Instrument Assisted Soft Tissue Mobilisation (IASTM)
Instrument Assisted Soft Tissue Mobilisation or Simply IASTM is a new tool, which enables clinicians to efficiently locate and treat individuals diagnosed with soft tissue dysfunction. The technique itself is said to be a modern evolution from Traditional Chinese Medicine called Gua Sha. However Gua Sha was not used to treat Musculoskeletal conditions but was traditionally applied along meridiens to move the bad chi out through the skin. IASTM is a is a procedure that is rapidly growing in popularity due to its effectiveness and efficiency while remaining noninvasive,with its own indications and limitations. IASTM is performed with ergonomically designed instruments that detect and treat fascial restrictions, encourage rapid localization and effectively treat areas exhibiting soft tissue fibrosis, chronic inflammation, or degeneration. As in any Manual therapy treatment, supplementation with exercises and additional modalities e.g. joint mobilization designed to correct biomechanical deficiencies by addressing musculoskeletal strength and muscle imbalances throughout the entire kinetic chain should be used in conjunction with IASTM.
How does it work?
Instruments effectively break down fascial restrictions and scar tissue. The ergonomic design of these instruments provides the clinician with the ability to locate restrictions and allows the clinician to treat the affected area with the appropriate amount of pressure. The introduction of controlled microtrauma to affected soft tissue structure causes the stimulation of a local inflammatory response. Microtrauma initiates reabsorption of inappropriate fibrosis or excessive scar tissue and facilitates a cascade of healing activities resulting in remodeling of affected soft tissue structures. Adhesions within the soft tissue which may have developed as a result of surgery, immobilization, repeated strain or other mechanisms, are broken down allowing full functional restoration to occur.
- Limited motion
- pain during motion
- motor control issues
- Muscle recruitment issues
Conditions for which IASTM is usually used:
- Medial Epicondylitis, Lateral Epicondylitis
- Carpal Tunnel Syndrome
- Neck Pain
- Plantar Fascitis
- Rotator Cuff Tendinitis
- Patellar Tendinitis
- Tibialis Posterior Tendinitis
- Heel Pain /Achilles Tendinitis
- DeQuervain's Syndrome
- PostSurgical and Traumatic Scars
- Myofascial Pain and Restrictions
- Musculoskeletal Imbalances
- Chronic Joint Swelling Associated with Sprains/Strains
- Ligament Sprains
- Muscle Strains
- NonAcute Bursitis
- RSD (Reflex Sympathetic Dystrophy)
- Back Pain
- Trigger Finger
- Hip Pain (Replacements)
- IT Band Syndrome
- Shin Splints
- Chronic Ankle Sprains
- Acute Ankle Sprains (Advanced Technique)
- Scars (Surgical, Traumatic)
- Compromised tissue integrity (open wound, infection, tumor)
- Active implants (pacemaker, internal defibrillator, picc/pump lines)
- Cervical carotid sinus
IASTM Physiology & Benefits
1. Cellular Level
Studies have addressed the benefits of IASTM at the cellular level. Benefits include increased fibroblast proliferation, reduction in scar tissue, increased vascular response, and the remodeling of unorganized collagen fiber matrix following IASTM application.
Fibroblast is considered the most important cell in the extracellular matrix (ECM). The repair, regeneration and maintenance of soft tissue take place in the ECM. The fibroblast synthesizes the ECM, which includes collagen, elastin and proteoglycans, among many other essential substances. Fibroblasts have the ability to react as mechanotranducers, which means they are able to detect biophysical strain (deformation) such as compression, torque, shear and fluid flow, and create a mechanochemical response.
Gehlsen et al investigated the effects of 3 separate IASTM pressures on rat Achilles tendons. They concluded that fibroblast production is directly proportional to the magnitude of IASTM pressure used by the clinician. Davidson et al supported Gehlsen et al. by concluding that IM significantly increased fibroblast production in rat achilles tendons by using electron microscopy to analyze tissue samples following IM application. Davidson et al. found morphologic changes in the rough endoplasmic reticulum following IM application. Thus, indicating micro trauma to damaged tissues, resulting in an acute fibroblast response.
2. Clinical Benefits
Studies have also showed clinical benefits of IASTM showing improvements in range of motion, strength and pain perception following treatment. Melham et al found that IASTM significantly improved range of motion in a college football player following 7 weeks of IASTM and physical therapy. Melham et al. found that scar tissue surrounding the lateral malleolus was reduced and remodeled structurally following IASTM application. Wilson et al found improvement in pain reduction and impairment scale at 6 & 12 weeks following IASTM application for patellar tendonitis.