#ContinuingEducation #PinnacleTrainingConsultingSystems
www.PersonalTrainerCEU.com

The lumbar spine, particularly the lumbopelvic junction, also known as the core,
is comprised of twenty-nine dynamic muscles. Each designed to stabilize, transmit force and work synergistically during daily and sport movements. Within these muscles, there are four that are particularly important to remember. They include the transverse abdominis, obliques, multifidus and quadratus liumborum. Research by Paul Hodges, PT discovered that when someone suffers a low back injury, the transverse abdominis becomes absent or delayed. Further research has shown those with chronic low back pain, the mulifidus is weaker than those without an injury.

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.

shoulder impingement

Is caused by a mechanical dysfunction such as bursa, AC joint, acromion, humerus or rotator cuff/supraspinatus tendon beneath the coracromial arch. Clinically, the pectorals, posterior capsule and upper trapezius muscles are tight. Focus on training clients with SI, performing posterior capsule stretch, scapular retraction(mid row exercise) and external rotation strengthening to name a few.

The rotator cuff is part of the shoulder comprised of four dynamic muscles. These include the supraspinatus, infraspinatus, teres minor and subscapular is muscles. Research shows that the supraspinatus is biomechanically weaker and has less blood supply as compared to the other muscles of the rotator cuff. Making it susceptible to injury.

How to work with a Shoulder Impingement and Rotor Cuff Tear Client

Exercising Programming For Common Shoulder Dysfunctions
By Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, C-IASTM

Exercises selection and prescription is just one component of working with a client who has a movement dysfunction.

Do you know what exercises are safe vs. unsafe? There are a plethora of shoulder conditions that affect the four joints within the shoulder. In this article, we are going to talk about shoulder impingement and rotator cuff tear.

Shoulder impinfement: safe vs. unsafe exercises based on science

Background: Shoulder impingement is caused by Impingement between the humeral head and coracromial arch occurs from repetitive loads. With strong RTC muscles, the GH joint is properly supported. Weak scapulothoracic muscles leads to abnormal humeral positioning/humeral mechanics where humeral head is not synchronized with scapular elevation. Thereby, the rotator cuff impinges under the coracromial arch causing inflammation to the suprahumeral tissues.

  Figure 1. Shoulder impingement

Emphasis: stretch the tight postural muscles, which includes the upper trapezius, pectoral and posterior capsule, while strengthening weak scapular/trunk muscles. Gradually increase chest exercises, but the focus of working with a shoulder impingement client is to train the posterior upper extremity chain. Targeting the rhomboids, low trapezius, mid back, spinal extensors, rotator cuff and core.

Safe exercises

                          

 Standing upper trap stretch                       posterior capsule stretch              Mid row

 

 

 

DB Side raises                      Low trapezius pulldown                    Pull apart exercise

 

Unsafe exercises

1-Shoulder press: Places unnecessary loading and vertical stress to AC joint and surgical graft further stressing the shoulder.

 

2- Upright row: at end of range Upright row exercise places stress to AC joint creating further impingement.

 

3-Ketlle bell snatch: during from the beginning phase, maximally lengths the medial deltoid, supraspinatus, placing greatest stress, then with the overhead press, loads the AC joint, placing unnecessary stress to the surgical site.

 

Rotator Cuff Repair: safe vs. unsafe exercises based on science
Pathophysiology/Mechanism of Injury: Commonly occurs as a result of a traumatic accident or fall and is graded from one to three in severity. They are classified as acute, chronic, degenerative, partial or full-thickness tears.

Emphasis: stretch tight postural muscles, which include upper trapezius, pectoral and posterior capsule, while strengthening weak scapular/trunk muscles. The focus of working with a rotator cuff client is to avoid reinjuring the shoulder. Train the posterior upper extremity chain. Targeting the rhomboids, low trapezius, mid back, spinal extensors, rotator cuff and core.

 

Safe exercises

 

Standing upper trap        posterior capsule stretch

        

DB Side raises                     Low trapezius pulldown            Pull apart exercise

 

Unsafe exercises

1-Shoulder press: Places unnecessary loading and vertical stress to AC joint and surgical graft further stressing the shoulder.

 

2- Upright row: at end of range Upright row exercise places stress to AC joint creating further impingement.

 

3-Ketlle bell snatch: during from the beginning phase, maximally lengths the medial deltoid, supraspinatus, placing greatest stress, then with the overhead press, loads the AC joint, placing unnecessary stress to the surgical site.