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Learning About Instrument-Assisted Soft Tissue Mobilization

Physical therapy students get crash courses in the latest modality

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When Scott Dolly, MS, ATC, CSCS, ruptured his Achilles tendon, the rehab specialist working on him used instrument-assisted soft tissue mobilization, also called IASTM.

"I felt an immediate difference in the length and freedom of my gastroc/soleus complex and in the overall mobility of my ankle," he said.

It was from this experience that Dolly, owner of Evolution Human Performance and Rehabilitation, Winchester, Va., began to learn more about IASTM and how it might improve outcomes in his patient population.

IASTM in the Clinic

Dolly uses IASTM as a major component of the prevention, rehabilitation, and performance spectrum of a large range of patient presentations.

"One of the advantages I have over other professionals that use IASTM is that I get to use it in various settings with a very diverse demographic," he explained.

Dolly averages between 50 and 60 patients a week. Clinically, patients range from adolescent post-op ACL rehab, to postural repetitive stress syndromes, to running dysfunction injuries, to geriatric double knee replacements. In sports performance, his patient load ranges from adolescent athletes working on jump-land and cut-pivot mechanics, to national competitive Olympic lifters, to increasing movement efficiency in competitive Crossfit athletes, to increasing mobility and injury prevention with competitive Brazilian jiu-jitsu athletes.

"I use IASTM on every one of these patients in both settings and continue to get profound results," Dolly remarked.

As a human motion specialist, he observes how the body moves in order to predict injury, finds the root causes of repetitive stress syndromes, and takes someone's sport performance to a new level.

When tissues are adhered to themselves or to surrounding tissues, they can create dysfunctional movement patterns that throw off joint biomechanics, and can alter muscle activation patterns, explained Dolly. IASTM can play a major role in eliminating these adhesions and scar tissues, consequently restoring oxygen back to the tissue. The technique must be used as part of a treatment program that's rooted in restoring movement with the use of functional corrective exercises.

"For example," he said, "if a patient were to receive IASTM on the proximal quadriceps and rectus femoris attachment, and then sit in a car for a 6-hour road trip, many of the adhesions would reform. However, if this patient, immediately following IASTM, was given the right set of exercises that address muscle activation patterns, correct joint biomechanics, and mobility and stretching exercises, fewer of the adhesions would reform, if any."

IASTM in the Classroom

For the past several years, Dolly has practiced with other rehab professionals that use IASTM, and said the results speak for themselves when asked about his thoughts on the technique. He believes all professionals who utilize soft tissue work in their current practice should learn the modality.

"I think IASTM is a vital piece of injury prevention, physical rehabilitation, and sports performance. I couldn't imagine practicing without it at this point," Dolly shared.

As an adjunct professor at Shenandoah University in Winchester, Va., Dolly teaches a two-day course on IASTM in the university's athletic training program. The course includes a history of IASTM, review of tools and tool surfaces, IASTM techniques including strokes, indications and contraindications, physiological responses to IASTM, IASTM as part of a treatment plan, IASTM protocols, and a hands-on lab.

The course originated when one of his fellow professors asked Dolly to conduct a seminar consisting of a lecture and a lab for the DPT and master's in athletic training students.

"There was such a good response from the students and other faculty from the first one that it has grown from there," he said.

Dolly shared that all of his students and clients are impressed with the results using IASTM as part of their rehabilitation and sport performance programs. "The treatment works, and more professionals need to know about it," he said. "Evolution has interns every semester who learn IASTM and each one says they are going to use it as part of their own treatment plans when they graduate."

IASTM at the Doctorate Level

Brian Eckenrode, PT, DPT, OCS, orthopaedic clinical residency coordinator in the physical therapy department at Arcadia University, Glenside, Penn., noted that physical therapy students returning from their clinical experiences reported back to Arcadia faculty that they were seeing IASTM used in clinics. In addition, the technique was commonly noted in feedback from students as an area to which exposure would be beneficial.

"As clinical practice trends continue to evolve, students and clinicians need to be knowledgeable about the evidence to support their clinical decision making," Eckenrode remarked, noting that the published research on IASTM is limited to primarily small-scale animal studies investigating the effects of IASTM on soft tissue morphology.

"Despite the limited evidence for IASTM, the increasing use of the techniques in the clinical setting warranted an introduction to its use in our curriculum," he stated.

The Department of Physical Therapy decided to trial IASTM as a lab experience with its graduate PT students, where the theory was presented along with the limited evidence supporting its use at this time. Sample techniques were demonstrated and students had the opportunity to use the tools to practice on each other.

Eckenrode acknowledged that the lab session was well received by second-year physical therapy graduate students who were in their final week of classes before they began their six-month internships.  

"We will re-evaluate the content provided to the students and the amount of time allotted for instruction on IASTM each year," Eckenrode concluded.

For questions on IASTM or educational seminars, contact Scott Dolly at evosnc@gmail.com.

Beth Puliti is a frequent contributor to ADVANCE.

Eliminating Scapular Scar Tissue

Here is a common example of how IASTM can eliminate scar tissue at the superior-medial border of the scapula.

One of the major adhesion sites that most of us suffer from is on the superior-medial border of the scapula, where the levator scapula, upper trapezius, serratus posterior, and rhomboids share attachment sites in close proximity to one another.

This adhesion site commonly forms as a result of Janda's upper cross syndrome. Many therapists who treat this syndrome or related pathologies know that part of correcting its components is to strengthen the lower trapezius, serratus anterior, longus coli and longus capitus, as well as lengthen the pectoralis major, pectoralis minor, and upper trapezius.

Having an array of scar tissue at the superior-medial border of the scapula can make fixing upper cross syndrome a long process that is often unsuccessful. It doesn't matter how strong you can get the serratus anterior and lower trapezius if the scapula is held superior by scar tissue. The scapula physically cannot sit lower until these adhesions are addressed.

By using IASTM to eliminate scar tissue at the superior-medial border of the scapula, as well as throughout the surrounding structures, we can now have much more success in restoring scapulo-thoracic movement and rhythm. Try it; it works.

-Scott Dolly, MS, ATC, CSCS

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