Everything I Wish I Knew About IASTM
Well, it was early in my career, and I think it’s safe to say I fell for it hook, line, and sinker.
I think it was my third continuing education course, and I was entranced by the idea of saving my hands and using these cool-looking tools. I figured I could really dig in and go deeper in treatments without beating my hands up. I’d also stand out as different from all the other therapists I knew around me because I would be offering something “different”.
So, I jumped in with two feet and headed to Vancouver for the weekend. I believe the course was $500 plus at the end I would invest another $3000 into those cool looking tools.
I heard some pretty fanciful explanations as to what I would be capable of doing with this new modality, “breaking down scar tissue” and “bringing more inflammation to areas to cause healing.”
While it all didn’t make total sense to me, I went with it.
The following week people came into the clinic, looked at the tools and said, “what’s with the torture implements”?
Some people loved them; others hated them.
What Does IASTM Propose?
When I took this course, one of the main things they taught was how going in with these tools and digging in really deep would bring inflammation to the area to promote tissue healing.
This was the purpose (or the reason) why the skin looked all red and bruised post-treatment.
Some other proposed mechanisms (1) would be causing greater flexibility compared to doing manual therapy without the tools as they would “reach deeper tissues” to have a more significant effect. Other proposed changes would include improvements in joint range of motion, increased stretch tolerance, and decreasing muscle stiffness by inhibiting muscle activity by modulating the nervous system.
So this study (1) looked at how IASTM would influence these proposed mechanisms on ankle dorsiflexion. What they found was quite interesting:
- there were improvements in dorsiflexion range of motion
- No input from the central nervous system
- IASTM had a lesser effect than static stretching
- less effective in improving flexibility than static stretching
- IASTM does not change the stiffness of the muscle belly or stretch tolerance
- IASTM does not change the perception of pain due to stretch tolerance
Throughout this paper, there was no mention of contextual factors or other things that contribute to successful clinical outcomes, especially since this was done on healthy people.
Another study (2) compared the effects between a massage roller stick and IASTM on hamstring range of motion and found that neither one was better than the other. Both helped increase ROM after a 3.5-minute treatment, but one was not better than the other.
However, a significant point in the study is how the massage sticks are probably better for home use and is perhaps a lot more cost-effective for the practitioner; they also pointed out how clinician preference plays a vital role on which to use.
What about if we compare IASTM to other therapies like spinal manipulation (typical of a chiropractic adjustment)? Well, one study (3) looked at the difference between SMT (spinal manipulation), IASTM, and placebo and found no difference in outcomes when helping with thoracic pain. However, it is essential to remember there is a lot of placebo involved in treatments.
In most of the studies, patients received over four weeks of treatment and more than eight treatment sessions. Also, the most successful ones were combined with exercise. In fact, they were more successful when combined with a home exercise program, so give good homecare! (3)
Important to take into account (4) that one IASTM company has a guideline protocol of doing:
- assessment
- warm-up
- IASTM treatment
- post-treatment stretching
- strengthening
- ice
If we handled every treatment like this, we would have good outcomes with just about any soft tissue treatment (except for the ice, unless a patient really likes that).
Most research (4) doesn’t use IASTM as a stand-alone intervention; it is always combined with other things to show a positive outcome. However, since most of the case reports reflect more of a subjective outcome, it’s essential to consider this if you’re deciding to put this modality to use.
Fortunately, the studies also show it is better to move away from the theory of causing increased inflammation with skin redness (ecchymosis, petechiae) due to the potential of iatrogenic tissue damage.
Some research(5) was done in a laboratory setting on rabbits to study the effectiveness of IASTM. They put a surgical injection into the Achilles tendon to induce tendinopathy. Then, after allowing three weeks to heal, they used IASTM on the tendon.
The results showed that the cross-sectional area of the tendon was larger on the treated tendon than the untreated one. They also found changes in elasticity and viscosity, but not to the point of being statistically significant.
While the study proposes that the larger cross-sectional area could mean a stronger tendon, they leave something significant out.
They went in and caused damage to the area with a surgical incision. This would naturally signal the body to send healing properties to the site to help with this. However, the rabbits were also allowed to move freely in their cage between treatments, and they were only comparing their results to “conservative” treatments.
The most recent research shows us that the best thing for a tendon injury is to load the tissue with movement. Yet, they disregard the contribution of the rabbit’s activities and that loading the tissue is not part of “conservative treatment”.
Also, none of this has been performed on humans, so it’s hard to say how it would affect our Achilles tendon until this human research is done.
Disinfecting
As we have seen over the past year and a half (with a pandemic going on), there has been increased awareness of disinfecting our treatment rooms and clinic space for both patient and therapist safety.
Well, there’s an issue with this modality in this regard too.
Since there is no best practice guideline in place (4), the therapist’s responsibility is to make sure these tools are properly disinfected after each use.
While this can be tricky in a clinical setting, IASTM is very popular with therapists involved in sport.
The recommendations in a clinical setting look something like this(4):
- use an intermediate level disinfectant (isopropyl alcohol)
- flush with soap and clean water
This is recommended after every patient. If the tool were to contact any bodily fluid (blood, mucous, etc.), we would be required to use a high-level disinfectant as they use with surgical instruments.
This is obviously a hygiene issue, so the new recommendation is (4):
- Before and after treatment clinician washes hands (I hope this is being done regardless of modality). As well as possibly using PPE.
- Area of treatment is checked and cleared for treatment. Patients skin is wiped with a sanitizing wipe.
- IASTM treatment delivered.
- Monitor for changes in patients skin colour etc.
- Post-treatment, the body area is inspected and sanitized again.
- Treatment is done, wash hands, dispose of PPE, and clean instruments.
So in addition to all of the sanitization procedures, we now have to do in our clinic space, with the extra time this would take, could we accomplish it effectively between patients?
Also, if you’re a sports therapist working in the field, is this really practical? I think it would be difficult.
Another hygiene issue is using a lubricant. When I took the course, we were given a small container filled with something resembling coconut oil. The direction was to take the tool, use the tip and dig out some of the lotion/oil. Then put a small dab on your hand for more use; however, there were still times you would dip the same tool back into the lubricant.
The new recommendation would be to use a tongue depressor (easily discarded) to scoop the lubricant, then put the amount needed for treatment into a paper cup or another disposable container.
When it all comes down to it, IASTM is like any other modality. The original narrative needs to change. However, one difference is the importance of discussing the potential consequence of its use (because of petechiae). This is important because, like any other modality, if we aren’t giving patients the most up-to-date information and narrative, we aren’t actually getting proper consent. I still use my tools once in a while because I have some patients who love how it feels and request it. If I decide to use them on another person (because there is still some things I can do with them I can’t do with my hands), then there is a good conversation with them about what I’m doing, explaining why, and letting them know it’s okay to withdraw their consent if they don’t like it. All in all, if you want to learn IASTM, then by all means take the course and use it, just make sure your patients are properly informed when you do.
References:
- Ikeda N, Otsuka S, Kawanishi Y, Kawakami Y. Effects of instrument-assisted soft tissue mobilization on musculoskeletal properties. Medicine and science in sports and exercise. 2019 Oct;51(10):2166.
- Lee J, Young A, Erb NJ, Herzog VW. Acute and Residual Effects of IASTM and Roller Massage Stick on Hamstring Range of Motion. Journal of allied health. 2020 Feb 27;49(1):51E-5E.
- McKivigan JM, Tulimero G. An Analysis of Graston Technique® for Soft-Tissue Therapy. Rehabilitation Science. 2020;5(4):31.
- Cheatham SW, Baker R, Kreiswirth E. Instrument assisted soft-tissue mobilization: a commentary on clinical practice guidelines for rehabilitation professionals. International journal of sports physical therapy. 2019 Jul;14(4):670.
- 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. Journal of manipulative and physiological therapeutics. 2015 Feb 1;38(2):112-8.
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