instrument-assisted soft tissue mobilization

1. Instrument-Assisted Soft Tissue Mobilization

2. Overview History of Instrument-Assisted Soft Tissue Mobilization (IASTM) Physiology & theory behind IASTM Systems of IASTM Application of IASTM Clinical outcomes related to IASTM therapy

3. History of IASTM Dave Graston Professional water-skier sustained serious knee injury in 1987 Shown cross fiber friction by PT during recovery Cross fiber treatments proved very effective Began to develop CTS from knee self-treatment Developed first of a series of metal instruments Patented Grastech instruments and incorporated into private clinic Co-founded TherapyCare Resources, Inc.

4. History of IASTM Graston Technique 1994 TherapyCare Resources, Inc. outpatient clinic Michael Arnolt now majority owner Incorporated into AT curriculum at IU AKA: Graston Augmented Soft Tissue Mobilization (GASTM) Graston Instrument Assisted Soft Tissue Mobilization (GISTM) Graston Technique (GT)

5. History of IASTM Performance dynamics Founded in 1996 w/ Dr. Thomas Sevier, Ball Memorial Hospital & Midwest Health Strategies Incorporated into AT curriculum at Ball State U. AKA: Augmented Soft Tissue Mobilization (ASTM) ASTM AdvantEDGE ASTYM

6. History of IASTM Carpal Therapy, Inc. Released 2003 AKA: Graston-Hall Method (GHM) Sound Assisted Soft Tissue Mobilization (SASTM) following lawsuit between TherapyCare and Carpal Therapy bioPERFORM

7. Physiology & Theory of IASTM Immobilization, repetitive microtrauma, injury, and/or other pathological mechanisms result in the development of localized Soft Tissue Adhesions (STA) within the soft tissue structure

8. Physiology & Theory of IASTM Once developed, these STA alter the elastic capability of the involved structure, thereby inducing further degradation through faulty movement patterns

9. Physiology and Theory of IASTM Soft Tissue Mobilization The forceful passive movement of the musculofascial element through the restrictive direction(s) beginning with the most superficial layers and progressing into depth while taking into account its relationship to the joins concerned (Grodin & Cantu) Deep Friction Massage (DFM) Therapeutic modality used to “break up” or “soften” scar tissue, thus allowing for normalization of stress within the soft tissue during movement

10. Physiology & Theory of IASTM IASTM utilizes an instrument to identify and treat localized STA Once identified using an instrument, STA treated with introduction of controlled microtrauma, triggering inflammatory response & increased fibroblast activity Davidson CJ, Ganion L, Gehlsen G, Roepke J, Verhoestra B, & Sevier TL, 1995 Initiates reabsorption of excess scar tissue resulting in remodeling of affected soft tissue structures

11. Physiology & Theory of IASTM Medial epicondylitis, lateral epicondylitis Carpal tunnel Plantar fasciitis Patellar tendinitis/tendonosus Heel pain/Achilles tendinitis DeQuervain’s syndrome Post-surgical and traumatic scars Myofascial pain and restrictions Ligament sprains Muscle strains Non-acute bursitis RSD Back pain Trigger finger IT band syndrome MTSS Musculoskeletal imbalances Chronic effusion/edema associated with sprains/strains

12. Systems of IASTM Graston Technique (GT) Performance Dynamics (ASTYM) Sound Assisted Soft Tissue Mobilization (SASTM)

13. Systems of IASTM: Graston Technique First tools available (patented) Manufactured from stainless steel Utilize convex/concave and beveled treatment surfaces Increased treatment depth accomplished by increasing pressure May result in bruising due to collateral damage of uninjured tissue

14. Systems of IASTM: Graston Technique Six instruments and 12 hour training $2995 for one clinician Each additional clinician $345 each or $2500 for 10 or more Annual license fee of $150, additional $50 per clinician and/or instrument set Training conducted at seminars across the country NATABOC approved provider

15. Systems of IASTM: Graston Technique

16. Systems of IASTM: Performance Dynamics Released two years after original Grastech instruments Cannot purchase (only lease) instruments Manufactured from clear plastic Convex/concave beveled edges sharper than original Graston patents Increased treatment depth accomplished by increasing pressure

17. Systems of IASTM: Performance Dynamics Best research support of three systems Training conducted at seminars across the country Three instrument set (lease, $360), three day workshop ($995) & annual licensing agreement ($700 per clinician) $2055 first year $710 per clinician every following year NATABOC approved provider

18. Systems of IASTM: Performance Dynamics

19. Systems of IASTM: SASTM Released in 2003 (originally Graston-Hall Method) Manufactured from ceramic polymer that resonates Utilizes a series of progressively smaller square surfaces Increase treatment depth/intensity by decreasing surface area (treatment pressure remains the same) Minimizes bruising and collateral damage by avoiding uninjured tissue

20. Systems of IASTM: SASTM Training conducted at seminars across the country, one-on-one in Indianapolis, or on-site Eight instrument set, CD-ROM, booklet, and training for one clinician $2495, $295 for each additional clinician No annual license fees or lease fees Not yet NATABOC approved provider

22. Application of IASTM Apply moist heat 10 minutes Apply cream Scan local and regional areas looking for adhesions (chart/track) Once identified, use progressively smaller tool to gradually reduce/remove adhesion 10-15 minutes total treatment time, 3-5 minutes per lesion Disinfect instruments with HibiClens or comparable Approximately 4-8 treatment sessions (every other day)

23. Application of IASTM Analyze entire kinetic chain Stretch and/or mobilize hypomobile structures Strengthen hypermobile structures Treatment of adhesions only with no treatment of source will almost always result in eventual return of symptoms…fix the machine, not just the part!

24. Clinical Outcomes of IASTM Graston Technique

25. Clinical Outcomes of IASTM Performance Dynamics

26. Clinical Outcomes of IASTM SASTM with Liberty Football fall 2004