When I (Trista) first learned about instrument assisted soft tissue mobilization (IASTM) in 2010, there was very little quality research associated with it. Most clinicians referenced the infamous rat-tendon study conducted by Davidson et al in 1997,1 and many still do! We’ve come quite a long way in a short time, but unfortunately still have a long way to go before we understand all there is to know about IASTM and its efficacy.

However, the past two years have seen the publication of not just one, but two systematic reviews on IASTM research! These include “The efficacy of instrument assisted soft tissue mobilization: a systematic review,” published in The Journal of the Canadian Chiropractic Association by Cheatham et al in 2016;2 and “Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application,” published in the Journal of Exercise Rehabilitation by Kim et al in 2017.3 If you’re like me, systematic reviews can be a little dense and intimidating to read. So Phil and I have gone through them and summarized the findings below.

The goals of both systematic reviews were to look at the mechanisms and effects of IASTM and provide guidelines for its practical application. Both reviews concluded that use of instruments may provide a mechanical advantage for the clinician by allowing deeper penetration and more specific treatment, while reducing imposed stress on the clinician’s hands. The main difference between the two reviews is that Cheatham et al2 excluded studies utilizing Astym, due to the creators of Astym stating that it is distinct from IASTM. Therefore, these researchers only found seven randomized controlled trials. The Kim et al3 study was less exclusive, citing over 15 articles, including case studies and articles utilizing Astym. Neither of the systematic reviews included articles utilizing gua sha due to the extreme differences in treatment methodologies and goals with this method.

Systematic Review #1: The Journal of the Canadian Chiropractic Association

systematic reviews Journal of the Canadian Chiropractic Association IASTM Astym research case studies patients

Cheatham et al2 divided the results of their search by studies conducted to treat pathology (five studies) versus those that focused on range of motion among healthy patients (two studies). Of the studies that evaluated efficacy of IASTM on pathology, only three reported treatment time, which varied between 3 and 8 minutes. The results between studies were reported as insignificant, with the IASTM group displaying equal improvement to control/comparison groups.

For range of motion (ROM), both studies also had differing treatment methodologies. One used Graston Technique and the other utilized the Fascial Abrasion Technique (FAT) tool. The first study only measured outcomes immediately after treatment, which were significant when compared to the control. The FAT tool study had comparable improvement across groups immediately after treatment (groups were treated with FAT tool or foam rolling), but only the group treated with the FAT tool preserved ROM changes at a 24-hour follow-up.

The authors identified quite a few limitations to this systematic review. Almost all of the IASTM studies utilized different treatment protocols and various conjunctive therapies, with inconsistent outcome measures and assessment times. This makes it very challenging to assess the efficacy of a sole IASTM treatment, even when used in isolation, given inconsistent methodologies. With these limitations, it’s difficult to identify the optimal treatment protocol and thus the efficacy is not fully determined.

Systematic Review #2: Journal of Exercise Rehabilitation

systematic reviews Journal of Exercise Rehabilitation IASTM Astym research case studies patients

Kim et al3 divided the studies they found by tissue treated or desired outcome. IASTM on tendinopathy represented the greatest number of studies the authors found. These studies included IASTM treatment ranging from five to 16 sessions over the course of 4 to 12 weeks. Treatment was typically performed two to three times per week. In some of the studies, IASTM was accompanied by strength exercises, often eccentric in nature. All of these studies saw significant improvements in their subjects, including a decrease in symptoms, such as perceived pain, with an increase in strength and overall functionality.

Only two studies looked at the effects of IASTM on musculature. One was a case study of a cyclist with a partial rectus femoris tear. After five IASTM sessions over 6 weeks, the patient reported increased functionality. Upon ultrasound inspection, the focal lesion size was reduced and tissue continuity had improved. The other study looked at muscle performance before and immediately after a single IASTM session compared to sham IASTM and control groups. The IASTM group received 12 minutes of treatment applied to their quadriceps, gastrocnemius-soleus complex, hamstrings, gluteus maximus, and gluteus medius unilaterally. The maximal force output was significantly improved in the IASTM group compared to the sham and control groups.

In terms of reducing pain, a large number of case studies and case series demonstrated beneficial effects from four to 12 IASTM treatments. Kim et al3 found one study that applied IASTM to 30 patients with chronic lumbar pain for 4 weeks. The subjects in this study had significantly decreased pain after treatment.

The effect of IASTM on increasing ROM is very well-documented. Case studies included a range of one to eight treatments, all with increased ROM immediately after IASTM and lasting if measured at a 24-hour follow-up. These studies were conducted on both injured and healthy patients and included various treatment protocols and conjunctive therapies.

The authors of this systematic review deduced that IASTM was found to improve soft tissue function and ROM in acute or chronic sports injuries to soft tissue, while also reducing pain. However, the scientific basis for the mechanisms and effects of IASTM must be broadened. To accomplish this, we need more human studies and randomized controlled trials with consistent treatment protocols and variables, in order to really analyze the full impact of IASTM.  We also need to look at other soft tissue such as muscles and/or ligaments to gain a better understanding of the effects of IASTM.

What’s the Clinical Bottom Line?

We need more quality research. Read what research is out there and analyze it for yourself. Would you use the same methodology when treating your patients? Do you have a patient matching those in a particular study who were effectively treated? At the end of the day, you are the clinician with the power to choose which technique and products work with the demands of your practice.

 

References
  1. Davidson CJ, Ganion LR, Gehlsen GM, Verhoestra B, Roepke JE, Sevier TL. Rat tendon morphologic and functional changes resulting from soft tissue mobilization. Med Sci Sports Exerc. 1997;29(3):313-319.
  2. Cheatham SW, Lee M, Cain M, Baker R. The efficacy of instrument assisted soft tissue mobilization: a systematic review. J Can Chiropr Assoc. 2016; 60(3): 200-211.
  3. Kim J, Sung DJ, Lee J. Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application. J Exer Rehab. 2017; 13(1)12-22.

Trista Barish is the director of education for HawkGrips and can be reached at tbarish@hawkgrips.com. Dr. Phil Page is the global director of clinical research and education for Performance Health, a clinical instructor of orthopedics at Tulane University School of Medicine, and an instructor in the Kinesiology Department at Louisiana State University.

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