IASTM – Instrument Assisted Soft Tissue Manipulation

IASTM -  Instrument Assisted Soft Tissue Manipulation
IASTM – Instrument Assisted Soft Tissue Manipulation

Instrument-assisted soft tissue mobilization (IASTM) is a popular treatment for myofascial restriction. IASTM uses specially designed instruments to provide a mobilizing effect to scar tissue and myofascial adhesions. Several IASTM tools and techniques are available such as the Graston® technique.

How IASTM works – tissue remodeling

To maintain healthy cartilage, bone, muscle and tendons there exists a tissue remodeling. Remodeling is needed to remove damaged cells and matrix (catabolic process) and to replace damaged tissue (anabolic process).

This occurs with ordinary exercise and exposing a body to mechanical forces. It turns out that IASTM performs as a localized exercise to a lesion, stimulating tissue remodelling. In the tendon, the fibroblast is a key player responsible for its maintenance, adaptation to changes, and remodelling in cases of minor and severe damages to tendon tissue.

Collagen Remodelling
Collagen Remodelling

Standley has shown that manual light myofascial treatment was anti-inflammatory and Yang et al. (2005) suggested that repetitive, small magnitude stretching was anti-inflammatory, while large magnitude stretching was proinflammatory.

More researches are needed to determine the numerous effects of manual loading, but just as motion and exercise are related to homeostasis, it is now evident that manual loading leads to positive healing results.

It is established that using acute exercise such as 1 hour of knee extension against resistance to fatigue, the collagen synthesis rate remained elevated for at least 2–3 days. Whether it was a single loading bout or a long-term habitual loading, they produced a noticeably high collagen synthesis response (Langberg et al. 1999).

How IASTM Works – Stimulating Nervous System

The effects we observe when applying IASTM is also a result of the stimulation of the patient’s nervous system. Slow stroking of the back inhibits the Gamma motor system, producing a reduction in muscle tone, and the stimulation of the mechanoreceptors produces a reflex response that lowers overall muscle tone leading to a whole body and local area relaxation. 

The skin and underlying fascia are profoundly innervated with sensory nerves. Fascia has been found to contain up to 10 times as many mechanoreceptors as muscles. This may explain the fascia's role in motor function recovery.

The skin and underlying fascia are profoundly innervated with sensory nerves. Fascia has been found to contain up to 10 times as many mechanoreceptors as muscles. This may explain the fascia’s role in motor function recovery. 

ASTM – Controlled Inflammatory Process

Researches have reported an increased fibroblastic proliferation with mechanical load.

And this is responsible for reproducing the extracellular matrix (ECM), especially collagen 1, elastin, cytokines, and growth factors, among other important proteins. It is believed that for degenerated connective tissue (i.e., tendinosis) IASTM re-initiates the inflammatory process by applying a controlled amount of microtrauma to the affected area. A healing effect is created by the proliferative supply of blood, nutrients, and fibroblasts to the region, resulting in collagen remodeling and eventual tissue maturation.

Since tendons have an inherent capacity to heal, it can occur if a fibroblast-driven process integrates old and new collagen to add to the final stability of the matrix.

Any conservative rehabilitation program is encouraging collagen synthesis, maturation, and strength. But exposing tissues to mechanical loading mobilizes scar tissue, increasing its pliability and loosening it from adjacent healthy tissue without creating inflammation.

What is instrument assisted soft tissue mobilization?

Instrument-assisted soft tissue mobilization (IASTM) is a manual therapy treatment technique that utilizes specially designed stainless steel instruments to assist in detecting and treating areas exhibiting scar tissue, soft tissue restriction, adhesions or chronic inflammation.

What is the Graston technique used for?

Graston Technique® (GT) is a unique, evidence-based form of instrument-assisted soft tissue mobilization that enables clinicians to effectively and efficiently address soft tissue lesions and fascial restrictions resulting in improved patient outcomes.

What is graston scraping?

The Graston Technique is a form of manual therapy known as soft-tissue instrument-assisted mobilization. It is one of a number of manual therapy approaches that use instruments with a specialized form of massage/scraping the skin gently.

Is graston technique painful?

No pain, no gain – There will be some discomfort during treatment, but the instrument and massage should not cause intense pain. Some slight bruising may occur, however, if bruises appear often, the technique is being administered too intensely. The technique does not need to bruise or cause pain to be effective.

How often can you do Graston?

The Graston treatment is generally given for a period of four to five weeks. Patients get two treatments every week.

What is Iastm therapy?

IASTM aka “Instrument Assisted Soft Tissue Mobilization,” is a manual therapy approach to musculoskeletal injuries using specifically designed tools. … Smart Tools were developed to assist in the effective treatment of adhesions and scarring brought on by surgeries, injuries, and overuse of muscles.

What is scraping therapy?

Gua sha is a natural, alternative therapy that involves scraping your skin with a massage tool to improve your circulation. This ancient Chinese healing technique may offer a unique approach to better health, addressing issues like chronic pain

What does scraping do for muscles?

Pronounced (GWA – SHAH), this treatment involves scraping the skin to form light bruises. … The treatment itself involves using a tool to “scrape” over a wound-up/knotted muscle (usually identified by sore spots in your body), to help move toxins out or to break up scar tissue.


Instrument-assisted soft tissue mobilization (IASTM) is a popular treatment for myofascial restriction based upon the rationale introduced by James Cyriax.1,2 Unlike the Cyriax approach utilizing digital cross friction, IASTM is applied using specially designed instruments to provide a mobilizing effect to soft tissue (e.g., scar tissue, myofascial adhesion) to decrease pain and improve range of motion (ROM) and function.2 The use of the instrument is thought to provide a mechanical advantage for the clinician by allowing deeper penetration and more specific treatment, while also reducing imposed stress on the hands (Figure 1).24 Using instruments for soft tissue mobilization is theorized to increase vibration sense by the clinician and patient. The increased perception of vibration may facilitate the clinician’s ability to detect altered tissue properties (e.g., identify tissue adhesions) while facilitating the patient’s awareness of altered sensations within the treated tissues.2,5


How does it work?

Instruments effectively break down fascial restrictions and scar tissue. The ergonomic design of these instruments provides the clinician with the ability to locate restrictions and allows the clinician to treat the affected area with the appropriate amount of pressure.

The introduction of controlled microtrauma to affected soft tissue structure causes the stimulation of local inflammatory response. Microtrauma initiates reabsorption of inappropriate fibrosis or excessive scar tissue and facilitates a cascade of healing activities resulting in remodelling of affected soft tissue structures. Adhesions within the soft tissue which may have developed as a result of surgery, immobilization, repeated strain or other mechanisms, are broken down allowing full functional restoration to occur.

Conditions for which IASTM is usually used:

  • Medial Epicondylitis, Lateral Epicondylitis
  • Carpal Tunnel Syndrome
  • Neck Pain
  • Plantar Fascitis
  • Rotator Cuff Tendinitis
  • Patellar Tendinitis
  • Tibialis Posterior Tendinitis
  • Heel Pain /Achilles Tendinitis
  • DeQuervain’s Syndrome
  • Post-Surgical and Traumatic Scars
  • Myofascial Pain and Restrictions
  • Musculoskeletal Imbalances
  • Chronic Joint Swelling Associated with Sprains/Strains
  • Ligament Sprains
  • Muscle Strains
  • Non-Acute Bursitis
  • RSD (Reflex Sympathetic Dystrophy)
  • Back Pain
  • Trigger Finger
  • Hip Pain (Replacements)
  • IT Band Syndrome
  • Shin Splints
  • Chronic Ankle Sprains
  • Acute Ankle Sprains (Advanced Technique)
  • Scars (Surgical, Traumatic)




Post-Operative Surgical Massage
IASTM -  Instrument Assisted Soft Tissue Manipulation
Post-Operative Surgical Massage

*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
The information provided is for educational purposes only and is not intended as diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader. These statements are not expressions of legal opinion relative to the scope of practice, medical diagnosis or medical advice, nor do they represent an endorsement of any product, company or specific massage therapy technique, modality or approach. All trademarks, registered trademarks, brand names, registered brand names, logos, and company logos referenced in this post are the property of their owners.

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Nicola of Riktr Pro Massage is a practicing licensed insured professional LMT (Licensed Massage Therapist) and fine artist based in Santa Barbara, CA. Nicola has a wide range of female and male clients, including athletes, professionals, housewives, artists, landscapers, out of town visitors, people who are retired and students.

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