75 Instrument-Assisted Soft Tissue Mobilization (IASTM) to the Lower Quarter: Summary
IASTM Considerations Indications
Relative Contraindications
Absolute Contraindication • Inflammatory or infectious skin conditions (psoriasis, eczema , cellulitis, shingles, etc) • Impaired skin integrity (open wound) • Over surgical incision (12+ weeks) • Over ecchymosis or effusion • Over acutely traumatized tissues or unstable fractures • Hematoma/ myositis ossificans • Osteomyelitis
• Trigger points • Chronic tendinopathies • Adhesion/ fibrosis/ scarring • ITB syndrome • Postural dysfunction • Ligament sprains • Nerve entrapments • Plantar fasciitis
• Varicose veins • Cancer areas • Recent body art • Complex regional pain syndrome (CRPS) • Polyneuropathies (numbness) • Unhealed, closed non-complicated fractures • Autoimmune disorders • Diabetes • Rheumatoid Arthritis • Ankylosing spondylitis • Adjacent to pacemaker or insulin pump • Post-injections (PRP) • Lymphedema • Central sensitization/ hypersensitivity • Blood thinners
Principles Scanning/Assessing the Tissues • Use the tool parallel to muscle in both directions • Start superficially then move deeper • Assess for resistance (bump=trigger point/ grainy= fascia) Treatment • Use multiple angles/strokes ○ 30-90 degrees from tissue ○ Greater angle for deeper application ○ Stroke Types: ■ Sweep stroke : tool edge 30-60 degree angle ■ J stroke : pencil grip, tool edge 30-60 degree angle ■ Strum stroke : deep, tool edge 60-90 degree angle ■ Scoop stroke : deep, tool edge 90 degree angle ■ Brushing/framing : light/desensitizing, used on bony prominences ■ Fanning : home one end of tool stationary and more like a fan • Start superficially and work deeper ○ Tool shape/size makes a difference ○ Superficial (Fascia): larger surface area, sharp/thin edge, concave edges ○ Deep structures (muscle): small surface area, dull/thick edge, convex edges
• Parameters ○ 2-3x/week (2-3 days in between) ○ 8-10 minutes per session:
■ Time will vary based on size of tissue – Knee MCL- 2 min – ITB: 8-10 min • Tissue Response ○ Non-aggressive treatment – used to reduce pain and edema (used acutely) ○ Aggressive treatment—used to improve ROM or disrupt fibrotic tissue ■ May cause ecchymosis but not bruising or bleeding • Treatment Sequence ○ Warm up prior to treatment → IASTM → corrective exercises → ice (potentially) ○ Some may choose to end with IASTM as well ○ For a more advanced treatment, place the targeted tissue on stretch while performing Re-Assessment • Helps to determine the effectiveness of the treatment • Increases patient’s “buy in” • Test for any immediate improvements ○ Examine the comparable sign/chief complaint (pain, ROM, postural changes, functional movement)
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