The effect of Astym® Therapy on muscle strength: a blinded, randomized, clinically controlled trial

Investigation of the functional and biomechanical effect of instrument-assisted soft tissue mobilization technique in individuals with asymptomatic dynamic knee valgus - Randomized controlled trial

Although there are studies showing that myofascial release will increase muscle force production, the contribution of its application alone to muscle force production has not been examined. Aim of the study is to investigate the effect of instrument-assisted soft tissue mobilization (IASTM) on eccentric strength, frontal plane projection angle (FPPA), dynamic (DPS), and static postural stability (SPS), femoral internal rotation (FIR) angle in females with dynamic knee valgus (DKV). A total of 44 recreationally active females with asymptomatic DKV (age: 21,39 ± 1,79, body mass index: 20,09 ± 2,45) participated and were randomly assigned to either control group (CG) or IASTM group (IASTMG). Participants' eccentric contraction strength, FPPA, DPS, SPS, and FIR on the involved leg were measured pre- and post. IASTM application was applied to IASTMG for 6 weeks, twice a week, for 5 min, using Graston Technique® instruments on gluteus medius. CG received no intervention. In comparison of ECS difference values, change in IASTMG was found to be statistically significantly higher than CG (p = .004; p < .01). There was no statistical difference in comparison of FIR and FPPA values (respectively p = .213, p = .360; p < .05). In SPS and DPS evaluation, a statistically significant improvement was observed in favor of IASTMG in comparison of both intergroup and difference values (p < .05 for all). Strength gain without exercise can increase postural stability, but it isn't sufficient to correct faulty movement patterns. We recommend adding IASTM to injury prevention programs, but there is a need to investigate the effect of IASTM with technique correction feedback.

Effect of instrument-assisted soft tissue mobilization combined with exercise therapy on pain and muscle endurance in patients with chronic neck pain: a randomized controlled study

OBJECTIVES

The use of instrument-assisted soft tissue mobilization (IASTM) has been documented to be effective for improving pain and function, but it is unclear whether it helps improve muscle performance in musculoskeletal diseases. This study investigated the effects of IASTM combined with exercise therapy on muscle endurance and pain intensity in patients with chronic neck pain.

METHODS

Forty-eight individuals with chronic neck pain were randomly divided into exercise therapy (ET, n = 24) and combined therapy (CT, n = 24) groups. For 4 weeks, each group underwent exercise therapy 3 days a week for a total of 12 sessions. The ET group received exercise therapy only. The CT group received IASTM combined with exercise therapy twice per week for a total of 8 sessions. The muscle endurance of the participants was assessed with the Deep Neck Flexor Muscle Endurance (DNFE) test and pain intensity with Visual Analogue Scale (VAS) at baseline and post-treatment.

RESULTS

While both groups showed significant improvement in pain intensity (p < 0.05), the CT group showed a greater effect size for pain (CT group: Cohen's d = 3.28; ET group: Cohen's d = 2.12). The CT group showed significant improvement for muscle endurance (p < 0.05), whereas the ET group did not (p > 0.05).

CONCLUSION

In the current study, the IASTM intervention combined with ET improved pain and muscular endurance in participants with chronic neck pain compared to exercise therapy alone. As an alternative method, IASTM intervention before exercise seems to increase the short-term recovery effect in chronic neck pain conditions.

A comparative study of the efficacy of instrument-assisted soft tissue mobilization and massage techniques in patients with patellofemoral joint pain

Purpose

The aim of this study was to compare the clinical efficacy of instrument-assisted soft tissue mobilization (IASTM) and manipulative therapy Tui-na techniques in the treatment of patients with patellofemoral joint pain syndrome, and to evaluate their impact on pain relief, functional improvement, and joint range of motion.

Methods

In this study, 25 patients with patellofemoral pain syndrome were enrolled, comprising of an intervention group of 13 patients who received IASTM treatment and a control group of 12 patients who received Tui-na manipulation therapy. The treatment cycle lasted for 4 weeks, featuring two interventions per week. Before treatment, the visual analog pain scale (VAS) of the knee, Lysholm score of the knee, modified Thomas test (MTT), and maximum isometric strength of the extensor muscles of the lower limbs were measured and recorded for both groups. After the first and last treatments, the aforementioned indexes were reassessed, and the maximum isometric muscle strength of the lower extremity extensors was measured only after 4 weeks of treatment had been completed.

Results

There was no significant difference in the basic information of the two intervention groups (p > 0. 05). After the first treatment and 4 weeks of treatment, the Lysholm score in both groups significantly improved (p < 0. 05), indicating that both interventions can improve the function of patients' lower limbs. However, the Lysholm score in the IASTM group significantly increased compared with that of the massage group after 4 weeks of treatment, indicating that its improvement in functional performance is superior. Both groups showed significant improvement in knee joint pain after the first treatment and 4 weeks of treatment (p < 0. 05), with the IASTM group having a lower VAS score and better pain improvement after 4 weeks of treatment. The strength of the two intervention groups significantly increased after the maximum isometric muscle strength test of the lower limb extensor muscles before and after 4 weeks of treatment (p < 0. 05). After the MTT test, the extension angle, deviation angle, and hip abduction angle of the tested legs in the two intervention groups were significantly reduced (p < 0. 001), indicating an improvement in lower limb joint mobility.

Conclusion

Instrument-assisted soft tissue mobilization treatment and Tui-na manipulation therapy significantly reduced pain, improved knee flexibility, and increased range of motion of the lower extremity in patients with PFPS. However, IASTM treatment significantly improved pain and function and sustained pain in the short to medium-term post-trial period.

Clinical trial registration

www.isrctn.com, ISRCTN88098928.

Acute effects of instrument assisted soft tissue mobilization technique on pain and joint position error in individuals with chronic neck pain: a double-blind, randomized controlled trial

PURPOSE/AIM

The aim of this study was to determine the acute effects of IASTM on cervical joint position error and pain in individuals with chronic neck pain.

METHODS

A total of 39 individuals with chronic neck pain were included in this study. Participants were randomized into three groups: Instrument-assisted soft-tissue mobilization(IASTM (n = 13), sham (n = 13), and control (n = 13). In the IASTM group, intervention was applied to the sternocleidomastoid and trapezius muscles with an application time of 45 s and a frequency of 60 beats/min. In the sham group, IASTM was applied at a 90° angle without pressure. The control group did not receive any intervention. The pain severity and joint position error(JPE) were evaluated before and after the intervention, by using the visual analogue scale and a cervical range of motion device.

RESULTS

The effects of time and treatment group on visual analogue scale(VAS) score were statistically significant (p = .001). Instrument-assisted soft-tissue mobilization was more effective in VAS score than sham and control group (p < .001). Significant improvement was found in JPE in all range of motions of the cervical region in the instrument-assisted soft-tissue mobilization group (p < .05). In the sham group, significant improvements were observed in cervical extension, left rotation, and left lateral flexion movements in JPE during each cervical spine active movement (p < .05). Instrument-assisted soft-tissue mobilization group was more effective in JPE all directions than sham and control group.

CONCLUSIONS

Instrument-assisted soft-tissue mobilization may be a useful technique in individuals with chronic neck pain. Instrument-assisted soft-tissue mobilization decreases VAS and improves JPE.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04882397 (05 August 2021).

The Use of Instrument-Assisted Soft-Tissue Mobilization for Manual Medicine: Aiding Hand Health in Clinical Practice

Instrument-assisted soft-tissue mobilization (IASTM) represents a treatment strategy for soft tissue (skin) and musculoskeletal tissue (myofascia). There are different morphologies of these tools that are used by clinicians and manual therapists for the management of scars, fibrotic formations, muscle-joint pain, and movement limitations. The literature demonstrates the effectiveness of IASTMs in different clinical areas. However, the literature does not consider the use of these tools for the protection of the clinician’s hands. The main objective of this article is to draw attention to the fact that IASTM can protect clinicians from professional joint injuries of the hands and can likely become a preventive tool for the operator. Further research is needed to fully determine the positive adaptations in operators who use IASTMs compared to those who do not use them.

The effect of a single high velocity low amplitude hip mobilization on strength in subjects with knee injuries

BACKGROUND

Manual therapy have been used as a disinhibitory intervention to increase muscle activation before performing functional tasks that are limited by weakness. Knee injuries are commonly associated with weakness in quadriceps and gluteus. Currently, there is no evidence to support anecdotal experience that a hip distraction mobilization improves muscle performance in subjects with knee injuries and lower extremity weakness.

OBJECTIVES

To determine if a hip distraction mobilization would result in an immediate change of maximal force output of the quadriceps and gluteus.

DESIGN

Non-controlled observational pre-post design.

METHODS

Forty individuals with knee pathology were included. Subjects underwent quadriceps, gluteus maximus, and gluteus medius muscle strength assessment before a single hip distraction of the symptomatic side. An immediate re-assessment of muscle strength of both symptomatic and asymptomatic sides followed the mobilization.

RESULTS

/findings: Comparing pre-to post-mobilization strength on the symptomatic side, a significant increase was found with the gluteus maximus (average change = 2.0 kg [95%CI 0.6-3.4]; p < 0.01) but not gluteus medius (0.2 kg [-0.7-1.0]; p = 0.71) or quadriceps (0.1 kg [-1.4-1.7]; p = 0.86). When comparing the strength on the symptomatic side in subjects with weakness greater than the MDD₉₅ (0.7-2.9 kg), a significant increase was again found for gluteus maximus (4.7 kg [2.6-6.8]; p < 0.01) but not for gluteus medius (0.2 kg [-1.0-1.4]; p = 0.71) or quadriceps (1.6 kg [-0.7-3.9]; p = 0.15).

CONCLUSION

A single hip distraction resulted in a significant increase in gluteus maximus strength but did not produce a change in gluteus medius or quadriceps strength in subjects with knee injuries.

Astym® therapy improves FOTO® outcomes for patients with musculoskeletal disorders: an observational study

Background

Current healthcare providers function in an environment where there is increased emphasis on value-based models of reimbursement; therefore, the delivery of better patient outcomes is critical. Consequently, it is necessary to identify successful treatments that improve outcomes and can be applied across a broad range of clinic settings, treatment styles and therapist expertise.

Methods

Data from 2,450 patients who received Astym therapy as component of their outpatient rehabilitation (treatment group) was matched to data from 2,450 randomly chosen patients with similar orthopedic impairments who did not receive Astym therapy during their rehabilitation (control group). Data was collected across 116 clinics in 17 U.S. states. All patients completed a standardized functional status survey at admission and at discharge. The effectiveness (discharge functional status score), efficiency (number of treatment visits, treatment duration) and utilization (unit of functional improvement per visit) was compared across two groups. Ethics approval was not required for this study as this is an observational study, with both sets of participants receiving actual (not placebo) treatment.

Results

Compared to the control sample, patients who received Astym therapy as part of their rehabilitation had higher discharge functional status (FS) scores (68.5 vs. 64.5, F_1,4897 =53.1, P<0.001) and had more functional improvement per visit noted with a higher utilization index (2.0 vs. 1.9, ANCOVA F_1,4897 =5.5, P=0.019), and after risk adjustment, had the same number of visits. There was no difference in duration of treatment episode across groups (Astym, 47.8±31.1 days; control, 47.5±30.0 days) (ANCOVA F_1,4897 =1.7, P=0.199).

Conclusions

Patients with musculoskeletal disorders who received Astym therapy as part of the treatment process experienced increased treatment effectiveness as compared to those who did not receive Astym therapy. The addition of Astym therapy improved physical therapy outcomes for patients across a broad range of treatment styles, clinical settings and therapist expertise.

The current role of Astym therapy in the treatment of musculoskeletal disorders

Background: In general, chronic problems of soft tissues (muscles, tendons, ligaments) are due to scarring or degeneration. Astym therapy (Performance Dynamics, Inc. Muncie, Indiana) has been reported to address tendinopathy by stimulating regeneration in soft tissues (muscles, tendons, ligaments) and the resorption of unwanted scar tissue that causes pain and limits mobility.Purpose: To analyze the effectiveness of Astym therapy in the treatment of musculoskeletal problemsMethods: A narrative review of the literature on the topic was carried out. A Cochrane Library and PubMed (MEDLINE) search related to the role of Astym therapy was analyzed. The only language searched was English. Scientific meeting abstracts and other sources of evidence were not considered. The main criteria for selection were articles that were focused on the role of Astym therapy.Results: Astym therapy seems to be useful for the treatment of chronic ankle sprains, Achilles tendon tendinopathy, hamstring tendinopathy, elbow tendinopathy, and the stiff total knee arthroplasty. Astym therapy also appears to be useful to gain range of motion, muscle strength, and function in patients with cerebral palsy, and after mastectomy.Conclusions: Astym therapy seems to activate a regenerative response in degenerative tendinopathy and eliminate or reduce the scar tissue/fibrosis that causes pain and limitation of mobility. Based on the positive findings of the emerging published research further study is warranted to confirm the benefits of Astym therapy on a variety of musculoskeletal disorders.

Instrument-Assisted Soft Tissue Mobilization: A Systematic Review and Effect-Size Analysis

OBJECTIVE

To determine the overall effectiveness of instrument-assisted soft tissue mobilization (IASTM) in improving range of motion (ROM), pain, strength, and patient-reported function in order to provide recommendations for use. We also sought to examine the influence of IASTM on injured and healthy participants, body part treated, and product used.

DATA SOURCES

We searched the Academic Search Premier, Alt Healthwatch, CINAHL Complete, Cochrane Library, MEDLINE with full text, NLM PubMed, Physical Education Index, Physiotherapy Evidence Database (PEDro), SPORTDiscus with full text, and Web of Science databases for articles published from 1997 through 2016. The Boolean string advantEDGE OR astym OR graston OR iastm OR "instrument assist* soft tissue mobil*" OR "augment* soft tissue mobil*" OR "myofascial release" OR "instrument assist* massage" OR "augment* massage" OR "instrument assist* cross fiber massage" was used.

STUDY SELECTION

Included articles were randomized controlled trials that measured ROM, pain, strength, or patient-reported function and compared IASTM treatment with at least 1 other group.

DATA EXTRACTION

Thirteen articles met the inclusion criteria. Four independent reviewers assessed study quality using the PEDro and Centre for Evidence-Based Medicine scales. Twelve articles were included in the effect-size analysis.

DATA SYNTHESIS

The average PEDro score for studies of uninjured participants was 5.83 (range = 5 to 7) and that for studies of injured participants was 5.86 (range = 3 to 7). Large effect sizes were found in outcomes for ROM (uninjured participants), pain (injured participants), and patient-reported function (injured participants). The different IASTM tools used in these studies revealed similar effect sizes in the various outcomes.

CONCLUSIONS

The current literature provides support for IASTM in improving ROM in uninjured individuals as well as pain and patient-reported function (or both) in injured patients. More high-quality research involving a larger variety of patients and products is needed to further substantiate and allow for generalization of these findings.

INSTRUMENT ASSISTED SOFT-TISSUE MOBILIZATION: A COMMENTARY ON CLINICAL PRACTICE GUIDELINES FOR REHABILITATION PROFESSIONALS

Instrument assisted soft-tissue mobilization (IASTM) has become a popular myofascial intervention for sports medicine professionals. Despite the widespread use and emerging research, a consensus on clinical standards, such as a describing the intervention, indications, precautions, contraindications, tool hygiene, safe treatment, and assessment, does not exist. There is a need to develop best practice standards for IASTM through a universal consensus on these variables. The purpose of this commentary is to discuss proposed clinical standards and to encourage other sports medicine professionals and researchers to contribute their expertise to the development of such guidelines.

LEVEL OF EVIDENCE

5.

Astym® therapy: a systematic review

Soft tissue dysfunction can result from the degeneration of tissues as in the case of degenerative tendinopathy or from the build-up of problematic scar tissue, which can be the result of several aggravating factors, including overuse injuries, acute or chronic trauma, or as a result of surgery. This dysfunction often results in impaired movement, pain, and swelling of the affected area, which can lead to patient dissatisfaction and a lower quality of life. These soft tissue dysfunctions also have a marked economic impact. Although a number of traditional treatments attempt to address these issues, no optimal treatment choice has emerged. Traditional treatments are not always successful, can be invasive, and can consume many medical resources. A relatively new treatment approach, Astym therapy, is a potentially useful, non-invasive, more cost-effective option. This therapy was developed to address soft-tissue dysfunctions by stimulating the regeneration of soft tissues and the resorption of inappropriate scar tissue/fibrosis. It has been reported to help with the resorption and remodeling of abnormal tissue, thereby leading to improved motion, function and pain relief. The purpose of this analysis was to review the published literature related to Astym therapy on various musculoskeletal disorders. Specifically, we evaluated the effectiveness of this therapeutic method on disorders related to the: (I) knee; (II) upper extremity; (III) hamstring muscles; and (IV) ankle and Achilles tendon injuries.

The Effects of Astym Therapy® on a Child With Spastic Diplegic Cerebral Palsy

Purpose:

Limited research exists regarding use of Astym® therapy with neurologic conditions. The purpose of this case was to describe using Astym therapy in treating spastic diplegic cerebral palsy (CP).

Case description:

A 6-year-old female was treated more than 9 months (36 sessions) for decreased flexibility, muscle weakness, spasticity, and abnormal gait.

Examination findings:

Gait performed with articulated ankle-foot orthoses (75% of the time) or foot orthosis (25%); lack of active dorsiflexion (DF); lack of heel strike during gait; spasticity in hamstrings, gastrocnemius, hip adductors; hamstring flexibility (90/90 test position) 50° right and 60° left; gastrocnemius flexibility neutral bilaterally; and Peabody Developmental Motor Scales, second edition (PDMS-2) age equivalence (in months) 23 locomotion, 25 object manipulation, and 21 stationary tasks. Therapeutic interventions included Astym therapy, stretching, strengthening, neuromuscular reeducation, and gait training.

Outcomes:

At 6 months, flexibility improved bilaterally to 10° past neutral in gastrocnemius and 0° in hamstrings. The PDMS-2 age equivalence scores were 27 locomotion, 32 object manipulation, and 28 stationary tasks. At discharge, patient ambulated full-time with foot orthosis, exhibiting improved stride length bilaterally with active ankle DF to initiate heel strike. Spasticity was unchanged.

Discussion:

Astym therapy was effective in treating a child with spastic diplegic CP, resulting in enhanced strength, flexibility, and gait.

Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application

This article reviews the mechanism and effects of instrument-assisted soft tissue mobilization (IASTM), along with guidelines for its practical application. IASTM refers to a technique that uses instruments to remove scar tissues from injured soft tissues and facilitate healing process through formation of new extracellular matrix proteins such as collagen. Recently, frequent use of this instrument has increased in the fields of sports rehabilitation and athlete training. Some experimental studies and case reports have reported that IASTM can significantly improve soft tissue function and range of motion following sports injury, while also reducing pain. Based on the previous studies, it is thought that IASTM can help shorten the rehabilitation period and time to return to sports among athletes and ordinary people who have suffered sports injuries. However, few experimental studies of the mechanisms and effects of IASTM have examined, while case reports have accounted for the majority of articles. In the future, the scientific basis of IASTM and its reliability should be provided through well-designed experimental studies on humans. Moreover, IASTM studies that have mostly focused on tendons need to broaden their scope toward other soft tissues such as muscles and ligaments.

Astym Therapy Improves Bilateral Hamstring Flexibility and Achilles Tendinopathy in a Child with Cerebral Palsy: A Retrospective Case Report

PURPOSE

The purpose of this case report was to describe the use of Astym therapy to improve hamstring flexibility and Achilles tendinopathy in a child with cerebral palsy.

CASE DESCRIPTION

An eight-year-old female with cerebral palsy was referred to physical therapy for the treatment of bilateral hamstring inflexibility and Achilles tendinopathy. Treatment focused on an Astym therapy protocol of eccentric exercise, stretching, active and passive range of motion, gait training, and a home exercise program. The patient underwent a total of 11 physical therapy treatment sessions.

OUTCOMES

At the conclusion of treatment, the patient demonstrated improved resting muscle tone in bilateral lower extremities with active 90/90 hamstring flexibility measured at 165° and ankle dorsiflexion active range of motion of 5° without pain at 0° and 90° knee flexion. The patient exhibited an improved gait pattern with even stride length and diminished genu recurvatum, decreased pain with standing and walking, discontinued use of ankle–foot orthoses, and improved activity tolerance and overall function for daily activities.

DISCUSSION

The results of this case report indicate that physical therapy rehabilitation utilizing an Astym therapy protocol can successfully achieve gains in flexibility and strength and allow for improved function of bilateral lower extremities in a patient with cerebral palsy.

CONCLUSION

Based on the findings of this case report, clinicians should consider the use of Astym therapy in treating musculoskeletal soft tissue dysfunction in pediatric patients with cerebral palsy.

The efficacy of instrument assisted soft tissue mobilization: a systematic review

BACKGROUND

Instrument assisted soft tissue mobilization (IASTM) is a popular treatment for myofascial restriction. IASTM uses specially designed instruments to provide a mobilizing effect to scar tissue and myofascial adhesions. Several IASTM tools and techniques are available such as the Graston® technique. Currently, there are no systematic reviews that have specifically appraised the effects of IASTM as a treatment or to enhance joint range of motion (ROM).

PURPOSE

The purpose of this study was to systematically appraise the current evidence assessing the effects of IASTM as an intervention to treat a musculoskeletal pathology or to enhance joint ROM.

METHODS

A search of the literature was conducted during the month of December 2015 which included the following databases: PubMed, PEDro, Science Direct, and the EBSCOhost collection. A direct search of known journals was also conducted to identify potential publications. The search terms included individual or a combination of the following: instrument; assisted; augmented; soft-tissue; mobilization; Graston®; and technique.

RESULTS

A total of 7 randomized controlled trials were appraised. Five of the studies measured an IASTM intervention versus a control or alternate intervention group for a musculoskeletal pathology. The results of the studies were insignificant (p>.05) with both groups displaying equal outcomes. Two studies measured an IASTM intervention versus a control or alternate intervention group on the effects of joint ROM. The IASTM intervention produced significant (P<.05) short term gains up to 24 hours.

CONCLUSION

The literature measuring the effects of IASTM is still emerging. The current research has indicated insignificant results which challenges the efficacy of IASTM as a treatment for common musculoskeletal pathology, which may be due to the methodological variability among studies. There appears to be some evidence supporting its ability to increase short term joint ROM.