Instrument Assisted Soft Tissue Mobilization Discussion

"What IASTM is, is not, and might be"  is a recent post by Leonard van Gelder via his Dynamic Principles Blog. In this post, he discusses his usage of the EDGE Tool, why he uses it and the controversy surrounding using different instruments in his treatment sessions. First off, it is important to note that there is not a great deal of evidence surrounding IASTM. While major IASTM companies report high levels success, the amount of published articles does not directly correlate with these claims. 

A few of these reported health benefits include regarding IASTM: 
1. Activating the histamine response and triggering localized tissue inflammation
2. Scar Tissue (Type III Collagen) breakdown and "realigning fibers"
                                     3. Promoting collagen synthesis by promoting fibroblast proliferation

---

Histamine Response:
Histamine's 2 main functions following acute injury are localized vasodilation and inducing fluid secretions to the site of injury or infection. These functions are important for bringing white blood cells to the area and stimulating certain macrophages.  

Type III Collagen:
Around the third week following tissue injury, the maturation and remodeling phase of healing begins. During this phase, Type III Collagen begins to be replaced by more mature Type I Collagen, which is aligned along tensile forces. This collagen is continually remodeled until permanent repair is achieved. 

Fibroblast Proliferation:
During the initial stages of healing, fibroblasts are important for secreting large amounts of type III collagen. Additionally, fibroblasts help maintain the structural integrity of connective tissue. 

Of those reported benefits (above), increasing fibroblast proliferation is the only property that has been consistently demonstrated through various research articles. With that said, the current studies have mainly been performed on rat MCL's with little evidence supporting long term differences in collagen synthesis whether or not IASTM was used. 

In conclusion, it is important to remember that regular mobility of an affected area helps increase lubrication and maintains critical fiber distance. Whether it be from hands on techniques or the use of an instrument, it is important to keep structures mobile. As Goodman and Fuller state, "Immobilization is associated with excessive deposition of connective tissue in associated areas. This is accompanied by a loss of water and subsequent dehydration. The result is an increase in intermolecular cross-linking, which further restricts normal connective tissue flexibility and extensibility." When using Graston tools, the back edge of spoon, or the EDGE Tool, one must remember their intent behind treating with an instrument. In other words, what are you really trying to change or modify? The body of knowledge surrounding IASTM is limited, but being informed about what it is and maybe is a step in the right direction. 

---

References:
Goodman C, Fuller K. Pathology: Implications for the Physical Therapist. 3rd Edition. St. Louis: Saunders 
     Elsevier, 2009. Print.