HawkGrips has been teaching continuing education courses for almost two years now. In that time, we’ve seen some understandable mistakes from course attendees. After all, instrument assisted soft tissue mobilization (IASTM) can be an unfamiliar concept to these clinicians, who range from novice professionals to those with decades of experience in providing more traditional treatments.
So for this article, we asked some of our instructors about the top mistakes they see new IASTM practitioners make during HawkGrips CE courses. Take a look and if you see yourself on this list, remember that anybody can improve their skills through practice and focus!
1. Applying Too Much Emollient
Often we see first-time users slathering on thick layers of emollient. We get it — the emollient smells really good and maybe your lab partner is a little ashy today. This is definitely the least serious offense you can commit, so it’s okay. But emollient is used with IASTM for a reason: The body doesn’t absorb it as easily as massage creams and lotions.
As a result, you’ll end up “snow-plowing,” with an excess of emollient gathering on the treatment surface. Maybe you like snow plows, but this “snow” will pick up dead skin cells and turn an unappealing gray-brown that isn’t reminiscent of snow angels and snowball fights. While too much emollient isn’t a problem physiologically, it may lead to slippage. For more information on emollient usage, check out this HawkTalk Blog post about the same issue!
2. Treating Too Aggressively
More pressure does not mean better treatment! As the treating clinician, you’re utilizing an instrument that focuses force to a small area. You don’t need to use the same pressure as you would with your hands for manual therapy! In fact, only about 10% of that pressure is necessary. Trust the patient’s (or lab partner’s) verbal and physical feedback to tell when you’re treating too hard.
Check in with your patient often to ensure they’re not feeling pain during treatment. Does it “hurt so good”? Experiencing mild pain may be beneficial, but any pain above 4/10 on the Visual Analogue Scale (or “ouch-ouch” pain, as you may have heard some of our instructors call it) is too much! Back off your pressure and lower your angle for a more comfortable treatment.
Now, let’s look at our lab partner’s skin. After receiving an IASTM treatment, it’s probably a beautiful red color, which is both normal and desired. What is not desired is petechiae, or broken capillaries on the skin’s surface. This could lead to bruising, which isn’t a preferred outcome of IASTM. Exchange contact information with your lab partner and if you wake up the day after class with bruising, please let them know.
Bruising is a sign of over-treating! Sometimes it occurs without the patient showing petechiae during treatment. The first time you treat a new patient, err on the side of lighter pressure for a short period of time. Chances are they will still feel great benefits of decreased pain and increased range of motion without debilitating soreness or bruising afterwards, meaning they will want the treatment again!
3. Not Using the Bevel to Your Advantage
This mistake is actually a two-fold talking point, since the beveled edge is the primary reason why IASTM works:
Not applying enough pressure: This may seem a bit confusing after Mistake #2, but stay with us here. You’re sitting in a HawkGrips continuing education class. The instructor just spent about 30 minutes reviewing the online lecture content and now you’re unwrapping the instruments for the first time.
First of all, they come in a roll-up case not unlike the knife kit from the popular Showtime television series “Dexter”. Now you’ve them laid out in front of you and are wondering what you got yourself into. Looking like a cross between medieval torture devices and ninja throwing stars, these instruments seem as if they could hurt someone (especially that heavy handlebar)!
We totally understand the potential for intimidation, and promise if you listen to the instructor during the course and utilize your best clinical judgment outside it, you won’t harm anybody! While the instruments do most of the work, accessing deeper tissue may require more pressure. This deeper treatment should always be to the tolerance of the patient, and can be modified based on the level of pressure applied or angle of the instrument.
Treatment edge is too flat or inconsistent: Many first-time IASTM users don’t understand how to utilize the bevelled edge, which is certainly understandable. It may be a new concept to trust an edge such as this for manual therapy instead of your fingers. But the bevel acts like a chisel or shovel.
The lower the angle of the shovel to the ground, the more it skims the surface. The higher the angle, the deeper into the ground the shovel will dig. The ideal angle of the bevelled edge on the skin is 45 degrees. Without this bevel, the instrument would simply rub over the surface of the skin, desensitizing dermatomes but not mobilizing soft tissue. The angle of the bevel should also be consistent throughout your treatment.
We recommend you keep the same angle during the treatment stroke that you have on the up-stroke (or return stroke to the starting point). Simply lighten the pressure slightly during the up-stroke and your patient will be perfectly comfortable. This ensures consistency in your treatment, a happy patient, and decreased stress on your wrists from being able to hold them in a lightly locked position.
4. Not Treating the Whole Patient
IASTM is part of a complete treatment regimen for the patient’s whole body. When presented with a patient who has a specific area of pain, clinicians should focus on not only that region, but also the applicable fascial connections and muscular interactions. In school, clinicians learn that if a joint is injured, it’s important to ensure treatment includes the areas above and below that joint.
This is because of the many different bony attachments as well as ligamentous, tendinous, and muscular interactions that cross the joint and may be affected by an injury. The same is true of soft tissue. Every fiber in our bodies — nerve, blood, organ, muscle — is covered with fascia. As an analogy, let’s think of fascia as a sausage casing and soft tissue as the sausage. When you tug on one link, the rest of the links will follow. This may explain why tightness or adhesions in the cervical spine can lead to ipsilateral elbow pain.
So we always encourage students to scan the areas of the body above and below the presented source of pain. When treating a muscle for tightness, it can also be helpful to assess the antagonistic muscle. Is it hypotonic? Does it need to wake up a little? Scanning the muscles above and below the pain source, as well as the antagonist, should provide clinicians with a better idea of treatment goals and how long it will take to restore functionality for each patient.
✶ Thanks to our expert instructors who shared their vast IASTM teaching experiences for this article, including Mark Butler, PT, DPT, OCS, Cert. MDT; Chris Capilli, PT, DPT, FAAOMPT, MS; Ken Johnson, PT; and Jim Wagner, OTD, OTR/L, CHT, CPAM, CSCS, CKTP.
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