What is Instrument Assisted Soft Tissue Mobilization?



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What is Instrument Assisted Soft Tissue Mobilization?

Instrument Assisted Soft Tissue Mobilization (IASTM) is a soft tissue technique that uses hand held tools to impart a mechanical stimulates local mechanoreceptors. IASTM devices may be made from different materials (e.g. wood, stone, jade, steel, ceramic, resin).

How can Massage Therapists Incorporate IASTM into Treatments?

IASTM has been shown to improve short term range of motion and improve function for athletes (Cheatham et al. 2016). IASTM is closely related to transverse friction massage which has long been used for tendon pain and sports injuries. The depth of application varies from simple massage based techniques aiming at stimulating mechanoreceptors and improving range of motion to a complex soft-tissue treatment system encompassing the latest research on mechanotherapy.

There are many nuances to using these techniques, with the possibility of bruising and petechiae if treatments are not done with care. Not fully understanding the different aspects and approaches to IASTM is leading to a great deal of confusion about what exactly IASTM is, when it’s appropriate and how to use these techniques. 

IASTM Protocols

IASTM techniques are frequently combined with other techniques, exercises, positions or different types of stretching. First, the treatment area is lubricated with massage lotion, then short sweeping movements are applied using multi-directional assessment and treatment strokes. IASTM techniques are frequently combined with active and passive stretching. Around 2-3 minutes of light scraping per area should be enough to stimulate local mechanoreceptors. 

Why Does IASTM Work?

The responses to IASTM are complex and multifactorial - biopsychosocial factors interplay in a complex manner. Research has looked at neuroimmune responses at both the peripheral and central levels elicited by treatments. Input from large sensory neurons activate spinal cord interneurons that prevents the spinal cord from amplifying the nociceptive signal. This anti-nociceptive can help ease pain and discomfort.

Post-Operative Care

Treatments depend on the underlying pathology, but IASTM may have a role in post-surgical care. Hypothetically is may be used to impart a mechanical stimulus that contributes to the break down of immature scar tissue and developmental fibrosis.

Fibrosis is a potential complication of surgery or trauma characterized by the production of excessive fibrous scar tissue, which may result in decreased movement. Understanding the cellular effectors and signaling pathways that drives the accumulation of fibrotic deposition, helps therapists optimize treatment protocols.

In the normal wound healing response, the cascade of biological responses is tightly regulated. Fibrotic development is characterized by a lack of apoptosis in the proinflammatory phase, resulting in an imbalance between synthesis and degradation. Persistent transforming growth factor-β (TGF-β) secretion and downstream responses are thought to contribute to a sustained inflammatory response (Cheuy et al. 2017).

A recent study published in The Journal of Knee Surgery looked at the effect that soft-tissue treatments with hand-held instruments have on post-surgical knee stiffness (Chunghtai et al. 2016). In the study soft-tissue treatments was shown to improve knee flexion deficits by 35° and knee flexion contractures by 12° in a small cohort of individuals who had failed to respond to traditional rehabilitation and manipulation under anesthesia. 

Summarizing Point

The use of prophylactic IASTM may help patients manage postoperative pain. It may also affect the development of fibrosis by mediating differential cytokine production. The next step for researchers is to look into what sort of dosage and duration would be needed to optimize the effects of this non-pharmacological approach. 

More to Explore

Bailey, L.B., Thigpen, C.A., Hawkins, R.J., Beattie, P.F., Shanley, E. (2017). Effectiveness of Manual Therapy and Stretching for Baseball Players With Shoulder Range of Motion Deficits. Sports Health.

Begovic, H., Zhou, G., Schuster, S., & Zheng, Y. (2016). The neuromotor effects of transverse friction massage. Manual Therapy.

Bialosky, J.E., Beneciuk, J.M., Bishop, M.D., ... George, S.Z. (2018). Unraveling the Mechanisms of Manual Therapy: Modeling an Approach. J Orthop Sports Phys Ther.

Bove, G., Harris, M., Zhao, H., & Barbe, M. (2016). Manual therapy as an effective treatment for fibrosis in a rat model of upper extremity overuse injury. Journal of the Neurological Sciences.
http://www.ncbi.nlm.nih.gov/pubmed/26810536 (OPEN ACCESS)

Cheatham, S.W., Lee, M., Cain, M., Baker, R. (2016). The efficacy of instrument assisted soft tissue mobilization: a systematic review. J Can Chiropr Assoc. 
https://www.ncbi.nlm.nih.gov/pubmed/27713575 (OPEN ACCESS)

Chen, L., Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ.

Chughtai, M., Mont, M.A., Cherian, C., Cherian, J.J., Elmallah, R.D., Naziri, Q., Harwin, S.F., Bhave, A. (2016). A Novel, Nonoperative Treatment Demonstrates Success for Stiff Total Knee Arthroplasty after Failure of Conventional Therapy. J Knee Surg.

Christie, W.S., Puhl, A.A., Lucaciu, O.C. (2012). Cross-frictional therapy and stretching for the treatment of palmar adhesions due to Dupuytren's contracture: a prospective case study. Man Ther.

Coviello, J.P., Kakar, R.S., Reynolds, T.J. (2017). Short-term effects of instrument-assisted soft tissue mobilization on pain free range of motion in a weightlifter with subacromial pain syndrome. Int J Sports Phys Ther.

Gordon, C.M., Lindner, S.M., .. Andrasik, F. (2018). Self-Myofascial Vibro-Shearing: a Randomized Controlled Trial of Biomechanical and Related Changes in Male Breakdancers. Sports Med Open. (OPEN ACCESS)

Hussey, M.J., Boron-Magulik, A.E., McLeod, T.C., Bacon, C.E. (2017). The Comparison of Instrument-Assisted Soft Tissue Mobilization and Self-Stretch Measures to Increase Shoulder Range of Motion in Overhead Athletes: A Critically Appraised Topic. J Sport Rehabil.

Kim, J., Sung, D.J., Lee, J. (2017). Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application. J Exerc Rehabil. (OPEN ACCESS)

Lambert, M., Hitchcock, R., Lavallee, K., ... Cleland, J. (2017). The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: a systematic review. Physical Therapy Reviews.

Laumonier, T., & Menetrey, J. (2016). Muscle injuries and strategies for improving their repair. Journal of Experimental Orthopaedics. (OPEN ACCESS)

Loghmani, T.M., Bayliss, A.J., Clayton, G., Gundeck, E. (2015). Successful treatment of a guitarist with a finger joint injury using instrument-assisted soft tissue mobilization: a case report. J Man Manip Ther.

McCormack, J.R., Underwood, F.B., Slaven, E.J., Cappaert, T.A. (2016). Eccentric Exercise Versus Eccentric Exercise and Soft Tissue Treatment (Astym) in the Management of Insertional Achilles Tendinopathy. Sports Health. (OPEN ACCESS)