Instrument Assisted Soft Tissue Mobilization

Instrument Assisted Soft Tissue Mobilization (IASTM) is a form of soft tissue manipulation that utilizes a tool to improve tissue mobility and stimulate your bodies innate healing mechanisms.  The instruments consist of convex and concave curves that mold to the contours of the body and offer either a gentler or more aggressive soft tissue release, depending on their shape and the practitioners desired effect.  The shapes allow for the treatment of any region of the body, from the small contours of the hand to the larger muscle groups like the hamstring. Commonly known approaches that utilize Instrument Assisted Soft Tissue Mobilization include “Graston” and “AYSTM“ techniques. (Click here to read an article from ‘Trail Runner’ magazine on ASTYM technique)

When these instruments are run along the surface of a muscle or tendon, the therapist (and patient) can appreciate occasional vibrations where the instruments ‘catch’ on irregular fibrosis 1 (commonly, if not totally accurately, referred to as ‘scar tissue’) within the muscle, fascia or tendon. This abnormal tissue (disorganized and/or fibrosed) can result from repetitive strain, trauma, surgery and immobilization.

Treatment with these specialized instruments is thought to break up adhesions in fibrosed tissue, particularly within the various interfaces between the planes of muscles, nerves, fascia, etc., can become adhered and restricted.  2

Improving the ‘glide’ between tissue layers and breaking up adhesions within the various tissues can improve the mobility of muscle, tendon and fascia. 3 4 5

Our patients routinely report an immediate sensation of improved mobility with treatment.

Diagnostic ultrasound has shown, as an example, in a study of patients with chronic low-back pain, demonstrated a lack of gliding and sliding of the dense fibrous connective tissue overlying the lumbar spine known as the Thoraco-Lumbar fascia. Patients with pain demonstrated ~ 20% less mobility as compared to the control group (without low back pain) 6

IASTM can also be used to promote the ‘remodeling’ and/or activate the ‘regeneration’ of abnormal soft tissues (muscle, tendon, etc) through a process referred to as ‘Capillary Leakage’. It is hypothesized that mechanically induced leakage from local capillaries can “lead to fibroblast activation, phagocytosis, and the release of growth factors” 7 8 9 to jump start the bodies natural healing processes.

Whatever the mechanism, IASTM has been shown to accelerate healing time frames for both tendon and ligament injuries 10 11 and result in improved biomechanical properties in treated tissues. Researchers found that torn knee MCL (ligament) treated with IASTM intermittently during the healing /recovery phase, resulted in a 43% stronger ligament 4 weeks out from injury! 12

Research describes the usefulness of IASTM in treating a multitude of injuries including Patellofemoral Pain, 13 14 Plantar Fasciitis, 15 16 Ankle Pain, 17 18 Calf Pain, 19 Shin Splints, 20 Achilles Teninopathy, 21 22 23 Hamstring Tendinopathy, 24 Wrist Tendonitis, 25 Elbow Tendonitis, 26 27 and Carpal Tunnel. 28

IASTM is most effective when used in conjunction with other therapeutic interventions (progressive loading with exercise, mobility drills, etc.). All of our Physical Therapists have undergone training specific to the use of Instrumented Soft Tissue Mobilization.

If you have a stubborn soft tissue injury make an appointment today and see how this treatment approach can enable a more rapid return to activity, free from pain and limitation.

Over the last twenty years and ten orthopedic surgeries, I’ve worked with a dozen physical therapists in New England. Unequivocally, Jeff Albertson is the best. First, he actively listens when I describe my pain – this is more rare for a PT than it should be. Second, he rigorously deduces the root causes of my pain through detailed, often time-intensive assessment. Jeff runs a custom practice, not one-size-fits-all therapy. Finally, by virtue of this careful, methodical, and compassionate care, I leave my time with Jeff feeling significantly better and more knowledgeable. As someone who suffers from multiple sports injuries, I want momentary pain relief but also ongoing pain management that I can put in practice. No one does this better than Jeff. As an added bonus, he’s also a great conversationalist!

AK
AKShelburne, Vermont

I came to VASTA with hip issues, result of a fracture and early arthritis caused by a really bad car accident I had back on 2013. Since then I went through different procedures but never pain free. I had the opportunity to have PT with the great Mike Woods! and because the work and time invested in my recovery, I owe him getting back to my ability to run, stand straight, walk and do anything I want without pain! At VASTA you can see that therapists work with one person at a time, which help them getting to know their patients and needs very well, creating a specific treatment program and monitoring the progress better. Thanks to you Mike and to the whole VASTA team! I am so grateful for all your support, sense of humor and the kind welcome I got from you all always! Loving what you do and having fun doing it, translates in good service which motivates a patient to reach their goals and getting great results. This is what you get to experience as soon as you put your trust on getting back on track with the VASTA team!! THANK YOU!

NM
NMBurlington

I was out with a couple of friends last night whose daughters also attend Kristina’s youth class. We were all saying what a positive influence Kristina has on the girls and how much they enjoy training with her. It is great for the girls to have a program outside of school sports where they can challenge themselves and build strength and confidence.

Tina
TinaShelburne, Vermont

  1. Hammer WI. The effect of mechanical load on degenerated soft tissue. J Bodyw Mov Ther. 2008;12(3):246-56.)
  2. Bove GM, Chapelle SL. Visceral mobilization can lyse and prevent peritoneal adhesions in a rat model. J Bodyw Mov Ther. 2012;16(1):76-82.
  3. 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.
  4. Boyer S, Novack J, Madsen LP, Kingma JJ, Schrader JW, Docherty CL (2017). The Immediate Effects of Graston Technique® on Hamstring Flexibility Compared to a Control. Journal of athletic training, 52(6), S-94
  5. Heyer K, Docherty C, Donahue M, Schrader JW (2012). Effect of implement assisted soft tissue mobilization techniques on iliotibial band tightness. Journal of athletic training, 47(3), S128
  6. Langevin HM, Fox JR, Koptiuch C, et al. Reduced thoracolumbar fascia shear strain in human chronic low back pain. BMC Musculoskelet Disord. 2011;12:203.
  7. http://rapidrehabilitation.com/wp-content/uploads/2014/09/ATYM-PFPS.pdf
  8. Slaven EJ, Mathers J. Management of chronic ankle pain using joint mobilization and ASTYM treatment: a case report. J Man Manip Ther. 2011 May; 19 (2): 108-12.
  9. McCormack JR. The management of bilateral high hamstring tendinopathy with ASTYM treatment and eccentric exercise: a case report. J Man Manip Ther. 2012 Aug; 20(3):142-6.
  10. Davidson CJ, Ganion LR, Gehlsen GM, et al. Rat tendon morphologic and functional changes resulting from soft tissue mobilization. Med Sci Sports Exerc. 1997;29(3):313-19.
  11. Loghmani MT, Warden SJ. Instrument-assisted cross-fiber massage accelerates knee ligament healing. J Orthop Sports Phys Ther. 2009;397):506-14.
  12. Loghmani MT, Warden SJ. Instrument-assisted cross-fiber massage accelerates knee ligament healing. J Orthop Sports Phys Ther. 2009;397):506-14.
  13. http://rapidrehabilitation.com/wp-content/uploads/2014/09/ATYM-PFPS.pdf
  14. McCrea, E., George, S. (2010). Outcomes following augmented soft tissue mobilization for patients with knee pain: a case series. Orthopaedic Physical Therapy Practice, 22(2), 69-74.
  15. Daniels CJ, Morrell AP (2012) Chiropractic management of pediatric plantar fasciitis: a case report. J Chiropr Med 11: 58-63.
  16. Garrett TR, Neibert PJ (2014). Effect of Graston Technique as a treatment for patients with chronic plantar fasciosis: a randomized controlled trial (.pdf). Journal of athletic training, 49(3), S57-58.
  17. Slaven EJ, Mathers J. Management of chronic ankle pain using joint mobilization and ASTYM treatment: a case report. J Man Manip Ther. 2011 May; 19 (2): 108-12.
  18. Melham TJ, Sevier TL, Malnofski MJ, Wilson JK, Helfst RH (1998) Chronic ankle pain and fibrosis successfully treated with a new noninvasive augmented soі tissue mobilization technique (ASTM): a case report. Med Sci Sports Exerc 30: 801-804.
  19. 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):127-34.
  20. 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.
  21. McCormack JR. The management of mid-portion Achilles tendinopathy with ASTYM and eccentric exercise: a case report. Int J Sports Phys Ther. 2012 Dec; 7(6):672-7.
  22. Papa, J. A. Conservative management of Achilles Tendinopathy: a case report. The Journal of the Canadian Chiropractic Association, 2012, 56(3), 216.
  23. 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: 269-279.
  24. McCormack JR. The management of bilateral high hamstring tendinopathy with ASTYM treatment and eccentric exercise: a case report. J Man Manip Ther. 2012 Aug; 20(3):142-6.
  25. Papa JA. Conservative management of De Quervain’s stenosing tenosynovitis: a case report. The Journal of the Canadian Chiropractic Association. 2012 Jun;56(2):112.
  26. Slaven EJ (2014) The Role of ASTYM Treatment in the management of Lateral Epicondylosis: A single case research design. OPPT 26: 44-48.
  27. Papa JA (2012) Two cases of work-related lateral epicondylopathy treated with Graston Technique and conservative rehabilitation. J Can Chiropr Assoc 56: 192-200.
  28. Burke J, Buchberger DJ, Carey-Loghmani MT, et al. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther. 2007;30(1):50-61.