Updated: Apr 1, 2019
Dr. Christopher Dorsa, DC, CCSP
Instrument Assisted Soft Tissue Mobilization (IASTM) began thousands of years ago in traditional Chinese medicine known as Gua Sha. Today, The Graston Technique® has refined the tools and technique popularizing this treatment among manual therapists. Basically, IASTM consists of rubbing or scraping a metal instrument along the skin to affect the underlying tissues. Currently, IASTM research is positive towards effectiveness in treating pain and increasing function of musculoskeletal injuries throughout the healing and rehab process.
What to expect:
Graston or IASTM treatment is typically quick ranging from 1-3 minutes per region and used to increase pain-free range of motion. There are several brands and types of instruments, some even available to the public! Self-IASTM is gaining popularity among CrossFitters. However, it is important to understand the anatomy and function of the areas being treated. I advise serious caution with self treating using a blunt metal object. Most chiropractors and body workers that use IASTM have extensive training. We understand that deep pressure is not necessary to create the desired response, however sometimes even with lighter pressure bruising can occur. An emollient or lotion is used to create less skin irritation. Typically, this therapy is used in combination with other manual therapy techniques, manipulation and movement training.
There are many proposed thoughts and theories on the mechanism of how IASTM effects the body.
Breaking Down Adhesions - One popular belief is that IASTM can help “break down adhesions”. It has been shown that 2000 pounds per square inch of pressure is the minimum force required to make any actual physical tissue change. So, it’s unlikely that this force can be generated by rubbing a mental instrument over skin, or without causing significant trauma to the skin.
Improving Blood Flow - Michael Phelps made cupping a popular treatment after showing off his bruises in the 2012 Olympics, much is the same with social media and IASTM. Originally in traditional Chinese medicine, it was thought that the bruise response seen with aggressive treatment indicated more blood flow to the tissues below, however the research shows that blood flow is only increased in the superficial skin due to trauma and tissue damage.
Stimulating Healing - There are several studies that support immediate increase in range of motion. The reason for this is likely neurologic due to the speed of the response. We have receptors in the skin and fascia that respond to pressure. When these receptors are stimulated, as in the pressure from IASTM, they send a signal to the brain which tells the muscles to relax, which translates to increased range of motion.
Pain is a huge aspect of why treatment is warranted in the first place. Pain research is hard to conduct due to the complexity of pain, but the “pain gate theory” is helpful in understanding Graston. For example, when stubbing your toe you may find yourself rubbing the area or slapping another body part to distract yourself from the pain. The idea is that we are stimulating other stronger sensations to override the painful stimulus from reaching our brain.
IASTM is theorized to break up scar tissue, re-align fascia and healing tissues faster. In addition, it definitely provides temporary pain relief and temporary increased range of motion, that when utilized in combination with other modalities and consistent movement therapy will ultimately result in significant change in movement and overall pain levels.
Christopher Dorsa, DC, CCSP is certified in Active Release Techniques (ART) and Functional Range Conditioning (FRC). He is a certified personal trainer through NASM as well as a Kinstretch Coach. He integrates his training background into individualized care to provide the best form of treatment, rehab and education to facilitate healthy lifestyles and ultimately influence positive change in healthcare. Areas of special interest include shoulder and hip injuries, and performance mobility training.