Instrument Assisted Soft Tissue Mobilization is rooted in ancient medicine

There are many established methods of treatment for both acute and chronic soft-tissue injuries.

Examples of such include massage (many different types), dry needling, active release technique, heat, ice, vibration, taping, exercise (including stretching), and passive modalities such as therapeutic ultrasound. Instrument Assisted Soft Tissue Mobilization (IASTM) is one of these methods.

Gua Sha was one of the first instrument assisted techniques, and dates back to circa 220 BC. The original Gua Sha instruments were simple things such as spoons, coins, jars, and pieces of wood, bamboo, bone, and jade. The goal of Gua Sha is to intentionally create petechiae and ecchymosis (sha) by scraping soft tissue. Raising sha is thought to remove blood stagnation and promote normal circulation and metabolic processes.

In the mid-1990s, David Graston, a pioneer of IASTM, created a method and instruments for treating soft-tissue injuries. Instead of the scraping technique that was meant to remove sha, the Graston Technique (GT) was developed with the goal of detecting and alleviating 19 adhesions of the body.

Following the development of GT, nearly 25 other instruments and similar techniques have been developed based on the original Gua Sha philosophy.

Treatment effects of IASTM

The clinical use of soft-tissue mobilization instruments is purported to enhance musculoskeletal treatment effectiveness, particularly in areas of scar or tissue restriction.^1-12

IASTM is performed by using medical instruments or tools on and around the injured tissue to aid in the healing process. Specially designed tools are used to apply longitudinal pressure along the course of tissue. The tools facilitate the clinician’s ability to detect altered tissue properties, as well as facilitate the patient’s awareness of altered sensations within the treated tissues.

Increased vibration within the tool is believed to be an indication of abnormal tissue properties. Additionally, the tools are believed to provide a mechanical advantage that allows the clinician to achieve greater depth of mechanical force transmission than can be produced with the hands alone. Tools also reduce compressive stress on the clinician’s hands, which can prolong the career of a manual therapist.

Treating abnormal densities in tissue

Clinical studies of IASTM administered to patients with tendinopathies have demonstrated pain resolution, improved ROM, and return to normal function at a faster rate than observed with traditional therapeutic interventions. Case studies have documented similar lASTM benefits. The best outcomes appear to be when IASTM is used in conjunction with other therapeutic interventions (ie. heat and exercise).^2,3,6,8

Additional research describes the restrictions in the interfaces between the planes of muscles, nerves, fascia, etc., as a component of musculoskeletal pain.¹³

The lack of gliding (or restriction) limits range of motion and can be a pain generator. When manual treatment is administered and positive effects are observed, the current thinking is the effects are at the loose connective tissue and not in the fascia or muscle.

The key to treatment is early intervention.¹³

An example of the lack of gliding was demonstrated in a study of chronic low-back pain patients who, on diagnostic ultrasound, demonstrated a lack of gliding and sliding of these interfaces compared to the control group (non-lower-back pain patients).¹⁴

IASTM may also assist in improving the gliding and sliding of these interfaces.

For example, the thoracolumbar fascia is composed of dense connective tissue layers separated by layers of loose connective tissue that normally allow the dense layers to glide past one another during trunk motion. In a study of chronic low-back pain patients, gliding and sliding of the thoracolumbar fascia was approximately 20 percent less than those without low-back pain. The reduction of shear plane motion was thought to be due to intrinsic connective tissue pathology or abnormal trunk range-of-motion patterns.¹⁴

Consequently, IASTM may be an alternative modality to assist in normalizing soft tissue and improving patient outcomes. A secondary benefit for the provider is decreased wear and tear on the hands, which can prolong a career. If one is interested in learning how to use tools to treat patients, obtain professional education in IASTM.

Ed Le Cara , DC, PhD, MBA, ATC, CSCS, has over 20 years of chiropractic, athletic training, and strength and conditioning experience. His practice is in Dallas, where he treats high intensity and endurance athletes. He can be contacted at ed@kinetikchain.com or follow him on Twitter and Instagram @drlecara.

 

References:

1. Aspegren D, Hyde T, Miller M. Conservative treatment of a female collegiate volleyball player with costochondritis. J Manipulative Physiol Ther. 2007;30(4):321-5.
2. Bayliss AJ, Klene FJ, Gundeck EL, Loghmani MT. Treatment of a patient with post-natal chronic calf pain utilizing instrument-assisted soft tissue mobilization: a case study. J Man Manip Ther. 2011;19(3):127-34.
3. Burke J, Buchberger DJ, Carey-Loghmani MT, et al. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther. 2007;30(1):50-61.
4. Davidson CJ, Ganion LR, Gehlsen GM, et al. Rat tendon morphologic and functional changes resulting from soft tissue mobilization. Med Sci Sports Exerc. 1997;29(3):313-19.
5. Fowler S, Wilson JK, Sevier TL. Innovative approach for the treatment of cumulative trauma disorders. Work. 2000;15(1):9-14.
6. Hammer WI. The effect of mechanical load on degenerated soft tissue. J Bodyw Mov Ther. 2008;12(3):246-56.
   
7. Hammer WI, Pfefer MT. Treatment of a case of subacute lumbar compartment syndrome using the Graston technique. J Manipulative Physiol Ther. 2005;28(3):199-204.
8. Howitt S, Jung S, Hammonds N. Conservative treatment of a tibialis posterior strain in a novice triathlete: a case report. J Can Chiropr Assoc. 2009;53(1):23-31.
9. 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. Int J Sports Phys Ther. 2014;9(1):1-7.
10. Lee JJ, Kim DH, You SJ. Inhibitory effects of instrument-assisted neuromobilization on hyperactive gastrocnemius in a hemiparetic stroke patient. [ITAL]Biomed Mater Eng.[/ITAL] 2014;24(6):2389-94.
11. Loghmani MT, Warden SJ. Instrument-assisted cross-fiber massage accelerates knee ligament healing. [ITAL]J Orthop Sports Phys Ther.[/ITAL] 2009;39(7):506-14.
12. Loghmani MT, Warden SJ. Instrument-assisted cross fiber massage increases tissue perfusion and alters microvascular morphology in the vicinity of healing knee ligaments. [ITAL]BMC Complement Altern Med.[/ITAL] 2013;13:240.
13. Bove GM, Chapelle SL. Visceral mobilization can lyse and prevent peritoneal adhesions in a rat model. [ITAL]J Bodyw Mov Ther. [/ITAL] 2012;16(1):76-82.
14. Langevin HM, Fox JR, Koptiuch C, et al. Reduced thoracolumbar fascia shear strain in human chronic low back pain. [ITAL]BMC Musculoskelet Disord. [/ITAL]2011;12:203.