1 ISSN 0008-3194 (p)/ISSN 1715-6181 (e)/2016/200 211/$ JCCA 2016. The efficacy of instrument assisted soft tissue mobilization: a systematic review Scott W. Cheatham, PT, PhD, DPT, OCS, ATC, CSCS1. Matt Lee, PT, MPT, CSCS2. Matt Cain, MS, CSCS, USAW-I3. Russell Baker, DAT, ATC4. Background: instrument assisted soft tissue Contexte : La mobilisation des tissus mous assist e par mobilization (IASTM) is a popular treatment for instrument (MTMAI) est un traitement populaire pour la myofascial restriction. IASTM uses specially designed restriction des tissus myofasciaux. La MTMAI utilise des instruments to provide a mobilizing effect to scar instruments sp cialement con us pour fournir un effet de tissue and myofascial adhesions. Several IASTM tools mobilisation sur les tissus cicatriciels et les adh rences and techniques are available such as the Graston myofasciales.
2 Plusieurs outils et techniques de MTMAI. technique. Currently, there are no systematic reviews sont disponibles, comme la technique GrastonMD. that have specifically appraised the effects of IASTM as Actuellement, il n'y a aucun examen syst matique a treatment or to enhance joint range of motion (ROM). ayant notamment valu les effets de la MTMAI comme Purpose: The purpose of this study was to traitement ou pour am liorer l'amplitude articulaire. systematically appraise the current evidence assessing Objectif : Cette tude visait valuer the effects of IASTM as an intervention to treat a syst matiquement les donn es actuelles valuant les musculoskeletal pathology or to enhance joint ROM. effets de la MTMAI comme m thode d'intervention pour Methods: A search of the literature was conducted traiter une pathologie musculo-squelettique ou pour during the month of December 2015 which included am liorer l'amplitude articulaire.
3 The following databases: PubMed, PEDro, Science M thodologie : Une recherche des publications Direct, and the EBSCO host collection. A direct search of scientifiques a t r alis e au cours du mois de d cembre known journals was also conducted to identify potential 2015, incluant les bases de donn es suivantes : PubMed, PEDro, Science Direct, et la collection EBSCO host. Une recherche directe a galement t r alis e dans les 1. Division of Kinesiology, California State University Dominguez Hills 2. Ohlone College 3. Division of Kinesiology, California State University Dominguez Hills 4. Department of Movement Sciences, University of Idaho Corresponding author: Scott W. Cheatham California State University Dominguez Hills, 1000 E. Victoria Street, Carson, California 90747. Tel:(310) 892-4376. e-mail: JCCA 2016.
4 200 J Can Chiropr Assoc 2016; 60(3). SW Cheatham, M Lee, M Cain, R Baker publications. The search terms included individual or revues connues pour relever les publications possibles. a combination of the following: instrument ; assisted ; La recherche tait bas e sur les termes ou combinaisons augmented; soft- tissue ; mobilization; Graston ; and de termes suivants : instrument ; assist e; accrue; tissu technique. mou; mobilisation; GrastonMD; technique. Results: A total of 7 randomized controlled trials R sultats : Au total, sept essais contr l s randomis s were appraised. Five of the studies measured an IASTM ont t valu s. Cinq des tudes mesuraient une intervention versus a control or alternate intervention intervention de MTMAI par rapport un groupe de group for a musculoskeletal pathology. The results of contr le ou une intervention diff rente pour l' valuation the studies were insignificant (p>.)
5 05) with both groups de la pathologie musculo-squelettique. Les r sultats des displaying equal outcomes. Two studies measured tudes taient n gligeables (p > ,05) les deux groupes an IASTM intervention versus a control or alternate affichant des r sultats gaux. Deux tudes mesuraient intervention group on the effects of joint ROM. The une intervention de MTMAI par rapport un groupe IASTM intervention produced significant (P<.05) short de contr le ou une intervention diff rente sur les effets term gains up to 24 hours. de l'amplitude articulaire. L'intervention de MTMAI a Conclusion: The literature measuring the effects produit des gains court terme significatifs (P < ,05). of IASTM is still emerging. The current research allant jusqu' 24 heures. has indicated insignificant results which challenges Conclusion : Les publications scientifiques sur la the efficacy of IASTM as a treatment for common mesure des effets de la MTMAI sont encore leur musculoskeletal pathology, which may be due to the d but.
6 La recherche actuelle a indiqu des r sultats methodological variability among studies. There appears n gligeables qui mettent en question l'efficacit de la to be some evidence supporting its ability to increase MTMAI comme traitement de la pathologie musculo- short term joint ROM. squelettique courante, ce qui peut tre d la variabilit . de la m thodologie entre les tudes. Il semble y avoir des preuves soutenant sa capacit augmenter l'amplitude articulaire court terme. (JCCA. 2016;60(3):200-211) (JCCA. 2016;60(3):200-211). k e y w o r d s : chiropractic, Graston ; myofascial; m o t s c l s : chiropratique, GrastonMD, myofascial, massage massage Introduction instrument assisted soft tissue mobilization (IASTM) is a popular treatment for myofascial restriction based upon the rationale introduced by James ,2 Unlike the Cyriax approach utilizing digital cross friction, IASTM.
7 Is applied using specially designed instruments to pro- vide a mobilizing effect to soft tissue ( , scar tissue , myofascial adhesion) to decrease pain and improve range of motion (ROM) and The use of the instru- ment is thought to provide a mechanical advantage for the clinician by allowing deeper penetration and more specif- Figure 1. ic treatment, while also reducing imposed stress on the Example of hands (Figure 1).2-4 Using instruments for soft tissue mo- IASTM treatment. J Can Chiropr Assoc 2016; 60(3) 201. The efficacy of instrumented assisted soft tissue mobilization: a systematic review bilization is theorized to increase vibration sense by the arthrofibrosis31,33. Recently, higher level controlled inves- clinician and patient. The increased perception of vibra- tigations14,32,34-38 have been published assessing the effi- tion may facilitate the clinician's ability to detect altered cacy of IASTM treatment for various conditions but have tissue properties ( , identify tissue adhesions) while not been appraised.
8 The goal of this systematic review facilitating the patient's awareness of altered sensations was to appraise the current IASTM literature to provide a within the treated ,5 current update for the clinician. The IASTM treatment is thought to stimulate connect- ive tissue remodeling through resorption of excessive Methods fibrosis, along with inducing repair and regeneration of collagen secondary to fibroblast ,7 In turn, Search Strategy this will result in the release and breakdown of scar tis- A systematic search strategy was conducted according sue, adhesions, and fascial In laboratory the Preferred Reporting Items for Systematic Reviews studies using a rat model, the use of instruments resulted and Meta-Analyses (PRISMA) guidelines for reporting in increased fibroblast proliferation and collagen repair systematic ,40 The following databases were ( , synthesis, alignment, and maturation) in cases of en- searched during the month of December 2015.
9 PubMed, zyme-induced ,10 Many of these benefits were PEDro, Science Direct, and the EBSCO host collection. also found in a laboratory study on ligament healing using A direct search of known journals was also conducted to the rat model which further provided supporting evidence identify potential publications. The search terms included that instrument massage produces a significant short-term individual or a combination of the following: instrument ;. ( , 4 weeks) increase in ligament strength and stiffness assisted ; augmented; soft- tissue ; mobilization; Graston ;. compared to the contralateral control While these and technique. findings provide initial support for IASTM stimulating The terms Gua sha and ASTYM were omitted from connective tissue remodeling, these physiological chan- this search.
10 Gua sha is a popular Asian medical treatment ges are still being studied and have not been confirmed in that uses a smooth edged instrument ( water buffalo human trials. horn, honed jade, soup spoon) to scrape the skin until a There are various IASTM tools and companies such as red blemish The red ecchymosis caused by the Graston , T cnica Gavil n , Hawk Grips , Functional scraping is believed to be blood stasis. The Gua sha treat- and Kinetic Treatment and Rehab (FAKTR) , Adhesion ment is supposed to relieve blood stagnation and reduce Breakers and Fascial Abrasion Technique that have Clinicians may consider the Gua sha approach a their own approach to treatment and instrument design form of IASTM but the treatment rationale, goals, and ap- ( , instrument materials, instrument shape). Anecdotally, plication differs from the other IASTM An- the Graston technique contains a protocol for treatment other form of myofascial treatment called augmented soft that contains several components: examination, warm-up, tissue mobilization (ASTYM ) is often considered a type IASTM treatment ( , 30-60 seconds per lesion), post of The creators and proponents of ASTYM.