IASTM: Cervical and Thoracic Spine Fascia

This course describes instrument-assisted soft tissue mobilization (IASTM) for the fascial sheaths of the cervical spine and cervicothoracic junction, including the superficial cervical fascia and the fascia overlying the trapezius muscles, up to the borders of pectoral fascia (superficial chest fascia), infraspinatus fascia (superficial scapula fascia), and deltoid fascia (shoulder muscle fascia). Note, IASTM for these fascial sheaths bordering the cervical fascia are covered in the course Upper Extremity IASTM . Additionally, modifications of the techniques are discussed, incorporating specific treatments for trigger points, and pin and stretch techniques with IASTM.

Pre-approved credits for:

• Integrated Manual Therapist (IMT) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Massage Therapists
• Physical Therapists
• Physical Therapy Assistants

This Course Includes:

• AI Tutor
• Study Guide
• Text and Illustrations
• Audio Voice-over
• Research Review
• Technique Videos
• Sample Intervention
• Practice Exam
• Pre-approved Final Exam

Unfortunately, it is easy to be confused by a large number of synonyms for the techniques in this course. Instrument-assisted soft tissue mobilization (IASTM) is a technique that generally includes the application of shear force (scraping) to skin and superficial fascia using a tool with a rounded, but relatively acute edge. IASTM could be viewed as a Western approach to a Traditional Chinese Medicine (TCM) technique called Gua Sha. While the application of IASTM is most commonly based on orthopedic assessment with stainless steel tools, the application of Gua Sha is based on TCM-specific assessments and jade or stone tools. Graston is the most well-known brand of IASTM stainless steel tools; however, we do prefer Smart Tools based on the quality, edge, and price. Note, historically the origin of these techniques is undoubtedly Gua Sha, which is perhaps 1000s of years old, Graston popularized IASTM in the Western world, and now there are many brands and tools to choose from.

The techniques in this course are recommended as an adjunct mobility technique, included in an integrated program that already includes or has considered soft-tissue release techniques, joint mobilization and manipulation techniques, and or lengthening stretching techniques. The addition of IASTM may be especially beneficial for individuals assessed with range of motion (ROM) restriction of the cervical spine, thoracic spine, or perhaps the upper extremity. They may be included in a program designed to address chronic neck pain, cervicogenic headache, active trapezius muscle trigger points, loss of cervical range of motion (ROM), scapular dyskinesis, upper thoracic spine pain, and/or shoulder impingement syndrome (SIS). Further, these techniques may be beneficial for those with assessed impairments including, forward head posture (increased cervical vertebral angle), upper body dysfunction (upper crossed syndrome), and/or rounded shoulder posture (RSP).

The techniques in this course are recommended for all clinical human movement professionals (physical therapists, physical therapy assistants, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) with the intent of developing an evidence-based , systematic, integrated , patient-centered, and outcome-driven approach.

Topics Covered in this Course

• Signs of Altered Extensibility
• Sample Program
• Research Corner
• IASTM Protocols
• Techniques (with Video)

Techniques Covered in this Course:

• Cervical Fascia IASTM
• Thoracic, Infraspinatus and Deltoid Fascia IASTM

Additional IASTM Courses

• Upper Extremity IASTM

For more on an integrated approach:

• Upper Body Dysfunction (UBD)

Bibliography for Research Review

Compared to Controls

1. Gulick, D. T. (2014). Influence of instrument assisted soft tissue treatment techniques on myofascial trigger points. Journal of bodywork and movement therapies, 18(4), 602-607.
2. Bryant, T., Buczynski, M., Gant, C., & Gill, R. (2012). Algometric Characterization of Gua Sha in the Upper Trapezius.
3. Saha, F. J., Brummer, G., Lauche, R., Ostermann, T., Choi, K. E., Rampp, T., ... & Cramer, H. (2019). Gua Sha therapy for chronic low back pain: a randomized controlled trial. Complementary therapies in clinical practice, 34, 64-69.
4. Gulick, D. T. (2018). Instrument-assisted soft tissue mobilization increases myofascial trigger point pain threshold. Journal of bodywork and movement therapies, 22(2), 341-345.
5. Xingze, W., Baohui, J., Houyong, Z., Xingyu, H., Rong, C., & Jinsheng, Y. (2019). Effects of Gua Sha therapy on weightlifting training: a randomized trial. Journal of Traditional Chinese Medicine, 39(04), 575.
   • IASTM compared to Heat, Stretching, and Therapeutic Exercise
6. Braun, M., Schwickert, M., Nielsen, A., Brunnhuber, S., Dobos, G., Musial, F., ... & Michalsen, A. (2011). Effectiveness of traditional Chinese “gua sha” therapy in patients with chronic neck pain: a randomized controlled trial. Pain Medicine, 12(3), 362-369.
7. Mahgoub, M. S. E., Abdelraouf, N. A., Elshafey, M. A., Eldesoky, M. T., Aly, S. M., Zahran, S. S., & Abutaleb, E. E. (2022). Graston Technique Versus Soft Tissue Release on Myofascial Neck Pain Syndrome: A Randomized Controlled Trial. Revista iberoamericana de psicología del ejercicio y el deporte, 17(6), 441-444.
8. Mostafa, M. S. E. M., Abdelraouf, N. A., Eldein, Z. S., Mohamed, M. I. A. E., & Abdalla, M. R. EFFECT OF INSTRUMENT ASSISTED SOFT TISSUE MOBILIZATION ON MECHANICAL NECK PAIN: A RANDOMIZED CONTROLLED TRIAL. Turkish Journal of Physiotherapy and Rehabilitation, 32, 3.
   • IASTM Compared to Massage
9. Paranjape, S., & Lad, R. (2020). Comparison of manual versus instrument assisted soft tissue mobilization of levator scapulae in chronic neck pain. International Journal of research and Review, 7(3), 364-369.
10. El-Hafez, H. M., Hamdy, H. A., Takla, M. K., Ahmed, S. E. B., Genedy, A. F., & Al Shaymaa, S. (2020). Instrument-assisted soft tissue mobilization versus stripping massage for upper trapezius myofascial trigger points. Journal of Taibah University Medical Sciences, 15(2), 87-93.
    1. IASTM compared to Trigger Point Techniques (Dry Needling, Ischemic Compression, Integrated Neurmuscular Inhibition)
11. YOUSSEF, E. F., MOHAMED, N. A., MOHAMMED, M. M., & AHMAD, H. A. (2020). Trigger Point Release versus Instrument Assisted Soft Tissue Mobilization on Upper Trapezius Trigger Points in Mechanical Neck Pain: A Randomized Clinical Trial. The Medical Journal of Cairo University, 88(December), 2073-2079.
12. Haq, K., & Riaz, H. (2022). Comparison of dry needling and Graston technique on Active Myofascial trigger points in the upper trapezius. Rawal Medical Journal, 47(1), 129-129.
13. Aksan Sadikoglu, B., Analay Akbaba, Y., & Taskiran, H. (2022). Effects of ischemic compression and instrument-assisted soft tissue mobilization techniques in trigger point therapy in patients with rotator cuff pathology: randomized controlled study. Somatosensory & Motor Research, 39(1), 70-80.
14. Thakur, R., Mande, P., & Lokwani, M. (2022). Effectiveness of Integrated Neuromuscular Inhibition Technique and Instrument Assisted Soft Tissue Mobilisation in the Management of Upper Trapezius Myofascial Trigger Points. Indian Journal of Physiotherapy & Occupational Therapy Print-(ISSN 0973-5666) and Electronic–(ISSN 0973-5674), 16(4), 94-100.
    • IASTM compared to Joint Intended Techniques (Joint Mobilizations and Manipulations)
15. Crothers, A. L., French, S. D., Hebert, J. J., & Walker, B. F. (2016). Spinal manipulative therapy, Graston technique and placebo for non-specific thoracic spine pain: a randomized controlled trial. Chiropractic & manual therapies, 24, 1-9.
16. Zaghloul, H. M. S., Ghally, S. A. O., Abdelkhalek, M. M. T., Mohamed, M. T., Mahmoud, L. S. E. D., & Ghaly, L. A. O. (2022). Comparison between upper thoracic spine mobilization and the Ergon technique in the treatment of mechanical neck pain. SPORT TK-Revista EuroAmericana de Ciencias del Deporte, 3-3.
    • Comparing the Addition of IASTM to Conventional Therapy (Infrared, ROM Exercises and Stretching, Postural Exercises, and Isometrics)
17. Saad, N. G., Yamany, A. A., Azzam, A. A., & Grase, M. O. (2021). Effect of instrument-assisted soft tissue mobilization on trigger points of tension headache. Turkish Journal of Physiotherapy and Rehabilitation, 32, 3.
18. Mahmood, T., Afzal, M. W., Waseem, I., Arif, M. A., & Mahmood, W. (2022). Comparative Effectiveness of Routine Physical Therapy with and without Instrument Assisted Soft Tissue Mobilization for Improving Pain and Disability in Patients with Neck Pain Due to Upper Crossed Syndrome. Annals of Punjab Medical College (APMC), 16(1), 45-50.
19. Erden, A., Şenocak, E., Kalaycıoğlu, A., & Aktürk, A. (2020). Effectiveness of instrument assisted soft tissue mobilization in myofascial pain syndrome: preliminary results of a randomized controlled trial. Sports Medicine Journal/Medicina Sportivâ, 16(1).
    • Comparing the Addition of IASTM to Release Techniques and Specific Exercise
20. Mylonas, K., Angelopoulos, P., Billis, E., Tsepis, E., & Fousekis, K. (2021). Combining targeted instrument-assisted soft tissue mobilization applications and neuromuscular exercises can correct forward head posture and improve the functionality of patients with mechanical neck pain: a randomized control study. BMC musculoskeletal disorders, 22(1), 1-9.
21. Kumar, V. N. (2020). Effect of Sub Occipital Release, Myofascial Release with Iastm Tool on Cervicogenic Headache. Indian Journal of Physiotherapy & Occupational Therapy Print-(ISSN 0973-5666) and Electronic–(ISSN 0973-5674), 14(4), 204-210.
22. Banerjee, R. (2021). Effectiveness of instrument assisted soft tissue mobilization technique on cervicogenic headache in smartphone-addicted college students: a pilot study.