Re-Thinking Instrument Assisted Soft Tissue Mobilization
Instrument assisted massage or soft tissue mobilization (manipulation) has been around for quite some time, regardless of the terms or vernacular you choose to reference it. Some texts suggest that Gua Sha, a traditional Chinese medical treatment where the skin is scraped to produce light bruising, has been around since the 5th - 7th century. So this, like many other ideas, is not "new".
Traditional models of IASTM have been mechanical, modeled after Cyriax rational of micro trauma and tissue remodeling to promote healing, however, in thinking of more recent research on mechanotransduction (how cells convert mechanical stimulus into chemical activity) simply rubbing vigorously on the skin may not give us the greatest treatment outcomes, or may be too non-specific to produce the intended results. Yes, there is some evidence to support increased fibroblastic activity with IASTM, but lack of specific inputs following such treatments will often lead to less then desired results in tissue repair, or adaptation and improvement in movement and tissue resiliency.
The increased fibroblast activity seems to correlate with increased pressure on rat models, likely resulting in the feeling or thought that we need to "bruise" our patients, or go as hard as we can, to get a desired result. If we think about this practically for a moment, however, if a patient came into us on visit 1 with bruising and signs of soft tissue injury we would immediately go to a protocol of pain management and tissue protection, so then why would the same bruising be acceptable on visit 2 because "we did it"? Often times patients will not be able to tolerate another treatment dosage due to sensitivity or discomfort resulting in decreased consistency of input and therefor lack of carryover between sessions.
Additionally, IASTM has been reported to "release" scar tissue or deform fascia which also may be challenged by some recent research considering that plastic change in fascial structures may take place AFTER 2000LBS of pressure per sq inch. This seems to be well out of the range of tolerance for patients, as well as the capability of a therapist to administer.
So how can we think about IASTM differently? Simple. Change the name to IANSM - as in Instrument Assisted NeuroSensory Modulation. This is a concept spoken in great detail during instrument assisted courses such as RockTape FMT Blades. Instead of focusing on the mechanical effects of the treatment, courses such as Blades are focused on what the treatment is doing to the individual as a whole, guided by recent discoveries in pain science research, and how targeting specific receptors on the skin can produce significant results in patients symptoms and movement patterns. The mantra "less is more" becomes evidently clear.
By focusing more on skin receptors, tactile discrimination, and improving proprioception we can not only be more specific with techniques to match specific clients needs, but we will realize that we do not have to cause "hurt" (and potentially harm) to produce desired results. The instrument essentially becomes a tool to change afferants (inputs) to impact efferants (outputs).
The following are examples of primary treatment outcomes and a brief description of the technique used:
- Pain Mitigation = Light feathering with your tooling may be all that is necessary to improve/gate/block pain response in patients by stimulating free nerve endings
- Tactile Acuity = Rapid strokes, to the pace of ~180-200bpm, (I find La Grange by ZZ Top to be helpful here) can allow for increased activity of pacinian corpuscles resulting in temporary improvement in proprioception
- Muscle Tone = Slower, deeper strokes to stimulate ruffini nerve endings which have been linked to parasympathetic nervous system activity to alleviate tension and pain in areas of potentially neurological origin
- Dry Release = According to anatomists like Stecco(s) and Bove, it appears that fascia needs to slide and glide to allow for painfree movement and nutrient exchange of tissues. By introducing shear we can attempt to impact more local adhesions of tissue (ie scars) to improve movement capacity and alleviate pain
- Note this is a "mechanical" treatment however there is no intention to bruise or push tissue as hard as possible
What has been your experience with IASTM in practice? Do you see different outcomes with approaches and/or tools?