The IASTM technique (Instrument Assisted Soft Tissue Mobilization) is a simple, non-invasive form of treatment, with manipulations aimed at mobilizing the fascia and soft tissues of the human body.
By the term soft tissue we mean all the tissues of the body that are around the bones (Fibrous tissue, Adipose tissue, Muscle tissue, Vascular tissue and sheaths of Nerve tissue).
The IASTM technique is becoming more and more popular these days among both health professionals and patients due to its remarkable safety and effectiveness. These techniques can be applied either alone or in combination with complementary exercises and additional methods (Baker et al., 2013).
Stainless surgical steel instruments are commonly used to mechanically stimulate soft tissue structures, relieve musculoskeletal pain and discomfort, and improve overall mobility and function. In other words, IASTM is a collective term that describes the use of a range of ergonomically designed tools that enable therapists to assess, detect and treat soft tissue pain, injury and dysfunction (Cheatham et 2016).
Soft tissue techniques are applied to points of tissue shortening and fascial adhesions, directly improving the functionality of the area. Some of the therapeutic effects of this technique are:
The tools used for the IASTM technique are uniquely designed to detect potential soft tissue dysfunctions and precise force application during treatment. These tools help therapists apply different manipulations and palpate deeper structures. In other words, they allow a greater depth of transmission of mechanical force to various parts of the body where the hands simply cannot reach (Stow, 2011).
These tools can be either convex or concave in shape and are made from many different materials, including stainless steel, wood, plastic, ceramics and stone. Of these, stainless steel tools are the most popular and often used in clinical practice.
In many traditional medical practices worldwide, there are various forms of instrument-assisted manipulations that closely resemble IASTM techniques. These practices have been around for centuries. Hence, there are several stories about where the IASTM Technique started. Its roots can be traced back to ancient Egypt, China, India as well as Greece. However, the most widely accepted origin of the IASTM technique is Gua Sha, a form of Traditional Chinese Medicine in which the skin is scraped with instruments to create light bruising. This technique is still widely used today in Asia (Cheatham et 2016).
In the Western medical model, the IASTM technique was reintroduced at the end of the last century, particularly during the 1990s. The procedure then quickly grew in popularity and evolved into techniques that fit the way health professionals think and work. Today IASTM has its own indications and contraindications and health professionals practicing this technique can be found in clinics, physical therapy gyms as well as sports teams (Baker et al., 2013).
In general, the IASTM technique has similar principles and reasoning to common soft tissue mobilization practices. He sees the human being in a holistic way and believes that the body has its own ways of healing and regulating itself. The purpose of this treatment is to create an ideal environment for the body's self-preservation mechanisms, either by altering the normal responses to injury or by encouraging the normal functioning of the musculoskeletal system. This approach involves evaluating possible tissue changes or dysfunctions and applying specifically directed techniques to encourage smooth recovery of soft tissue dysfunctions.
Theoretically, IASTM is based on deep friction techniques, as proposed by Cyriax and Russell (1980). These researchers introduced a deep friction massage technique, which must be applied transverse to the direction of the specific tissue involved, to reach the soft tissue structures of the tendon, ligaments, and muscles. They hypothesized that application of this technique could have therapeutic effects within the affected tissue and help maintain mobility by preventing scar tissue adhesions causing local hyperemia (Chamberlain, 1982).
IASTM follows the same rationale as traditional cross-friction kneading, but the difference is that it is performed with specially designed tools. It has been hypothesized that the use of tools provides the therapist with a mechanical advantage, which allows for deeper mobilization, rapid localization and more effective treatment (Baker et 2013). It also helps to apply manipulations along the course of the muscle fibers and minimize the force imposed on the therapist's hands (Laudner et al., 2014).
Another advantage of the IASTM technique is that both the therapist and the patient perceive an increased sensation of vibration, which you consider to be an indication of a change in tissue properties. This heightened perception of vibration facilitates the therapist's task of assessing structural and functional changes in tissues. At the same time, it increases the patient's awareness of reduced and altered sensation within the affected tissues (Lee et al., 2014; Cheatham et al., 2016).
Stow (2011); Hammer (2008)
The IASTM technique has numerous effects on the organization's systems. It breaks down scar tissue and its adhesions, increases fibroblast proliferation and releases fascial restrictions, thereby facilitating collagen synthesis, resorption of inappropriate fibrosis and tissue maturation. However, the mechanism of action behind these effects is not yet fully understood. Many theories exist so far, but the evidence supporting these hypotheses is still limited. This chapter lists some of the important theories that have been developed so far.
In patients with soft tissue injuries, scar tissue and adhesions form when the body completes its self-healing process. Then, the range of motion of the injured area is reduced and the movement of the muscles and other surrounding tissues is inhibited. For this reason, it is critical for therapists to restart the body's healing process so that the affected structures can be remodeled (Hammer, 2004).
This technique is considered to introduce a localized microtrauma to the affected tissue structures, which causes capillary and microvascular bleeding, stimulating the body's inflammatory process. This, in turn, triggers a restart of the natural process of tissue repair and regeneration, initiating the resorption of excess tissue fibrosis and facilitating the body's self-healing (Melham et al., 1998). As a result, the amount of blood, nutrients and fibroblasts in the affected area is enhanced and remodeling of the injured structures is facilitated. This ultimately leads to breakdown of adhesions and scar tissue, allowing for optimal soft tissue repair in the affected area (Hammer, 2008; Laudner et al., 2014).
Fibroblasts are important cells for connective tissue, which are responsible for the production of the extracellular substance (ECM) and collagen. The ECM is where almost all soft tissue repair and regeneration processes take place. Fibroblasts synthesize the ECM and serve as mechanotransducers (Chiquet et al. 2003). This means that fibroblasts can not only detect biological stress (deformation), but also generate appropriate responses to mechanical stimuli.
The IASTM technique has been shown to increase the regeneration and generation of fibroblasts and promote collagen repair. Gehlsen et al. (1999) reported that in rats with enzyme-induced tendonitis, application of the IASTM Technique significantly improved the healing process. They pointed out that the rate of fibroblast proliferation correlates with the high pressure exerted by the tools. In another study in a rat, Davidson et al. (1997) also concluded that soft tissue mobilization techniques may promote healing of injured tissues by increasing fibroblast recruitment. Similarly, they also observed increased fibroblast production in tendinitis. In conclusion, it can be considered that the manipulations of the IASTM technique can lead to restoration and preservation of soft tissues by affecting the recruitment of fibroblasts.
Fascia is an uninterrupted network of white fibrous tissue that runs throughout the body just below the skin. It becomes limited and loses its flexibility if pressure is applied or an injury occurs. When shortening occurs in the fascia, its mobility will be reduced resulting in altered motor patterns and movement patterns in the muscles and pain in distant sensitive areas of the body, e.g. blood vessels and nerves (Findley et al., 2012).
IASTM techniques are thought to restore balance, movement and function by changing the mechanical properties of fascia such as density, tone and arrangement. It has been hypothesized that once the fascial restrictions are released through the appropriate application of IASTM techniques, pressure on the vessels is reduced from the distal irritated areas and blood circulation returns to its normal range (DeLuccio, 2006). Although the scientific evidence to support this hypothesis is still limited, some studies have reported palpable tissue release after applying soft tissue mobilization to areas where the fascia is dense (Juhan, 1987; Ward, 1993; Stecco, 2004). These palpable sensations of tissue release have been attributed to the breakdown of fascial cross-links, a transition from a thickened state of the fascia to one of less extracellular substance.
Connective tissue dysfunction occurs due to internal or external trauma. O'Connell (2003) suggested that this dysfunction could be normalized by applying myofascial release techniques. These techniques involve applying compressive forces to the injured tissues. He hypothesized that once a force is applied to the restraint, the fascia responds directly through the collagen fibers, creating potential microelectrical changes. As a result, the fascial restrictions are reduced and movement continues. Because these techniques can be applied to areas of dense fascia using compressive forces, it is reasonable to say that they can restore movement to the affected area and release the fascia.
IASTM techniques are believed to have some neurophysiological effects, as there have been reports of immediate and sustained fascial response following treatment. Several theories have been proposed to explain these results. However, there is very little scientific evidence to support these assumptions.
One of the most debated theories is that soft tissue mobilization may stimulate Golgi sensory receptors within fascial fibers (Cottingham, 1985). It has been found that during slow stretching of myofascial tissues, the receptors respond by reducing the firing rate of specific alpha motor neurons, which ultimately leads to changes in the tone of the affected tissues. Although it has been hotly debated whether Golgi receptors could be activated by passive stretch, Schleip (2003a) suggested that deep tissue mobilization could indeed affect these receptors, as 90% are located outside the tendon. Because IASTM techniques are a deep treatment, there is a high chance that it will activate the Golgi receptors.
Another important theory that has been used to explain the neurophysiological mechanism of IASTM is fascial plasticity, which was stated by Schleip (2003a, 2003b). The fascia is densely populated by mechanoreceptors and sensory receptors that respond to mechanical stimuli. Schleip proposed that these mechanoreceptors may respond to slow myofascial techniques and trigger changes in the sympathetic system and local vasodilation. He hypothesized that stimulation of these mechanoreceptors results in the transmission of differentiated proprioceptive signals to the central nervous system (CNS). When these inputs are transmitted to the brain, the CNS responds by restarting C motor neurons, which leads to changes in the regulation of muscle tone. This ultimately results in the release of myofascial pain and fascial restrictions.
Research evidence supporting the safety and efficacy of IASTM is still limited.
However, in the past decade, some studies have reported therapeutic benefits of the technique that include improvements in the healing process, range of motion, length, normal function, and pain perception.
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