Instrument Assisted Soft Tissue- What is the benefit?

You may have noticed these shiny metal tools in some of my photos, or seen “instrument assisted soft tissue mobilization” (IASTM) discussed as a treatment option in some of my posts. You may have even heard of different types of this treatment called “Graston Technique” or “Gua Sha”. But what is the benefit of having these (sometimes scary looking) tools used on you?

This type of instrument assisted treatment dates all the way back to 220 BC with Gua Sha technique, where different instruments made from spoons, coins, wood, bamboo, jade or even bones were used to scrape the soft tissues. The goal of treatment was to create petechiae (little blood spots) and ecchymosis (bruising) which was proposed to remove stagnant blood, promote normal circulation and metabolic processes.

Modern IASTM using the type of stainless steel tools pictured was developed by David Graston, with many similar systems following.

So what is the modern understanding of the benefits of this treatment? To aid in the healing process! This process is believed to stimulate the nervous system, break up abnormal tissue densities, and re-initiate the early stages of tissue healing. The design of the tools also helps your therapist better feel the areas of tissue adhesion.

Lets look a bit more into each of these benefits and what they mean.

1. Nervous system stimulation
   • As with any touch, these tools stimulate the skin and the different sensation receptors that lay below
   • By stimulating different types of these receptors (i.e. pain and sensation) at the same time, it takes the brain longer to perceive the pain signals (pain gate theory)
   • Stimulation of mechanoreceptors can allow increased range of motion, a similar way to foam rolling
   • Improves proprioception- the body’s ability to sense position in space
2. Breaking up abnormal tissue densities
   • One of the most common uses of this type of therapy
   • When treating a tendinopathy, IASTM helps decrease pain, improve range of motion and enable a faster return to function than traditional treatment
   • This technique does this best when it is a part of other treatment modalities
   • It can also assist when the connective tissue between layers of muscle are not gliding like they normally would
3. Re-initiating the first stage of healing
   • The microtrauma caused by this technique causes a local inflammatory response, similar to the one that happens at the time of injury
   • We tend to think of inflammation as bad, but this is what brings the different healing factors to the injured area
   • The increase in blood flow also helps to bring the necessary healing factors and nutrients to help the body rebuild injured tissues

This technique can be used for both acute and chronic conditions affecting the spine and extremities. Your chiropractor can assess your specific injury/condition determine if this type of treatment is appropriate for you.

This technique should not be used if you have open wounds or skin rashes, fractures, existing bruises, acute inflammatory conditions or are taking anti-coagulant medications. Always make sure to be full and complete in the medical history that you provide to your chiropractor.

Resources:

• Baker RT, Nasypany A, Seegmiller JG, Baker JG. Instrument-assisted soft tissue mobilization treatment for tissue extensibility dysfunction. International Journal of Athletic Therapy and Training. 2013 Sep 1;18(5):16-21.
• Bayliss AJ, Klene FJ, Gundeck EL, Loghmani MT. Treatment of a patient with post-natal chronic calf pain utilizing instrument-assisted soft tissue mobilization: a case study. Journal of Manual & Manipulative Therapy. 2011 Aug 1;19(3):127-34.
• Bove GM, Chapelle SL. Visceral mobilization can lyse and prevent peritoneal adhesions in a rat model. Journal of bodywork and movement therapies. 2012 Jan 1;16(1):76-82.
• Davidson CJ, Ganion LR, Gehlsen GM, Verhoestra BE, Roepke JE, Sevier TL. Rat tendon morphologic and functional changes resulting from soft tissue mobilization. Medicine and science in sports and exercise. 1997 Mar 1;29(3):313-9.
• 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.
• Langevin HM, Fox JR, Koptiuch C, Badger GJ, Greenan-Naumann AC, Bouffard NA, Konofagou EE, Lee WN, Triano JJ, Henry SM. Reduced thoracolumbar fascia shear strain in human chronic low back pain. BMC musculoskeletal disorders. 2011 Dec;12(1):203.
• Loghmani MT, Warden SJ. Instrument-assisted cross-fiber massage accelerates knee ligament healing. journal of orthopaedic & sports physical therapy. 2009 Jul;39(7):506-14.
• Loghmani MT, Warden SJ. Instrument-assisted cross fiber massage increases tissue perfusion and alters microvascular morphology in the vicinity of healing knee ligaments. BMC complementary and alternative medicine. 2013 Dec;13(1):240.
• Markovic G. Acute effects of instrument assisted soft tissue mobilization vs. foam rolling on knee and hip range of motion in soccer players. Journal of bodywork and movement therapies. 2015 Oct 1;19(4):690-6.
• Smart Tools Instrument Assisted Soft Tissue Mobilization Certification Level 1