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“Is bruising OK?” This is one of the most common questions I hear about instrument assisted soft tissue mobilization (IASTM). Here’s the best possible answer: Yes, it is OK. But let me explain why:

Bruising will not kill a human being (except possibly if you have hemophilia). Nor should bruising cause any kind of irreversible harm. Therefore, bruising is OK. But I also want to emphasize that bruising is not the goal of IASTM.

bruising IASTM treatment HawkGrips instrument assisted soft tissue mobilization

Although bruising can sometimes occur with instrument assisted soft tissue mobilization (IASTM), it is not the goal of treatment.

There’s nothing in modern literature that says bruising indicates a release of toxins or of any adhesion. Those are purely ideas from traditional Eastern medicine. When it comes to modern-day Western medicine, we’ve seen that bruising may actually inhibit the healing caused when we use IASTM.

“Does bruising happen after an IASTM treatment?” More often than you would think. If it does, let this be a guide that the treatment you conducted before the bruising occurred might have been a little too aggressive. Some people bruise easier than others, so patient education is key.

Patient Education

Inform your patients that bruising may occur following treatment with IASTM. Ask if they bruise easily or not. Some other questions that clinicians may consider asking include: “Are you currently on blood-thinners?” and “Do you have a higher pain-tolerance level than average?” If the patient’s pain-tolerance is high, they may not provide any sort of warning that the treatment is too aggressive, even if you are constantly adding more pressure to the point of bruising.

When bruising does occur, the patient may feel mildly sore. This bruising and soreness typically clears up after a day or two. If it doesn’t resolve or actually worsens, please contact a physician. For a more complete discussion on patient education, check out this previous HawkTalk Blog post.


Petechiae (pronounced peh-tee-kee-ah) refers to broken capillaries near the skin’s surface. The Wikipedia definition for petechia (singular) is a small (1-2 mm) red or purple spot on the skin, caused by a minor bleed (from broken capillary blood vessels). Usually referred to in the plural as petechiae, they may occur when excessive pressure is applied to tissue.

This is a normal occurrence (don’t be alarmed!) when friction forces are applied to the skin. It’s a sign that treatment should begin to wrap up since these broken capillaries could lead to bruising.

Trista Barish is the director of education at HawkGrips and can be reached at tbarish@hawkgrips.com.

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