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  • Writer's picturePhysical Therapy International Service

Instrument Assisted Soft Tissue Mobilization

Updated: Jul 8, 2022

Last week we touched on a few techniques within soft tissue mobilization (STM), including sustained pressure, unlocking spiral, and perpendicular mobilization. All of these techniques are direct hand-on-skin contact between the physical therapist (PT) and patient. Another STM technique — instrument assisted STM (IASTM) — involves the use of specialized tools to help reduce a patient’s pain. IASTM includes scraping, myofascial (connective tissue) decompression, and percussion massage.

“Scraping” is just as it sounds — the PT uses a tool to scrape along the skin to increase blood flow and help alleviate dysfunction and pain. An IASTM technique that utilizes scraping with specific stainless steel tools is the Graston Technique ® — named after David Graston, an athlete who had a knee injury and later coined the massage technique and tools. Scraping, called “gua sha” in Traditional Chinese Medicine (TCM) has been used for hundreds of years with the intent of moving and balancing qi (the energy flowing in the body). Rose quartz or jade is often used with gua sha, and some PTs will even use the back of a spoon or the flat edge of a butter knife as their IASTM tool. Recipients of scraping should be aware that they will have “petechiae” — small, red dots or bruising on the skin as a result of the tools breaking small blood capillaries. Scraping is used to treat adhesions (scar tissue), increase blood flow, and ultimately reduce muscle tension. Common injuries treated with scraping can include back pain, tendon strains, and carpal tunnel syndrome.

Myofascial Decompression (MFD) — often referred to as “cupping” — is another IASTM method used to reduce soft tissue pain and improve mobility. Like scraping, MFD utilizes TCM tools (cups, in this case) and applies Western Medicine principles. The cups — attached to the skin most commonly via suction — create negative pressure, which increases blood flow to the treated area and “decompresses” or lifts away the superficial tissues from underlying tissues. With the cups in place, the related body parts are passively stretched by the PT or actively moved by the patient to help restore mobility or improve movement patterns. Massage cream is typically applied to the skin beforehand to reduce the potential for friction. This is especially important if the PT chooses to glide the cups along the skin. Common issues MFD is used for include postoperative scar management, back pain, carpal tunnel syndrome, and even headaches.

Lastly, percussive massage is another way to increase blood flow to the affected or painful area. It is commonly known outside of PT too! This is just a special term for the popular massage guns you’ve been seeing. Used to relax tightened fascia and improve circulation, you should expect more of a beating and pounding movement with this technique. Percussion massage may help reduce muscle soreness and increase range of motion (ROM) of stiff joints. Common injuries treated with percussion include shin splints, bursitis, sciatica, and tendonitis.

Do you see a similarity in all three of these techniques? Yep, they all increase blood flow! This is essential because good blood flow is needed for healing. With all of these treatments (and any treatment, for that matter), clinical decision making by the PT will drive the specifics of the treatment. It is also important to know that contraindications and precautions exist for IASTM, so it is not appropriate for everyone.

Next week we will delve into blood flow restriction therapy (BFR)... yes, that’s a thing! And yes… by its name, it contradicts the above statement about the importance of blood flow for healing.


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