IASTM Flashcards
what is IASTM?
a skilled intervention that includes the use of specialized tools to manipulate the skin, myofascia, muscles, and tendons by various direct compressive stroke techniques
what are the benefits of using IASTM over STM?
provide mechanical advantage to the clinician
allows deeper tissue penetration
more specific treatment
provides vibration feedback sense
t/f: vibration feedback may facilitate the DPT’s ability to detect altered tissue properties like detecting an adhesion
true
what is the most common among work-related MSK injuries among PTs?
back injuries
what is the 2nd most common among work-related MSK injuries among PTs?
hand/thumb
what are risk factors for hand/thumb injuries for PTs?
manual therapy
repetitive workloads
treating many pts/day
working while injured
what materials can the instruments be made of?
metal, plastic, ceramic
where does IASTM originate from?
James Cyriax’s idea of transverse friction massage
Gua sha
what was the purpose behind James Cyriax’s “digital cross friction”?
soften/break-up scar tissue
proper laying down of scar tissue
what is the difference bw gua sha and IASTM?
Gua sha aims to “scrap/scratch” until blemish appears to relive blood stagnation and reduce pain, but in IASTM blemishes like petechiae is considered a precaution/contraindication and we stop when we see this
what are the proposed mechanisms of action of IASTM?
mechano-transduction
tissue healing
mechanical
neuro-physiological effects
fluid dynamics
what is the mechano-transduction MOA of IASTM?
cells response to mechanical load
load used therapeutically to stimulate tissue repair and remodeling
what is the tissue healing MOA of IASTM?
stimulate CT remodeling through re-absorption of excessive fibrosis
induce repair and regeneration of collagen secondary to fibroblast recruitment
what is the mechanical MOA of IASTM?
release and breakdown of scar tissue adhesions, fibrotic nodules, and fascial restrictions (improves ROM and mobility)
what is the neuro-physiological MOA of IASTM?
high concentration of mechanoreceptors in fascia causes relaxation and pain reduction in local and surrounding tissues through CNS afferent stim and efferent responses
t/f: a neurophysiological effect of IASTM is improved NCV in pts with CTS
true
what are the indications for use of IASTM?
tendinopathies
postural abnormalities
myofascial pain syndromes
entrapment syndromes
scar tissue/adhesions
edema reduction
lengthen ms fibers
inhibit hypertonic muscles
what tendinopathies can we using use IASTM to treat?
epicondylitis
trigger finger
Achilles tendinopathy
why would we use IASTM to treat postural abnormalities?
bc they are often caused by muscle stiffness/tightness
what myofascial pain syndromes can we treat with IASTM?
fibromyalgia
PF
ITB
what entrapment syndromes can be treated with IASTM?
CTS
TTS
TOS
t/f: other options like exercise for muscle pumping action, compression, cold, or ES would better choices to treat acute edema than IASTM
true
t/f: IASTM for tissue lengthening is only used for pathological pts
false, it can be used in healthy individuals like athletes too
what does the research say about IASTM?
mixed reviews
what are the precautions for IASTM? (long ass list)
petechiae
HTN
meds: NSAIDs, steroids, narcotics
herbal supplements
pt age, flu, or flu-like sx
cancer
acute inflammatory conditions
post injection (ie steroids)
unhealed closed or non-complicated fx
congestive heart disease, circulatory disorders
kidney dysfxn
body art
DM
allergies to metal, emolients, latex (professional wearing gloves)
abnormal sensations (ie numbness)
pregnancy
pacemaker or insulin pumps (treatment around devices)
autimmune disorders, RSD, or chronic regional pain syndrome
polyneuropathy
RA, ankylosing spondylitis
burn scars
varicose veins
osteoporosis
lymphedema
pt intolerance, hypersensitivity, high pain sensation due to injury
meds: anti-coagulants, hormone replacement, fluoroquinolone antibiotics
what are the contraindications to IASTM? (long ass list)
acute or severe cardiac, liver, or kidney disease
acute injury or infection (viral or bacterial), fever, or contagious condition
skin rash, open wounds, blisters, local tissue inflammation, or tumors
osteoporosis (advanced)
unhealed or unstable bone fx
hematoma, myositic ossificans
neuro conditions resulting in loss or altered sensation (ie MS)
metabolic conditions (ie DM=poor skin integrity) or high-risk pregnancy
connective tissue disorders (ie EDS, Marphan’s) (hypermobility in these pts=more risk for injury)
meds that thin blood or alter sensations
chronic pain conditions (ie RA) (LT steroids affect tissue integrity)
severe pain felt by pt
recent surgery or injury
epilepsy (unstable)
direct pressure over face, eyes, arteries, veins (varicose veins) or nerves
direct pressure over bony prominences or regions (ie lumbar vertebrae)
thrombophlebitis or osteomyelitis
peripheral vascular disease or insufficiency, varicose veins
unhealed surgical site
bleeding disorders (hemophilia)
congestive heart disease, circulatory disorders
insect bite of unexplained origin
HTN (uncontrolled)
cancer or malignancy
treatment over surgical hardware
petechiae (severe) or ecchymosis
what is involved in IASTM treatment?
exam/eval
warm up
pt ed
tx
assessment
specific exercises prescription
what can we do for a warm-up b4 IASTM?
active exercise
diathermy
HP
US
what should we tell a pt during pt ed?
tell them what to expect, what you are doing, and why you are doing it
what things can we use to assess efficacy of tx?
VAS
ROM
fxnal activity
what is involved in Graston tx?
exam
warmup
IASTM tx
post-tx stretching
strengthening
ice
when would you use light to moderate tx?
over acute injuries
to move fluid
hypersensitivity
Ms fascilitation
when would we use more firm tx?
chronic conditions
tendinopathy
fibroblast proliferations
breaking cross links
what angle should we keep the instrument at during tx?
30-60 deg angle bw the edge of the instrument and the skin
what is the dosage for IASTM?
no specific dosing has been established, so it is generally accepted to limit tx time using one tool in one direction and depth to 30 sec
should we grip the tool hard?
NO! lightly grip it with a neutral wrist
when doing IASTM tx, we should using sweeping motions from prox to dist or dist to prox?
either one
t/f: when doing IASTM tx, we should treat the entire kinetic chain (above and below)
true
what is the general tx sequence with IASTM?
clean hands b4 and after tx
inspect and clean the body area to be treated
apply a small amount of emollient
do your tx and monitor for changes in the pt’s status
complete tx and clean the body area
clean the instruments and hands
when selecting a tool size, what size instrument should be used for a larger surface area?
a larger instrument
when selecting a tool size, what size instrument should be used for a smaller surface area?
a smaller instrument
what convexity of the tool should we choose for a broader tx area?
concave
what convexity of the tool should we choose for a more focused tx area?
convex
what bevel has an edge with less slope and angle?
a double bevel
what bevel is more intense?
a single bevel
what bevel is only found on multi-curve tools?
double bevel
what bevel allows strokes to be applied in both directions?
a double bevel
what bevel allows strokes to be applied in one direction only?
a single bevel
when treating the Achilles, should we start with a double or single bevel?
double bevel and work to a single bevel with low reactivity
what bevel direction do we almost always use?
upward facing
what is an upward facing bevel used for?
mobilizing tissue
when is the only times we would use downward facing bevel?
for desensitization or lymphatic drainage
what phase involves soft tissue evaluation, gentle tx to desensitize the area and to gauge the pt response?
phase 1
what phase involves IASTM with the tissue on stretch?
phase 2
what phase involves IASTM while the PT is performing active exercise?
phase 3
what phase involves IASTM with the tissue on slack?
phase 1
what phase involves IASTM with light pressure?
phase 1
what are potential side effects of IASTM?
pain
petechiae
bruising
what should we do if we see petechiae or bruising appearing?
discontinue further IASTM
treat and manage the area to ensure healing
what is the purpose of the scanning/sweeping stroke?
for adhesions in a Unidirectional prox to dist/dist to prox manner
vibration feedback
feeling for “gritty” sensation
what is the purpose of the fanning stroke?
to scan for and treat adhesions in different planes while fixing one side of the instrument to the skin while pivoting the other side like opening a fan
what is the purpose of the brushing stroke?
to desensitize areas with very light pressure strokes in all directions
what is the purpose of the strumming stroke?
to use small strokes on localized adhesions in all directions to break them up similar to transverse friction massage
what is the purpose of the J stroke?
to use a sweeping curve ending in a sharp curve like a “J” to often treat around boney prominances
what is the purpose of the framing stroke?
to sue short strokes framing a bone or boney prominence
how do we perform the scapular release technique?
using the handlebar tool
pt in SL
get the bevel up under the scap and apply tension like the scap mob
what is GIRD?
GH IR deficit
what is the difference bw pathological and anatomical GIRD?
anatomical GIRD is a loss of about 18 deg (??)
pathological GIRD is at least a 5 deg loss of IR compared to ER usually due to a bony, ms, or capsule problem
how can we have pts stretch for GIRD?
hor abd
sleeper stretch
what musculature can we treat with IASTM for GIRD?
post delts/post musculature
traps, lats, supra/infra, teres major/minor
how can we modify the sleeper stretch?
have them lying back more if they can’t do the normal sleeper stretch
