IASTM stands for Instrument Assisted Soft Tissue Mobilization, otherwise known as a viable and valuable treatment method to add to our toolbox.

We are constantly inundated with educational opportunities to put more letters behind our names.

Some are worth our time and money; some are not. IASTM stands for Instrument Assisted Soft Tissue Mobilization, otherwise known as a viable and valuable treatment method to add to our toolbox.

In truth, IASTM is not a new modality. In fact, using tools to address soft tissue issues has a history roughly 2,000 years old—most notably within the Chinese practice of Gua Sha. The term gua means to rub or scrape. The term sha refers to a type of stagnant energy in the body that causes excess heat to accumulate in the body. Together, these terms refer to the act of rubbing the skin to remove an energy blockage.

In Chinese medicine, healthy chi relies on maintaining healthy, flowing energetic meridians. While this article is not about Gua Sha or its methods directly, it’s warranted to acknowledge the foundation on which using tools to treat tissues is founded upon.

Now backed by science, IASTM has evolved into Western medicine, and as a result we are offered the opportunity to examine this practice—now with a broader, less monocular view of what’s actually taking place beneath the surface of the skin and how this tool can be effective.

A Better Sense of What’s Happening

An IASTM tool becomes an extension of a therapist’s hands, but it also offers an array of neurosensory input and feedback for both the therapist and the client. We rely on our palpation skills to sense what is happening under our client’s skin. Using IASTM as both a palpation and treatment tool gives a unique feel of the dermal and fascial topography that our hands might not otherwise sense.

Ridges or ripples, for example, are often felt more easily with the gentle, gliding edge of a tool than with an effleurage stroke. A tool can offer pinpointed treatment and an array of intended neurological tissue responses without the compounding damaging effects on the therapist that often arise with a high-volume practice.

Scar tissue work, upregulating or downregulating tissue tone, inciting pain relief or affecting fluid mechanics are all within the realm of benefits with IASTM.

Tools are not meant to replace the hands for all methods of soft tissue work, but they enhance your current methods while simultaneously alleviating some of the wear and tear on your own body.

How IASTM Works

The term Instrument Assisted Soft Tissue Mobilization implies that we are mechanically altering tissue. Many therapists think that the intention of a tool is to allow deeper work that releases the devils inhabiting tight and sticky tissues.

All too often, harder is thought to be better within the massage community, as well as within the community of clients that seeks our treatment. Some IASTM courses will support that theory and even go as far as to reference bruising as a positive therapeutic response. Other courses take a different approach and offer up the notion that the real modulation taking place is neurological—thus creating a physiological tissue response.

Using IASTM in your practice is not the equivalent of a steamroller or baseball bat that allows you to go deeper. Let’s think about treatment methods from the perspective of the nervous system and dive into the latter thought process here.

Touch the skin, and you’re touching the brain. This is an oversimplified statement, but one with profound depth nonetheless. Intra-fascial mechanoreceptors—Golgi, Ruffini, Pacinian and interstitial—within our tissues are the communication lines to our central nervous system, each responding differently to types of touch or external stimuli.

Our proprioception, exteroception and interoception feed our brain with information that dictates how we perceive and react to our environments. Sensations of heat, cold, pressure, texture, pain and pleasure are all communicated to the brain through these receptors within the skin.

As manual therapists, we instantly send input into our client’s nervous system with even the lightest touch, to which it responds with physiological reactions within affected tissue and surrounding areas. The outcome is either a relaxation response or one of guarded retreat, depending on its perception of our treatment tactics; i.e., IASTM with light pressure, deep pressure, shearing or feathering, rapid or slow movement, heat therapy or cold therapy.

According to Hilton’s Law, the same trunks of nerves whose branches supply groups of muscles also furnish a distribution of nerves to the skin over the insertion of the same muscles as well as the interior of the relevant joint space. This means that instead of a one-dimensional surface level effect on the tissue we are touching, our treatments elicit a nervous system response deep within the tissues of the body and joint spaces that dictate physiological reaction and tone.

IASTM stands for Instrument Assisted Soft Tissue Mobilization, otherwise known as a viable and valuable treatment method to add to our toolbox.

In fact, an increasing amount of research is challenging the belief on whether we actually create mechanical change in tissue at all, but is indicating that, more likely, we incite a neurological response that creates viscosity changes within the fascial ground substance—and thus a decrease in tissue tension as a result of the intra-fascial mechanoreceptors input to the CNS.

In other words, our touch and how it is applied either convinces the nervous system to reduce tone or increase it. The widely adopted notion that fascia can be released by way of manual therapies was debunked by famous fascial researcher and key organizer of the first Fascial Congress, Robert Schliep, Ph.D., in his published article “Fascial Plasticity-A New Neurological Explanation” (somatics.de/schleip2003.pdf).

Schliep dismisses the traditional explanations of thixotropy and peizoelectric-effect adaptation and suggests that the actual toughness of fascia would require shearing forces far greater than any living human could actually handle before any measurable structural change to the tissue is actually made.

How much pressure exactly? Try 2,000 pounds per square inch.

I don’t know about you, but if someone came at me with a tool that looked like brass knuckles or a butter knife and started applying even a fraction of a fraction of that kind of pressure, I’d be running for the hills.

Even if you were able to deliver that much force, your clients could never tolerate it.

As it pertains to the idea of thixotropy, Shleip is quoted as saying, “Fascial sheets are incredibly tough, and you can’t ‘change their density and arrangement’ quickly or easily. And thixotropy just isn’t fast enough to explain the relatively speedy, dramatic effects on tissues that therapists claim to achieve.” (Source: sciencedirect.com/science/journal/13608592.)

So, if we’re not actually releasing fascia, what are we doing?

Feed the Brain

Most of our clients seek our help due to chronic pain, stress relief, injury rehabilitation or movement limitations. Let’s look at these things differently by visiting the concept of body mapping as presented by David Nesmith a certified teacher of the Alexander Technique.

Body mapping is the conscious correcting and refining of one’s body map to produce efficient, graceful and coordinated movement. It is the self-representation of our physical bodies in our brain. If our representation is accurate, we move well. If our representation is faulty, our movement suffers—which can lead to injury or chronic pain.

Through tactile stimulation such as that performed with IASTM, we feed the brain information via the intrafascial mechanoreceptors, which triggers the motor responses we observe. The appropriately applied stimulation—soft touch, glide, shearing, feathering or pressure—incites either an upregulation or downregulation of tone within the fascia and muscle tissue and ultimately a palpable tissue response of either priming or relaxing due to the nervous system’s response.

If it’s the sensory nerves that we’re ultimately affecting, it makes sense that a less aggressive tactic can be used in lieu of one that leaves our clients white knuckling, cursing and jaw clenching for the duration of their treatment.

Using a model of graded exposure therapy with IASTM, in which tissue tolerance is the focus, allows us to apply deeper work in a way that works with the client’s nervous system rather than against it. If our clients are suffering from chronic pain, understanding the neurological concept of body mapping arms us with the ability to help them not only with pain relief using milder and more effective tactics but, also assist them with re-creating proper movement patterns and proprioception that have long lasting positive, clinical outcomes.

Becoming efficient at assessing and understanding movement patterns can greatly assist in your clinical decision-making. When you approach IASTM from this viewpoint it is legitimately an added benefit in any practice.

Lorimer Moseley, Ph.D., F.A.C.P., and David Butler, D.Ed., of the Neuro Orthopaedic Institute’s NOI Group, said it best. “Modern rehabilitation will be via normalization of sensation, motor control and the congruence of these factors.” As manual therapists, being armed with knowledge like this is the best tool for success.

About the Author

 IASTM stands for Instrument Assisted Soft Tissue Mobilization, otherwise known as a viable and valuable treatment method to add to our toolbox.

Stacey Thomas, L.M.T., S.F.M.A., F.M.S., N.K.T., C.F.-L2, has been dedicated to human movement and athletic performance since 1997 and certified as a sports massage therapist since 2005. She holds certification in Functional Movement Screen, Selective Functional Movement Assessment, Neurokinetic Therapy and CrossFit Level 2, as well as other training and soft tissue modalities. She is credentialed by educational organizations regarding human movement and soft tissue treatment. You can find her in one of her three Front Range clinics treating athletes or teaching courses for RockTape.

 

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