Instrument Assisted Soft Tissue Mobilization (IASTM).pptx

Instrument Assisted Soft Tissue Mobilization (IASTM) is a modern, evidence-based manual therapy technique used by physiotherapists to assess and treat soft tissue dysfunctions. This seminar presentation provides an in-depth exploration of the principles, tools, techniques, and clinical applications of IASTM, making it valuable for physiotherapy students, practitioners, and rehabilitation professionals.

This comprehensive seminar covers the biomechanical and physiological basis of IASTM, how it promotes soft tissue healing, improves range of motion, and reduces pain. It also explains how the technique stimulates fibroblast proliferation, increases collagen synthesis, and enhances tissue remodeling, making it an effective approach for managing chronic musculoskeletal conditions.

The presentation includes:

✅ Introduction to IASTM: Definition, evolution, and theoretical background.

✅ Tools and Equipment: Different types of stainless-steel instruments, their design, and usage.

✅ Mechanism of Action: How controlled microtrauma and mechanical stimulation promote healing.

✅ Clinical Indications and Contraindications: Safe and effective use of IASTM in various patient conditions.

✅ Treatment Techniques: Angulation (30–60°), stroke direction, pressure control, and tissue engagement.

✅ Physiological Effects: Circulation improvement, fascial release, and scar tissue breakdown.

✅ Integration with Other Modalities: Combining IASTM with stretching, cryotherapy, and strengthening exercises.

✅ Evidence-Based Practice: Recent research findings supporting IASTM in rehabilitation.

✅ Clinical Case Discussions: Practical examples and outcomes in musculoskeletal rehabilitation.

IASTM has become a key technique in modern physiotherapy due to its efficiency, minimal invasiveness, and ability to accelerate recovery in soft tissue pathologies such as tendinopathies, muscle tightness, myofascial restrictions, and post-surgical adhesions.

Whether you are a physiotherapy student, clinician, sports therapist, or rehabilitation specialist, this presentation provides valuable insights into how IASTM can be effectively integrated into your treatment protocols to enhance patient outcomes.

1. INSTRUMENT ASSISTED SOFT TISSUE MOBILIZATION (IASTM) Dr. Naeem Rahbar (PT)

2. Introduction Instrument assisted soft tissue mobilization (IASTM) is a skilled myofascial intervention used for soft-tissue treatment. It is applied using instruments that are usually made of stainless steel with bevelled edges and contours that can conform to different body anatomical locations and allows for deeper penetration [1] . The technique itself is said to have evolved from Gua sha which is a method used in Chinese medicine. Gua sha uses instruments with smoothed edges to scrape the skin till red blemishes occur [2] .

3. Principles It is based on the principles of James Cyriax cross-friction massage (also known as DFM). Cross-friction massage (also known as DFM) is a specific connective tissue massage that was developed by James Cyriax. The purpose of DFM is to: maintain the mobility within the soft tissue structures of ligament, tendon, and muscle, and prevent scars from forming. The massage is deep, as the name implies, and must be applied transversely to the specific tissue involved unlike the superficial massage given in the longitudinal direction parallel to the vessels which enhances circulation and return of fluids [3] .

4. Indications Neck Pain Plantar Fasciitis Tendonitis Post-Surgical and Traumatic Scars Myofascial Pain and Restrictions Muscle Strains Ligament Sprains

5. Contraindications Open wound Unhealed fracture Uncontrolled hypertension Patient intolerance/hypersensitivity Hematoma Osteomyelitis Myositis ossificans Hemophilia

6. Tools There are many companies for IASTM such as RockTape , HawkGrips , Graston. Each company has its own treatment approach with different instrument designs [1] . IASTM can be made from varying materials including stainless steel, titanium, plastic, buffalo horn, stone, quartz. The most common IASTM instruments used are stainless steel [1] .

7. Practical Applications IASTM can’t be done by itself, it must be combined with motion and strengthening program to enhance the tissues remodeling. IASTM is applied through 6 steps Examination Warm-up is done for 10-15 mins. IASTM, done at 30-60 degrees angle for 40-120 seconds. Stretching, 3 reps for 30 seconds

8. Strengthening, high repetitions with low load exercise Cryotherapy, 10-20 min [4] . It is important to disinfect the instrument between patients to avoid transfer of infections .

9. Graston Technique: Targeting the levator scapulae and upper trapezius [5] .

10. Graston Technique: Relieve Foot Pain and Improve Mobility [6] .

11. Benefits - Cellular Level The inflammatory response initiated through micro-trauma to the affected tissues results in increased fibroblast proliferation, collagen synthesis, maturation and the remodeling of unorganized collagen fiber matrix following IASTM application. Which result in a breakdown of scar tissues, adhesions and fascial restrictions [1][3] .

12. Neurophysiological Effects It stimulates mechanosensitive neurons through skin deformation by the instrument. Mechanosensitive neurons include mechanoreceptors which are responsible for two-point discrimination and mechano-nociceptors which are responsible for pain perception [1][3] . Studies found that there is a decrease in the area of 2-point discrimination suggesting improved local tactile sense through mechanoreceptors stimulation and a decrease in the pain pressure threshold [1] .

13. Vascular Response Increased blood flow. Studies suggest that there is increase in tissue perfusion and increase in the proportion of blood vessels in the treated area [3] .

14. Clinical Benefits Studies have also showed clinical benefits of IASTM showing improvements in range of motion, strength and pain perception following treatment [7] . IASTM provide therapists a mechanical advantage, thus preventing over-use to the hands, it provides deeper tissue penetration with less compressive forces to the interphalangeal joints of the therapist’s hand [7] .

15. Advantages Non-invasive. Can target specific tissue adhesions. Requires less physical strain for therapist. Quick results compared to manual therapy alone.

16. Disadvantages May cause temporary bruising, redness, soreness. Needs training to use effectively.

17. Limitations Not suitable for all patients (contraindicated). Does not replace exercise therapy. Limited evidence for some conditions.

18. Conclusions IASTM is a valuable adjunct physiotherapy tool. Helps in treating soft tissue dysfunctions effectively. Best used in combination with exercise & patient education.

19. References Lambert M, Hitchcock R, Lavallee K, Hayford E, Morazzini R, Wallace A, Conroy D, Cleland J. The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: a systematic review. Physical Therapy Reviews. 2017 Mar 4;22(1-2):76-85. Nazari G, Bobos P, MacDermid JC, Birmingham T. The effectiveness of Instrument-Assisted soft tissue mobilization in athletes, participants without extremity or spinal conditions, and individuals with upper extremity, lower extremity, and spinal conditions: a systematic review. Archives of Physical Medicine and Rehabilitation. 2019 Sep 1;100(9):1726-51. Cheatham SW, Baker R, Kreiswirth E. Instrument assisted soft-tissue mobilization: A commentary on clinical practice guidelines for rehabilitation professionals. International journal of sports physical therapy. 2019 Jul;14(4):670.

20. Kim J, Sung DJ, Lee J. Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application. Journal of exercise rehabilitation. 2017 Feb;13(1):12. https://www.youtube.com/shorts/NmwWV8DH4VY https://www.youtube.com/shorts/7UOLMKtHUiw Melham TJ, Sevier TL, Malnofski MJ, Wilson JK, Helfst Jr RH. Chronic ankle pain and fibrosis successfully treated with a new noninvasive augmented soft tissue mobilization technique (ASTM): a case report. Medicine and science in sports and exercise. 1998 Jun 1;30(6):801-4.