Move Better, Feel Better: A Movement Based Approach to Soft Tissue Mobilization for the Upper Body: Summary 39
IASTM
Application: • Can use tools made of different materials (plastic, metal) and different shapes: ○ Concave edge—more gentle; convex tool—more aggressive ○ The more vertical the tool, the more aggressive • Scan the tissue first to assess for texture (bumpy, gritty) • Start treatment in direction of least resistance/pain (proximal to distal, distal to proximal) • Start with tissue on slack and then can add stretch to increase intensity for reducing tone Goal of Treatment: Stimulate Mechanoreceptors • Reduce pain via light touch with sharper edge (interstitial fibers): Use faster strokes • Reduce tone via slow, deep strokes with beveled side/dull edge (Ruffini): Move from superficial to deep, starting with tissue on slack: ○ The greater the angle of the tool, the more intense • Facilitate muscle via faster medium-deep stroke with beveled side (Pacinian)
Pros
Cons
• Patients report relief and
• No strong research • Might not be better than placebo • Not a standalone treatment
improved mobility • Can be an effective adjunct treatment to exercise
Research: • Reduced pain • Increased fibroblast proliferation in tendons • Improved collagen formation and orientation in ligaments • Reduced size/improved tissue quality for chronic tears • Physiological changes via: ○ Increased blood flow ○ Reduced tissue viscosity ○ Myofascial release ○ Interruption of pain receptors ○ Improvement of flexibility Proposed Benefits: • Pain relief/improved mobility • Neurophysiologic response (gate theory, DNIC or CMP, neuroplasticity) • Mechanical mechanisms (mechano- transduction, gliding of tissues, fluid dynamics)
UPPER QUARTER TREATMENT Body Region Spine
Shoulder/Upper Arm Elbow/Forearm
ROM exam: Before/ after treatment Common muscles
Cervical : Rotation, side bending, flexion, extension Thoracic : Side bending, rotation Pain and tone : Upper trap, levator scapula, paraspinals, suboccipitals
Shoulder : Scaption, functional IR, functional ER
Elbow : Flexion, extension with over pressure Wrist : Flexion, extension, supination, pronation (with over pressure) Pain : Around the epicondyles, triceps tendon, olecranon, junction along ulna/radius, between metacarpals Tone : Extensors, flexors, pronators, thenar/ hypothenar eminence
Pain : Triceps, posterior deltoid, supraspinatus, infraspinatus, teres minor/ major Tone : upper trap, ant/ post deltoid, pectoralis
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