Foundation of Instrument Assisted Soft
Tissue Manipulation(IASTM)

By Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, C-IASTM

Background

Soft tissue manipulation (STM) is a type of manual therapy administered by hands alone or with a rigid device. Instrument assisted soft tissue mobilization (IASTM) is a type of STM that uses rigid devices to deliver directed, targeted forces to specific tissue (Loghmani 2016). The history of IASTM has been traced back to ancient Greek and Roman baths some 220 B.C., where small metal tools known as “strigils” were used to scrape dirt and sweat from the body (Hammer, WI 2008).

What is Gua sha?

Gua sha consists of repeated multidirectional press stroking with a smooth edged tool at a lubricated area of the body until petechiae appears. Petechiae physiologically is when capillaries vasodilate, leaking blood into the skin. Here the skin appears red, where round spots appear on the skin.

Figure 1. Strigil

With Gua sha, a smooth-edged instrument is used to apply unidirectional pressure that rises petechial (small red spots caused by bleeding into the skin) and ecchymosis.  In Chinese, “gua” means “to scrape” and “sha” loosely translates to “sand” and refers to the rough, sand-like rash and bruises created by the treatment (Nielsen, Arya, et al. 2008). 

Understanding the ‘why’ behind IASTM

The use of Instrument Assisted Soft Tissue Mobilization (IASTM) has been commonly used by sports medicine professionals for treatment of myofascial restrictions. Specifically fascial restrictions and rigger points. IASTM is a soft-tissue treatment technique where an instrument is used to provide a mobilizing stimulus to positively affect scar tissue and myofascial adhesion (Papa JA 2012.) The use of the instruments, as opposed to a clinician's hands, has been theorized to provide a mechanical advantage to the clinician by allowing deeper penetration into the tissue, while reducing imposed stress of treatments on the clinician's hands (Sevier 2015).

Mechanical and neurophysiologic responses to IASTM

Injury, trauma or surgery, all affect the connective tissue within the body. It has been show in research, that after an injury and surgery, the body starts to heal itself from the inside out.  Scar tissue is a natural occurrence from the inflammatory response that is seen after trauma or injury. Adhesions are fibrous bands of scar tissue that form between internal organs and tissues, joining them together abnormally.

Physiologic effects of IASTM
Instrument assisted soft tissue mobilization (IASTM) is thought to stimulate connective tissue remodeling through resorbtion of excessive fibrosis, along with inducing repair and regeneration of collagen secondary to fibroblast recruitment. In turn, this will result in the release and breakdown of scar tissue, adhesions, and fascial restrictions.  When a stimulus is applied to the injured soft tissue using an instrument, the activity and number of fibroblasts increase, along with fibronectin, through localized inflammation, which then facilitates the synthesis and realignment of collagen is one of the proteins that makes up the extracellular matrix (Jooyoung K. et al 2017 and Hammer, 2008) Additional physiological effects include increased blood flow, increased drainage of toxins, reduced stiffness and alteration in neuromuscular activity, resulting in a decrease inflammatory response (Vardiman, JP et al 2015).

Mechanical effects of IASTM

Mechanotransduction is the physiologic process where cells both sense and respond to mechanical loads. Biomechanically, IASTM decreases the resistance of the involved tissue(s), providing a direct improvement in the range of motion (ROM) of the areas being treated (Ostojic et al 2014).

Type of tools
There are a plethora of tools to use with IASTM that include a buffalo horn, plastic, jade, wood, and the traditional stainless steel instrument as seen in figure two and three below.

Summary
Learning the foundation of Instrument Assisted Soft Tissue Manipulation (IASTM) doesn’t require a lot of time, is affordable, and can be learned via two ways. First, taking Pinnacle Training & Consulting Systems(PTCS) home study course and second, attending one of their live seminars taught in conjunction with New Jersey Massage. For more information, please visit www.newjerseymassage.com or call 973-263-2229.

REFERENCES

Hammer, WI., 2008,  ‘The effect of mechanical load on degenerated soft tissue,’ Journal of  

Bodywork and Movement Therapies, vol. 12, issue 3, pp. 246–56.

Jooyoung K. et al 2017, ‘Therapeutic effectiveness of instrument assisted soft tissue

mobilization for soft tissue injury: mechanisms and practical application’ Journal of Exercise

Rehabilitation, vol., 13. Issue 1, pp. 13-22.

Loghmani, MT, 2016, ‘Soft Tissue Manipulation: A Powerful Form of Mechanotherapy,’ 

Journal of Physiotherapy and Physical Rehabilitation, vol. 1, issue 4, pp. 1-6.

Nielsen, Arya, et al., 2008, ‘The Effect of Gua Sha Treatment on the Microcirculation of      

Surface Tissue: A Pilot Study in Healthy Subjects. EXPLORE: The Journal of Science and Healing, vol. 3, issue 5, pp. 456-466.

Ostojic SM., et al, 2014, ‘Effectiveness of oral and topical hydrogen for sports-related

soft tissue injuries,’ Postgrad Medicine, vol. 126, pp. 187–195.

Vardiman, JP et al, 2015, ‘Instrument-assisted Soft Tissue Mobilization: Effects on the

Properties of Human Plantar Flexors,’ International Journal of Sports Medicine.