IASTM: Crural and Plantar Fascia

This course describes instrument assisted soft tissue mobilization (IASTM) of the crural fascia (lower leg) and plantar fascia (bottom of the foot), including the superficial fascial sheaths overlying the gastrocnemius, soleus, peroneal muscles (fibularis muscles), tibialis anterior, Achilles tendon, calcaneus, interossei, and toe flexors. Additionally, modifications of these techniques are discussed, including specific techniques for addressing trigger points, and pin and stretch (a.k.a. active or dynamic release) techniques with IASTM tools.

This course does not cover the fascial sheaths above the knee (fascia latae), and does not cover the superficial fascia over the dorsal aspect of the foot (top of the foot). Although the fascia lata will be covered in a separate course, the dorsal fascia of the foot is not covered due to excessive discomfort for the patient and inconsistent outcomes.

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 with jade or stone tools. Graston is the most well-known brand of IASTM stainless steel tools; however, we do prefer Smart Tools based on their 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 IASTM 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 stretching techniques. The addition of the techniques described in this course may be especially beneficial for individuals assessed with range of motion (ROM) restriction of the foot, ankle, or knee. Further, they may be included in a program designed to address plantar fasciitis, Achilles tendonitis (tendinopathy), chronic ankle instability (CAI), chronic ankle pain, or balance issues. Further, these techniques may be beneficial for those with assessed impairments including dorsiflexion restriction, pes planus, hyper-pronation, a positive Feiss line test, a positive Jack's test, pronation distortion, or lower extremity dysfunction (LED) .

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.

Pre-approved credits for:

• Integrated Manual Therapist (IMT) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Massage Therapists
• Occupational 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

Topics Covered in this Course

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

Techniques Covered in this Course:

• Plantar Fascia IASTM
• Crural Fascia IASTM

Additional IASTM Courses

• Upper Extremity Fascia IASTM
• Cervical and Thoracic Spine Fascia IASTM

For more on an integrated approach:

• Lower Extremity Dysfunction (LED)

Bibliography: Plantar and Crural Fascia IASTM

IASTM Compared to Controls

1. Ikeda, N., Otsuka, S., Kawanishi, Y., & Kawakami, Y. (2019). Effects of instrument-assisted soft tissue mobilization on musculoskeletal properties. Medicine and science in sports and exercise, 51(10), 2166.
2. MacDonald, N., Baker, R., & Cheatham, S. W. (2016). The effects of instrument assisted soft tissue mobilization on lower extremity muscle performance: a randomized controlled trial. International journal of sports physical therapy, 11(7), 1040.
3. Vardiman, J. P., Siedlik, J., Herda, T., Hawkins, W., Cooper, M., Graham, Z. A., ... & Gallagher, P. (2014). Instrument-assisted soft tissue mobilization: effects on the properties of human plantar flexors. International journal of sports medicine, 197-203.
4. Fousekis, K., Eid, K., Tafa, E., Gkrilias, P., Mylonas, K., Angelopoulos, P., ... & Tsepis, E. (2019). Can the application of the Ergon® IASTM treatment on remote parts of the superficial back myofascial line be equally effective with the local application for the improvement of the hamstrings’ flexibility? A randomized control study. Journal of physical therapy science, 31(7), 508-511.
5. Gamboa, A. J., Craft, D. R., Matos, J. A., Flink, T. S., & Mokris, R. L. (2019). Functional movement analysis before and after instrument-assisted soft tissue mobilization. International journal of exercise science, 12(3), 46.
6. Croft, B. D., Aronson, P. A., & Bowman, T. G. (2022). Effects of Instrument Assisted Soft-Tissue Mobilization on Dynamic Balance in Those with Chronic Ankle Instability. Trauma Care, 2(2), 197-204.
7. Nasir, M., Khan, L. G., Haq, K., Khan, U. A., Batool, M., & Ali, S. (2022). Effects of Graston assisted soft tissue mobilization in patients with chronic plantar fasciitis. Rawal Medical Journal, 47(4), 978-978.
8. Lee, H. W., Beak, H. J., Yoon, E. J., & Kim, J. (2021). Effect of Instrument-Assisted Soft Tissue Mobilization on Ankle of Range of Motion and Balance in Older Women: A Preliminary Study. The Asian Journal of Kinesiology, 23(2), 2-8.
9. Jordan, J. A., Turner, M. J., Thomas, A., Wikstrom, E. A., & Hubbard-Turner, T. (2020). Effects of a 4-Week Instrumented Soft Tissue Mobilization and Sham Treatment as Rehabilitation Strategies for Chronic Ankle Instability. Athletic Training & Sports Health Care, 12(1), 14-20.
   • IASTM Compared to Stretching
10. Myburgh, C., Hammern, A., Mannfjord, P., & Boyle, E. (2018). Effects of instrument-assisted soft-tissue mobilization on ankle range of motion and triceps surae pressure pain sensitivity. Journal of Rehabilitation Medicine-Clinical Communications, 1.
11. Shinde, S., Jethwa, K., & Pawar, D. (2022). Comparative study between instrumental assisted soft tissue mobilization and static stretching on delayed onset of muscle soreness in young adult female. International Journal of Health Sciences and Research, 2(6), 186-196.
12. Kang, H. S., & Lee, J. H. (2020). The immediate effects of Graston instrument-assisted soft-tissue mobilization and self-stretching on the muscular properties of the gastrocnemius in athletes. Journal of the Korean Society of Physical Medicine, 15(4), 29-35.
    • IASTM Compared to Manual Myofascial Release
13. Arshad, M. U., Bashir, M. S., Zia, W., & Ahmad, S. Effects of Instrument Assisted Soft Tissue Mobilization and Myofascial Release Technique among patients with Chronic Heel Pain.
14. Shah, J. T., Ghumatkar, M., & Kumar, A. Comparison between the Immediate Effects of Instrument Assisted Soft Tissue Mobilization and Active Release Technique in Individuals Wearing High Heels.
15. Stanek, J., Sullivan, T., & Davis, S. (2018). Comparison of compressive myofascial release and the Graston technique for improving ankle-dorsiflexion range of motion. Journal of athletic training, 53(2), 160-167.
16. Vijayakumar, M., Jaideep, A., Khankal, R., Gazbare, P., & Abraham, B. (2019). Effectiveness of compressive myofascial release vs instrument-assisted soft tissue mobilization in subjects with active trigger points of the calf muscle limiting ankle dorsiflexion. Int J Health Sci Res, 9(4), 98-106.
17. Garrett, T. R., & Neibert, P. J. (2019). Graston Technique® as a treatment for patients with chronic plantar heel pain. Clinical Practice in Athletic Training, 2(3), 35-47.
    • IASTM Compared to Modalities
18. Bhurchandi, S., & Phansopkar, P. (2021). Efficacy of Instrument Assisted Soft-Tissue Mobilization in Patients with Heel Pain: An Experimental Study.
19. Tyagi, A., & Bhardwaj, A. (2022). Effect of IASTM vs. THERAGUN on Triceps Surae Active Range of Motion and Functional Movements in University Level Sprinters. Indian Journal of Physiotherapy & Occupational Therapy Print-(ISSN 0973-5666) and Electronic–(ISSN 0973-5674), 16(4), 1-6.
20. Pisirici, P., Cil, E. T., Coskunsu, D. K., Saylı, U., & Subasi, F. (2022). Extracorporeal Shockwave Therapy Versus Graston Instrument-Assisted Soft-Tissue Mobilization in Chronic Plantar Heel Pain: A Randomized Controlled Trial. Journal of the American Podiatric Medical Association, 112(6).
    • IASTM Compared to Self-Myofascial Release
21. SK, M. E., Zutshi, K., & Dhingra, M. (2022). Immediate and Acute Effect of Self Myofascial Release vs Instrument Assisted Soft Tissue Mobilization on Flexibility, Strength and Sport-Specific Performance in Young Male Soccer Players. Indian Journal of Youth and Adolescent Health (E-ISSN: 2349-2880), 9(2), 14-20.
22. Stroiney, D. A., Mokris, R. L., Hanna, G. R., & Ranney, J. D. (2020). Examination of self-myofascial release vs. instrument-assisted soft-tissue mobilization techniques on vertical and horizontal power in recreational athletes. The Journal of Strength & Conditioning Research, 34(1), 79-88.
23. Pişirici, P., Ekiz, M. B., & İlhan, C. A. (2020). Investigation of the acute effect of myofascial release techniques and dynamic stretch on vertical jump performance in recreationally active individuals. Journal of Physical Education and Sport.
24. Jadhav, A., & Gurudut, P. (2023). Comparative Effectiveness of Gua Sha, Cryostretch, and Positional Release Technique on Tenderness and Function in Subjects with Plantar Fasciitis: a Randomized Clinical Trial. International Journal of Therapeutic Massage & Bodywork, 16(1), 13.
    • IASTM with Exercise
25. Park, J. H., Rhyu, H. S., & Rhi, S. Y. (2020). The effects of instrument-assisted soft tissue mobilization rehabilitation exercise on range of motion, isokinetic strength, and balance in chronic ankle instability taekwondo players. Journal of exercise rehabilitation, 16(6), 516.
26. McCormack, J. R., Underwood, F. B., Slaven, E. J., & Cappaert, T. A. (2016). Eccentric exercise versus eccentric exercise and soft tissue treatment (Astym) in the management of insertional Achilles tendinopathy: a randomized controlled trial. Sports health, 8(3), 230-237.
27. Williams, Z., Carlson, S., & Rife, G. (2019, April). Comparing the Effects of Tissue Flossing and Instrument Assisted Soft Tissue Mobilization on Ankle Dorsiflexion. In Proceedings of The Research and Scholarship Symposium, Cedarville, OH, USA (Vol. 3).
28. Bush, H. M., Stanek, J. M., Wooldridge, J. D., Stephens, S. L., & Barrack, J. S. (2020). Comparison of the Graston technique with instrument-assisted soft tissue mobilization for increasing dorsiflexion range of motion. Journal of Sport Rehabilitation, 30(4), 587-594.
29. Jones, E. R., Finley, M. A., Fruth, S. J., & McPoil, T. G. (2019). Instrument-assisted soft-tissue mobilization for the management of chronic plantar heel pain: a pilot study. Journal of the American Podiatric Medical Association, 109(3), 193-200.
30. Kiran, N., Sahar, W., Hameed, N., Sarfraz, N., & Niaz, A. (2022). Effectiveness of the Graston Technique on Pain and General Foot Health in Patients with Chronic Plantar Fasciitis: A Randomized Clinical Trial. Alternative Therapies in Health and Medicine.
31. Gupta, U., Sharma, A., Rizvi, M. R., Alqahtani, M. M., Ahmad, F., Kashoo, F. Z., ... & Ahmad, I. (2023, March). Instrument-Assisted Soft Tissue Mobilization Technique versus Static Stretching in Patients with Pronated Dominant Foot: A Comparison in Effectiveness on Flexibility, Foot Posture, Foot Function Index, and Dynamic Balance. In Healthcare (Vol. 11, No. 6, p. 785). MDPI.
32. Nadeem, K., Arif, M. A., Akram, S., Arslan, S., Ahmad, A., & Gilani, S. Effect of IASTM ergon technique on pain, strength and range of motion in plantar fasciitis patients. RCT. Physiotherapy Quarterly, 31(4).
33. Schaefer, J. L., & Sandrey, M. A. (2012). Effects of a 4-week dynamic-balance-training program supplemented with Graston instrument-assisted soft-tissue mobilization for chronic ankle instability. Journal of sport rehabilitation, 21(4), 313-326.
34. Ahmed, M.M., Amin, F., & Sedhom, M.G. (2022). Efficacy of instrument-assisted soft tissue mobilization on chronic ankle instability. Fizjoterapia Polska.