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Instruments can assist with deep tissue therapy

By David Freidson | Posted: Monday, March 24, 2014 12:00 am

Instrument Assisted Soft Tissue Mobilization is a physical medicine technique used to treat scar tissue in muscles, tendons and ligaments.

IASTM is used by tens of thousands of manual medicine practitioners (physical therapists, chiropractors, massage therapists, athletic trainers, and occupational therapists).

The origin of IASTM can be traced back thousands of years ago to China. In Chinese Medicine, a technique called "gua sha" was, and still is used. Gua sha is sometimes called coining.

Objects such as a spoon, or metal coin were used to treat conditions in which the blood was stagnant. These items would be rubbed, or scraped over the skin to create "sha" to increase the blood flow. In the medical world, the word petechia is used to describe what the Chinese call sha. Gua sha is still used in Chinese Medicine, usually in the form of hand held plastic instruments.

Fast forward a couple of thousand years from ancient China to the early 1980s when the modern use of IASTM has its roots.

In the early 80s, physical therapist Gail Chamberlin and orthopedic surgeon James Cyriax both published literature on the benefits of transverse friction massage. TFM involves using the hands to vigorously rub in a transverse direction to hypertonic or tight muscle fibers.

The current use of instruments was developed as an alternative to TFM, since TFM is fatiguing on the practitioners hands. The birth of modern day IASTM is due to David Graston.

In 1987, David Graston was dealing with scar tissue following a knee surgery, which was causing him a lot of pain. Graston, in conjunction with Ball State University developed Graston Instruments.

The Graston Technique is considered by most the gold standard in IASTM. It is a patented technique using six stainless steel Graston instruments and it is performed by nearly 20,000 practitioners worldwide.

Physical therapists, chiropractors, athletic trainers and occupational therapists are the most common providers who are certified in the Graston Technique. The list of college and professional sports teams that use the Graston Technique is too numerous for this article. For full disclosure, I am a Graston certified provider.

IASTM is used to treat a variety of conditions. I prefer to use Graston on areas of the body in which there isn't a lot of muscle; such as the feet, neck, forearms, hands and the front of the lower legs.

I use Graston to treat achilles tendon problems, golfer's elbow, tennis elbow, plantar fasciitis, neck pain, thumb pain, carpal tunnel syndrome and shin splints.

I decided to become certified in the Graston Technique for two reasons - the effectiveness of the technique and because I wanted to save my hands.

I chose Graston because it was the most studied and most widely used IASTM technique. The Graston website cites that there are positive outcomes in 75-90 percent of all conditions treated and that results are usually seen in three to four visits.

IASTM isn't the most pleasant technique to have performed and I discuss this with patients before I do the technique. Most patients who see me are okay with the temporary discomfort if it will help them to feel better after.

But if you don't like deep tissue massage, then IASTM probably isn't for you. Also, I show people pictures of the petechia, or redness that can linger for a couple of days after a Graston treatment. Some patients don't want to have petechia on visible skin for cosmetic reasons.

There are also contraindications to this technique such as hematomas, rheumatoid arthritis, skin problems such as infection, blisters and ulcers, fractures, open wounds, over cancerous tissue and for those on blood thinners.

I don't advise trying to do IASTM on your own at home. There are several different IASTM techniques out there. And there are several competent providers in this area who utilize IASTM techniques.

David Freidson is a licensed chiropractor and works out of the Synergy Health & Rehabilitation office in Minnetonka. To learn more, visit or call 952-475-4080.

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