Date of Graduation


Document Type


Degree Type



College of Physical Activity and Sport Sciences


Athletic Training

Committee Chair

Michelle A. Sandrey.


Context. Despite case reports and clinical studies, there have been no experimental studies conducted on Graston Instrumented-Assisted Soft Tissue Mobilization (GISTM) technique and the effects on chronic ankle instability. Most of the clinical studies and case reports that have been conducted have used animals and human subjects for lateral epicondylitis, and patellar, rotator cuff and achilles tendinopathy. Since only a case report exists in the literature for chronic ankle instability using GISTM, the intent of this study is to further evaluate the effects of GISTM and dynamic postural balance on improvements in healing and function. Objective. The present study aims to investigate the affects of GISTM technique and the influence on improving range of motion, neovascularization, collagen alignment, pain and disability in individuals experiencing chronic ankle instability. Design. Subjects were randomly assigned to the GISTM/Dynamic Balance-Training (DBT), GISTM-S/DBT, or C/DBT group. All groups participated in a 4wk DBT program consisting of four exercises and a lower extremity dynamic stretching protocol using a Flex band twice a week throughout the training period. The GISTM/DBT and GISTM-S/DBT groups received the GISTM treatment of sham treatment twice a week before performing the DBT program throughout the training period. Setting. A AAA High School in North Central West Virginia. Patients or other participants. This study included 36 healthy, physically active individuals (5 female, 31 male; age=17.771+/-1.972 years; ht=69.403+/-5.775; 30 right, 6 left foot; 28 six sessions, 8 seven sessions completed of rehab) with a history of CAI volunteered to be in this study from a North Central High School in WV and a DI Mid-Atlantic University. Interventions . The DBT program that was performed twice a week for 4-wks included a battery of exercises that was advanced from week to week for all three experimental groups. The 4-wk GISTM treatment protocol for the GISTM and GISTM-S groups also was performed twice a week. Pre- and Post-test measurements were taken using the Foot and Ankle Ability Measures (FAAM), FAAM Sport, the Visual Analog Scale (VAS), ankle range of motion (ROM) in four directions, ultrasonography (US), and the Star Excursion Balance Test (SEBT) in three directions. Outcomes measures. A greater increase will be found in the talocrural range of motion, neovascularization, and collagen alignment between groups pre- and post-test. And also a decrease in the FAAM, FAAM Sport and VAS will be found; with a significant difference in pre- and post-test results between groups. Results. There was a significant difference for test with FAAM (F1,33=47.963, P=0.01, ES=0.592, 1-beta=1.00), FAAM Sport (F1,33=18.377, P<0.001, ES=0.358, 1-beta=0.932), VAS (F1,33=55.564, P<0.001, ES=0.590, 1-beta=1.000), ROM (F1,33=40.087, P<0.001, ES=0.548, 1-beta=1.000), and SEBT (F1,33=58.493, P=0.000, ES=0.639, 1-beta=1.000) with post-test results greater except for VAS, which decreased. There were also significant differences for movement (F3,33=196.721, P<0.001, ES=0.856, 1-beta=1.000) with ROM and direction (F1,33=71.355, P0.01). Conclusion. The 4-wk GISTM and dynamic balance-training program could be used to increase ROM, sensorimotor facilitation, and stability for the ankle musculature, along with postural stability and endurance in all athletes suffering from chronic ankle instability.