After an acute injury, collagen fibers collectively known as fascia are laid down to support damaged tissue (see previous blog on fascia here: https://rbpt.com/is-fascia-restricting-your-mobility/). Normally these fibers form a neatly constructed spider web-like network, allowing stretch in specific directions like the picture above. However, after an acute injury like an Achilles strain, the body goes almost too far. The body lays down too many collagen strands in a haphazard manner at the injury site, making the fascia very thick lump of scar tissue. These strands can get twisted and get “stuck,” causing tightness and further pain in the muscle connected to the tendon. This lump may not decrease in size but remain “stuck” in this phase of healing for an extended period, which is typically when patients decide they have had enough.
These tight adhesions respond well to mobilization such as stretching, foam rolling, cupping, and hands-on manual therapy due the elastic nature of the tissue. On top of heat, stretching, massage, and strengthening the opposite muscle group, your therapist may decide to use IASTM. In the right hands these specialized tools can be very effective to loosen up these restrictions by scraping along the area with adequate pressure and causing a new inflammatory response in the capillary beds. Which is exactly what we want! As blood flow increases to these areas the body can also start to reorganize the tissue properly to allow for the necessary movement. These tight fibers start to unwind and stretch as blood flow is increased to the area and also stimulated the nerve pathways to allow the muscle to properly relax and decrease pain.
This treatment can be used to release both superficial layers and deep layers. By re-starting this healing process in a controlled manner we can increase range of motion which enables the muscle to contract fully. This leads to better strength gains and improved function for exercises following this hands-on therapy. The Journal of Bodywork and Movement Therapies compared foam rolling versus instrument assisted soft tissue mobilization (FAT: a specific fascial abrasion technique using tools) and found that while foam rolling (FR) did have some benefits, “…the magnitude of the observed acute effects of FAT were 13–15°, twice as large compared with those observed following FR of the same duration” in the 24 hours following soft tissue work (Markovic, 2015). IASTM can also be very helpful for our post-operative patients, not just acute injuries. The scars from surgery don’t allow as much movement compared to healthy tissue for that body part, similar to kneading out pizza dough in a round shape when the pan is square—it’s close, but not quite right.
As clinicians, having an understanding of how these structures are designed to move allows the us to manipulate the tissue in the appropriate directions to allow for proper shape for that structure—square pan, square dough! While IASTM is more beneficial, we may also prescribe foam rolling at home if a roller is available to help maintain progress made in the clinic on top of a patient centered special-designed home exercise program performed away from the clinic.Are you a visual learner? Check out the following youtube video for a visual of how this kind of therapy affects the tissue.
Brook, M. (2018). The best way to prevent and reduce the risk of postoperative adhesions is to be proactive both before and after surgery [Photograph].
Markovic, Goran. (2015). Acute effects of instrument assisted soft tissue mobilization vs. foam rolling on knee and hip range of motion in soccer players. Journal Of Bodywork And Movement Therapies, 19(4), 690-696. doi: 10.1016/j.jbmt.2015.04.010
Dr. Nikita Vizniak. [prohealthsys]. (2016, April 18th). What is IASTM? [https://www.youtube.com/watch?v=65e-mp3Xjh0].