The role of Instrument-Assisted Soft Tissue Mobilization for Musculoskeletal Health

Instrument-Assisted Soft Tissue Mobilization (IASTM) is a treatment technique that has shown promising results in improving musculoskeletal properties and addressing various soft tissue issues. A review published in Journal of Exercise Rehabilitation summarised its therapeutic effectiveness and possible mechanism.

The Effect of Instrument-Assisted Soft Tissue Mobilization (IASTM) on Musculoskeletal Properties:

Soft Tissue Function: IASTM has been shown to have a positive impact on soft tissue function, particularly in cases of tendon injuries. Studies have demonstrated significant improvements in lower extremity function in individuals with patellar tendon injuries, lateral elbow tendinopathy (tennis elbow), and Achilles tendinitis after IASTM treatment. The treatment regimen varies, but results include increased walking distances, improved functional scales, and reduced disabilities of the arm, shoulder, and hand scores. In some cases, patients recovered from Achilles tendinopathy entirely. Combining IASTM with eccentric exercises has shown even greater improvements in patients with Achilles tendinopathy, with benefits lasting up to 52 weeks.

Chronic tendon injuries, such as tendinopathy, can be challenging to manage due to the slow healing process of tendons. IASTM provides a promising alternative to traditional treatments like steroids, which can have adverse effects on tissue healing. IASTM can also prevent Achilles tendinopathy by increasing the elasticity and resting length of shortened tendons.

Studies on cyclists with partial rectus femoris tears have shown reduced lesion size and improved tissue continuity after IASTM treatment, leading to improved functional scores. Additionally, IASTM has been associated with increased muscle performance in cases of muscular weakness.

Pain: Pain reduction is one of the observed effects of IASTM in musculoskeletal diseases. Patients with chronic lumbar pain, trigger thumb, costochondritis, and plantar fasciitis have experienced reduced pain levels after IASTM treatment. Inflammation is a common cause of pain, and IASTM may control it, although this effect is still under investigation. Increased blood flow, facilitated by IASTM, could help alleviate pain by removing pain substrates or reducing swelling around injured tissues.

Range of Motion (ROM): Sufficient joint ROM is crucial for optimal musculoskeletal function and injury prevention. IASTM has shown potential in significantly improving ROM. The mechanism behind this improvement includes making soft tissues more extensible by treating restrictions and reducing tissue viscosity. Additionally, IASTM may affect the nervous system, stimulating mechanoreceptors and altering proprioceptive input, leading to changes in tissue tension.

Studies in athletes, including baseball and soccer players, have shown improved hamstring and shoulder ROM after IASTM treatment. Interestingly, some studies have reported significant ROM improvement with just a single session of IASTM, although these studies mainly involve healthy individuals.

Mechanism

The mechanism of IASTM is a multifaceted process aimed at promoting healing and restoring normal function in injured soft tissues. Soft tissue injuries, often caused by excessive tension or overuse, can lead to inflammation, the proliferation of new cells, and the formation of scar tissue in the affected area. This scar tissue reduces tissue elasticity, causes adhesions, and hampers soft tissue function, resulting in pain and an increased risk of reinjury.

IASTM seeks to address these issues by removing scar tissue and promoting functional recovery. When IASTM is applied to the injured area, it initiates microvascular and capillary hemorrhage and localized inflammation. This inflammation triggers the healing process by breaking down scar tissue, releasing adhesions, and increasing blood flow and nutrient supply to the injured tissue. Fibroblasts, responsible for collagen synthesis, are recruited and activated during this process. Collagen is essential for tissue regeneration and proper healing, and IASTM helps realign and resynthesize collagen in the injured tissue.

Furthermore, IASTM increases the levels of fibronectin, a glycoprotein that plays a crucial role in connecting collagen and cells. Fibronectin is synthesized by fibroblasts and epithelial cells and is essential for tissue formation and repair. By increasing fibronectin levels, IASTM contributes to organized collagen alignment, preventing excessive scar tissue formation.

IASTM also influences the vascular response in injured soft tissues. It can significantly increase perfusion and promote the repair of microvascular structures, ultimately aiding in the healing process. Recent research has shown that IASTM can increase the number of tissue-resident mesenchymal stem cells, which are associated with fibroblast activity and collagen synthesis.

There is a hypothesis that IASTM achieves its effects by inducing localized inflammation in the soft tissue. Adequate inflammation can stimulate the secretion of growth factors, which further promote fibroblast activity and collagen synthesis. However, studies in healthy individuals have not consistently supported this hypothesis, and more research is needed to explore the relationship between IASTM and inflammation in patients with sports injuries.

In summary, IASTM is hypothesised to work by breaking down scar tissue, increasing blood flow, stimulating fibroblast activity, and promoting the synthesis and alignment of collagen in injured soft tissues. While the precise mechanism may involve inflammation, further research is required to fully understand the intricacies of this process.

In summary, IASTM has demonstrated promising effects on soft tissue function, pain reduction, and range of motion improvement. While its mechanisms are not entirely understood, IASTM appears to offer valuable benefits to individuals recovering from musculoskeletal injuries and athletes looking to enhance their performance and prevent injuries.