Instrument-Assisted Soft Tissue Mobilization (IASTM) to the Upper Quarter: Summary
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IASTM Considerations Indications • Trigger points • Chronic tendinopathies (epicondylitis) • Adhesion/fibrosis/ scarring • Postural dysfunction • Ligament sprains (UCL) • Nerve entrapments (carpal tunnel)
Relative Contraindications
Absolute Contraindication • I nflammatory 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
• 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 Prep the tissue with a massage cream or ultrasound gel • 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 – UCL - 2 min – PIGH shoulder capsule 4-5 min • Tissue Response ○ Non-aggressive treatment – used to reduce pain and edema (used sub-acutely) ○ Aggressive treatment—used to improve ROM or disrupt fibrotic tissue ■ May cause ecchymosis but not bruising or bleeding
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