IASTM

Question 1

What is it?

Answer 1

GT is a method of instrument assisted soft- tissue mobilization combined with rehabilitative exercises to improve musculo- skeletal function.

Question 2

What are the clinical indications?

Answer 2

• Tendinopathies
– Lateral Epicondylosis
– Medial Epicondylosis
– Supraspinatus Tendinosis
– Achilles Tendinosis
– DeQuervains Syndrome
– Patellar Tendinosis
• Fascial Syndromes
– Plantar Fasciitis
– ITB Syndrome
– Compartment Syndromes – Trigger Finger
• Myofascial Pain Syndromes

• Entrapment Syndromes – Carpal Tunnel/Tarsal Tunnel – Ulnar Entrapment
– Thoracic Outlet

Ligament Pain Syndromes – MCL/LCL Sprains
– Coronary Ligament Sprains
– AC Ligament Sprains
– Ankle Sprains
– Ulnar collateral sprains

• Oedema Reduction

• Scar Tissue/Adhesions – Postsurgical
– Traumatic

Question 3

What are the relative contraindications?

Answer 3

Cancer
• Burn scars (mature scars 9 months post-healing)
• Kidney dysfunction
• Pregnancy
• Medications: Anticoagulants, steroids, hormone replacements, NSAIDS
• Rheumatoid arthritis
• Varicose veins
• Lymphedema
• RSD (Chronic Regional Pain Syndrome CRPS)
• Polyneuropathies
• Unhealed closed non-complicated fractures (soft tissue component)

Question 4

Absolute contraindications?

Answer 4

Open wounds/unhealed suture sites/sutures
• Thrombophlebitis
• Uncontrolled hypertension
• Inflammatory conditions due to infection
• Contagious or infectious skin conditions
• Hematoma/Myositis Ossificans
• Osteomyelitis
• Unstable fractures

Question 5

Physiology and theory of IASTM

Answer 5

• IASTM utilizes an instrument to identify and treat localised STA
• Once identified using an instrument, STA treated with introduction of controlled microtrauma, triggering inflammatory response & increased fibroblast activity
– Davidson CJ, Ganion L, Gehlsen G, Roepke J, Verhoestra B, & Sevier TL, 1995
• Initiates reabsorption of excess scar tissue resulting in remodeling of affected soft tissue structures

Question 6

Innervation by layers of TFL

Answer 6

• 90% of all nerve fibres were located in the superficial layer of TLF
• Middle layer composed of dense collagen bundles with few fibres
• Inner layer was likewise few nerve fibres

Question 7

What is the neurologic hyposthesis behind it>

Answer 7

• Johansson et. al have proposed it is the gamma motor neurons that chiefly influence the alpha system, through extensive interconnections in the spinal cord.
• The sensory afferents from the skin, ligaments, muscles and tendons have extensive interconnections on the gamma motor neurons in the cord….not the alpha motor neurons.

•These soft tissues are constantly relaying messages to the gamma motor neurons, which feedback onto the intrafusal fibres of the muscle spindles and therefore set the reaction time of the muscle. •We stimulate the skin, fascia and ligaments over a joint and start to introduce normal motion (FAKTR) •Creating a barrage of proprioceptive input that alters muscle reaction time and “resets” normal tone in the muscles. •End Result of FAKTR may not be the break down of adhesions as much as proprioceptive reflex on the gamma-alpha loop

Question 8

Fascia

see slide 28

Answer 8

-interstitial myofascial receptors, generate a neuro and vascular cascade of events occur from soft tissue manipulation
• It is thought that the interstitial receptors may affect the hypothalamus resulting in a “deep and healthy” change of the global NMS, emotional state and cortical and endocrine function

Question 9

Components of connective tissue

Answer 9

Collagen (3 Types) – dense (regular/irregular), loose Collagen components include;
• Elastin
• Glycosaminoglycans • Water


Question 10

Describe the effects of immobilisation and trauma of connective tissue
slide 30
31

Answer 10

• Loss of sarcomeres/muscle weight.
• Decreased protein, mitochondria & enzymes.
• Increased fibrosis at musculotendinous junction in healing tissue.
• Muscle contusions heal with scar tissue of dense connective tissue.
• Decreased muscle extensibility.

Question 11

What are the benefits of soft tissue mobilisation?

Answer 11

Release of fascial restrictions and adhesions.
• Separates and breaks down cross-links.
• Splays and stretches connective tissue & muscle fibers.
• Increases skin temperature.
• Facilitates reflex changes in muscle tone.
• Alters spinal reflex activity.
• Increases amount and rate of blood flow to & from area.
• Increases cellular activity in the region including. fibroblasts and mast cells.
• Increases histamine response secondary to mast cell activity.

Question 12

What are the phases of tissue healing and how does this affect treatment with IASTM

Answer 12

1. Inflammatory stage
2. Granulation stage
3. Fibroblastic stage
4. Maturation stage
   
   Acute: Treat/ control edema, increase ROM, decrease pain
   Select GT instrument of choice Place tissue in appropriate position
   • Chronic
   Mechanically disrupt fibrotic tissue to increase
   ROM, decrease pain, create new fibroblasts. Select appropriate instrument of choice Place tissue on stretch with mild resistance.