The Evolution and Benefits of Instrument-Assisted Soft Tissue Mobilization (IASTM) in Manual Therapy by Daniel Lawrence
Introduction: The history of Instrument-Assisted Soft Tissue Mobilization (IASTM) is both ancient and contemporary, with roots dating back over 2000 years. Originally IASTM was used for personal pain relief and recovery utilising everyday items like a spoon or coin. In the east this personal application practice continues while in the western hemisphere the more contemporary medicalized use of purpose made tools continues to gain popularity among manual therapists (Figure 1).
Figure 1: The RockBlade in use on a patients back.
This text explores the historical journey of IASTM, its development, and its current applications in the field of manual therapy.
Historical Roots: Traditional IASTM tools were crafted from commonly found and affordable materials, including wood, jade stone (Figure 2), horns, and the previously mentioned household items like spoons, coins and even combs.
Figure 2: Stone Gua Sha tool set
In China, Indonesia, Vietnam, Laos, and Cambodia, scraping devices continue to be used extensively for therapeutic purposes. They are perhaps most well-known as a component of traditional Chinese medicine called Gua Sha. “Gua” means scraping, and “Sha” roughly translates as skin reddening (Figure 3).
Figure 3: Example of some skin reddening during treatment.
In Greece there is evidence of metal scrapers called Strigils (Figure 4) being used to scrape off sweat and applied oils prior to bathing. Interestingly, it is speculated that scrapers were used to collect the sweat off gladiators for “gladiator sweat therapy” or “sudatio”. While this may be a myth, it is agreed that scraping devices were used to treat athletes and healthy individuals as a means of cleansing and regeneration.
Figure 4: A strigil tool from the Roman Empire
IASTM as we know it today made its way to the Western world in the 1970s. In Germany, physiotherapists developed the Gentle Myofascial Tracking Technique, offering relief for hands strained from transverse frictions. A Swedish Physiotherapist who worked alongside Dr James Cyriax called Kurt Ekmen also developed a tool based therapy called Crochetage or Hooking that uses a set of unique hook like tools (Figure 5). Those of you who are aware of James Cyriax will know that he advocated transverse frictions, which can be very fatiguing to the fingers and hands. Kurt Ekmen developed his tools to offer more precision when navigating around muscles and tendons. Around this time of tool development this approach became collectively known as IASTM. Although IASTM can technically cover any soft tissue instrument, including vacuum cups, it is generally agreed that it mainly refers to hand held metal, stone and composite tools in common use. The theoretical understanding has evolved to appreciate the role of the neurosensory system in mediating the response to the different application speeds and levels of pressure.
Figure 5: Crochetage or Hooking tools.
Mechanical and Neurophysiological Effects: The mechanical benefits of IASTM are recognized at the cellular level, stimulating fibroblast production, and facilitating collagen alignment. These mechanical changes are believed to influence fascial adhesions, ultimately improving tissue and joint mobility. Neurosensory effects play a role in proprioception and nociception management, contributing to pain reduction and improved movement patterns.
Contemporary IASTM: Surgical-grade stainless steel has emerged as the most popular material for IASTM tools due to its durability, weight, and smooth beveled edge finish (Figure 6). Therapists often turn to these tools to save their hands, particularly their thumbs, and reduce fatigue from manual therapy. The tools also offer a novel and pleasurable therapeutic experience for patients.
Figure 6: One of the popular RockBlade tools.
IASTM Research and Current Applications: IASTM research is still emerging, relying largely on anecdotal and empirical evidence. While current scientific evidence is limited, there is growing interest in understanding the mechanisms of action and outcomes associated with IASTM. Studies suggest potential benefits, such as increased short-term joint range of motion (Cheatham et al 2016), but the overall quality of research is a significant consideration.
Reducing thumb stress: Manual therapy often places high loads and cumulative loads on the therapists carpometacarpal joint of the thumb on the dominant hand. Research reports, based on practitioner surveys, have cited high levels of reported thumb pain and career limiting dysfunction (Snodgrass 2002; McMahon et al 2006). It is therefore reasonable to suggest, as other authors already have, that tools could protect the smaller joints of the hands and therefore protect careers. It is becoming increasingly prevalent for this to be the main reason why seasoned professionals enroll on IASTM training courses.
Conclusion: Instrument-Assisted Soft Tissue Mobilization has come a long way from its historical roots to becoming an integral part of contemporary physiotherapy. As therapists seek ways to protect their hands and improve patient outcomes, IASTM offers a promising avenue for both mechanical and neurosensory intervention. The historical richness, combined with contemporary tool advancements, positions IASTM at the forefront of manual therapy. While research continues to explore its efficacy and applications, the evolving field of IASTM holds great potential for sustaining the future of manual therapy.
I have lots of IASTM videos here: https://youtube.com/playlist?list=PLdckhr2gFaBNoNGQVZR1fPm7lGxr4LZTR&si=y2XIilrM2Srspcn8
References:
Cheatham SW, Lee M, Cain M et al. (2016) The efficacy of instruments assisted soft tissue mobilization: a systematic review. J Can Chiropr Assoc 60(3):200-211.
McMahon M, Stiller K, Trott P (2006): The prevalence of thumb problems in Australian physiotherapists is high: an observational study. Aust J Physiother. 2006, 52:287-92.
Suzanne J. Snodgrass & Darren A. Rivett (2002) Thumb Pain in Physiotherapists: Potential Risk Factors and Proposed Prevention Strategies, Journal of Manual & Manipulative Therapy, 10:4, 206-217, DOI: 10.1179/106698102790819111