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Good afternoon. My name is Lauren Wu, SPT, and I thank you for having your time and attention during this in-service. Today I will be talking to you about InstrumentAssisted Soft Tissue Mobilization, or IASTM. We have learned a few introductory techniques from our patient care class, such as gua sha in traditional chinese medicine. Some companies, such as Graston Technique ®, have patented the technique. I will be talking about the Graston Technique®’s instruments specifically today. We will review the basics of how this technique can aid in the healing of soft tissue dysfunction.

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Before we begin, you will take a short pre-test to get a feel for where you stand with your current knowledge base about this topic. Once you get the quiz, you may start. This should only take a few minutes and we will review the answers.

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Here are some broad goals that I hope you will take away from this presentation. I hope you’ll gain an understanding of what IASTM is as well as use this as a scaffolding to any other scraping techniques you’ve learned in the past from previous patient care courses. I also hope this expands your current ”PT Toolbox” so that you’ll have a variety of options for treating your future patients. Lastly, I hope you’ll be able to identify when the circumstances are appropriate in which to consider IASTM.

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Additionally here are some specific goals that you may read through on your own time.

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Here is an overview of IASTM. IASTM is a form of soft tissue mobilization that consists of scraping techniques. There are a variety of stainless steel tools for contact with the skin. The clinician uses these to target abnormalities in soft tissue, such as adhesions, scar tissue, areas of tension or tightness in the muscle, pain, or swelling. The technique is similar to cross friction massage1

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These instruments are specific to the Graston Technique brand. They are made of stainless steel, are smooth, and have a little bit of weight to them. Some have broad edges for large areas of contact, while others are smaller for more localized, specific areas. Most of them typically have a beveled edge which is used for changing the angle of the scraping, which will be discussed in a few moments. (Note the different shapes of tools. Ask students what body parts they think each instrument could be used on. What are the benefits of some instrument shapes over others?)

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The clinician uses the tools on the surface of the patient’s skin to target underlying soft tissue, such as fascia, muscle, and tendon. The clinician locates, via palpation or through using the tools, areas of restriction or irregularity. Depending on the restrictions and the patient’s tolerance, the technique can be modified via speed, angulation, pressure, and direction of stroking. The scraping technique is proposed to facilitate local tissue healing by producing controlled microtrauma to the tissue. This increases blood flow to the area of treatment, as well as inflammatory factors, such as fibroblasts, aiding the healing process1,2. For edematous areas, it can help move fluid out of the area by pushing it back into circulation.

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There are several different goals for using IASTM. Since the technique primarily targets tissue restrictions, the primary outcomes are decreased tissue tension, and increased range of motion and tissue mobility. These restrictions can be accompanied by pain, so decreased pain is also a big outcome. Finally, the technique can also be used to decrease swelling, which can also contribute to decreased pain and increased range of motion at the site.2,3 One proposed mechanism is that IASTM leads to acute improvements In many of these areas in order to see the long-term benefits when used in conjunction with other interventions.

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Here is a list, again mentioning the indications in which IASTM may be used.

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Speaking more specifically about which pathologies can be treated, IASTM primarily focuses on soft tissue. Tendinitis and tendinopathies, muscle strain, myofascial pain syndrome, plantar fasciitis, post-surgical sites and restricted scar tissue are all things that IASTM can be used for, among others.

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Some patients may be hypersensitive to scraping. Redness, which we will discuss again in a moment, is an expected side effect but some patients’ skin just might be too sensitive for the technique or they may be allergic to the scraping medium used. The scraping technique should not be used over open wounds or other lesions. Cancer may another, since modalities that increase circulation are contraindicated.

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Some side effects of the treatment may include acute eccyhmosis, or bruising, and some swelling at the site of treatment. Patients should expect erythema, or redness at the skin, as well as temperature increases which are signs that increased blood flow to the area is occurring. Patients should be informed of these possible side effects prior to the treatment. Additionally, there may be an increased sensation of pain or tenderness.

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The clinician finds the irregularities in the soft tissue either by palpation or using the tool. The scraping medium should be applied prior to scraping. This will decrease the amount of friction between the tool and the skin. Using the tool, after applying a scraping medium, such as shea butter, the clinician can begin gently scraping. The tool passing over the abnormal texture in the underlying tissues transmits a grainy, rough texture, called resonance, that can be felt by the clinician.1 There are a few different stroking techniques, which will be discussed in more detail on the following slide. These techniques include sweeping, fanning, feathering, and functional massage, and more. The angulation of the instrument, which again has a beveled edge, can help control how intense the scraping is felt in addition to the pressure applied. The more angled, that is the more upright at a 90 degree angle the instrument is, the more intensely the scraping will feel because it contacts the skin more directly. The pressure and speed of strokes can also be modified according to the patient’s tolerance or the severity of the irregularity. Treatment typically takes about 6-10 minutes per session, but visible redness is typically achieved.

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There are a variety of techniques depending on what the clinician wants to target. The main techniques are sweeping, feathering, fanning, and functional massage.

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For breaking down adhesions in large areas of muscle or decreasing edema, long, broad sweeping motions may be best.Feathering consists of shorter, quick motions and can be used to decrease pain or target more specific tissues. Fanning changes the direction of the scraping and can target multiple directions of tissue adhesions. Functional massage can be administered by either passively moving the patient’s body part or having the patient actively move their body part at the same time the pressure is applied. The tool can be held in the same spot during this movement, or it can be followed up the fiber direction of the tissue.

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Here are the things you’ll need to prepare your patient for IASTM. Rubbing alcohol and towels are necessary for cleaning and sanitizing both the equipment as well as the patient’s skin. The skin should be cleaned with alcohol as well, and free of lotion and oils, even though you are going to apply a scraping medium like the shea butter. You could choose to shave the person’s hair but usually this isn’t an issue. Finally, you’ll need to get the appropriate pillows, supports, and draping materials. You’ll need to set up your patient in an accessible position that will be comfortable for the next 8 to 10 minutes, and in a position that is biomechanically safe and comfortable for you. Positioning the patient’s body part with the targeted treatment site may differ as well- for example, you may need to position their limb off the table if you plan to do functional massage that requires space for movement, or you may propr their limb on a bolster so that their muscle or other soft tissue is on stretch.

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Patients typically find this modality to be very relaxing and comfortable. Also, the clinician can easily find and feel the tissue irregularities due to the grainy texture transmitted by the tissue into the tool and to the clinician’s hands. For the clinician, the instrument is slightly weighted so the force necessary is slightly decreased. It requires less muscle strength from the clinician, so it bears less stress on the hands. There are a variety of techniques and ways to modify these techniques, so the clinician has a number of options to try to see what is most suitable for their patient.

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Graston Technique, since it is patented with its tools and specific protocols, can be very expensive to purchase. Certification programs can be costly in terms of money, effort, and time. However there are a number of cheaper alternatives for tools. Additionally, IASTM should not be used as the sole intervention, but as an adjunct to other interventions such as therapeutic exercise and strengthening, stretching, and hot or cold packs. Finally, IASTM may not show results right away. It can take a few session, potentially between 4-6 sessions, before any outcomes manifest.

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I would now like to demonstrate a few of the scraping techniques, and for this I will need a volunteer. (Choose a volunteer and interact with volunteer as with a patient. As if there is a particular region of the body they would like treated and set up the ”patient” as appropriate, with proper positioning, support, and draping. Inform the “patient” what IASTM is, why we are doing it, what to expect, and obtain consent. Go over proper set up and demonstration of the four main techniques for a minute or so each, and illicit feedback from the patient often. Conclude with proper clean up.)

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Here is the Graston Technique® website if you would like more information on this brand specifically, including the brand’s mission, products, services, and other resources.

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Are there any questions or things you would like to know more about regarding IASTM?

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We will now take a few minutes to take a post-test to see where you stand now with the information you have gained in this presentation.

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Here is the bibliography of the sources I have referenced for the information provided in this in-service for your perusal and further reading.

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