Instrument-Assisted Soft-Tissue Mobilization (IASTM) is an evidence-based manual therapy treatment using a stainless device to break down fascial scar tissues that surround muscle fibers and connective tissues of the body (Graston Technique, 2020). The concept of using metallic instruments for therapeutic purposes stemmed from ancient Greece and Rome when the “strigil” was used to scrape the skin clean in bathhouses, leading to the modern-day use of metallic instruments like Graston® tools in therapy settings (Kim, Sung, & Lee, 2017).

Additionally, IASTM also originated from a traditional Chinese manual therapy called “gua sha,” which means to scrape the skin using therapeutic instruments for a specific redness on the skin that increases blood and oxygen flow to the soft tissues to reduce sickness such as headaches and migraines (Kim, Sung & Lee, 2017). These two ideas of scraping the soft tissues with a metallic device lead to the modern-day IASTM therapy often known as the “Graston® technique” (Kim, Sung & Lee, 2017). The Graston technique was refined by David Graston in the late 1980s from the treatment idea by English orthopedist James Cyriax of crossing muscle fibers in massage therapy to alleviate muscle tension (Myofascial Correction, 2020). The IASTM instruments in therapy treatment are thought to benefit the client through deeper penetration, while also benefiting the clinician by reducing the demand and potential wear-and-tear on the hands. It is also believed to allow greater vibrations to be felt than through manual therapy which allows the clinician to detect any atypical areas that require greater focus (Cheatham, Lee, Cain, & Baker, 2016). The different tools and techniques in IASTM serve to provide patients with the best-individualized results, whether it is a large area on the back that requires tension relief due to lower back pain, or small areas on the palm of the hand from the stress of constant use of the thumb muscles (Lee, Lee, & Oh, 2016). The IASTM instruments should be applied parallel and perpendicular to the muscle fibers at a 45° angle for approximately 20-seconds or the amount of time necessary for the individualized treatment (Lee, Lee, & Oh, 2016). The selection of tools depends on the area on the body that is being worked on and the patient’s ability to receive IASTM treatment.

The main focus of IASTM is to return the individual to the client’s functional range of motion in their targeted muscle after the soft tissue is healed (Kim, Sung, & Lee, 2017). IASTM targets myofascial restrictions in the body, breaking up adhesions, and “[facilitating the] healing process through formation of new extracellular matrix proteins such as collagen” (Kim et al, 2017). “Fascia is an uninterrupted viscoelastic tissue which forms a functional 3-dimensional collagen matrix.” (Kumka & Bonar, 2012). Fascia binds and encloses bundles of muscle fibers. For example, the resulting inflammation following an injury and the creation of new cells can potentially result in fibrosis and formation of scar tissue in the injured soft tissue (Sato et al., 2003, as cited in Kim, et al. 2016). This can lead to adhesions and reduced elasticity, which may increase pain and decrease function (Huard et al., 2002; Melham et al., 1998, as cited in Kim et al., 2016). “Scar tissue limits perfusion to the injured soft tissue, restricting the supply of oxygen and nutrients, and interferes with collagen synthesis and regeneration of tissues” (Chen & Li, 2009; Gauglitz et al., 2011, as cited in Kim et al., 2016). Scar tissue is removed by IASTM and will facilitate “functional normalization around the soft tissue” (Black, 2010, as cited in Kim, et al. 2016). If done correctly with the appropriate pressure and shearing force of the instruments, IASTM can cause “microvascular and capillary hemorrhage, along with localized inflammation.” The “inflammation will remove the scar tissue and release adhesions, while also increasing blood and nutrient supply to the injured area and migration of fibroblasts” (Baker et al., 2013; Davidson et al., 1997; Gehlsen et al., 1999; Hammer, 2008, as cited in Kim, et al. 2016). As new collagen is produced and realigned, regeneration of the injured tissue can occur (Davies and Backopp, 2010; Gehlsen et al., 1999, as cited in Kim, et al. 2016).

Due to the effectiveness of IASTM in increasing blood flow and helping the muscles recover at a faster speed, IASTM has been implemented in various therapeutic settings for acute injuries such as sports accidents with athletes to a chronic diagnosis such as tendinopathy, that can cause injuries to the muscles (Kim, Sung & Lee, 2017; Lambert et al, 2017). Several educational institutions for physical therapy and chiropractic care in America have now organized IASTM training into their curriculum due to its various health benefits (Kim, Sung & Lee, 2017). The use of IASTM is now expanding into other rehabilitation settings such as physical therapy, sports therapy, occupational therapy, hand therapy, massage therapy, and so on. IASTM combined with other strengthening treatments has also been used for patients with musculoskeletal pathology to the upper extremities such as epicondylitis, carpal tunnel, and increasing shoulder range of motion (Cheatham, Lee, Cain, & Baker, 2016). IASTM can be used on patients of various diagnoses with specific contraindications and precautions to consider. IASTM courses and certifications are available for students working towards the following credentials: ATC, CHT, DC, DO, DOM, MD, MT, OT, OTA, PT, PTA (Hawk Grip, 2020).

Cryotherapy, or “cold” therapy, is a common modality frequently used in the treatment of acute injuries or trauma, decreasing spasticity, spasms, reducing edema, and managing pain. Cooling is achieved by removing heat from the body by lowering the temperature of the skin and tissues.

Superficial cooling lowers the tissue temperature and can produce analgesia, decrease edema, reduce spasms, and lower metabolic activity.

Commonly used applications of cryotherapy in rehabilitation include: cold packs or ice pack, ice massage, controlled cold compression units, vapocoolant sprays/gels, frozen towels, ice water immersion, cold whirlpool, contrast bath.

Uses fine particles (ground cellulose from corn husks) suspended in a hot air stream to heat the extremity. Can be used on the UE – hands, wrist, forearm.

Offers varying doses of dry heat. The temperature can be controlled by a thermostat on the outside of the machine.
Easy implementation and consistent temperature of the air.
Provides heat and sensory effect useful for desensitization and pressure oscillations that may decrease edema.

Often used for the desensitization effect that it provides for abnormally hypersensitive areas.
Benefits have been reported for pain, ROM, swelling, and increasing blood flow.

Paraffin is a mixture of paraffin and mineral oil and provides moderate to vigorous dosages of heat to a localized area and smaller joints.

In therapeutic US, the sound energy that is produced occurs as the electronics of the ultrasound machine modifies the electrical energy and transmits it to the crystal located in the transducer of the soundhead.

These sound waves correspond to the frequency range of the ultrasound machine.

Applying US to the body induces vibrations in the tissues, leading to friction between cell and tissue layers, resulting in thermal heating.

Common types of therapeutic electrical stimulation include:

Neuromuscular electrical stimulation (NMES)
○ Muscle reeducation
○ Strengthening
○ Functional electrical stimulation

 Transcutaneous electrical stimulation (TENS)
○ Pain management