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Picture

Instrument Assisted Soft Tissue Mobilization Discussion

5/11/2013

2 Comments

 
Picture
"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. 
Picture
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.
2 Comments
Art McAlister link
5/11/2013 12:18:43 pm

Jim, we have been using the Edge tool for chronic neck pain and stiffness by getting into the intravertebral spaces along the articular pillars.

Reply
Nick Rainey link
9/24/2014 02:33:05 am

I use IASTM a lot. When evidence is lacking I feel that is when testing and retesting is most important. If evidence is strong for an intervention then I'll explore it a little more even if I don't find retesting to be as powerful immediately. Thus, if I find a retest to be beneficial when using IASTM then I will continue to use it, but if not then I forgo it for the time being.

Reply



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  • Home
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    • Return to Sport Essentials Course
  • Resources
    • Newsletter
    • Business Minded Sports Physio Podcast
    • Day in the Life of a Sports PT
    • Residency Corner
    • Special Tests >
      • Cervical Spine >
        • Alar Ligament Test
        • Bakody's Sign
        • Cervical Distraction Test
        • Cervical Rotation Lateral Flexion Test
        • Craniocervical Flexion Test (CCFT)
        • Deep Neck Flexor Endurance Test
        • Posterior-Anterior Segmental Mobility
        • Segmental Mobility
        • Sharp-Purser Test
        • Spurling's Maneuver
        • Transverse Ligament Test
        • ULNT - Median
        • ULNT - Radial
        • ULNT - Ulnar
        • Vertebral Artery Test
      • Thoracic Spine >
        • Adam's Forward Bend Test
        • Passive Neck Flexion Test
        • Thoracic Compression Test
        • Thoracic Distraction Test
        • Thoracic Foraminal Closure Test
      • Lumbar Spine/Sacroiliac Joint >
        • Active Sit-Up Test
        • Alternate Gillet Test
        • Crossed Straight Leg Raise Test
        • Extensor Endurance Test
        • FABER Test
        • Fortin's Sign
        • Gaenslen Test
        • Gillet Test
        • Gower's Sign
        • Lumbar Quadrant Test
        • POSH Test
        • Posteroanterior Mobility
        • Prone Knee Bend Test
        • Prone Instability Test
        • Resisted Abduction Test
        • Sacral Clearing Test
        • Seated Forward Flexion Test
        • SIJ Compression/Distraction Test
        • Slump Test
        • Sphinx Test
        • Spine Rotators & Multifidus Test
        • Squish Test
        • Standing Forward Flexion Test
        • Straight Leg Raise Test
        • Supine to Long Sit Test
      • Shoulder >
        • Active Compression Test
        • Anterior Apprehension
        • Biceps Load Test II
        • Drop Arm Sign
        • External Rotation Lag Sign
        • Hawkins-Kennedy Impingement Sign
        • Horizontal Adduction Test
        • Internal Rotation Lag Sign
        • Jobe Test
        • Ludington's Test
        • Neer Test
        • Painful Arc Sign
        • Pronated Load Test
        • Resisted Supination External Rotation Test
        • Speed's Test
        • Posterior Apprehension
        • Sulcus Sign
        • Thoracic Outlet Tests >
          • Adson's Test
          • Costoclavicular Brace
          • Hyperabduction Test
          • Roos (EAST)
        • Yergason's Test
      • Elbow >
        • Biceps Squeeze Test
        • Chair Sign
        • Cozen's Test
        • Elbow Extension Test
        • Medial Epicondylalgia Test
        • Mill's Test
        • Moving Valgus Stress Test
        • Push-up Sign
        • Ulnar Nerve Compression Test
        • Valgus Stress Test
        • Varus Stress Test
      • Wrist/Hand >
        • Allen's Test
        • Carpal Compression Test
        • Finkelstein Test
        • Phalen's Test
        • Reverse Phalen's Test
      • Hip >
        • Craig's Test
        • Dial Test
        • FABER Test
        • FAIR Test
        • Fitzgerald's Test
        • Hip Quadrant Test
        • Hop Test
        • Labral Anterior Impingement Test
        • Labral Posterior Impingement Test
        • Long-Axis Femoral Distraction Test
        • Noble Compression Test
        • Percussion Test
        • Sign of the Buttock
        • Trendelenburg Test
      • Knee >
        • Anterior Drawer Test
        • Dial Test (Tibial Rotation Test)
        • Joint Line Tenderness
        • Lachman Test
        • McMurray Test
        • Noble Compression Test
        • Pivot-Shift Test
        • Posterior Drawer Test
        • Posterior Sag Sign
        • Quad Active Test
        • Thessaly Test
        • Valgus Stress Test
        • Varus Stress Test
      • Foot/Ankle >
        • Anterior Drawer
        • Calf Squeeze Test
        • External Rotation Test
        • Fracture Screening Tests
        • Impingement Sign
        • Navicular Drop Test
        • Squeeze Test
        • Talar Tilt
        • Tarsal Tunnel Syndrome Test
        • Test for Interdigital Neuroma
        • Windlass Test