Can the application of the Ergon® IASTM treatment on remote parts of the superficial back myofascial line be equally effective with the local application for the improvement of the hamstrings' flexibility? A randomized control study

Instrument-Assisted Soft Tissue Mobilization 2-Handed Grip Force Production Consistency During Simulated Treatment: A Technical Report

CONTEXT

Instrument-assisted soft tissue mobilization (IASTM) continues to increase in popularity and utilization among manual therapists. Despite its popularity, little is known about the consistency in peak or average forces that clinicians apply when performing IASTM treatments with a 2-handed grip. The purpose of this study was to examine intraclinician consistency in peak and average forces when applying a 2-handed IASTM grip.

DESIGN

Randomized crossover study conducted in a university biomechanics laboratory.

METHODS

Five (5) licensed athletic trainers with prior IASTM training used 5 different IASTM instruments to apply simulated treatment. Average peak forces (Fpeak) and average mean forces (Fmean) were collected via force plate for all 5 IASTM instruments with a skin simulant attached. Descriptive statistics, coefficients of variation (CVs), box and density plots, and Bland-Altman plots were assessed.

RESULTS

The clinicians' average Fpeak ranged from 3.0 N to 11.6 N and average Fmean from 1.9 N to 8.1 N. Fpeak CVs for all instruments ranged from 14% to 31%, and Fmean CVs ranged from 15% to 35%. Bland-Altman plots indicated that for both Fpeak and Fmean, 97% of the data points fell within the limits of agreement across instruments and clinicians. Mean differences across instruments ranged from 0.9 N (91.8 g) to 4.1 N (418.1 g) for Fpeak and from 1.0 N (102.0 g) to 2.8 N (285.5 g) for Fmean. Thus, CVs, box and density plots, and Bland-Altman plots supported general force application consistency.

CONCLUSION

Trained IASTM clinicians produced consistent treatment application forces (ie, Fpeak and Fmean) within treatment sessions during 2-handed simulated application.

The effects of instrument-assisted soft tissue mobilisation and kinesiology taping on pain, functional disability and depression in patients with chronic low back pain: A randomised trial

Objectives: Low back pain is a common condition that can become chronic, which reduces the life quality of the patient by causing functional disability and depression. This study aimed to investigate the effects of instrument-assisted soft tissue mobilisation (IASTM) and kinesiology taping (KT) along with conservative treatment in patients with chronic nonspecific low back pain. Patients and methods: A total of 30 patients (22 males, 8 females; mean age IASTM = 37.3 ± 7.1 years, KT = 37.3 ± 6.6 years; range, 30–50 years) with chronic nonspecific low back pain (CNLBP) were randomised into the IASTM (n = 15) and KT (n = 15) groups. Both the groups underwent conservative treatment that comprised of a hot pack, ultrasound, transcutaneous electrical nerve stimulation and home exercises. The pain level was assessed using the Visual Analog Scale, the functional impairment level was assessed using the Roland Morris Disability Questionnaire and the level of depression was measured using the Beck Depression Inventory. The measurements were carried out at the beginning and end of the treatment. Results: The two methods did not have superiority over each other in parameters like pain, functionality and depression (p>0.05). Conclusion: IASTM and KT have therapeutic effects on pain, functionality and depression in patients with CNLBP.

Effectiveness of instrument-assisted soft tissue mobilization for the management of upper body, lower body, and spinal conditions. An updated systematic review with meta-analyses

PURPOSE

To critically appraise randomized controlled trials (RCTs) on Instrument-Assisted Soft Tissue Mobilisation (IASTM) and quantify the effects of IASTM compared with other treatment individuals with or without pathologies on function, pain, and range of motion.

MATERIALS AND METHODS

We search four electronic databases from January 1999 to January 2022 and included RCTs of healthy participants/athletes and people with upper, lower, or spinal conditions, who received IASTM versus other active treatment for clinical outcomes (function, pain, and range of motion).

RESULTS

Forty-six RCTs were considered eligible for data analysis. Effects of IASTM plus other treatment versus other treatment on function and pain intensity were not statistically significant or clinically meaningful (very low quality, SMD -0.28, 95% CI -0.66 to 0.09) and (very low quality, SMD -0.05, 95% CI -0.53 to 0.43) at up to one-year follow-up respectively. No clinically meaningful improvements were found on range of motion outcomes. Out of the 46 included RCTs, only 10 assessed and reported IASTM-related adverse events.

CONCLUSION

Evidence of very low-quality certainty does not support the efficacy of IASTM in individuals with or without various pathologies on function, pain, and range of motion in the management of upper body, lower body, or spinal conditions. IMPLICATIONS FOR REHABILITATIONThe included RCTs had a high risk of bias and were assessed as very-low quality evidence for all the included outcomes.IASTM does not lead to clinically meaningful improvements in function, pain, or range of motion in individuals with upper body, lower body, and spinal conditions.The publication of IASTM trials in suspected predatory journals is increasing.The available evidence on IASTM does not support its use to improve function, pain, or range of motion in individuals with upper body, lower body, and spinal conditions.Health care practitioners should consider other evidence-based management strategies (physical activity and exercise) to improve function, pain, or range of motion in individuals with musculoskeletal injuries and disorders.Given the rise of publications on IASTM in suspected predatory journals, health care practitioners should be judicious to examine the legitimacy of a journal when searching for evidence on IASTM treatment technique.

Clinician Reliability of One-Handed Instrument-Assisted Soft Tissue Mobilization Forces During a Simulated Treatment

Clinicians utilize instrument-assisted soft tissue mobilization (IASTM) to identify and treat myofascial dysfunction or pathology. Currently, little is known regarding the ability of clinicians to provide similar IASTM forces across treatment sessions. The authors' purpose was to quantify clinician reliability of force application during a simulated IASTM treatment scenario. Five licensed athletic trainers with previous IASTM training (mean credential experience = 5.2 [4.3] y; median = 5 y) performed 15 one-handed unidirectional sweeping strokes with each of the 3 instruments on 2 consecutive days for a total of 90 data points each. The IASTM stroke application was analyzed for peak normal forces (Fpeak) and mean normal forces (Fmean) by stroke across 2 sessions. The authors' findings indicate IASTM trained clinicians demonstrated sufficient Fpeak and Fmean reliability across a treatment range during a one-handed IASTM treatment. Future research should examine if IASTM applied at different force ranges influences patient outcomes.

The Effect of Hamstring Relaxation Program on Headache, Pressure Pain Threshold, and Range of Motion in Patients with Tension Headache: A Randomized Controlled Trial

The purpose of this study was to determine if the severity of headache is reduced by decreasing hamstring tension in patients with tension headache. Thirty patients participated in this study. The participants were randomly allocated to two groups: hamstring relaxation program (HR) group (n = 15) and control group (n = 15). The participants in the HR group participated in a HR program for 25 min per day, three times per week, for a period of 4 weeks, and the control group participated in an electrotherapy for 25 min per day, three times per week, for a period of 4 weeks. Both groups participated in a self-myofacial release for 5 min per day, three times per week, for a period of 4 weeks. Headache was evaluated using the headache impact test (HIT-6) and visual analog scale (VAS). The pain pressure threshold (PPT) was evaluated using a digital pressure algometer. The range of motion (ROM) was evaluated using a goniometer and two special tests: straight leg raise test (SLRT) and popliteal angle test (PAT). The two groups showed no significant differences in terms of age, sex, height, and weight. The VAS and HIT-6 scores (p < 0.05) and neck and hamstring PPT showed significant improvements (p < 0.05). Neck flexion ROM and SLRT and PAT scores showed significant improvements (p < 0.05) in both groups, and the HR group showed significantly more improvements than the control group. This study confirmed that the HR program has positive effects on tension headache and is a good intervention for alleviating headaches in patients with tension headache.

The Effects of Instrument-Assisted Soft Tissue Mobilization, Tissue Flossing, and Kinesiology Taping on Shoulder Functional Capacities in Amateur Athletes

CONTEXT

Instrument-assisted soft tissue mobilization (IASTM), tissue flossing, and kinesiology taping are increasingly popular treatments among athletes for improving functional performance, despite limited evidence for their efficacy.

OBJECTIVE

Previous research regarding the efficacy of soft tissues and neuromuscular techniques on improving functional capacity of shoulder joints in athletes has yielded conflicting results. We examined the immediate and short-term effects of IASTM, flossing, and kinesiology taping on the functional capacities of amateur athletes' shoulders.

DESIGN

Randomized controlled study.

SETTING

Clinical assessment laboratory.

PARTICIPANTS

Eighty amateur overhead athletes (mean [SD]: age = 23.03 [1.89]; weight = 78.36 [5.32]; height = 1.77 [.11]).

INTERVENTIONS

We randomly assigned participants to 4 research sub-groups in which they received the following treatments on their dominant shoulders: IASTM (n = 20), flossing (n = 20), both IASTM and flossing (n = 20), and kinesiology tape (n = 20). Nondominant shoulders served as controls.

MAIN OUTCOME MEASURE

We evaluated participants-before, immediately after, and 45 minutes after the therapeutic interventions-with the following tests: internal and external shoulder rotation range of motion, isokinetic strength and total work, the functional throwing performance index, and the one-arm seated shot put throw performance.

RESULTS

All therapeutic interventions significantly improved the strength and functional performance of the dominant shoulder in comparison with the control (P < .005) immediately after and 45 minutes after the treatment. The IASTM led to significantly greater improvement in shoulder internal rotation than kinesiology taping immediately after (P = .049) and 45 minutes after the treatment (P = .049). We observed no significant differences between the other treatment interventions (P > .05).

CONCLUSION

Findings from the current study support the use of novel soft tissue and neuromuscular techniques for the immediate and short-term improvement of the shoulder functional capacities in amateur overhead athletes.

Combining targeted instrument-assisted soft tissue mobilization applications and neuromuscular exercises can correct forward head posture and improve the functionality of patients with mechanical neck pain: a randomized control study

Background

The purpose of this study was to evaluate the short- and intermediate-term effects of the combined application of instrument-assisted soft tissue mobilization (IASTM) techniques and neuromuscular exercises of the cervical and thoracic area on the improvement of the functionality of patients with mechanical neck pain and accompanying forward head posture (FHP).

Methods

Twenty patients with neck pain and FHP were randomized and received eight treatment sessions of either targeted IASTM in combination with neuromuscular exercises (Group A) or a classical massage and the same set of exercises (Group B). The cervical vertebral angle (CVA), cervical range of motion (ROM) and strength, pain (visual analogue scale-VAS), and neck disability index (NDI) were measured throughout the treatment period and in the two- and four-week post-treatment periods.

Results

The combined application of IASTM and neuromuscular exercises contributed to a significantly greater improvement in CVA (Group A: + 7,2 deg vs Group B: + 1,1 deg) and NDI (Group A:-25,2 vs Group B:-5,8) than massage and the application of the same exercises. Both interventions improved cervical ROM and strength in the short term. Pain was also significantly improved in both groups in both the short (Group A VAS: − 5,97 vs Group B VAS: − 3,1) and intermediate term (Group A VAS:-5,5 vs Group B:-1,5).

Conclusions

Combining IASTM and exercises for the cervical and thoracic area can induce positive postural adaptations and improve the functional status of neck pain patients.

Trial registration

ISRCTN, ISRCTN54231174. Registered 19 March 2020 - Retrospectively registered.

Treatment of scalene muscles with the Ergon technique can lead to greater improvement in hip abduction range of motion than local hip adductor treatment: a study on deep front line connectivity

[Purpose] This study aimed to investigate the effects of Ergon^® instrument-assisted softtissue mobilization of the upper and lower midpoints of the Deep Front Line (DFL) on hip abduction range of motion (ROM). [Participants and Methods] Forty healthy adults (29.3 ± 6.3 years; height: 175.8 ± 7.4 cm; weight: 77.2 ± 9.2 kg) were randomly divided into two groups and received a single 15-minute Ergon treatment in the upper midpoint (scalene muscles) and the lower midpoint of the DFL (hip adductors) on their dominant side. The non-dominant hip served as a control. Pre-and post-therapy active and passive hip abduction ROM at 0° and 90° flexion was examined using a goniometer. [Results] In both experimental groups, active and passive hip abduction ROM on the treated side improved significantly compared to the control side. Scalene treatment led to significantly greater improvement in active hip abduction ROM at 0° and 90° and in passive ROM at 90° compared to local hip adductor treatment. [Conclusion] The application of the Ergon technique on remote parts of the DFL may lead to a significant increase in hip abduction ROM compared to local hip adductors treatment.

Role of fascial connectivity in musculoskeletal dysfunctions: A narrative review

INTRODUCTION

Musculoskeletal dysfunctions happen to be the most common reason for referral to physiotherapy and manual therapy services. Therapists use several articular and/or soft tissue concepts/approaches to evaluate and treat such dysfunctions that may include integration of myofascial system. Despite the research in this area spanning more than three decades, the role played by fascia has not received its duly deserved attention, owing to the lack of definitive research evidence. The concept of 'fascial connectivity' evolved two decades ago from a simple anatomical hypothesis called 'myofascial meridians'. Since then it has been widely researched, as conceptually it makes more sense for functional movements than 'single-muscle' theory. Researchers have been exploring its existence and role in musculoskeletal dysfunctions and clinicians continue to practice based on anecdotal evidence. This narrative review attempts to gather available evidence, in order to support and facilitate further research that can enhance evidence based practice in this field.

METHODS

A search of most major databases was conducted with relevant keywords that yielded 272 articles as of December 2019. Thirty five articles were included for final review with level of evidence ranging from 3b to 2a (as per Center of Evidence Based Medicine's scoring).

RESULTS

Findings from cadaveric, animal and human studies supports the claim of fascial connectivity to neighboring structures in the course of specific muscle-fascia chains that may have significant clinical implications. Current research (level 2) supports the existence of certain myofascial connections and their potential role in the manifestation of musculoskeletal dysfunctions and their treatment.

CONCLUSION

Although these reviews and trials yield positive evidence for the objective reality/existence of fascial connectivity and continuity, several aspects need further exploration and in-depth analysis, which could not be evidenced entirely in this review. Manual and physical therapists may utilize the concept of fascial connectivity as a convincing justification to deal with clinical problems, but need to remain vigilant that functional implications are still being investigated.

The effectiveness of Ergon Instrument-Assisted Soft Tissue Mobilization, foam rolling, and athletic elastic taping in improving volleyball players' shoulder range of motion and throwing performance: a pilot study on elite athletes

[Purpose] The purpose of this pilot study was to investigate the effectiveness of instrument-assisted soft tissue mobilization (IASTM), foam rolling, and athletic elastic taping on improving elite volleyball players' shoulder range of motion (ROM) and throwing performance. [Participants and Methods] Fifteen elite male volleyball players (mean age: 24 ± 4.54 years; mean height: 177 ± 0.08 cm; mean weight: 81 ± 7.71 kg) received shoulder Ergon IASTM, foam rolling, and elastic taping treatment in random order on both upper extremities once a week for three weeks. Pre-and post-treatment assessments of their shoulders' ROM and functional throwing performance were performed. [Results] Ergon IASTM technique resulted in significantly higher shoulder flexion ROM values than foam rolling and elastic taping. Foam rolling, in turn, showed better results than athletic elastic taping. Moreover, the Ergon IASTM technique resulted in significantly higher OSP values than athletic elastic taping. No significant differences were observed between the therapeutic interventions in terms of FTPI. [Conclusion] This pilot study on elite athletes provides evidence that both IASTM and foam rolling techniques may improve their passive shoulder ROM compared to elastic athletic taping while Ergon IASTM can also enhance their shoulder throwing performance.

Effects of instrument-assisted soft-tissue mobilization at three different application angles on hamstring surface thermal responses

[Purpose] This study aimed to examine the thermal skin responses (thermal buildup and retention rate) to instrument-assisted soft tissue mobilization (IASTM) procedures applied on hamstrings at different angles. [Participants and Methods] Thirty university students (age: 20 ± 4 years, weight: 70.61 ± 9.11 kg, height: 168.5 ± 7.5 cm) received three sessions of 10-min Ergon^® IASTM treatment on their dominant limbs' hamstrings at 20°, 60°, and 90° application angles, respectively. The skin temperature was measured with a thermometer immediately before and after treatment, and every minute thereafter until it returned to the baseline value. [Results] IASTM resulted in a significant increase in skin temperature irrespective of the application angle. The thermal retention rate produced by the treatment at a 90° angle was significantly higher than that produced by the 20° application angle (78.9 vs. 64.53 min). No significant differences were observed between the 60° and 90° angle applications (72.5 vs. 78.9 min). [Conclusion] IASTM application at 60° and 90° angles can increase and retain the hamstring's skin temperature for more than an hour, creating the conditions for potential positive adaptations to local metabolism and muscle tone.

Effects of the Ergon® instrument-assisted soft tissue mobilization technique (IASTM), foam rolling, and static stretching application to different parts of the myofascial lateral line on hip joint flexibility

[Purpose] This study was aimed to compare the effects of three soft tissue treatments in different parts of the myofascial lateral line (LL) on the hip adduction range of motion (ROM). [Participants and Methods] Thirty university students received Ergon^® instrument-assisted soft tissue mobilization (IASTM) treatment, foam rolling, and static stretching on the upper or lower part of the LL on the side of their non-dominant lower limb, while the other body side served as control. The participants received one treatment per week for six weeks with a simultaneous pre-and post-therapy assessment of their hip adduction ROM. [Results] The hip adduction ROM was improved on the intervention side in all experimental groups. The gains were more significant in groups that received the Ergon treatment. All Ergon interventions, as well as foam rolling on the upper part of the LL, led to the greatest hip adduction ROM improvement compared to the control side. No differences were observed between the Ergon groups. [Conclusion] The findings suggest that the implementation of Ergon IASTM, foam rolling, and stretching can produce positive effects on the hip ROM. The Ergon Technique is more effective compared to foam rolling and stretching, irrespective of the application site.

Posterior thigh thermal skin adaptations to radiofrequency treatment at 448 kHz applied with or without Indiba® fascia treatment tools

[Purpose] This study aimed to evaluate the posterior thigh’s skin thermal responses to 448-kHz radiofrequency-based therapy applied either in the form of standard application (Indiba^®Activ) or combined soft tissue treatment (Indiba^®Fascia treatment). [Participants and Methods] Ten healthy males (22 ± 3 years of age, weight 75.2 ± 4.9 kg, height 178.5 ± 4.7) received four different treatments which included a) Indiba^®Activ (IA) radiofrequency treatment, b) Indiba^®Fascia (IF), c) Indiba^®Activ placebo (IAP) and d) Indiba^®Fascia Placebo (IFP) in the posterior thigh of their dominant lower limb, while the non-dominant served as the control. Skin temperature was recorded pre- and post-treatment and every minute until the surface temperature reached pre-treatment levels using a wireless infrared thermometer. [Results] Both radiofrequency-based therapy groups IA and IF led to a significant increase in skin temperature compared to placebo applications. The IF intervention led to an average retention of elevated temperature for 164.2 minutes compared to 54.8 minutes of IA, 23.17 of IFP and 17.6 minutes of IAP. [Conclusion] These findings indicate that radiofrequency treatment at 448 kHz can induce and sustain significant thermal skin adaptations reflecting an increased blood circulation and metabolism of underlying tissues.