Sunday, June 12, 2011

Soft tissue mobilization by instruments

To spare the treating hands of the clinicians & more to increase the precision of treatment in musculoskeletal therapy, clinicians now days are more and more inclined to use instruments for soft tissue mobilization. None the less these equipments can also be used to diagnose the soft tissue lesions more accurately enhancing the palpation capacity of the clnician.

However, the objectives of this form of treatment are as follows:
• Break down scar within the tissues
• Promote blood flow into the sore area
• Establish healing in damaged tissues
• Release adhesions within the layers of tissue
• Improve lymphatic circulation

David Grastron is the pioneer in developing the new area instruments for soft tissue mobilization. However stylus massage was reported to be used in trigger point deactivation by Russian in Olympic game. Spa professionals use various types of massage equipments during spa sessions.

Three common treatments always come into mind when soft tissue mobilization is assisted by instruments by therapists.
2. SASTM that includes Graston technique (GT)

Let us discuss the 3 mentioned in a greater detail.


IASTM stands for Instrument Assisted Soft Tissue Mobilization. The original form of IASTM has its roots in Traditional Chinese Medicine (TCM). Gua Sha, as it is called, involves use of the edge of an object such as a coin, a spoon, or piece of horn or jade to “scrape” along the skin.

IASTM involves use of a precision tool to stroke along the involved area. The repeated action of gliding the tool along the sore area helps to improve lymphatic drainage, improve mobility in the soft tissues, and improve blood flow. IASTM treatment may be somewhat uncomfortable at first, it is highly effective in releasing tissue adhesions and scar tissue that contribute to tendonitis, chronic pain, and sport- or work-related injuries.


Soft tissue mobilization has been used to treat a number of diagnoses for some time. SASTM is another form of this process, but it utilizes instruments designed for treatment of soft tissue disorders. SASTM stands for Sound Assisted Soft Tissue Mobilization. SASTS is regarded as the next generation development of Graston technique. SASTM is also developed by David Graston of USA. Like earlier Graston equipments SASTM is a set of handheld instruments that effectively break down fascial restrictions and scar tissue.

How SASTM works?

It is theorized that S.A.S.T.M. is effective because of the following:

Instruments effectively break down fascial restrictions and scar tissue. The ergonomic design of these instruments provides the clinician with the ability to locate restrictions through sound waves. This allows the clinician to treat the affected area with the appropriate amount of pressure, due to square surface concept.

The introduction of controlled microtrauma to affected soft tissue initiates reabsorption of excessive scar tissue and facilitates a cascade of healing activities resulting in remodeling of affected soft tissue structures. Adhesions and scar tissue within the soft tissue that may have developed as a result of surgery, immobilization, repeated strain, or other mechanisms, are broken down allowing full functional restoration to occur.

Graston Technique (GT):

Graston Technique (GT) is a therapeutic method for diagnosing and treating disorders of the skeletal muscles and related connective tissue. The method employs a collection of six stainless steel tools of particular shape and size, which are used by practitioners to palpate patients' bodies in order to detect and resolve adhesions in the muscles and tendons.

The Graston Technique is proprietary—the name of the treatment is trademarked and the instruments are subject to patents held by a licensing corporation, TherapyCare Resources Inc. Practitioners must be licensed by the parent corporation in order to use the Graston Technique trademark or the patented instruments. The Graston Technique was developed by David Graston who now operates SASTM (Sound Assisted Soft-Tissue Mobilization).

The Graston Technique has not been rigorously scientifically tested and its evidence basis and assumptions are considered questionable by physician Harriet Hall. However according to Eric Schoenberg (MSPT, CSCS) Graston technique concept is grounded in the works of English orthopedist James Cyriax and the concept of cross fiber treatment. The treatment edge of the Graston instruments allows for improved precision in the treatment of fascial restriction and fibrotic/scar tissue.

He (Eric Schoenberg) also enlists the following clinical observations working with Graston equipments
1. The specificity of the treatment edge and the ability to provide uniform pressure is what sets the technique apart from other manual approaches.
2. The instruments truly enhance the clinician’s ability to detect and treat fascial restrictions and adhesions (particularly effective in positions of provocation).
3. Incorporating stretching and strengthening (tendon-loading) exercises with the instrument assisted soft tissue mobilization is the key to promoting re-alignment of the fibers and helping to fully remodel the injured tissue.
4. Coupling Graston in the clinical setting with self myofascial release (SMR) products, such as foam rollers and other similar equipment at home or in an athletic setting (pre/post activity) is an ideal way to achieve maximum success.

Finally Eric enumerate that most exciting part of using Graston Technique in the clinical setting is feeling better suited to treat the more difficult diagnoses (plantar fasciitis, chronic tendonosis, etc) with the expectation of good clinical outcomes.


ASTYM is augmented soft tissue mobilization (ASTM). ASTYM allows the clinician to stimulate the body's own capacity for healing in patients with soft tissue degeneration or fibrosis and chronic inflammation. This leading edge, non-invasive treatment is performed with ergonomically designed instruments that initiate the healing process necessary for tissue remodeling.

How does ASTYM work?

The ASTYM System's effectiveness is theorized to be due to the following:

• Adhesions and inappropriate fibrosis within soft tissue can result from trauma, surgery, immobilization or repetitive strain. The ASTYM System stimulates the breakdown of this dysfunctional tissue and allows functional restoration to occur.
• Soft tissue adhesions and resulting restrictions are identified and broken down.
• Controlled microtrauma initiates a local inflammatory response that leads to the resorption of inappropriate fibrosis or excessive scar tissue.
• In chronic tendonopathies, doses of controlled microtrauma stimulate regeneration of the affected tendons.
• Existing collagen is remodeled and new collagen is influenced by a program of specific functional activities and stretching.

What can the patient expect?

The ASTYM System program begins with a thorough evaluation. The clinician then administers a 10 to 15 minute treatment addressing the entire kinetic chain. A regimen of specific strengthening and stretching exercises is prescribed, customized to the patient's work, athletic or recreational activities. Patients experience a decrease in pain and rapid improvement in function which results in high patient compliance and satisfaction.

What benefits does ASTYM provide?

Multiple studies demonstrate the effectiveness of the System in restoring mobility and hastening recovery in patients with cumulative trauma disorders and other soft tissue dysfunctions. In a vast majority of cases it offers these distinct advantages:

• Restoration to pre-injury level of activity
• Enjoyment of maximal results with a minimal number of treatments through an emphasis on re-establishing function
• Maintenance of normal activity in conjunction with the treatment
• Decreased need for splints, braces or job site modifications
• Decreased need for surgical intervention

Indications for all soft tissue mobilization by instruments:

Here is a list of disorders that instrument-assisted soft tissue mobilization has most effectively been used for in the restoration of function and pain reduction.

Upper Extremity

• Bicep Tendinitis
• Carpal Tunnel Syndrome
• DeQuervain's Syndrome
• Frozen Shoulder
• Joint Contractures
• Medial/Lateral Epicondylitis
• Rotator Cuff Tendinitis
• Scars (Surgical/Traumatic)
• Trigger Finger

Lower Extremity

• Achilles Tendinitis(Heel Pain)
• Ankle Strains/Sprains
• Groin Pulls
• Hammer Toe
• Hamstring Injuries
• Hip Replacements
• Joint Contractures
• Knee Replacements
• Knee Sprains
• Morton's Neuroma
• Patellar Tendinitis
• Quadricep Injuries
• Scars (Surgical/Traumatic)
• Shin Splints
• Tarsal Tunnel Syndrome
• Tibialis Posterior Tendinitis
• Turf Toe
• Musculoskeletal Imbalances

Neck and Spine

• Cervical (Neck Pain)
• Lumbar/Sacral (Low Back Pain)
• SI Pain
• Thoracic (Mid Back Pain)
• Trigger Points (Muscle Knots)