INSTRUMENT ASSISTED SOFT-TISSUE MOBILIZATION: A COMMENTARY ON CLINICAL PRACTICE GUIDELINES FOR REHABILITATION PROFESSIONALS

Scott W Cheatham, Russell Baker, Ethan Kreiswirth, Scott W Cheatham, Russell Baker, Ethan Kreiswirth

Abstract

Instrument assisted soft-tissue mobilization (IASTM) has become a popular myofascial intervention for sports medicine professionals. Despite the widespread use and emerging research, a consensus on clinical standards, such as a describing the intervention, indications, precautions, contraindications, tool hygiene, safe treatment, and assessment, does not exist. There is a need to develop best practice standards for IASTM through a universal consensus on these variables. The purpose of this commentary is to discuss proposed clinical standards and to encourage other sports medicine professionals and researchers to contribute their expertise to the development of such guidelines.

Level of evidence: 5.

Keywords: ASTYM®; Graston®; instrument assisted soft tissue massage; muscle soreness; myofascial; perceived pain; recovery.

Conflict of interest statement

The authors have no conflict of interests to disclose regarding the content of this manuscript.

Figures

Figure 1.
Figure 1.
Petechiae, as produced by different forms of instrument soft-tissue mobilization.

References

    1. Looney B Srokose T Fernandez-de-las-Penas C Cleland JA. Graston instrument soft tissue mobilization and home stretching for the management of plantar heel pain: a case series. J Manipulative Physiol Ther. 2011;34(2):138-142.
    1. White KE. High hamstring tendinopathy in 3 female long distance runners. J Chiropr Med. 2011;10(2):93-99.
    1. McCrea EC George SZ. Outcomes following augmented soft tissue mobilization for patients with knee pain: a case series. Orthop Phys Ther Pract. 2010;22(2):69-74 66p.
    1. Papa JA. Two cases of work-related lateral epicondylopathy treated with Graston Technique(R) and conservative rehabilitation. J Can Chiropr Assoc. 2012;56(3):192-200.
    1. Baker RT Nasypany A Seegmiller JG Baker JG. Instrument-assisted soft tissue mobilization treatment for tissue extensibility dysfunction. Int J Athl Ther Train. 2013;18(5):16-21.
    1. Howitt S Jung S Hammonds N. Conservative treatment of a tibialis posterior strain in a novice triathlete: a case report. J Can Chiropr Assoc. 2009;53(1):23-31.
    1. Papa JA. Conservative management of De Quervain's stenosing tenosynovitis: a case report. J Can Chiropr Assoc. 2012;56(2):112-120.
    1. Papa JA. Conservative management of Achilles Tendinopathy: a case report. J Can Chiropr Assoc. 2012;56(3):216-224.
    1. Papa JA. Conservative management of a lumbar compression fracture in an osteoporotic patient: a case report. J Can Chiropr Assoc. 2012;56(1):29-39.
    1. Hudes K. Conservative management of a case of medial epicondylosis in a recreational squash player. J Can Chiropr Assoc. 2011;55:26-31.
    1. Howell ER. Conservative care of De Quervain's tenosynovitis/ tendinopathy in a warehouse worker and recreational cyclist: a case report. J Can Chiropr Assoc. 2012;56:121-128.
    1. Miners AL Bougie TL. Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique, ART, eccentric exercise, and cryotherapy. J Can Chiropr Assoc. 2011;55(4):269-279.
    1. Daniels CJ Morrell AP. Chiropractic management of pediatric plantar fasciitis: a case report. J Chiropr Med. 2012;11(1):58-63.
    1. Solecki TJ Herbst EM. Chiropractic management of a postoperative complete anterior cruciate ligament rupture using a multimodal approach: a case report. J Chiropr Med. 2011;10(1):47-53.
    1. Hammer WI Pfefer MT. Treatment of a case of subacute lumbar compartment syndrome using the Graston technique. J Manip Physiol Ther. 2005;28(3):199-204.
    1. 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. J Man Manip Ther. 2011;19(3):127-134.
    1. Black DW. Treatment of knee arthrofibrosis and quadriceps insufficiency after patellar tendon repair: a case report including use of the graston technique. Int J Ther Massage Bodywork. 2010;3(2):14-21.
    1. Blanchette MA Normand MC. Augmented soft tissue mobilization vs natural history in the treatment of lateral epicondylitis: a pilot study. J Manipulative Physiol Ther. 2011;34(2):123-130.
    1. Baker RT Hansberger BL Warren L Nasypany A. A novel approach for the reversal of chronic apparent hamstring tightness: a case report. Int J Sports Phys Ther. 2015;10(5):723-733.
    1. McCormack JR. The management of bilateral high hamstring tendinopathy with ASTYM(R) treatment and eccentric exercise: a case report. J Man Manip Ther. 2012;20(3):142-146.
    1. Henry P Panwitz B Wilson JK. Treatment of a bilateral total knee replacement using augmented soft tissue mobilization. Phys Ther Case Rep. 1999;2(1):27-30 24p.
    1. Scheer NA Alstat LR Van Zant RS. Astym Therapy improves bilateral hamstring flexibility and achilles tendinopathy in a child with cerebral palsy: a retrospective case report. Clin Med Insights Case Rep. 2016;9:95-98.
    1. Miller MM Ray JM Van Zant RS. The effects of astym therapy(r) on a child with spastic diplegic cerebral palsy. Clin Med Insights Case Rep. 2017;10:1179547617746992.
    1. Brantingham JW Globe GA Jensen ML, et al. A feasibility study comparing two chiropractic protocols in the treatment of patellofemoral pain syndrome. J Manip Physiol Ther. 2009;32(7):536-548.
    1. Burke J Buchberger DJ Carey-Loghmani MT Dougherty PE Greco DS Dishman JD. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manip Physiol Ther. 2007;30(1):50-61.
    1. McCormack JR Underwood FB Slaven EJ Cappaert TA. Eccentric exercise versus eccentric exercise and soft tissue treatment (astym) in the management of insertional achilles tendinopathy. Sports Health. 2016;8(3):230-237.
    1. Sevier TL Stegink-Jansen CW. Astym treatment vs. eccentric exercise for lateral elbow tendinopathy: a randomized controlled clinical trial. PeerJ. 2015;3:e967.
    1. Gulick DT. Instrument-assisted soft tissue mobilization increases myofascial trigger point pain threshold. J Bodyw Mov Ther. 2018;22(2):341-345.
    1. Laudner K Compton BD McLoda TA Walters CM. Acute effects of instrument assisted soft tissue mobilization for improving posterior shoulder range of motion in collegiate baseball players. Int J Sports Phys Ther. 2014;9(1):1-7.
    1. Markovic G. Acute effects of instrument assisted soft tissue mobilization vs. foam rolling on knee and hip range of motion in soccer players. J Bodyw Mov Ther. 2015;19(4):690-696.
    1. Chughtai M Mont MA Cherian C, et al. A novel, nonoperative treatment demonstrates success for stiff total knee arthroplasty after failure of conventional therapy. J Knee Surg. 2016;29(3):188-193.
    1. Davies CC Brockopp D Moe K. Astym therapy improves function and range of motion following mastectomy. Breast Cancer (Dove Med Press). 2016;8:39-45.
    1. Bhave A Corcoran J Cherian JJ Mont MA. Astym(R) Therapy for the management of recalcitrant knee joint stiffness after total knee arthroplasty. J Long Term Eff Med Implants. 2016;26(2):151-159.
    1. Gulick DT. Influence of instrument assisted soft tissue treatment techniques on myofascial trigger points. J Bodyw Mov Ther. 2014;18(4):602-607.
    1. Schaefer JL Sandrey MA. Effects of a 4-week dynamic-balance-training program supplemented with Graston instrument-assisted soft-tissue mobilization for chronic ankle instability. J Sport Rehabil. 2012;21(4):313-326.
    1. MacDonald N Baker R Cheatham SW. The effects of instrument assisted soft tissue mobilization on lower extremity muscle performance: a randomized controlled trial. Int J Sports Phys Ther. 2016;11(7):1040-1047.
    1. Kivlan BR Carcia CR Clemente FR Phelps AL Martin RL. The effect of Astym(R) Therapy on muscle strength: a blinded, randomized, clinically controlled trial. BMC Musculoskelet Disord. 2015;16:325.
    1. Gamboa AJ Craft DR Matos JA Flink TS Mokris RL. Functional movement analysis before and after instrument-assisted soft tissue mobilization. Int J Exerc Sci. 2019;12(3):46-56.
    1. Cheatham SW Lee M Cain M Baker R. The efficacy of instrument assisted soft tissue mobilization: a systematic review. J Can Chiropr Assoc. 2016;60(3):200-211.
    1. Lambert M Hitchcock R Lavallee K, et al. The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: a systematic review. Physical Therapy Reviews. 2017;22(1-2):76-85.
    1. 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. Arch Phys Med Rehabil. 2019. [Epub ahead on print]
    1. Nielsen A. Gua sha research and the language of integrative medicine. J Bodyw Mov Ther. 2009;13(1):63-72.
    1. Nielsen A Kligler B Koll BS. Safety protocols for gua sha (press-stroking) and baguan (cupping). Complement Ther Med. 2012;20(5):340-344.
    1. Wiwanitkit V. Culture-bounded skin lesion - a case due to chinese gua sha. Indian J Dermatol. 2017;62(4):441.
    1. Aprile A Pomara C Turillazzi E. Gua Sha a traditional Chinese healing technique that could mimick physical abuse: a potential issue with forensic implications. A case study. Forensic Sci Int. 2015;249:e19-20.
    1. Odhav A Patel D Stanford CW Hall JC. Report of a case of Gua Sha and an awareness of folk remedies. Int J Dermatol. 2013;52(7):892-893.
    1. Kim J Sung DJ Lee J. Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application. J Exerc Rehabil. 2017;13(1):12-22.
    1. Aspegren D Hyde T Miller M. Conservative treatment of a female collegiate volleyball player with costochondritis. J Manipulative Physiol Ther. 2007;30(4):321-325.
    1. Stow R. Instrument-Assisted Soft Tissue Mobilization. Int J Athl Ther Train. 2011;16(3):5-8.
    1. Vardiman JP Siedlik J Herda T, et al. Instrument-assisted soft tissue mobilization: effects on the properties of human plantar flexors. Int J Sports Med. 2015;36(3):197-203.
    1. Crothers AL French SD Hebert JJ Walker BF. Spinal manipulative therapy, Graston technique(R) and placebo for non-specific thoracic spine pain: a randomised controlled trial. Chiropr Man Ther. 2016;24:16.
    1. Hussey MJ Boron-Magulick AE Valovich McLeod TC Welch Bacon CE. The comparison of instrument-assisted soft tissue mobilization and self-stretch measures to increase shoulder range of motion in overhead athletes: a critically appraised topic. J Sport Rehabil. 2018:1-5.
    1. Lee JH Lee DK Oh JS. The effect of Graston technique on the pain and range of motion in patients with chronic low back pain. J Phys Ther Sci. 2016;28(6):1852-1855.
    1. Stanek J Sullivan T Davis S. Comparison of compressive myofascial release and the graston technique for improving ankle-dorsiflexion range of motion. J Athl Train. 2018;53(2):160-167.
    1. Crane P Ladden J Monica D. Treatment of axillary web syndrome using instrument assisted soft tissue mobilization and thoracic manipulation for associated thoracic rotation dysfunction. Physiother Theory Pract. 2018;34(1):74-78.
    1. Ge W Roth E Sansone A. A quasi-experimental study on the effects of instrument assisted soft tissue mobilization on mechanosensitive neurons. J Phys Ther Sci. 2017;29(4):654-657.
    1. Stroiney DA Mokris RL Hanna GR Ranney JD. Examination of self-myofascial release vs. instrument-assisted soft-tissue mobilization techniques on vertical and horizontal power in recreational athletes. J Strength Cond Res. 2018. [Epub ahead of print]
    1. Loghmani MT Warden SJ. Instrument-assisted cross fiber massage increases tissue perfusion and alters microvascular morphology in the vicinity of healing knee ligaments. BMC Complement Altern Medi. 2013;13:240.
    1. Jeong Jae L Jae Jin L Do Hyun K Sung Hyun Y. Inhibitory effects of instrument-assisted neuromobilization on hyperactive gastrocnemius in a hemiparetic stroke patient. Bio-Med Materials Engin. 2014;24(6):2389-2394.
    1. Portillo-Soto A Eberman LE Demchak TJ Peebles C. Comparison of blood flow changes with soft tissue mobilization and massage therapy. J Altern Complement Med. 2014;20(12):932-936.
    1. Strunk RG Pfefer MT Dube D. Multimodal chiropractic care of pain and disability for a patient diagnosed with benign joint hypermobility syndrome: a case report. J Chiropr Med. 2014;13(1):35-42.
    1. Lee MS Choi T-Y Kim J-I Choi S-M. Using Guasha to treat musculoskeletal pain: A systematic review of controlled clinical trials. Chinese Medicine. 2010;5:5.
    1. Page P Hoogenboom B Voight M. Improving the reporting of therapeutic exercise interventions in rehabilitation research. Int J Sports Phys Ther. 2017;12(2):297-304.
    1. Ikeda N Otsuka S Kawanishi Y Kawakami Y. Effects of Instrument-assisted Soft Tissue Mobilization on Musculoskeletal Properties. Med Sci Sports Exerc. 2019. [Epub ahead of print]
    1. Rowlett CA Hanney WJ Pabian PS McArthur JH Rothschild CE Kolber MJ. Efficacy of instrument-assisted soft tissue mobilization in comparison to gastrocnemius-soleus stretching for dorsiflexion range of motion: A randomized controlled trial. J Bodyw Mov Ther. 2019;23(2):233-240.
    1. Cheatham SW Kreiswirth E Baker R. Does a light pressure instrument assisted soft tissue mobilization technique modulate tactile discrimination and perceived pain in healthy individuals with DOMS? J Can Chiropr Assoc. 2019;63(1):18-25.
    1. Imai K Ikoma K Chen Q Zhao C An KN Gay RE. Biomechanical and histological effects of augmented soft tissue mobilization therapy on achilles tendinopathy in a rabbit model. J Manipulative Physiol Ther. 2015;38(2):112-118.
    1. Gehlsen GM Ganion LR Helfst R. Fibroblast responses to variation in soft tissue mobilization pressure. Med Sci Sports Exerc. 1999;31(4):531-535.
    1. Davidson CJ Ganion LR Gehlsen GM Verhoestra B Roepke JE Sevier TL. Rat tendon morphologic and functional changes resulting from soft tissue mobilization. Med Sci Sports Exerc. 1997;29(3):313-319.
    1. Ernst E. The safety of massage therapy. Rheumatology. 2003;42(9):1101-1106.
    1. Laimi K Makila A Barlund E, et al. Effectiveness of myofascial release in treatment of chronic musculoskeletal pain: a systematic review. Clin Rehabil. 2017:269215517732820.
    1. McKenney K Elder AS Elder C Hutchins A. Myofascial release as a treatment for orthopaedic conditions: a systematic review. J Athl Train. 2013;48(4):522-527.
    1. Westman KF Blaisdell C. Many benefits, little risk: the use of massage in nursing practice. Am J Nurs. 2016;116(1):34-39; quiz 40-31.
    1. Yin P Gao N Wu J Litscher G Xu S. Adverse events of massage therapy in pain-related conditions: a systematic review. Evid Based Complement Alternat Med. 2014;2014:480956.
    1. Batavia M. Contraindications for therapeutic massage: do sources agree? J Bodyw Mov Ther. 2004;8(1):48-57.
    1. Hammer WI. The effect of mechanical load on degenerated soft tissue. J Bodyw Mov Ther. 2008;12(3):246-256.
    1. Ranjbaran M Khorsandi M Matourypour P Shamsi M. Effect of massage therapy on labor pain reduction in primiparous women: a systematic review and meta-analysis of randomized controlled clinical trials in iran. Iran J Nurs Midwifery Res. 2017;22(4):257-261.
    1. Buntinx-Krieg T Greenwald J. Softball petechiae: a novel cutaneous finding in a patient participating in post-exercise massage. Cureus. 2016;8(9):e777.
    1. Amshel CE Caruso DM. Vietnamese “coining”: a burn case report and literature review. J Burn Care Rehabil. 2000;21(2):112-114.
    1. Veiga-Malta I. Preventing Healthcare-Associated Infections by Monitoring the Cleanliness of Medical Devices and Other Critical Points in a Sterilization Service. Biomed Instrum Technol. 2016;50 Suppl 3:45-52.
    1. Nielsen A Kligler B Koll BS. Addendum: Safety Standards for Gua sha (press-stroking) and Ba guan (cupping). Complement Ther Med. 2014;22(3):446-448.
    1. Jung YJ Kim JH Lee HJ, et al. A herpes simplex virus infection secondary to acupuncture and cupping. Ann Dermatol. 2011;23(1):67-69.
    1. Kim TH Kang JW Park WS. The reporting quality of acupuncture-related infections in korean literature: a systematic review of case studies. Evid Based Complement Alternat Med. 2015;2015:273409.
    1. Boyce JM Pittet D. Guideline for hand hygiene in health-care settings. recommendations of the healthcare infection control practices advisory committee and the hicpac/shea/apic/idsa hand hygiene task force. society for healthcare epidemiology of america/association for professionals in infection control/infectious diseases society of america. MMWR Recomm Rep. 2002;51(Rr-16):1-45, quiz CE41-44.
    1. Casey A Itrakjy A Birkett C, et al. A comparison of the efficacy of 70% v/v isopropyl alcohol with either 0.5% w/v or 2% w/v chlorhexidine gluconate for skin preparation before harvest of the long saphenous vein used in coronary artery bypass grafting. Am J Infect Control. 2015;43(8):816-820.
    1. Boyce JM. Alcohols as surface disinfectants in healthcare settings. Infect Control Hosp Epidemiol. 2018;39(3):323-328.
    1. Kim SS Yu SB Kim JD Ryu SJ. Comparison of disinfective power according to application order of 70% isopropyl alcohol and 10% povidone-iodine. Korean J Anesthesiol. 2013;65(6):519-524.
    1. Coviello JP Kakar RS Reynolds TJ. Short-term effects of instrument-assisted soft tissue mobilization on pain free range of motion in a weightlifter with subacromial pain syndrome. Int J Sports Phys Ther. 2017;12(1):144-154.
    1. Lee JJ Lee JJ Kim do H You SJ. Inhibitory effects of instrument-assisted neuromobilization on hyperactive gastrocnemius in a hemiparetic stroke patient. Biomed Mater Eng. 2014;24(6):2389-2394.

Source: PubMed

3
Subscribe