 3 = 4.67 
average. The NPRS categorizes pain as either 
mild (score of 1-4), moderate (5-6), or severe (7-
10).25 Previous work has demonstrated that the 
minimal clinically importance difference (MCID) is 
a reduction of one point.26 During the first week 
of intervention the patient’s NPRS score was 4.67, 
and week two’s average was 2.67. During the 
third week of the intervention the NPRS score was 
1.33, which remained unchanged the following 
week when the therapeutic intervention was 
discontinued per the hand specialist’s 
recommendation.  

ROM: Range of motion measurements during the 
3-week GT and therapeutic intervention period 
are displayed in Table 1. Flexion measurements 
were taken using three landmarks: distal arm was 
positioned dorsal midline of proximal phalanx, 
center point was positioned dorsal aspect of MCP, 
and proximal arm was positioned dorsal midline 
of metacarpal. Abduction measurements were 
taken using 3 landmarks: distal arm was 
positioned lateral midline of first metacarpal, 
center point was positioned lateral aspect of 
radial styloid, and proximal arm was positioned 
lateral midline of second 
metacarpal. Thumb opposition was assessed 
through visual observation by the athletic training 
staff. The tip of the thumb was observed 
attempting to touch the MCP joint on the palmar 
side of the involved hand. During the initial week 
of treatment, the patient was unable to complete 
thumb opposition to his 4th and 5th MCP joints. At 

Table 1: Weekly ROM Measurements of Patient’s Right Thumb 
ROM                                         Week 1                       Week 2                      Week 3 
Flexion                                         35°                           40°                             46° 
Abduction                                     50°                           55°                             58° 
*Opposition (visual)                   Able 2-3                     Able 2-4                     Able 2-5 
*Ability to successfully complete opposition to MCP joint of digits 2-5. 



Graston Technique Combined with Therapeutic Intervention as an Alternative Treatment for a Grade III UCL Thumb Sprain: A 
Disablement Model Case Study 

 

 

42 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 5 – Issue 1 – April 2022 

the conclusion of week three, the patient could 
successfully complete opposition by touching his 
thumb to MCP joint. Measurements were not 
completed following the cessation of GT and 
therapeutic exercise. Although, it is important to 
note that the patient reported an increase in 
stiffness within the weeks following cessation of 
therapeutic intervention.  

Quick DASH: This assessment was used 
to assess the patient’s ability to perform ADLs 
and sport specific activities. The QuickDASH 
consists of 11 items of ADL and 4 items in each 
of the optional work or sports/performing arts 
modules. Each item is rated on a scale from 1 (no 
difficulty) to 5 (unable), and the overall scoring 
ranges from 0 (no disability) to 100 (most severe 
disability).24 The patient first completed the 
QuickDASH with sport 
module upon initial evaluation with the athletic 
training staff. The work module portion of the 
quick DASH was not included because the patient 
was not employed. The outcome measure 
was completed every 1 to 2 weeks. Prior to the 
intervention of GT and therapeutic exercise the 
patient scored 50/100 in ADLs and 75/100 in the 
sport module. Overall scores decreased 
throughout the intervention and continued to 
decrease after the intervention was halted. By the 
end of week 7, the patient scored 0/100 in both 
ADL and the sport module. 

DISCUSSION  

Medical providers share a desire to help improve 
the quality of life of individuals in 
need. The option of conservative intervention is 
increasing as patients consider the factors which 
play a role in deciding surgical versus non-
surgical interventions. There 
are various reasons one might choose 
conservative treatment over surgery. These 
reasons include, but are not limited to, financial 
stability, health insurance coverage, mental 
fears/adaptations, physical risks, and loss of time 
of work/sport. Additionally, similar outcomes 

have been reported when examining conservative 
versus surgical treatment of both partial and full 
thickness ligamentous tears.12 The current case 
study provides an example of a 
potential beneficial non-
operative treatment option that warrants further 
exploration. Specifically, the results 
of the treatment option of GT combined 
with therapeutic exercise suggest an effectiveness 
in decreasing the patient’s perceived pain 
and stiffness following a grade III thumb UCL 
sprain. Historically, chief complaints of a grade III 
thumb UCL sprain are pain, decreased ROM, 
and instability.27 It should be noted that instability 
was not a symptom reported by the patient in the 
current case. The Graston Technique® combined 
with therapeutic exercise was chosen as the 
treatment of choice in this case study to address 
both pain and stiffness. The results of this case 
study suggest an improvement of two of the 
three common chief complaints, both pain and 
ROM. Our findings showed that there was a 
reduction in pain level each week above 
the minimal clinically importance difference. 
Additionally, ROM improved each week, and 
opposition was restored to normal after the three-
week intervention. It should be noted that 
in addition to the GT and therapeutic 
exercise, the patient was instructed to wear a soft 
splint continuously, which may have been a factor 
in the outcomes. It is speculated splinting would 
decrease pain by protecting the joint from further 
disruption. Interestingly, the primary reason for 
immobilizing acute soft-tissue injuries was for pain 
relief, while loss of motion was cited as the main 
reason to not immobilize, according to more than 
two-thirds of physicians polled.9 It is speculated 
that since GT and supervised therapeutic exercise 
was being completed once a day, ROM was able 
to be improved despite immobilization. Our 
findings are consistent with a previous literature 
review which reported that IASTM decreases 
pain as well as improves range of motion in acute 
injuries.28 It is theorized that the ability of 
IASTM to assist in healing of ligamentous injury is 



Graston Technique Combined with Therapeutic Intervention as an Alternative Treatment for a Grade III UCL Thumb Sprain: A 
Disablement Model Case Study 

 

 

43 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
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due to its effects on 
collagen, including maturation and remodeling, 
through localized blood flow.12,13,29 Scar tissue is 
thought to impede mobility and therefore oxygen 
supply to the injured area.28 Through the 
controlled repetitive microtrauma elicited by GT, 
a reinitiating of the inflammatory 
process may have led to enhanced tissue 
perfusion,12 which in turn allowed for fibroblastic 
proliferation.28 Tissue perfusion followed directly 
with therapeutic exercise may have played a role 
in the ability of the joint to reach improved 
ROM. This may be a reason why it is 
recommended that stretching and strengthening 
exercises are recommended 
to immediately follow the application of GT.19   

The results established from the Quick-
DASH presented noteworthy information. The 
patient reported an initial 50-75% 
disability to 0% in the ADL and sport module, 
respectively, over a period of six weeks. We 
suggest two main reasons why there was such 
a dramatic change in scores. One theory is that 
the treatment decreased pain, which allowed him 
to participate in more activities, aiding in an 
improved level of physical function. It 
was evident that pain was diminishing throughout 
the intervention; however, when treatment 
was terminated the level of disability continued to 
drop. It is possible that the patient felt less 
disabled due to the allowance of sport 
participation by the hand specialist, which would 
explain the continued improvement in scores after 
the intervention was terminated.  

Although there were promising scores in disability 
index, ROM, and pain ratings in favor of GT and 
therapeutic exercise, there are limitations that 
need to be addressed. First, it would have been 
helpful to continue measuring ROM once the 
intervention ceased to determine if the initial 
improvements were temporary. The authors 
acknowledge that the termination of the 
intervention may have played a role in the overall 
healing process, and the hand specialist’s 

judgement to cease treatment is unknown to have 
helped or hindered the outcome measures. The 
goniometric assessment could have also been 
measured by a second clinician to assist 
in accuracy – intra-rater reliability may have 
played a role in this case. Additionally, a second 
measurement tool besides ROM could have been 
used to assess the patient report of stiffness. 
Lastly, the addition of a psychosocial patient-
rated outcome measure may have been helpful 
in indicating a reason for the decrease in 
disability score. It is believed that multiple 
extrinsic and intrinsic factors may have played a 
key role in the improvements seen, and future 
investigations should consider adding a 
psychosocial outcome measure when the 
QuickDASH is used. 

CLINICAL BOTTOM LINE  

The findings suggested in this case study 
demonstrate that GT combined with therapeutic 
exercise and soft splinting may be beneficial to 
patient-reported limitations of a grade III thumb 
UCL sprain. This case study found that there were 
improvements in pain and ROM of the affected 
joint during a three-week intervention. Future 
research should investigate the effectiveness 
of initiating GT and therapeutic exercise at 
various time points of immobilization 
of thumb UCL sprains.  

ACKNOWLEDGMENTS  

I would like to acknowledge and thank the sports 
medicine team at Trinity International University. 
Thank you, Dr. Julia Bruene, for your contribution 
and professional insights. I am immensely grateful 
for the astounding guidance and mentorship from 
Ms. Kim Bacalla. Thank you, Ms. Annette Monk and 
Dr. Ryan Wilkinson, for your endless support and 
outstanding guidance in writing this case study. 

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Graston Technique Combined with Therapeutic Intervention as an Alternative Treatment for a Grade III UCL Thumb Sprain: A 
Disablement Model Case Study 

 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 5 – Issue 1 – April 2022 

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Graston Technique Combined with Therapeutic Intervention as an Alternative Treatment for a Grade III UCL Thumb Sprain: A 
Disablement Model Case Study 

 

 

45 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                              Volume 5 – Issue 1 – April 2022 

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https://www.sralab.org/sites/default/files/2017-07/Numeric%20Pain%20Rating%20Scale%20Instructions.pdf
https://www.sralab.org/sites/default/files/2017-07/Numeric%20Pain%20Rating%20Scale%20Instructions.pdf
https://www.sralab.org/sites/default/files/2017-07/Numeric%20Pain%20Rating%20Scale%20Instructions.pdf
https://doi.org/10.1111/j.1553-2712.2003.tb01355.x
https://doi.org/10.1111/j.1553-2712.2003.tb01355.x
https://doi.org/10.2106/jbjs.d.02060
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https://doi.org/10.1177/0363546516660979
https://doi.org/10.1177/0363546516660979
http://dx.doi.org/10.7860/JCDR/2019/42687.13356
http://dx.doi.org/10.7860/JCDR/2019/42687.13356
https://doi.org/10.31622/2019/0003.4

	ABSTRACT

