Understanding Instrument-Assisted Soft Tissue Mobilization

Can physical therapy with instrument-assisted soft tissue mobilization or IASTM improve mobility, flexibility, and health for individuals with musculoskeletal injuries or illnesses?

Instrument Assisted Soft Tissue Mobilization

Instrument-assisted soft tissue mobilization or IASTM is also known as the Graston technique. It is a myofascial release and massage technique used in physical therapy where the therapist uses metal or plastic tools to improve soft tissue mobility in the body. The ergonomically shaped tool is gently or vigorously scraped and rubbed across the injured or painful area. The rubbing is used to locate and release tightness in the fascia/collagen covering the muscles and the tendons. This helps reduce pain and improve movement.

Massage and Myofascial Release

Instrument-assisted soft tissue mobilization rehabilitation helps:

• Improve soft tissue mobility.
• Release of restrictions in tight fascia.
• Decrease muscle spasms.
• Improve flexibility.
• Increased circulation to the tissues.
• Relieve pain. (Fahimeh Kamali et al., 2014)

Individuals often develop tissue tightness or restrictions in the muscles and fascia after an injury. These soft tissue restrictions can limit the range of motion – ROM and can trigger pain symptoms. (Kim J, Sung DJ, Lee J. 2017)

History

The Graston technique of instrument-assisted soft tissue mobilization was developed by an athlete who created their instruments to treat soft tissue injuries. The practice has grown with input from medical experts, trainers, researchers, and clinicians.

• Physical therapists use different types of tools to perform IASTM.
• These massage instruments comprise various types for specific massage and release.
• The Graston company designs some of the tools.
• Other companies have their version of metal or plastic scraping and rubbing tools.
• The objective is to help release soft tissue and myofascial restrictions to improve body movement. (Kim J, Sung DJ, Lee J. 2017)

How It Works

• The theory is that scraping the tissues causes microtrauma to the affected area, activating the body’s natural inflammatory response. (Kim J, Sung DJ, Lee J. 2017)
• The body activates to reabsorb the tightened or scar tissue, causing the restriction.
• The therapist can then stretch the adhesions to alleviate pain and improve mobility.

Treatment

Certain conditions respond well to instrument-assisted soft tissue mobilization, including (Kim J, Sung DJ, Lee J. 2017)

• Limited mobility
• Decreased muscle recruitment
• Loss of range of motion – ROM
• Pain with movement
• Excessive scar tissue formation

Augmented soft tissue mobilization or ASTM techniques can treat certain injuries and medical conditions that include:

• Musculoskeletal imbalance/s
• Ligament sprains
• Plantar fasciitis
• Myofascial pain
• Tendonitis and tendinopathy
• Scar tissue from surgery or trauma (Morad Chughtai et al., 2019)

Benefits and Side Effects

Benefits include: (Kim J, Sung DJ, Lee J. 2017)

• Improved range of motion
• Increased tissue flexibility
• Improved cell activity at the site of injury
• Reduced pain
• Reduced scar tissue formation

Side effects may include:

• Redness of the skin at the treatment site
• Bruising(Kim J, Sung DJ, Lee J. 2017)
• Worsening of the pain

Research

• A review compared hands-on myofascial release to instrument myofascial release for chronic low back pain. (Williams M. 2017)
• Little difference was found between the two techniques for pain relief.
• Another review compared IASTM to other methods for treating pain and function loss. (Matthew Lambert et al., 2017)
• The researchers concluded that IASTM could positively affect blood circulation and tissue flexibility and reduce pain.
• Another study examined the use of IASTM, pseudo-fake ultrasound therapy, and spinal manipulation for patients with thoracic/upper back pain. (Amy L. Crothers et al., 2016)
• All groups improved over time with no significant negative events.
• The researchers concluded that instrument-assisted soft tissue mobilization is no more or less effective than spinal manipulation or pseudo-ultrasound therapy for thoracic back pain.

Every case is different, and musculoskeletal conditions respond differently to various treatments. For any questions or concerns, contact your primary healthcare provider to determine if IASTM is an appropriate treatment that can help.

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From Injury To Recovery

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References

Kamali, F., Panahi, F., Ebrahimi, S., & Abbasi, L. (2014). Comparison between massage and routine physical therapy in women with sub acute and chronic nonspecific low back pain. Journal of back and musculoskeletal rehabilitation, 27(4), 475–480. doi.org/10.3233/BMR-140468

Kim, J., Sung, D. J., & Lee, J. (2017). Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application. Journal of exercise rehabilitation, 13(1), 12–22. doi.org/10.12965/jer.1732824.412

Chughtai, M., Newman, J. M., Sultan, A. A., Samuel, L. T., Rabin, J., Khlopas, A., Bhave, A., & Mont, M. A. (2019). Astym® therapy: a systematic review. Annals of translational medicine, 7(4), 70. doi.org/10.21037/atm.2018.11.49

Williams M. (2017). Comparing pain and disability outcomes of instrumental versus hands-on myofascial release in individuals with chronic low back pain: a meta-analysis. Doctoral dissertation, California State University, Fresno. repository.library.fresnostate.edu/bitstream/handle/10211.3/192491/Williams_csu_6050D_10390.pdf?sequence=1

Matthew Lambert, Rebecca Hitchcock, Kelly Lavallee, Eric Hayford, Russ Morazzini, Amber Wallace, Dakota Conroy & Josh Cleland (2017) The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: a systematic review, Physical Therapy Reviews, 22:1-2, 76-85, DOI: 10.1080/10833196.2017.1304184

Crothers, A. L., French, S. D., Hebert, J. J., & Walker, B. F. (2016). Spinal manipulative therapy, Graston technique® and placebo for non-specific thoracic spine pain: a randomised controlled trial. Chiropractic & manual therapies, 24, 16. doi.org/10.1186/s12998-016-0096-9