IASTM technique and myofascial release is a rapidly-growing modality for young and older patients dealing with chronic issues that do not respond to typical therapies
Many older folks envision their “golden” years as a chance to relax, pick a retirement community to settle in, and catch up on their TV viewing. However, for many people their activity level actually increases as they age.
Over the past three decades, the number of older athletes has grown at an extraordinary rate. And it’s not just in the stereotypical retirement sports like golf, tennis and pickleball. It’s now commonplace to see older athletes competing in Ironman-length triathlons, long-distance cycling, and even ultra-marathons.
In fact, it’s not uncommon for “masters” athletes (40 years and older) to make up a majority of finishers. For example, at the New York City Marathon, male masters athletes make up approximately 50% of the finishers. At the most recent Ironman World Championship Triathlon in Hawaii, masters athletes accounted for 55% of all finishers.
Taking care of the body
An active, older population tends to see an increase in musculoskeletal injuries. As anyone over the age of 50 knows, your body doesn’t recover as well from hard exercise like it did in your 20s. Your muscles get sore quicker, and your joints stiffen up easier. As these athletes age it is crucial to get regular “bodywork” done from a professional. They need someone well-trained to loosen up their joints and relax their overworked muscles. That is where chiropractors become involved.
As powerful as a chiropractic manipulation can be, it is equally important to also address your patients’ soft-tissue problems. In particular, when you are working on older athletes, it is crucial that you spend some time doing some form of myofascial work. There is a wide variety of myofascial techniques and approaches, and many of them can be effective.
One technique that has been growing rapidly for years is instrument assisted soft tissue mobilization (IASTM).
Traditionally IASTM and myofascial release was primarily known for one thing — pain and bruising. Even today, many practitioners use these soft-tissue tools extremely aggressively. They think if you aren’t bruising your patient, or at least leaving them covered in petechiae, you aren’t doing the job correctly — the “no pain, no gain” approach.
This aggressive approach can be problematic, particularly when you are working on an older population. They tend to have complicating factors that can make aggressive myofascial work problematic. For example, their skin may be more fragile than someone younger. Or they may be on blood thinners that make them extremely susceptible to severe bruising. Either way, an aggressive IASTM technique approach may not be ideal for this population.
The brain and pain
Luckily our treatment philosophies are starting to change. We now understand that pain is much more complicated than we previously realized. Pain isn’t exclusively due to a tight muscle or inflamed joint. The recent research on pain science has started to cement the concept that the brain probably plays the most important role in experiencing and understanding pain.
We know that the brain of someone in pain is constantly “on guard” and always feeling threatened. Conversely, if we can somehow decrease the level of threat their brain is experiencing, perhaps we can also decrease their pain. So if our goal as a clinician is to “decrease the threat” our patient is experiencing, perhaps we shouldn’t be causing our patient more pain in the office. Instead, maybe we are better off using a more gentle, “neurosensory” approach to treating patients in pain.
How can you use a tool to increase the novel sensory input flooding your patient’s brain, in hopes of modulating their pain experience and improving their motor output? What can we do for someone in pain to decrease the perception of threat their brain is experiencing?
IASTM strokes can potentially decrease pain, increase range of motion, and improve stability or motor control. But these strokes do not have to be aggressive or leave patients bruised or sore.
Two effective strokes are “feathering” and “down-regulation”:
Feathering — With this IASTM technique stroke you are trying to stimulate the free nerve endings called interoceptors. There are approximately seven times more interoceptors in the body than any other type of mechanoreceptor. These interoceptors are located throughout the body, but we are going to target those in the skin and fascia. When the interoceptors are stimulated, it results in an activation of an area of the brain (insula) associated with pain perception and a sense of well-being. When these interoceptors are stimulated, pain seems to decrease.
These receptors respond best to very light touch. If you press too firmly with the tool, the stroke will not be as effective. So the next time you have a patient in pain, try using only a pressure of 1-3 out of 10. Remember, it should be your patient who is “grading” the amount of pressure you’re using, as some people have a high pain tolerance and others are hypersensitive. Lightly feather the tool back and forth over the painful area for approximately 30 seconds, as the interoceptive nerve endings tend to fatigue after about 30 seconds. After the 30 seconds I usually recommend to “ripple” upstream and downstream from the problem spot. It’s always a good idea to check the areas above and below the painful area.
Down-Regulation — This stroke can be used on any hypertonic tissue that needs to be relaxed or inhibited. Common areas for this stroke are the upper traps and sub-occipitals, the calves and the pectorals major/minor. With this stroke you are trying to target the Ruffini endings located in the superficial tissues. When Ruffini mechanoreceptors are stimulated, it results in a lowering of sympathetic nervous system activity (Van den Berg & Capri, 1999).
If you can lower sympathetic nervous system activity, it should result in a decrease in fascial tone. This leads to a relaxing of the local tissues in addition to a more global, whole-body relaxation. Ruffini endings respond best to slow, steady, moderately deep pressure. A patient should grade this pressure as a 4-6 out of 10.
Once the hypertonic muscles that need treatment have been identified, take the IASTM tool and start sliding the tool slowly across the tissue. Use lotion if there is trouble keeping the tool movement steady. Again, direction doesn’t matter. Start at one end of the muscle(s) and using a pressure depth of 4-6 out of 10, slowly slide the tool across the tissue. Take approximately 30 seconds per stroke. Do 2-3 passes with the tool if needed. As was the case with the first stroke, it’s always a good idea to quickly check the tissues above and below the area you’re targeting.
Less can be more
The “less is more” approach to IASTM technique and myofascial release can be challenging for a lot of chiropractors. It’s hard to resist the urge to grab a tool and start aggressively digging into the soft tissues.
Keep an open mind and try these strokes, and aging athletes will thank you. And they also won’t miss being too bruised and sore to train the next day.
JONATHAN MULHOLLAND, DC, CCSP, CSCS, is a sports chiropractor and strength coach who has helped athletes of all levels with injury recovery and performance enhancement. He earned his degree from Northwestern Health Sciences University in 2000. In addition to running his own private chiropractic practices, Mulholland has also acted as the chiropractic consultant for the United States Olympic Training Center in Lake Placid, N.Y. He can be contacted through rocktape.com.