What is Instrument Assisted Soft Tissue Mobilization?

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IASTM

IASTM

List of Resources

What is IASTM?

Instrument Assisted Soft Tissue Mobilization (IASTM) is a soft tissue technique that uses hand held tools to impart a mechanical stimulates local mechanoreceptors. IASTM is closely related to transverse friction massage which has long been used for tendon pain and sports injuries. 

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 is not a panacea, but it has been shown to improve short term range of motion and improve function for athletes (Cheatham et al. 2016, Kim et al. 2017).

IASTM varies in its depth of application, 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, there is a 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

First, the treatment area is lubricated with massage lotion, then short multi-directional assessment and treatment strokes are preformed. IASTM techniques are frequently combined with other techniques, exercises, positions or different types of stretching.

Why Does IASTM Work?

The responses to IASTM are complex and multifactorial - physiological and psychological 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, it is 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 Points

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

Where to buy IASTM tools:
IASTM - Stainless Steel
Hawk Grip 
Fascial Abrasion Tool
Smart Tools
The Edge Mobility Tool
Rock Blade
Stone or Plastic
SASTM 
Heskiers OneTool
Jade Stone
Bian Stone

Research Links

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.
https://www.ncbi.nlm.nih.gov/pubmed/28402756

Begovic, H., Zhou, G., Schuster, S., & Zheng, Y. (2016). The neuromotor effects of transverse friction massage. Manual Therapy.
https://www.ncbi.nlm.nih.gov/pubmed/27497646

Bialosky, J.E., Bishop, M.D., Penza, C.W. (2017). Placebo Mechanisms of Manual Therapy: A Sheep in Wolf's Clothing? J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28459190

Bishop, M. D., Torres-Cueco, R., Gay, C. W., Lluch-Girbés, E., Beneciuk, J. M., & Bialosky, J. E. (2015). What effect can manual therapy have on a patient's pain experience? Pain Management.
https://www.ncbi.nlm.nih.gov/pubmed/26401979 (OPEN ACCESS)

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)

Chaitow, L. (2016). New evidence of a dynamic fascial maintenance and self-repair process. Journal of Bodywork and Movement Therapies.
https://www.ncbi.nlm.nih.gov/pubmed/27814847

Chaitow, L. (2016). Dosage and manual therapies – Can we translate science into practice? Journal of Bodywork and Movement Therapies.
https://www.ncbi.nlm.nih.gov/pubmed/27210835

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.
https://www.ncbi.nlm.nih.gov/pubmed/28438745

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.
https://www.ncbi.nlm.nih.gov/pubmed/26713596

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.
https://www.ncbi.nlm.nih.gov/pubmed/22123331

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.
https://www.ncbi.nlm.nih.gov/pubmed/28217425

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.
https://www.ncbi.nlm.nih.gov/pubmed/28253058

Kalson, N.S., Borthwick, L.A., Mann, D.A. ...Krenn, V. (2016). International consensus on the definition and classification of fibrosis of the knee joint. Bone Joint J.
https://www.ncbi.nlm.nih.gov/pubmed/27803223

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.
https://www.ncbi.nlm.nih.gov/pubmed/28349028 (OPEN ACCESS)

Laumonier, T., & Menetrey, J. (2016). Muscle injuries and strategies for improving their repair. Journal of Experimental Orthopaedics. 
https://www.ncbi.nlm.nih.gov/pubmed/27447481 (OPEN ACCESS)

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.
https://www.ncbi.nlm.nih.gov/pubmed/26893309 (OPEN ACCESS)

Thompson, W. R., Scott, A., Loghmani, M. T., Ward, S. R., & Warden, S. J. (2016). Understanding Mechanobiology: Physical Therapists as a Force in Mechanotherapy and Musculoskeletal Regenerative Rehabilitation. Physical Therapy. 
https://www.ncbi.nlm.nih.gov/pubmed/26637643 (OPEN ACCESS)

Vigotsky, A. D., & Bruhns, R. P. (2015). The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review. Pain Research and Treatment. 
https://www.ncbi.nlm.nih.gov/pubmed/26788367 (OPEN ACCESS)

Waters-Banker, C., Dupont-Versteegden, E. E., Kitzman, P. H., & Butterfield, T. A. (2014). Investigating the Mechanisms of Massage Efficacy: The Role of Mechanical Immunomodulation. Journal of Athletic Training.
https://www.ncbi.nlm.nih.gov/pubmed/24641083 (OPEN ACCESS)