Feb 16, 2017Right Tool for the Job
In sports medicine, massage is commonly used to promote systematic relaxation, decrease pain, increase local blood flow, reduce muscle spasm, and reduce edema accumulation. Soft tissue mobilization (STM), a specific type of massage, can also increase soft tissue extensibility, increase flexibility, release tissue restriction, and decrease scar tissue. One method of STM — Instrument-Assisted Soft Tissue Mobilization (IASTM) — has become popular in the athletic training profession.
Clinicians utilizing IASTM often deviate from traditional sports massage by applying the intervention with instruments rather than hands, along and across targeted fibers, and in treatment sessions targeting more than the isolated area of reported pain and dysfunction. While it is not uncommon for athletic trainers to utilize traditional instruments (e.g., bone, jade, etc.), IASTM is more frequently applied with specifically manufactured instruments made of stainless steel, aluminum, or plastic. The use of instruments has been theorized to amplify tissue irregularities back to the clinician through vibration.
When studied in clinical trials and case reports, IASTM application has been found to decrease pain, increase range of motion, and return patients to normal function at rates faster than those found with natural healing or other treatment modalities. Many of the current studies, however, contain limitations preventing the results from being effectively translated to clinical practice. Currently, we still do not definitively know the optimal treatment number, treatment duration, treatment timing (e.g., acute inflammatory phase application, etc.), or treatment technique (e.g., instrument pressure, instrument direction, protocol used).
One of the most-cited benefits of IASTM is enhanced manipulation of soft-tissue fibrosis. The thought is that IASTM introduces controlled microtrauma to induce a local inflammatory response, stimulating connective tissue remodeling, along with collagen repair and regeneration.
That being said, one of the most-cited benefits of IASTM is enhanced manipulation of soft-tissue fibrosis. The thought is that IASTM introduces controlled microtrauma to induce a local inflammatory response, stimulating connective tissue remodeling, along with collagen repair and regeneration. The result is the release and breakdown of scar tissue, soft tissue adhesions, and fascial restrictions. For these reasons, IASTM has been proposed to treat a variety of conditions, such as tendinopathies, fascial pathologies, soft-tissue entrapment, ligament pathologies, scar tissue/adhesions, myofascial pain, carpal tunnel syndrome, and iliotibial band friction syndrome.
Other proposed benefits of IASTM pertain more to the athletic trainer. The use of different tools in IASTM may allow the clinician to achieve deeper tissue penetration with less effort, obtain more specific treatment to target tissues, and experience reduced stress on their hands.
A potential drawback of IASTM is that patients, even when indicated, may experience adverse responses to the modality. For example, it is common for patients to experience petechiae, or bruising, during and after treatment, which typically resolves in a few days. Depending on the IASTM application method, patients have also reported discomfort during or after treatment, but this varies. If a patient is hypersensitive or intolerant to IASTM application, however, it would be prudent to consider an alternative form of therapy.
For those interested in learning or applying IASTM in clinical practice, a variety of options exist to consider. There are techniques more rooted in Eastern medicine, such as Gua Sha. Yet, these often differ from more contemporary IASTM methods in treatment rationale, goals, and application.
In addition, there are a number of companies that provide in-person IASTM courses and the option to purchase instruments. Many of these companies also offer advanced courses on IASTM application (e.g., applying IASTM during exercises, combining kinesiology taping and IASTM, etc.). If an in-person course is not an option, clinicians may seek out online IASTM training, purchase instruments from companies who do not require formal training, utilize more traditional instruments, or choose to make their own tools out of thermo-moldable plastic.
As the popularity of STM grows, athletic trainers must be good stewards of IASTM. For effective treatment outcomes, it is imperative clinicians utilize IASTM when appropriate, use other adjunct therapies when needed, avoid haphazardly applying IASTM, and avoid being dogmatic to IASTM practices not based in sound literature or patient response models.
References:
Baker RT, Nasypany A, Seegmiller JG, Baker JG. Instrument-assisted soft tissue mobilization treatment for tissue extensibility dysfunction. International Journal Athletic Therapy and Training, 2013; 18(5): 16-21.
Blanchette MA, Normand MC. Augmented soft tissue mobilization vs. natural history in the treatment of lateral epicondylitis: A pilot study. J Manipulative Physiol Ther. 2007; 30(1):50-61.
Cheatham SW, Lee MD, Cain M, Baker R. The effects of instrument assisted soft tissue mobilization: a systematic review. J of Can Chiropr Assoc. 2016 [Accepted]
Loghmani MT, Warden SJ. Instrument-assisted cross-fiber massage accelerates knee ligament healing. Journal of Orthopedic and Sports Physical Therapy. 2009; 39(7):506.514.
McMurray J, Landis S, Lininger K, Baker RT, Nasypany A, Seegmiller J. A comparison and review of indirect myofascial release therapy, instrument-assisted soft tissue mobilization, and active release techniques to inform clinical decision making. International Journal of Athletic Therapy and Training, 2015; 20(5): 29-34.
