Course Summary: Crural and Plantar Fascia Instrument Assisted Soft Tissue Mobilization (IASTM)

Introduction: Crural and Plantar Fascia IASTM

Position Statement and Research Summary

Crural and Plantar Fascia IASTM Research Review

IASTM: Technique and Emollient Recommendations

Plantar Fascia IASTM

Crural Fascia IASTM

Crural and Plantar Fascia Instrument Assisted Soft Tissue Mobilization (IASTM)

TPTA

NYPT

PACE

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 <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a>, Achilles tendon, calcaneus, interossei, and toe flexors. Additionally, modifications of these techniques are discussed, including <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> techniques for addressing <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>, and pin and stretch (a.k.a. active or dynamic <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a>) techniques with IASTM tools.&#xA0; This course does not cover the fascial sheaths above the knee (fascia latae), and does not cover the superficial fascia over the <a id="dorsal" data-tip="1554" target="_blank" href="/glossary-term/dorsal" class="glossary">dorsal</a> aspect of the foot (top of the foot). Although the fascia lata will be covered in a separate course, the <a id="dorsal" data-tip="1554" target="_blank" href="/glossary-term/dorsal" class="glossary">dorsal</a> 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 <a id="glide" data-tip="1817" target="_blank" href="/glossary-term/glide" class="glossary">shear</a> 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 <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> with stainless steel tools, the application of Gua Sha is based on TCM-specific <a id="assessment" data-tip="1480" target="_blank" href="/glossary-term/assessment" class="glossary">assessments</a> with jade or stone tools. Graston is the most well-known brand of IASTM stainless steel tools; however, we do prefer <a href="https://www.smarttoolsplus.com/" title="Smart Tools" target="_blank" rel="noopener">Smart Tools</a> 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.&#xA0;
The IASTM techniques in this course are recommended as an adjunct <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> technique, included in an <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> program that already includes, or has considered soft-tissue <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> 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 <a id="stability" data-tip="1193" target="_blank" href="/glossary-term/stability" class="glossary">instability</a> (CAI), chronic ankle pain, or <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a> issues. Further, these techniques may be beneficial for those with assessed impairments including dorsiflexion restriction, pes planus, hyper-pronation, a positive Feiss line <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>, a positive Jack&apos;s <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>, pronation distortion, or <a href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">lower extremity dysfunction (LED)</a>.&#xA0;
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&#xA0;<a id="evidence-based-practice" data-tip="1538" target="_blank" href="https://brookbushinstitute.com/glossary-term/evidence-based-practice" class="glossary" rel="noopener">evidence-based</a>, systematic,&#xA0;<a id="integration" data-tip="1473" target="_blank" href="https://brookbushinstitute.com/glossary-term/integration" class="glossary" rel="noopener">integrated</a>, patient-centered, and outcome-driven approach.&#xA0;
<h3>Topics Covered in this Course</h3>
<ul>
 <li>Signs of Altered Extensibility</li>
 <li>Sample Program</li>
 <li>Research Corner</li>
 <li>IASTM Protocols</li>
 <li>Techniques (with Video)</li>
</ul>
<h3>Techniques Covered in this Course:</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/videos/plantar-fascia-instrument-assisted-soft-tissue-mobilization-iastm" target="_blank" rel="noopener">Plantar Fascia IASTM</a></li>
 <li><a href="https://brookbushinstitute.com/videos/crural-fascia-instrument-assisted-soft-tissue-mobilization-iastm" target="_blank" rel="noopener">Crural Fascia IASTM</a></li>
</ul>
Additional IASTM Courses
<ul>
 <li><a href="https://brookbushinstitute.com/courses/upper-extremity-instrument-assisted-soft-tissue-mobilization-iastm" target="_blank" rel="noopener">Upper Extremity Fascia IASTM</a></li>
 <li><a href="https://brookbushinstitute.com/courses/cervical-and-thoracic-spine-fascia-iastm" target="_blank" rel="noopener">Cervical and Thoracic Spine Fascia IASTM</a></li>
</ul>
For more on an <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> approach:
<ul>
 <li>&#xA0;<a href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">Lower Extremity Dysfunction (LED)</a></li>
</ul>

<h3>Research-based Position Statement:</h3>
<ul>
 <li>Plantar and crural fascia instrument assissted soft tissue mobilization (IASTM) is likely to significantly improve pain, pain pressure threshold, ankle range of motion (ROM), <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a>, and functional outcomes. However, outcomes may only improve, or be more significant, when used to address an assessed impairment (e.g. plantar fasciitis, a loss of dorsiflexion ROM, etc.). Research demonstrates that plantar and crural fascia IASTM likely improves most foot and ankle outcome measures more than ultrasound, massage guns, shockwave therapy, active <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> techniques (ART), and massage therapy, and may result in similar improvements in ROM and exercise performance as self-administered <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> (e.g. foam rolling) and stretching techniques, and may result in less improvement in ROM than static manual <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> techniques. Adding plantar and crural fascia IASTM to an intervention plan designed to address foot and ankle impairment is likely to result in significant additional benefits; however, less additional benefit may be noted if the intervention plan already includes <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> techniques. The Brookbush Institute recommends adding plantar and crural fascia IASTM to an <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> intervention plan, designed to address <a id="movement-impairment" data-tip="1576" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairments</a> assessed with <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> objective outcome measures, to enhance carry-over from session to session and client/patient outcomes.</li>
</ul>
<h3>Correlated Postural Dysfunction and Movement Impairment</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">Lower Extremity Dysfunction (LED)</a></li>
</ul>
<h3>Techniques Covered in this Course:</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/videos/plantar-fascia-instrument-assisted-soft-tissue-mobilization-iastm" target="_blank" rel="noopener">Plantar Fascia IASTM</a></li>
 <li><a href="https://brookbushinstitute.com/videos/crural-fascia-instrument-assisted-soft-tissue-mobilization-iastm" target="_blank" rel="noopener">Crural Fascia IASTM</a></li>
</ul>
<ul>
 <li style="list-style-type: none;">
 <ul></ul>
 <a href="https://brookbushinstitute.com/videos/deep-cervical-flexor-activation-and-progressions-for-stabilization-2" target="_blank" rel="noopener"> </a>
 </li>
</ul>
<h3>Signs of correlated dysfunction:</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/article/introduction-overhead-squat-assessment" target="_blank" rel="noopener">Overhead Squat Assessment:</a>
 <ul>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-4-feet-flat-breakdown" target="_blank" rel="noopener">Feet Flatten</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-5-feet-turn-out-breakdown" target="_blank" rel="noopener">Feet Turn Out</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-8-excessive-forward-lean" target="_blank" rel="noopener">Excessive Forward Lean</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-6-knees-bow-in-breakdown" target="_blank" rel="noopener">Knees Bow In</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-7-knees-bow-out" target="_blank" rel="noopener">Knees Bow Out</a></li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-15-sign-clusters-asymmetrical-weight-shift" target="_blank" rel="noopener">Asymmetrical Weight Shift</a></li>
 </ul>
 </li>
 <li><a href="https://brookbushinstitute.com/article/introduction-to-goniometry" target="_blank" rel="noopener">Goniometry</a>
 <ul>
 <li><a href="https://brookbushinstitute.com/video/dorsiflexion-goniometry" target="_blank" rel="noopener">Dorsiflexion Goniometr</a>y &lt;15 - 20&#xB0;</li>
 </ul>
 </li>
 <li><a href="https://brookbushinstitute.com/article/introduction-manual-muscle-testing-active-population" target="_blank" rel="noopener">Manual&#xA0;</a><a id="muscle-cell" data-tip="1781" target="_blank" href="https://brookbushinstitute.com/glossary-term/muscle-cell" class="glossary" rel="noopener">Muscle</a>&#xA0;Testing MMT:
 <ul>
 <li><a href="https://brookbushinstitute.com/video/tibialis-anterior-manual-muscle-testing-mmt-for-an-active-population" target="_blank" rel="noopener">Tibialis&#xA0;</a><a id="anterior" data-tip="1566" target="_blank" href="https://brookbushinstitute.com/glossary-term/anterior" class="glossary" rel="noopener">Anterior</a>&#xA0;Manual&#xA0;<a id="muscle-cell" data-tip="1781" target="_blank" href="https://brookbushinstitute.com/glossary-term/muscle-cell" class="glossary" rel="noopener">Muscle</a>&#xA0;<a id="assessment" data-tip="1482" target="_blank" href="https://brookbushinstitute.com/glossary-term/assessment" class="glossary" rel="noopener">Test</a>&#xA0;(MMT) - Weak or With Compensation (Eversion)</li>
 <li><a href="https://brookbushinstitute.com/video/posterior-tibialis-manual-muscle-testing-mmt-for-an-active-population" target="_blank" rel="noopener">Tibialis&#xA0;</a><a id="posterior" data-tip="1565" target="_blank" href="https://brookbushinstitute.com/glossary-term/posterior" class="glossary" rel="noopener">Posterior</a>&#xA0;Manual&#xA0;<a id="muscle-cell" data-tip="1781" target="_blank" href="https://brookbushinstitute.com/glossary-term/muscle-cell" class="glossary" rel="noopener">Muscle</a>&#xA0;<a id="assessment" data-tip="1482" target="_blank" href="https://brookbushinstitute.com/glossary-term/assessment" class="glossary" rel="noopener">Test</a>&#xA0;(MMT) - Weak or With Compensation (Eversion)</li>
 </ul>
 </li>
</ul>
<h3>Sample Intervention (Ankle Dorsiflexion Restriction)</h3>
<ul>
 <li>Manual Release
 <ul>
 <li><a href="https://brookbushinstitute.com/video/gastroc-soleus-manuel-release" target="_blank" rel="noopener">Gastrocnemius and Soleus Static Manual Release</a></li>
 <li><a href="https://brookbushinstitute.com/video/fibularis-release" target="_blank" rel="noopener">Fibularis&#xA0;</a><a id="muscle-cell" data-tip="1781" target="_blank" href="https://brookbushinstitute.com/glossary-term/muscle-cell" class="glossary" rel="noopener">Muscle Static Manual Release</a></li>
 <li><a href="https://brookbushinstitute.com/video/ehl-edl-release" target="_blank" rel="noopener">Extensor Hallucis Longus (EHL) and Extensor Digitorum Longus (EDL) Static Manual Release</a></li>
 <li><a href="https://brookbushinstitute.com/video/fhl-fdl-release" target="_blank" rel="noopener">Flexor Hallucis Longus (FHL) and Flexor Digitorum Longus (FDL) Static Manual Release</a></li>
 </ul>
 </li>
 <li>Mobilization or Manipulation
 <ul>
 <li><a href="https://brookbushinstitute.com/video/ankle-tibiotalor-joint-anterior-to-posterior" target="_blank" rel="noopener">Ankle Mobilization</a></li>
 <li><a href="https://brookbushinstitute.com/video/distal-tibiofibular-joint-anterior-posterior-manual-mobilization" target="_blank" rel="noopener">Distal Tibiofibular Joint Mobilization</a></li>
 </ul>
 </li>
 <li>Manual Lengthening
 <ul>
 <li><a href="https://brookbushinstitute.com/video/manual-calf-stretch" target="_blank" rel="noopener">Manual Calf Stretch</a></li>
 </ul>
 </li>
 <li>Instrument Assisted Soft Tissue Mobilization
 <ul>
 <li><a href="https://brookbushinstitute.com/videos/plantar-fascia-instrument-assisted-soft-tissue-mobilization-iastm" target="_blank" rel="noopener">Plantar Fascia IASTM</a></li>
 <li><a href="https://brookbushinstitute.com/videos/crural-fascia-instrument-assisted-soft-tissue-mobilization-iastm" target="_blank" rel="noopener">Crural Fascia IASTM</a></li>
 </ul>
 </li>
 <li>Activation
 <ul>
 <li><a href="https://brookbushinstitute.com/article/tibialis-posterior-activation" target="_blank" rel="noopener">Tibialis&#xA0;</a><a id="posterior" data-tip="1565" target="_blank" href="https://brookbushinstitute.com/glossary-term/posterior" class="glossary" rel="noopener">Posterior</a>&#xA0;Activation</li>
 <li><a href="https://brookbushinstitute.com/article/corrective-exercise-articles/activation/tibialis-anterior-activation/" target="_blank" rel="noopener">Tibialis&#xA0;</a><a id="anterior" data-tip="1566" target="_blank" href="https://brookbushinstitute.com/glossary-term/anterior" class="glossary" rel="noopener">Anterior</a>&#xA0;Activation</li>
 </ul>
 </li>
 <li>Reactive Activation:
 <ul>
 <li><a href="https://brookbushinstitute.com/video/tibialis-anterior-reactive-activation" target="_blank" rel="noopener">Heel walks</a></li>
 </ul>
 </li>
 <li>Integration
 <ul>
 <li><a href="https://brookbushinstitute.com/video/single-leg-deadlift-touchdown" target="_blank" rel="noopener">Single-Leg Touchdown</a></li>
 </ul>
 </li>
</ul>

Research Corner

<h3>Position Statement:</h3>
Plantar and crural fascia instrument assissted soft tissue mobilization (IASTM) is likely to significantly improve pain, pain pressure threshold, ankle range of motion (ROM), <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a>, and functional outcomes. However, outcomes may only improve, or be more significant, when used to address an assessed impairment (e.g. plantar fasciitis, a loss of dorsiflexion ROM, etc.). Research demonstrates that plantar and crural fascia IASTM likely improves most foot and ankle outcome measures more than ultrasound, massage guns, shockwave therapy, active <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> techniques (ART), and massage therapy, and may result in similar improvements in ROM and exercise performance as self-administered <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> (e.g. foam rolling) and stretching techniques, and may result in less improvement in ROM than static manual <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> techniques. Adding plantar and crural fascia IASTM to an intervention plan designed to address foot and ankle impairment is likely to result in significant additional benefits; however, less additional benefit may be noted if the intervention plan already includes <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> techniques. The Brookbush Institute recommends adding plantar and crural fascia IASTM to an <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> intervention plan, designed to address <a id="movement-impairment" data-tip="1576" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairments</a> assessed with <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> objective outcome measures, to enhance carry-over from session to session and client/patient outcomes.
<h3>Research Summary: Plantar and Crural Fascia</h3>
<ul>
 <li>IASTM Compared to Controls
 <ul>
 <li>Healthy Individuals Receiving a Single Session: Healthy individuals receiving a single session of lower extremity IASTM may exhibit improvements in dorsiflexion ROM, however, significant changes are unlikely for the outcomes measured (dorsiflexion ROM, musculotendinous stiffness, plantar flexion peak <a id="torque" data-tip="1294" target="_blank" href="/glossary-term/torque" class="glossary">torque</a>, jump height/power, and concentrations of IL-6 or TNF-&#x3B1;).</li>
 <li>Healthy Individuals Receiving Multiple Sessions: One or multiple sessions of lower extremity IASTM may result in a significant increase in spine, hip, and/or ankle dorsiflexion ROM (depending on the area treated), multiple sessions result in larger improvements, and multiple sessions may result in better carryover (retaining acquired improvements). Note, that the significant results exhibited in these studies may also be due to participants starting with restricted ROM, whereas the single-session studies may have recruited healthy individuals without measurable restrictions.</li>
 <li>Impaired Individuals: Individuals exhibiting CAI, chronic plantar fasciitis, or fall risk, may exhibit significant improvements in pain, ankle dorsiflexion ROM, <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a>, disability, and function following 1 - 24 sessions of IASTM.</li>
 </ul>
 </li>
 <li>IASTM compared to Static Stretching: Healthy individuals performing IASTM over the gastrocnemius and soleus, or performing the &quot;leaning into wall calf stretch,&quot; are likely to exhibit similar increases in dorsiflexion ROM. However, individuals experiencing DOMS may exhibit larger improvements from IASTM, and IASTM may have a large influence on <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> <a id="tone" data-tip="1639" target="_blank" href="/glossary-term/tone" class="glossary">tone</a>, stiffness, and <a id="elasticity-2" data-tip="1307" target="_blank" href="/glossary-term/elasticity-2" class="glossary">elasticity</a>.</li>
 <li>IASTM compared to Manual Myofascial Release: In summary, these studies suggest that individuals exhibiting chronic heel pain, Achilles tendonitis, plantar fasciitis, calf <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>, and/or ankle restriction may exhibit larger improvements in pain, pain pressure threshold, dorsiflexion ROM, and function when comparing treatment with IASTM to treatment with massage or ART techniques. Conversely, <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> ischemic <a id="compression" data-tip="1595" target="_blank" href="/glossary-term/compression" class="glossary">compression</a> is likely more effective for improving ROM, despite IASTM being more effective for improving pain pressure threshold.</li>
 <li>IASTM compared to Modalities: Athletes and individuals with chronic heel pain may exhibit larger improvements in pain, dorsiflexion ROM, <a id="fibromyalgia" data-tip="1137" target="_blank" href="/glossary-term/fibromyalgia" class="glossary">FMS</a> scores, and FAAM scores following IASTM when compared to ultrasound or massage gun treatment. Further, although short-term improvements in pain and foot function index (FFI) scores may be similar when comparing IASTM and shockwave treatment, IASTM may result in larger improvements in long-term FFI scores.</li>
 <li>IASTM compared to Self Myofascial Release: Healthy and athletic individuals are likely to exhibit similar increases in strength, flexibility, <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>, and agility (vertical jump, sprint times, Illinois Agility <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>) following IASTM or self-myofascial <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a>, and these techniques are likely to result in similar levels of discomfort. Additionally, individuals with plantar fasciitis may exhibit larger decreases in pain following IASTM when compared to cold rolling (frozen tennis ball) or manual release; however, cold rolling may result in larger improvements in FAI scores, and manual <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">release</a> may result in larger improvements in pain pressure threshold.</li>
 <li>IASTM with Exercise
 <ul>
 <li>Addition to an Intervention Plan That Did Not Include <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">Mobility</a> Techniques: Young athletic individuals exhibiting CAI or Achilles tendinopathy that receive a combination of ankle strengthening and lower extremity IASTM will likely exhibit significant improvements in pain, ankle ROM, strength, <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a>, and function.&#xA0;</li>
 <li>No Additional Benefits When IASTM is Added to a Program Including Stretching: IASTM added to an intervention plan that already includes <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">Mobility</a> techniques may not result in changes in ROM, pain, or function. However, the two studies that demonstrated no change in ankle ROM included asymptomatic participants, and the study that included participants with chronic plantar heel pain did not <a id="assessment" data-tip="1486" target="_blank" href="/glossary-term/assessment" class="glossary">assess</a> ankle ROM.</li>
 <li>Significant Improvement When IASTM is Added to a Program Including Stretching: The addition of IASTM to an <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> intervention plan that already includes stretching techniques, is likely to result in significant short-term and long-term improvements in pain, ROM, strength, foot <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a> index (FPI) scores, and function (GROC and VISA-A scores), for individuals exhibiting signs of chronic plantar fasciitis, Achilles tendinopathy, hyper-pronation, or CAI.</li>
 </ul>
 </li>
</ul>

Crural and Plantar Fascia IASTM: Technique and Videos

<h3>Technique: Instrument Assisted Soft Tissue Mobilization (IASTM)</h3>
<ul>
 <li>Pressure: Pressure should be sufficient to feel resistance from the target tissue; that is, pressure should be applied to the &quot;first resistance barrier&quot;.&#xA0;
 <ul>
 <li>Tissue Tension: It may be beneficial to increase tissue <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> by lengthening the target tissue. Pressing a tool into tissue that is in a passively shortened position can result in a lack of tissue resistance, which will result in little if any <a id="glide" data-tip="1817" target="_blank" href="/glossary-term/glide" class="glossary">shear</a> force to the target tissue.&#xA0;</li>
 </ul>
 </li>
 <li>Angle: The tool angle to the skin should be approximately 30&#xB0; - 45&#xB0;.</li>
 <li>Scanning Strokes: Start with long, slow strokes over the full length of the target tissue to note irregularities in tissue consistency.</li>
 <li>Treatment Strokes: Treatment strokes should be shorter, performed at a moderate tempo, in multiple directions, and over tissue assessed as irregular. The goal is to disrupt <a id="connective-tissue-cell" data-tip="1368" target="_blank" href="/glossary-term/connective-tissue-cell" class="glossary">connective tissue</a> that may be impeding <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a>.</li>
 <li>Total Strokes: 10 - 30 strokes per region is likely sufficient, with the total dose dependent on the size of the area and the individual&apos;s tissue tolerance. Note, that scanning strokes should be included in total strokes.</li>
 <li>Treatment Direction: Perform 2-5 strokes in each direction. It can be helpful to visualize a clock or compass face and perform strokes in line with each number or direction (e.g. N, NW, W, SW, S, SE, E, NE).
 <ul>
 <li>Redness and Patechaie: The development of petechiae or excessive redness is an indication to stop treatment in that area. Initially, this dosage may feel inadequate; however, petechiae and redness are often signs that bruising and significant soreness may follow (Note, bruising may take 24 - 72 hours to become visible). Although Traditional Chinese Medicine (TCM) and the practice of &quot;Gua Sha&quot; considered petechiae the goal of treatment, IASTM as taught by the Brookbush Institute, is performed with the intent to increase <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> and potentially decrease tissue <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a>. Patechaie and some bruising are not abnormal, but it is likely an indicator that either pressure or dose (total strokes) should be reduced if IASTM is performed in subsequent sessions.&#xA0;</li>
 </ul>
 </li>
 <li>Addressing Trigger Points: Addressing active and <a id="latent-trigger-point" data-tip="1133" target="_blank" href="/glossary-term/latent-trigger-point" class="glossary">latent trigger points</a> with IASTM, which are often areas of assessed irregularity in tissue consistency, may improve carry-over from session to session. That is, the addition of IASTM to an <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> treatment plan may aid in maintaining the reduction in <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> over-activity and <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> that results from a session.</li>
 <li>Advanced Technique - IASTM with Pin and Stretch: This technique is &quot;more aggressive&quot; and should likely be used in small doses to address &quot;stubborn&quot; <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> issues, with patients/clients who have already exhibited good tolerance to IASTM techniques (tissue tolerance and pain tolerance). Following the identification of an area of altered tissue consistency, the IASTM tool is used to &quot;pin&quot; the tissue in the opposite direction of lengthening (generally, pressure has a <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> to <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> vector). This technique may be progressed in intensity with the following additions:
 <ol>
 <li>Static IASTM tool with passive lengthening (manual lengthening by the practitioner)</li>
 <li>Dynamic IASTM tool (strokes in the opposing direction) with passive lengthening</li>
 <li>Static IASTM tool with active or active-assisted lengthening (lengthening by the client or patient)</li>
 <li>Dynamic IASTM tool with active or active-assisted lengthening</li>
 <li>Static IASTM tool with active-assisted lengthening and over-pressure (client/patient and practitioner force)</li>
 <li>Dynamic IASTM tool with active-assisted lengthening and over-pressure</li>
 </ol>
 </li>
 <li>Assess, Address, and Reassess: As with all techniques, IASTM should only be recommended when indicated by a <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> objective <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> (e.g. <a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">goniometry</a>), and continued use should be based on a significant improvement on that <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> (&gt; 5&#xB0; improvement in ROM). Note, &quot;feelings are not facts&quot;.</li>
</ul>
<h3>Emollient:</h3>
There are emollients specifically marketed for use during IASTM; however, a variety of emollients and lotions will suffice. Here are a few tips for choosing the best emollient for you and your patients.
<ul>
 <li>Hypoallergenic: Choose an emollient that is hypoallergenic, and/or has as few ingredients as possible. Although a fragrance or &quot;moisturizing agent&quot; may sound like a good idea, it is likely best to reduce the chances of adding an agent that could result in additional skin irritation due to a <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> or allergy.</li>
 <li>Consistency: Once you have found an emollient you prefer, be consistent. Although the choice of emollient likely does not affect outcomes, constantly switching emollients may reduce your <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a>. The best method for improving outcomes is through continuous refinement, based on comparison using a <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> objective outcome measure, following the consistent implementation of a technique.</li>
 <li>Viscosity: Different products have different viscosities. For example, lotion-like products tend to be less viscous (less sticky or thick), whereas coconut oil-based products tend to be more viscous (more sticky or thick). Your choice is likely going to depend on the feel you prefer, the amount of emollient you apply, and your ability to clean the emollient from the skin.&#xA0;</li>
 <li>Removal: If you perform IASTM techniques as part of an <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> intervention plan, you will need a safe and effective way to remove the emollient from the skin. Emollients left on the skin can make it very challenging to perform additional manual techniques, position bands, hold on to weights/handles, and/or apply <a id="kinesiology" data-tip="1692" target="_blank" href="/glossary-term/kinesiology" class="glossary">kinesiology</a> tape. We recommend using a spray bottle to spray rubbing alcohol on a towel to aid in wiping the emollient from the skin. Note, that fatty acids, which are the <a id="base-of-support" data-tip="1196" target="_blank" href="/glossary-term/base-of-support" class="glossary">base</a> of most emollients, are not water-soluble, so a wet towel will not suffice. However, fatty acids are alcohol-soluble which is why rubbing alcohol (or alcohol-based products) will work. Just when you thought you would never use chemistry again, we bring it back.</li>
</ul>

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<h3>Anatomy:</h3>
<ul>
 <li>Plantar Fascia: The plantar fascia is a thick layer of <a id="connective-tissue-cell" data-tip="1368" target="_blank" href="/glossary-term/connective-tissue-cell" class="glossary">connective tissue</a>, superficial to the plantar muscles of the foot. The function of the plantar fascia is to <a id="base-of-support" data-tip="1197" target="_blank" href="/glossary-term/base-of-support" class="glossary">support</a> the longitudinal arch, the tendons, and ligaments of various plantar structures, and act as an aponeurosis for the flexors, adductors, and abductors of the toes. The <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> attachment of the plantar fascia may have some continuity with the Achilles tendon; however, most of the fibers invest in the tuberosity of the calcaneus. The <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> attachment invests in the metatarsal heads and fibrous sheaths enveloping the flexor tendons of the toes. There are <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a>, central, and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> components of the plantar fascia, with the central component being the largest and most well-developed.&#xA0; 
 <ul>
 <li>Increasing Tension/Lengthening: Increased <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> in the plantar fascia may be achieved with a combination of toe extension, transverse tarsal joint dorsiflexion or pronation, and ankle dorsiflexion. Toe extension is likely to result in the largest increase in <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a>, followed by transverse tarsal joint dorsiflexion and pronation, and the least <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> may result from ankle dorsiflexion.&#xA0;</li>
 </ul>
 </li>
</ul>
<h3>Clothing and Covering:</h3>
<ul>
 <li>IASTM cannot be done over clothing. It is advised that the client/patient is informed prior to the session that they will be asked to remove shoes, socks, and/or stockings covering the feet. Although it is never our intent to make a client uncomfortable, we also do not want embarrassment to impede great therapy. Often authentic communication, a little empathy, and some planning can reduce or eliminate potentially embarrassing moments.&#xA0;</li>
</ul>
<h3>Patient Position</h3>
<ul>
 <li>It may be possible to address the plantar fascia with the practitioner sitting at the patient&apos;s feet, the feet off the end of the treatment table, and the patient in <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a>. However, it is likely most comfortable for the practitioner to stand or sit with the patient in <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a>, and the knee flexed to 30&#xB0; - 45&#xB0;.</li>
</ul>
<h3>Potentially Sensitive Tissues&#xA0;&#xA0;</h3>
<ul>
 <li>Soles of the feet: Usually, this section of the written instructions provides information on structures that have the potential to be injured or damaged with careless implementation (nerves, lymph nodes, or vessels). In the plantar aspect of the foot, these structures are well protected by the plantar fascia and/or course between the metatarsal bones. However, the sole of the foot itself is a densely innervated area. Light, feathery strokes may trigger a &quot;tickle response,&quot; and excessive pressure may be extremely painful. It takes some practice, but tickling and excessive discomfort may be avoided by starting with &quot;moderate/firm pressure&quot; that progressively increases to the appropriate treatment pressure.</li>
</ul>
<h3>Trigger Points</h3>
<ul>
 <li>Fascia does not develop <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>. Most IASTM techniques address <a id="connective-tissue-cell" data-tip="1368" target="_blank" href="/glossary-term/connective-tissue-cell" class="glossary">connective tissue</a> that is relatively thin and superficial to muscles that are likely to develop <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>. The plantar fascia is connective tissue; and therefore, cannot develop <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>. Further, most of the <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> mass of the toe flexors lies in the deep <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> compartment of the lower leg, with only tendons that cross the bottom of the foot. Most of the muscles with <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> mass in the plantar aspect of the foot are too deep to effectively treat with IASTM. In summary, it is unlikely that <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> will be addressed while administering plantar fascia IASTM.&#xA0;</li>
</ul>

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<h3>Anatomy:</h3>
<ul>
 <li>Crural Fascia: The crural fascia is the deep fascia of the lower leg, between the knee joint and ankle joint. This fascial sheath envelops and invests in the fascia of the muscles of the lower leg, the intermuscular septa, and the periosteum of the tibia and fibula. <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">Proximal</a> to the knee the crural fascia continues as the fascia latae, and <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> to the ankle the crural fascia continues into the retinacula of the ankle, and the plantar and <a id="dorsal" data-tip="1554" target="_blank" href="/glossary-term/dorsal" class="glossary">dorsal</a> fascia of the foot.
 <ul>
 <li>Increasing Tension/Lengthening: Terminal knee extension may increase <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> in the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> aspects of the crural fascia, and knee flexion may result in some increase in <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> in the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> aspect of the crural fascia. Ankle motion tends to have a larger influence on crural fascia <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a>, including dorsiflexion increasing <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> over the gastrocnemius and soleus, inversion increasing <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> over the fibularis (peroneal) muscles, and eversion increasing <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> of the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> crural fascia.&#xA0;</li>
 </ul>
 </li>
</ul>
<h3>Clothing and Covering:</h3>
<ul>
 <li>IASTM cannot be done over clothing. It is advised that the client/patient is informed prior to the session that they will be asked to remove shoes, socks, and/or stockings covering the ankle and/or lower leg. Although it is never our intent to make a client uncomfortable, we also do not want embarrassment to impede great therapy. Often authentic communication, a little empathy, and some planning can reduce or eliminate potentially embarrassing moments.&#xA0;</li>
</ul>
<h3>Patient Position</h3>
<ul>
 <li>It may be possible to address the crural fascia with the practitioner sitting at the patient&apos;s feet, the feet off the end of the treatment table, and the patient in <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a>. However, it is likely most comfortable for the practitioner to stand or sit with the patient in <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a>, and the knee flexed to 30&#xB0; - 45&#xB0;.</li>
</ul>
<h3>Potentially Sensitive Tissues</h3>
<ul>
 <li>No <a id="sensitivity" data-tip="1227" target="_blank" href="/glossary-term/sensitivity" class="glossary">Sensitive</a> Tissues:&#xA0;Assuming that these techniques are directed at the superficial layers of fascia, it is unlikely they will <a id="compression" data-tip="1597" target="_blank" href="/glossary-term/compression" class="glossary">compress</a> or abrade any <a id="sensitivity" data-tip="1227" target="_blank" href="/glossary-term/sensitivity" class="glossary">Sensitive</a> or delicate structures. However, responsible application of this technique is still expected. Two potential exceptions, may be the common fibular <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> and the Achilles tendon. The common fibular <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> is relatively superficial in the area just <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> to the fibular head, and although this is a relatively uncommon area to treat with IASTM, it may be addressed because it is a common soleus <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> site. It is advised that the depth or location of IASTM is adjusted if any burning, tingling, or numbness is experienced by the patient. Additionally, the Achilles tendon may not be especially susceptible to damage from IASTM; however, IASTM over the Achilles tendon can be quite uncomfortable. It is advised that IASTM over this area starts with less pressure than commonly applied and gradually increases to the desired treatment pressure.</li>
</ul>
<h3>Trigger Points</h3>
<ul>
 <li>Gastrocnemius: Common gastrocnemius <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> are in the middle of the <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> bellies of the <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> head.</li>
 <li>Soleus: Common soleus <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> occur just <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> the fibular head, and in the middle of the <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> belly - between the <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> ends of the heads of the gastrocnemius.</li>
 <li>Fibularis Muscles: Common fibularis <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a> are in the center of the <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> bellies of the fibularis longus and fibularis brevis. However, the muscles themselves are relatively short, with long tendons making up a large portion of their length. The <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> for the fibularis longus can generally be located approximately 2&quot; <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> of the fibular head, and the fibularis brevis <a id="trigger-point" data-tip="1632" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger point</a> can be located near the mid-length of the fibula.</li>
</ul>

<h3>Bibliography: Plantar and Crural Fascia IASTM</h3>
IASTM Compared to Controls
<ol>
 <li>Ikeda, N., Otsuka, S., Kawanishi, Y., &amp; Kawakami, Y. (2019). Effects of instrument-assisted soft tissue mobilization on musculoskeletal properties. Medicine and science in sports and exercise, 51(10), 2166.</li>
 <li>MacDonald, N., Baker, R., &amp; 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.</li>
 <li>Vardiman, J. P., Siedlik, J., Herda, T., Hawkins, W., Cooper, M., Graham, Z. A., ... &amp; Gallagher, P. (2014). Instrument-assisted soft tissue mobilization: effects on the properties of human plantar flexors. International journal of sports medicine, 197-203.</li>
 <li>Fousekis, K., Eid, K., Tafa, E., Gkrilias, P., Mylonas, K., Angelopoulos, P., ... &amp; Tsepis, E. (2019). Can the application of the Ergon&reg; IASTM treatment on remote parts of the superficial back myofascial line be equally effective with the local application for the improvement of the hamstrings&rsquo; flexibility? A randomized control study. Journal of physical therapy science, 31(7), 508-511.</li>
 <li>Gamboa, A. J., Craft, D. R., Matos, J. A., Flink, T. S., &amp; Mokris, R. L. (2019). Functional movement analysis before and after instrument-assisted soft tissue mobilization. International journal of exercise science, 12(3), 46.</li>
 <li>Croft, B. D., Aronson, P. A., &amp; 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.</li>
 <li>Nasir, M., Khan, L. G., Haq, K., Khan, U. A., Batool, M., &amp; Ali, S. (2022). Effects of Graston assisted soft tissue mobilization in patients with chronic plantar fasciitis. Rawal Medical Journal, 47(4), 978-978.</li>
 <li>Lee, H. W., Beak, H. J., Yoon, E. J., &amp; 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.</li>
 <li>Jordan, J. A., Turner, M. J., Thomas, A., Wikstrom, E. A., &amp; 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 &amp; Sports Health Care, 12(1), 14-20.
 <ul>
 <li>IASTM Compared to Stretching</li>
 </ul>
 </li>
 <li>Myburgh, C., Hammern, A., Mannfjord, P., &amp; 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.</li>
 <li>Shinde, S., Jethwa, K., &amp; 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.</li>
 <li>Kang, H. S., &amp; 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.
 <ul>
 <li>IASTM Compared to Manual Myofascial Release</li>
 </ul>
 </li>
 <li>Arshad, M. U., Bashir, M. S., Zia, W., &amp; Ahmad, S. Effects of Instrument Assisted Soft Tissue Mobilization and Myofascial Release Technique among patients with Chronic Heel Pain.</li>
 <li>Shah, J. T., Ghumatkar, M., &amp; Kumar, A. Comparison between the Immediate Effects of Instrument Assisted Soft Tissue Mobilization and Active Release Technique in Individuals Wearing High Heels.</li>
 <li>Stanek, J., Sullivan, T., &amp; 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.</li>
 <li>Vijayakumar, M., Jaideep, A., Khankal, R., Gazbare, P., &amp; 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.</li>
 <li>Garrett, T. R., &amp; Neibert, P. J. (2019). Graston Technique&reg; as a treatment for patients with chronic plantar heel pain. Clinical Practice in Athletic Training, 2(3), 35-47.
 <ul>
 <li>IASTM Compared to Modalities</li>
 </ul>
 </li>
 <li>Bhurchandi, S., &amp; Phansopkar, P. (2021). Efficacy of Instrument Assisted Soft-Tissue Mobilization in Patients with Heel Pain: An Experimental Study.</li>
 <li>Tyagi, A., &amp; 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 &amp; Occupational Therapy Print-(ISSN 0973-5666) and Electronic&ndash;(ISSN 0973-5674), 16(4), 1-6.</li>
 <li>Pisirici, P., Cil, E. T., Coskunsu, D. K., Saylı, U., &amp; 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).
 <ul>
 <li>IASTM Compared to Self-Myofascial Release</li>
 </ul>
 </li>
 <li>SK, M. E., Zutshi, K., &amp; 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.</li>
 <li>Stroiney, D. A., Mokris, R. L., Hanna, G. R., &amp; 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 &amp; Conditioning Research, 34(1), 79-88.</li>
 <li>Pişirici, P., Ekiz, M. B., &amp; 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.</li>
 <li>Jadhav, A., &amp; 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.&nbsp;International Journal of Therapeutic Massage &amp; Bodywork,&nbsp;16(1), 13.
 <ul>
 <li>IASTM with Exercise</li>
 </ul>
 </li>
 <li>Park, J. H., Rhyu, H. S., &amp; 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.</li>
 <li>McCormack, J. R., Underwood, F. B., Slaven, E. J., &amp; 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.&nbsp;Sports health,&nbsp;8(3), 230-237.</li>
 <li>Williams, Z., Carlson, S., &amp; 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).</li>
 <li>Bush, H. M., Stanek, J. M., Wooldridge, J. D., Stephens, S. L., &amp; 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.</li>
 <li>Jones, E. R., Finley, M. A., Fruth, S. J., &amp; 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.</li>
 <li>Kiran, N., Sahar, W., Hameed, N., Sarfraz, N., &amp; 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.</li>
 <li>Gupta, U., Sharma, A., Rizvi, M. R., Alqahtani, M. M., Ahmad, F., Kashoo, F. Z., ... &amp; 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.</li>
 <li>Nadeem, K., Arif, M. A., Akram, S., Arslan, S., Ahmad, A., &amp; Gilani, S. Effect of IASTM ergon technique on pain, strength and range of motion in plantar fasciitis patients. RCT. Physiotherapy Quarterly, 31(4).</li>
 <li>Schaefer, J. L., &amp; 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.</li>
 <li>Ahmed, M.M., Amin, F., &amp; Sedhom, M.G. (2022). Efficacy of instrument-assisted soft tissue mobilization on chronic ankle instability. Fizjoterapia Polska.</li>
</ol>

Bibliography

A-Band - Refers to the part of the muscle cell that looks darker under a microscope.  This area of the cell is darker due to parallel arrangement of thicker filaments (myosin) and overlap with the thinner filaments (actin).
<ul>
 	<li>As a muscle contracts, the A-band is where actin and myosin interact.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Accuracy - the proportion of individuals correctly identified by the test results.
<ul>
 	<li>For example, a special test with perfect accuracy would imply a test has 100% specificity, 100% sensitivity, 100% positive predictive value and 100% negative predictive values.</li>
</ul>

Action Potential - A rapid change in voltage, resulting in a wave of excitation, that may result in stimulation of a nerve or muscle cell.
<ul>
 	<li>In order for an action potential to be initiated, the resting membrane voltage must exceed the excitation threshold, which then results in a cascade of depolarization and the "wave of excitation." Any stimulus below that threshold will not result in an action potential, and a stimulus greater than the threshold will not increase a single action potential, but may result in additional action potentials.  In this way, the action potential functions more like an on/off switch (all or none), and less like a dimmer switch.</li>
</ul>

A single-joint movement pattern (most often) designed to load a specific under-active muscle(s), while minimizing the contribution of over-active synergists via specific cues/joint motions.
<ul>
 	<li style="text-align: left;">Activation techniques/exercises are performed with the intent of addressing a muscle exhibiting a reduction in activity (tone) as a result of, or contributing to postural dysfunction.</li>
 	<li style="text-align: left;">Activation techniques/exercises cannot be multi-joint movement patterns due to relative flexibility, altered reciprocal inhibition, and synergistic dominance resulting in compensation patterns.</li>
</ul>
Example, <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/activation/gluteus-medius-activation-progression/" target="_blank">gluteus medius activation</a> involves resisted hip abduction while minimizing the contribution of the TFL via hip extension.

Active stretching is a term used to describe a stretch that involves an active contraction of opposing musculature to lengthen a muscle to its end range. Generally these stretches are held for 2-5 seconds and repeated for 8-15 repetitions.

Adenosine triphosphatase (ATPase): is the enzyme responsible for catalyzing (initiating and accelerating) the decomposition of ATP to ADP.
<ul>
 	<li>This dephosphorylation (breakdown) reaction releases energy for processes like muscular contraction.</li>
</ul>

Adenosine triphosphate (ATP): The molecule that functions as a universal energy-transfer molecule, providing most of the energy associated with muscular contraction and human movement. ATP is composed of an adenine group, a ribose group, and three molecules of inorganic phosphates.
<ul>
 	<li>Energy is provided when hydrolysis results in the cleaving of a phophate group; resulting in adenosine diphosphate, an inorganigic phosphate group, and energy.</li>
</ul>

Algometry - measuring the amount of pressure to result in sensitivity or pain, using an algometer.
<ul>
 	<li>Generally, research uses algometry to establish a minimum pain pressure threshold (PPT), in which a lower PPT implies more sensitivity and pain, and a higher PPT implies less sensitivity and pain. PPT is a common outcome measure in trigger point research.</li>
</ul>
<a href="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg"><img class="aligncenter wp-image-140177" src="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg" alt="Image of an Algometer" width="500" height="333" /></a>

All-or-none principle - a nerve or muscle cell's response to a stimulus is independent of the strength of the stimulus. If that stimulus exceeds the threshold potential (threshold of an action potential), the nerve or muscle fiber will respond completely; otherwise, there is no response.

Example, when a motor unit in the biceps brachii is stimulated it contracts the same way whether a 10 lb or 50 lb dumbbell is lifted.  It is actually the number of muscle cells and the size of the motor unit that determines force output.

&nbsp;

The transition period between eccentric load and concentric contraction during a repetition of an exercise.  This term is most often used in reference to power/plyometric exercises, in which a shorter amortization phase is believed to be beneficial.  The shorter amortization phase may better use the stored energy from the elastic deformation of connective tissue and enhance synchronization of myotatic (stretch) reflex with maximum voluntary contraction.

Example, the athlete was cued to spend as little time as possible in the bottom of their squat stance (the amortization phase) during a set of box jumps.

Muscles that oppose the prime mover and synergists for a given joint action.

That is, all the muscles that can perform the opposing joint action.

Example: The triceps and anconeus are antagonists during elbow flexion.

An anatomical direction; toward the front

Example, the face is on the anterior aspect of the head

Appendicular Skeleton - referring to the bones the bones of the arms and legs, as well as the bones that support them. This includes the pelvis, clavicle and scapula. There are approximately 126 bones in the appendicular skeleton.
<ul>
 	<li>Etymology - Appendicular, as in appendage, "that which is appended to something as a proper part," 1640s, from <a class="crossreference" href="https://www.etymonline.com/word/append?ref=etymonline_crossreference">append</a> + <a class="crossreference" href="https://www.etymonline.com/word/-age?ref=etymonline_crossreference">-age</a>. - <a href="https://www.etymonline.com/word/appendage" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Appendicular skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/axial-skeleton/" target="_blank" rel="noopener">axial skeleton</a>".

A reflexive decrease in muscle activity due to joint dyskinesis.
For example, a reduction in deep cervical flexor activity as a result of cervical spine dyskinesis.

Arthrokinematic Motion - Small amplitude motions between bone surfaces at a joint.  The arthrokinematic motions are roll, glide (slide or translation), spin, compression and distraction (traction). Arthrokinematic motions accompany osteokinematic motions to maintain joint congruence.
<ul>
 	<li>Example, arthrokinematic motion of the talus includes posterior glide on the tibia during ankle dorsiflexion.</li>
</ul>
Synonyms include: arthrokinematics, passive accessory motion, joint play and component motion

&nbsp;

Assessment - is the act of assessing, i.e. determining the importance, size, or value of -

In most cases, the results of an assessment are compared to normative data. If the individual exhibits values that are within normal parameters, it may be assumed that the aspect of health or motion assessed is not contributing to the patient's complaint, symptoms or movement impairment. If the results fall outside of normal parameters, it may indicate that the aspect of health or motion assessed is contributing to, or being affected by the patient/client's complaint, symptoms, or movement impairment. In some cases, the results of an assessment are compared to an "ideal model." In this case, deviations from the ideal are noted as potential issues. For example, deviations noted in the <a title="Introduction to the Overhead Squat Assessment" href="https://brentbrookbush.com/online-courses/articles/assessment/introduction-overhead-squat-assessment/" target="_blank">Overhead Squat Assessment</a> are compared to an "ideal model" of posture and motion.

Assessments used by human movement professionals can be divided into three broad categories:
<ul>
 	<li>"Clear" the Patient/Client for Intervention - These are tests, assessments and evaluations used to determine if a patient/client's issue may improve given the assessing professional's scope, skills, abilities and willingness to treat that individual.
<ul>
 	<li>For example, many of the special tests used in orthopedic medicine assist in determining the level of pathology or likelihood of a particular diagnosis. Certain issues and diagnoses are beyond the scope of the human movement professional, and are better treated by diagnostic professionals in the medical community (physicians, podiatrists, surgeons, etc.). A Calf Squeeze (Thompson) Test is one example, in which a positive sign may indicate a rupture of the Achilles tendon that may be better treated via surgical intervention.</li>
</ul>
</li>
 	<li>Highlight Contraindications - Tests, assessments and evaluations used to stratify risk or preclude a professional from addressing certain tissues, motions or using a particular technique.
<ul>
 	<li>For example, the Vertebral Artery Test (VBI) is often used to determine if high velocity thrust mobilizations (manipulations) are safe for a patient with cervical dysfunction.</li>
</ul>
</li>
 	<li>Refine Exercise/Intervention Selection: Tests, assessments and evaluations used to assist the professional in determining which techniques, modalities and exercises will best address a patient/client's complaints or desired goals.
<ul>
 	<li>Most movement assessments fall into this category. For example, a positive <a href="https://brentbrookbush.com/vimeo_videos/elys-test-rectus-femoris-flexibility-assessment/" target="_blank">Ely's Test</a> may indicate a need to release and/or lengthen the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/rectus-femoris/" target="_blank">rectus femoris</a>.</li>
</ul>
</li>
</ul>
Note: An assessment, or assessment result, may fall into more than one category. For example, although goniometry is an assessment most often used to Refine Exercise/Intervention Selection, if a range of motion is significantly altered, with an abnormal end-feel, and/or causes the patient or client/pain, the individual may need to be referred to a physician for further testing and Clearance to resume rehab activities.  Further, that same patient may return to the human movement professional with a list of Contraindicated Activities from the physician. - "When in doubt, refer out!"

Axial Skeleton - referring to the bones of the head, neck, trunk and spinal column (does not include pelvis). There are approximately 80 bones in the axial skeleton.
<ul>
 	<li>Etymology - Axial, as in "axis", referring to "imaginary motionless straight line around which a body (such as the Earth) rotates," from Latin axis "axle, pivot, axis of the earth or sky" - <a href="https://www.etymonline.com/word/axis" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Axial skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/appendicular-skeleton/" target="_blank" rel="noopener">appendicular skeleton</a>".

Balance - The ability to maintain a body’s center of mass over its base of support. Balance can be static or dynamic.
<ul>
 	<li>For example, maintaining balance is harder on one leg because the center of mass must stay over a much smaller base of support.</li>
</ul>

A ball and socket joint (also called a spheroid joint or spheroidal joint) is a synovial joint in which the rounded or spherical end of one bone fits into a cup-like depression of another bone. The distal bone is capable of motion around an indefinite number of axes, which have one common center. Examples include the hip and shoulder (glenohumeral joint)

Base of support (BoS) - refers to the area beneath an object or person, and the area within the perimeter created by every point of contact that the object or person makes with the supporting surface. This may include the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/gluteus-maximus/" target="_blank" rel="noopener">glutes</a> of someone sitting on a chair, or the back of someone leaning against a wall.
<ul>
 	<li>For example, during a single leg balance the BoS is the area of the foot in contact with the surface; however, when a person is standing on two feet, the BoS is the area of both feet and the surface between them.</li>
</ul>

Pertaining to both sides

Example, bilateral rows are performed with both arms at the same time.

Case-control Study - a particular form of retrospective study that samples a matched group of people who have, and do not have the outcome being studied. A case-control study is a quasi-experimental design, often used in medicine to aid in determining potential contributing factors (cannot determine causality). In this study type exposure is the dependent variable and outcome is independent.
<ul>
 	<li>Example, in this retrospective case-control, medical records were investigated for trends correlated with cervical pain (1).
<ol>
 	<li>Mäkela, M., Heliövaara, M., Sievers, K., Impivaara, O., Knekt, P., &amp; Aromaa, A. (1991). Prevalence, determinants, and consequences of chronic neck pain in Finland. American journal of epidemiology, 134(11), 1356-1367.</li>
</ol>
</li>
</ul>

An anatomical direction; toward the tail, relative to humans this term is often used to refer to "in the direction of the tale (toward the feet)".

Example, to release the trapezius muscle the therapist used a force directed caudally.

Center of mass (CoM) - an object's mean position of mass; that is, a point that is perfectly surrounded by an equal amount mass in all directions.

Center of gravity (CoG) - point where gravity appears to act. Since the human body is so small compared to the earth, we can assume gravity acts uniformly on the body, and that CoG and CoM are the same.
<ul>
 	<li>Example, the CoM of the human body while lying down or standing straight up is close to our navel. However, it is possible that during a resistance exercise, the combination of the body's weight and the weight of the resistance will place the combined CoM outside the body. For example, during the mid-portion of a <a href="https://brentbrookbush.com/vimeo_videos/back-squat/" target="_blank" rel="noopener">back squat</a> the CoM would be several anterior to the naval.</li>
</ul>

An anatomical direction; toward the head (synonym: cranial)

Example, hip pain was felt with any force directed cephalad.

Cohort Study - a particular form of longitudinal study that samples a cohort (a group of people who share a defining characteristic), performing a cross-section at intervals through-out a period of time. A cohort study is a quasi-experimental design often used in medicine to aid in determining etiology or a cause-and-effect relationship. In this study type exposure is the independent variable and outcome is dependent.
<ul>
 	<li>Example, the study by Cholewicki et al. (1) investigated Yale Varsity Athletes (the cohort) with 2 and 3 year follow up (longitudinal design) and found that trunk muscle response time to off-loading was predictive of future low back injury.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/core/increased-trunk-muscle-latency-may-cause-rather-than-result-from-low-back-pain/" target="_blank" rel="noopener noreferrer">Cholewicki, J., Silfies, S., Shah, R., Greene, H., Reeves, N. Alvi, K., Goldberg, B. (2005). Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 30(23), 2614-2620</a></li>
</ol>

Comparable Sign: A combination of pain, stiffness and/or spasm during examination that is comparable to the patients symptoms.
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

An alternative movement pattern that has been adopted to compensate for dysfunction/impairment in the human movement system.
Example: A lack of calf extensibility may limit dorsiflexion, leading to the knees bowing inward (functional valgus) and excessive forward lean of the torso during a squat.

An arthrokinematic motion - the approximation of joint surfaces; that is, a force that directs one bone surface into another resulting in a reduction in intra-articular volume. Although widely thought of as a "destructive force", it is likely best to consider compression as a naturally occurring, stabilizing force. Any arthrokinematic force in excess (spin, glide, roll, traction) may be viewed as potentially deleterious.

For example, during a squat the femoral head is compressed into the acetabulum by muscular forces, bodyweight and any additional external load.

Concave (Concavity) - Having an outline or surface curved like the interior surface of a bowl or sphere - to cave-in or curve inward.
<ul>
 	<li>Example, the internal surfaces of the pelvis is concave, holding some of the bodies viscera.</li>
</ul>

Concordant Sign - The patient's specific pain, symptom or complaint. 
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

Conductivity: Stimulation results in more than a local effect (1).
<ul>
 	<li>For example, in a muscle cell the stimulation of a motor endplate results in a change in cell membrane polarity that rapidly propagates (is conducted) along the entire length of the muscle cell, stimulating all sacromere.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

A condyloid joint (also called condylar, bicondylar, ellipsoid, or ellipsoidal) is an ovoid articular surface, or condyle, that is received into an elliptical cavity.  These joints permit movement in two planes.  Examples include the knee, metacarpophalangeal joints and metatarsophalangeal joints.

Connective Tissue Cell - One of the four basic types of animal tissue, consisting mostly fibers and ground substance.  These cells are specialized to binds organs together, holds them in place, protect them from external forces, and may fill space in the body's cavities.

Example, the body's muscles are enclosed in durable connective tissue sheets known as the "epimysium", "perimysium", and "endomysium," which and in support and transmitting force.
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Contractility: The ability to shorten (1).
<ul>
 	<li>Contractility: Muscle cells are unique in the amount they can shorten when stimulated; this is this largerly due to the highly organized and unique arrangement of myofilaments (actin and myosin).</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Pertaining to the opposite side

Example, the external oblique muscle performs contralateral rotation; rotation to the opposite side.

Convex (Convexity) - Having an outline or surface curved like the exterior of a circle or sphere - to bulge or curve outward.
<ul>
 	<li>Example, the top of your head is shaped by the convex exterior surface of your skull.</li>
</ul>

Correlational Research - Non-experimental <a href="https://www.questionpro.com/blog/what-is-research/">research</a> method in which the statistical relationship between two variables is investigated.
<ul>
 	<li>In this research by Kwon et al., a correlation was noted between a decrease in extensibility during a hamstring length test (goniometry) and current knee pain (1).</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/correlation-patellofemoral-pain-syndrome-pfps-hamstring-activity/" target="_blank" rel="noopener">Kwon O, Yun M, and Lee W. (2014). Correlation between intrinsic patellofemoral pain syndrome in young adults and lower extremity biomechanics. J. Phys. Ther. Sci. 26: 961-964</a></li>
</ol>

Counter-nutation - posterior rotation of sacrum relative to ilium, and/or anterior rotation of ilium relative to sacrum.
<ul>
 	<li>The pelvic floor muscles are examples of muscle that may counter-nutate the sacrum.</li>
</ul>
[caption id="attachment_126335" align="aligncenter" width="400"]<a href="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png"><img class=" wp-image-126335" src="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png" alt="Nutation and Counter-nutation of the Sacroiliac Joint" width="400" height="967" /></a> Nutation and Counter-nutation of the Sacroiliac Joint[/caption]

&nbsp;

Crossover (Study) Design - A type of longitudinal, repeated measures quasi-experimental design in which each group receives both treatments, but at different times. It is named "crossover" due to the patients "crossing-over" to the other treatment or sham group after a specified period of time.
<ul>
 	<li>This type of study has the advantage of every individual serving as their own control, which may reduce the influence of confounding variables.</li>
 	<li>Unfortunately, the design itself introduces the chances that anyone receiving the experimental variable in the first period will continue to be effected in the second period.</li>
</ul>
In a study by Senna et al., a cross-over design was used to investigate the difference load made on inter-set rest intervals (1).
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/strength-training-research-corner/heavy-vs-light-load-single-joint-exercise-performance-with-different-rest-periods/" target="_blank" rel="noopener">Senna, G.W., Rodrigues, B.M., Sandy, Scudese, Bianco, A, &amp; Dantas, E.H.M. (2017). Heavy vs light load single-joint exercise performance with different intervals. Journal of Human Kinetics, 58, 197-206. </a></li>
</ol>

Cross-sectional Study - a research design that involves gathering data from a population or representative subset at a specific point in time.
<ul>
 	<li>Example, the study by Karimi-Mobarake et al.(1) investigated the prevalence of genu varum and genu valgum among school children 7-11 years old in Iran.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/low-prevalence-of-genu-varum-and-valgum-among-elementary-school-children/" target="_blank" rel="noopener noreferrer">Karimi-Mobarake, M., Kashefipour, A., Yousfnejad, Z. The prevalence of genu varum and genu valgum in primary school children in Iran 2003-2004. (2005) Journal of Medical Science 5(1). 52-54</a></li>
</ol>

Cytokine - A broad and loose category of small proteins that act through receptors, and are especially important to immune function (inflammation).
<ul>
 	<li>Cytokines include substances such as interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and have an effect on other cells. Their definite distinction from hormones is a topic of continued research.</li>
</ul>
&nbsp;

Dependent variable - in research, this is the variable that is changed by the independent variable, most often this is the "outcome" of the study.
<ul>
 	<li>Example, in the study by Cleland et al. (1), the independent variable is "thoracic manipulation," and the dependent variable is "lower trapezius muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/short-term-effects-lower-thoracic-manipulation-lower-trapezius-muscle-strength/" target="_blank" rel="noopener noreferrer">Cleland J, Selleck B, Stowell T, Brown L, Alberini S, St. Cyr H, Caron T. Short-term Effects of Thoracic Manipulation on Lower Trapezius Muscle Strength.  Journal of Manual &amp; Manipulative Therapy. 2004; 12(2): 82-90</a></li>
</ol>

An anatomical direction; further from the trunk or center of the body

Example, the foot is at the distal end of the leg.

An arthrokinematic motion - a force applied to a body part that may result in the separation of joint surfaces, a reduction in intra-articular pressure, and/or an increase in intra-articlar space.

For example, to hang from one's hands (i.g. in preparation for a pull-up) results in a traction force on the glenohumeral joint (shoulder).

An anatomical term of location; back or upper surface

Example, shoe laces may compress tissues on the dorsal surface of the foot

The "drawing-in" maneuver is a common cue used during exercise and rehabilitation programs. A light contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abominis</a> (and potentially the entire <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/core-subsystems/intrinsic-stabilization-subsystem/" target="_blank" rel="noopener">intrinsic stabilization subsystem</a>) achieved by gently pulling the lower abdominal region away from one's waist band. This should have minimal effect on breathing, and should not be confused with a maximal contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abdominis</a> resulting in a "vacuum pose".
<ul>
 	<li>Research often refers to this maneuver as the "abdominal drawing-in maneuver"; abbreviated ADIM.</li>
</ul>
Development and introduction of this cue into practice is based on the pivotal research and resulting text:
<ol>
 	<li>Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004</li>
</ol>

Faulty or abnormal movement; an alteration of normal kinematics.

For example, joint stiffness or a reduction in arthrokinematics motion that results in limited osteokinematic range of motion - inadequate inferior glide of the femoral head resulting in limited abduction of the hip.

The seeping into, or abnormal collection of fluid in a body cavity.

For example, knee effusion describes swelling within the knee joint.

Note: the word "effusion" is used differently in medicine than it is used in reference to the movement (seeping out) of liquids and gases, for example in chemistry.

&nbsp;

A trait of body tissues that allows a tissue to return to its resting length or state after deformation or stretch.
Example:  Muscle is elastic tissue; many muscles will return to their resting length after being stretched to 150% of that length without any appreciable change in tissue quality.

Elasticity: Elasticity refers to the ability of a cell to return to its resting length after being stretched/lengthened.
<ul>
 	<li>Note: this term is often confused with extensibility. Elasticity is not the ability to stretch; it is the ability to return to normal length after being stretched. Muscle tissue, connective tissue and even nerve tissue have varying levels of elasticity.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Epithelial cell - One of the four basic cell types, found lining the body's cavities, blood vessels, organs and constitutes most gland tissue.  These cells are specialized to aid with absorption, secretion, or act as a barrier from foreign objects.
<ol>
 	<li>Saladin, K. S., &amp; Miller, L. (1998). Anatomy &amp; physiology. New York (NY): WCB/McGraw-Hill.</li>
</ol>

Equilibrium - a state in which opposing forces or influences are balanced.
<ul>
 	<li>For example, to maintain a neutral trunk while pushing or pulling a weight in one hand, your core musculature must balance the force by creating an equal amount of force in the opposite direction.</li>
</ul>

The study of causation, or origination. The word is commonly used in the medical professions, where it may refer to the study of why things occur, or the reason behind why things act a certain way.

For example, the etiology of low back pain is a complex subject, with multiple contributing factors and various structures implicated.

<div class="gs_citr" tabindex="0">Evidence-based medicine (practice) is the integration of best research evidence with clinical expertise and patient(client) values (2)."</div>
<ul>
 	<li class="gs_citr" tabindex="0">...the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (clients).  It involves the integration of at least (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve (1).</li>
</ul>
&nbsp;
<ol>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., &amp; Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. Bmj, 312(7023), 71-72.</li>
 	<li class="gs_citr" tabindex="0">Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1</li>
</ol>

Excitability: The ability of a cell to change in membrane conductance as a response to stimulation.

<ul>
 	<li>For example, muscle cells are specialized to react to a change in membrane potential with contraction, where as nerve cells are specialized to propagate a change in membrane potential along there axons and communicate that message to other tissues via neurotransmitters.
</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Excitation threshold: The level that a depolarization must reach for an action potential to occur.
<ul>
 	<li>The excitation threshold is a contributing factor to the "all-or-none" response of muscle and nerves cells to a stimulus.</li>
</ul>

Exercise Progression - Modification of an exercise with the intent of promoting adaptation by increasing demand. This can be accomplished by increasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise progression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise, or series of exercises that make it harder to maintain stability with good form.
<ul>
 	<li>Sample Exercise Progression: <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a></li>
</ul>
</li>
</ul>

Exercise regression - The opposite of progression; that is, modification of an exercise with the intent of reducing demand. This can be accomplished by decreasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability. Generally, regressions are used to modify an exercise to the client's current level of ability, with the intent of improving form, motor learning and retention.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise regression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise or series of exercises that make it easier to maintain stability with good form.
<ul>
 	<li>Sample Exercise Regression: <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a></li>
</ul>
</li>
</ul>

Experimental Research - Studies in which the researchers introduce the variable to be studied, with the intent of observing the outcome. This is different than observational research which observes the effect of a variable already present. Many texts also assert that experimental research should include randomization and ideally a control group, as is seen in Randomized Control Trials. Studies in which the variable is introduced by the researchers, but participants are not randomized may be considered Quasi-experimental research.
<ul>
 	<li>In this study by Esformes, the experimental variable was squat depth and the outcome measures observed were various performance measures related to power (1).</li>
</ul>
<ol>
 	<li><a href="https://brookbushinstitute.com/article/back-squat-depth-lower-body-post-activation-potentiation/" target="_blank" rel="noopener">Esformes, J., &amp; Bampouras, T. (2013). Effect of back squat depth on lower-body postactivation potentiation. Journal of Strength and Conditioning Research, 27(11), 2997-3000.</a></li>
</ol>
&nbsp;

Extensibility: The ability of a cell to be stretched or lengthened without damage (1).
<ul>
 	<li>For example, most cells would rupture with even a modest stretch, but muscles can stretch up to 3 times their contracted length.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

False Negative - the proportion of negatives in a group that were assessed incorrectly (assessed as negative when the patient was actually positive)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

False Positive - the proportion of positives in a group that were assessed incorrectly (assessed as positive when the patient was actually negative)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

The function of fascia is to transmit force, provide support, and protect tissues. Fascia can effect motion by:
Transmitting force from one or more muscles (example: the thoracolumbar fascia)
Restricting motion in cases of adaptive shortening and/or adhesion to proximal structures (example: iliotibial band in cases of lower-leg dysfunction)
Elastic recoil after stretching can contribute to force production (example: plyometric exercise)

Note: There is evidence that fascia may house more receptors related to human movement than other tissues. In this way fascia may act as a motherboard for the nervous system

The fascial system does not contract or develop trigger points, and its capacity to adapt to stretching and or strengthening exercise is limited, especially when compared to the adaptive capacity of muscle tissue.

Fibromyalgia - A loosely defined diagnosis that is associated with a combination of widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. Consideration may also be given to the presence of psychosocial stressors and inflammatory disease in the patients history. Newer research suggests that fibromyalgia may be at least in part due to central sensitization of myofascial pain, often associated with trigger points (1 - 4).
<ol>
 	<li>Wolfe, F. (2018). Fibromyalgia Syndrome and Fibromyalgia Syndrome Criteria: Problems in Definition and Validity. Fibromyalgia Syndrome and Widespread Pain: From Construction to Relevant Recognition.</li>
 	<li>Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., ... &amp; Fam, A. G. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis &amp; Rheumatism: Official Journal of the American College of Rheumatology, 33(2), 160-172.</li>
 	<li>Alonso-Blanco, C., Fernandez-de-las-Penas, C., Morales-Cabezas, M., Zarco-Moreno, P., Ge, H. Y., &amp; Florez-García, M. (2011). Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. The Clinical journal of pain, 27(5), 405-413.</li>
 	<li>Staud, R., Nagel, S., Robinson, M. E., &amp; Price, D. D. (2009). Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: a randomized, double-blind, placebo-controlled study. PAIN®, 145(1-2), 96-104.</li>
</ol>
&nbsp;

Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.
Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.

An increase in joint stability via compressive forces resulting from muscular contraction and increased tension in fascial structures (1,2).
<ul>
 	<li>This term is most often used in reference to core intrinsic stabilizers, the thoracolumbar fascia and the sacroiliac joint; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Form closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

The relative contribution of joint shape and structure to the stability of a joint (1,2).
<ul>
 	<li>This term is most often used in reference to the "rough" articulating surfaces of the sacroiliac joint and the wedge shape of the sacrum; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Force closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

An arthrokinematic motion - linear motion across a joint surface parallel to the plane of the adjacent joint surface, just as your posterior moves relative to a "slide" in a park.

For example, the glide of facet joint in the spine during spinal flexion and extension, or the posterior glide of the humeral head that must accompany anterior roll to maintain congruence with glenoid fossa during shoulder horizontal adduction.

A plane joint (also called an arthrodial joint, gliding joint or plane articulation) is a synovial joint which allows only gliding movement in the plane of the articular surfaces. The opposed surfaces of the bones are flat or almost flat, with movement generally limited by tight capsules and ligaments. Plane joints are numerous, are most often small, and allow very little motion.  Examples include the carpal joints of the wrist, the tarsal joints of the ankle, and the facet joints of the spine.

"...refers to the measurement of angles, in particular the measurement of angles created at human joints by the bones of the body (1).

&nbsp;
<ol>
 	<li>Cynthia C. Norkin, D. Joyce White. Measurement of Joint Motion: A Guide to Goniometry 3rd Edition. Copyright (C) 2003 by F.A. Davis Company</li>
</ol>

Ground reaction force (GRF) - The force exerted by the ground on the body in contact with it.

For example, when a runner's foot strikes the ground with a force equal to the mass of the individual times their acceleration due to gravity, momentum and muscular exertion, the ground exerts an equal and opposite force on the runner's foot.
<ul>
 	<li>GRF is often measured in research studies using force plates as a means of quantitatively measuring the force generated by an individual.</li>
</ul>

H-Band - Refers to the central zone of a sarcomere that looks lighter under a microscope.  This area of the sarcomere is a lighter portion of the A-band where there is no overlap between the thinner filaments (actin), and the thicker filaments (myosin).
<ul>
 	<li>Example, when a muscle contracts, actin and myosin cross-bridging occurs in the region of the A-band until the H-band is reached where no overlap occurs.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

A hinge joint (also called a ginglymus) is a synovial joint in which the articular surfaces fit one another in a way that only permits motion in one plane. Examples include the elbow, the knee (unless considered a condyloid joint) and the interphalangeal joints.

Holism (holistic) (biological holism) - (from Greek holos "all, whole, entire") is the idea that systems and their properties should be viewed as wholes, not just as a collection of parts.
<ul>
 	<li>Summarized by Aristotle in his "Metaphysics": "The whole is more than the sum of its parts". However, the term "holism" was introduced into language by the South African statesman Jan Smuts as recently as 1926. (Smuts J. C. 1987 [1926]. Holism and evolution. Cape Town: N &amp; S Press.)</li>
</ul>
Example: The Brookbush Institute promotes a holistic approach to human movement science, in which the muscular, fascial, articular and neural systems are not viewed as separable and all proximal segments are considered.

Hormone: Chemical messengers produced by the endocrine system, transported via tissue fluids such as blood, to stimulate cells to "act."
<ul>
 	<li>Example: Growth hormone is secreted by the pituitary gland in the brain; stimulating growth, cell reproduction and cell regeneration in certain types of cells</li>
</ul>
The English physician E. H. Starling discovered in collaboration with the physiologist W. M. Bayliss secretin, the first hormone, in 1902. (1).
<ol>
 	<li>Henriksen, J. H., &amp; de Muckadell, O. S. (2000). Secretin, its discovery, and the introduction of the hormone concept. Scandinavian journal of clinical and laboratory investigation, 60(6), 463-472.</li>
</ol>

A range of motion achieved by the patient/client that is more than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If an individual can place their forehead on their knees they are likely hypermobile at one, if not several joints

Example 2: 110° of shoulder external rotation would be considered hyper-mobile.

Hyperplasia is an increase in organic tissue size due to an adaptive increase in the number of cells per organ.
<ul>
 	<li>Although muscle hyperplasia has been noted in some animals, human muscle tissue does not seem to have this adaptive ability.</li>
</ul>

A condition of excessive tone of the skeletal muscles; increased resistance of muscle to passive stretching.  May be related to increased neural drive, synergistic dominance, trigger points, reflexive over-activity, and/or muscle length.
Example:  Individuals who exhibit ankle eversion and abduction during an overhead squat assessment likely have hypertonic fibularis (peroneal) muscles.

Muscular hypertrophy is an increase in muscle mass/size due to increase in the volume and cross-sectional area (CSA) of individual muscle cells. The increase in cross-sectional area can be attributed to an an increase in contractile proteins and structural elements (myofibrillar hypertophy), as well as an increase in glycogen storage and elements related to metabolism (sarcoplasmic hypertophy). Hypertrophy is an adaptation of both cardiac and skeletal muscle fibers in response to progressive increases in workload.
<ul>
 	<li>Note: Hypertrophy is not hyperplasia. Hyperplasia is an increase in muscle size due to an adaptive increase in the number of muscle fibers/cells per muscle. This type of adaptation does not occur in human muscle tissue.</li>
</ul>

A range of motion achieved by a patient/client that is less than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If the end range of shoulder external rotation is reached and measured as 75° during goniometric assessment, the client/patient is exhibiting hypomobility of the glenohumeral joint (shoulder).

Hypothesis - a proposed explanation for a phenomenon; "scientific hypotheses" are generally constructed in a way that is testable or falsifiable.
<ul>
 	<li>Example: The hypothesis, "excessive knee valgus may be correlated with future knee pain and injury," has been the subject of several studies published over the last decade.</li>
</ul>

Diminished tone of skeletal muscles; diminished resistance of muscles to passive stretching.   May be related to inhibition, reciprocal inhibition, arthrokinematics inhibition and/or  increased resting length of muscle.
Example:  If your knees cave (hip adduction) during a squat or leg-press it is likely that your gluteus medius is hypotonic.

I-Band - Refers to the part of the muscle cell that looks lighter under a microscope.  This area of the cell is lighter due to parallel arrangement of thinner filaments (actin), and no overlap with the thicker filaments (myosin).
<ul>
 	<li>As a muscle contracts, the I-bands will decrease in width and move closer to one another.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Independent variable - in research, this is the variable or phenomenon being manipulated in the study.
<ul>
 	<li>Example, in the study by Ghanbari et al. (1), the independent variable is "knee joint mobilization", the dependent variable is "quadriceps muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/effect-knee-joint-mobilization-quadriceps-muscle-strength/" target="_blank" rel="noopener noreferrer">Ghanbari A. and Kamalgharibi S. (2013). Effect of knee joint mobilization on quadriceps muscle strength. International Journal of Health and Rehabilitation Sciences. 2(4): 186-191</a></li>
</ol>

An anatomical direction; toward the bottom (below)

Example, the mouth is inferior to the eyes

A reduction in neural drive, muscular activity, and or force output due to altered neuromuscular reflex.  Alterations in neuromuscular reflex may occur due to increases in muscle length (hypothesis: increased excitation threshold), altered reciprocal inhibition in response to increased antagonist tone, and or alterations in joint motion (arthrokinematics inhibition).

Making a whole of parts.

Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.

Intermuscular Coordination - Optimal timing and motor unit recruitment of agonists, antagonists, synergists, neutralizers, stabilizers and fixators.

Example: Role of Muscles during Hip Extension
<ul>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Prime Mover" href="https://brentbrookbush.com/glossary/prime-mover/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Prime Mover&lt;/div&gt;The muscle most responsible for a joint action under load -&lt;br /&gt;&lt;br /&gt;That is, the muscle that can produce the most force for a given joint action. Often this term is used synonymously with the term agonist. The prime mover as defined above, may or may not be the most active muscle for a joint action during activities of daily living.&lt;br /&gt;&lt;br /&gt;Example: the gluteus maximus is the most powerful hip extensor and therefore the prime mover; however, the hamstrings are likely the most active hip extensors during low level activities like walking or standing.">Prime Mover</a>:  <a href="https://player.vimeo.com/external/82855344.hd.mp4?s=54c3e7d98fb9d4e0af8d282c85ba9b3e">Gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Synergists" href="https://brentbrookbush.com/glossary/synergists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Synergists&lt;/div&gt;Muscles that assist the prime mover in performing a joint action.&lt;br /&gt;&lt;br /&gt;That is, all muscles that can perform a joint action that are not the prime mover, are termed synergists.&lt;br /&gt;Example: The rectus abdominis is the prime mover of spinal flexion. All other muscles that can perform spinal flexion are synergists including – external obliques, internal obliques and psoas.">Synergists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/biceps-femoris/">Biceps femoris (long head)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/semitendinosus-and-semimembranosus/">semitendinosus, semimembranosus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">posterior head of adductor magnus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Antagonist" href="https://brentbrookbush.com/glossary/antagonists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Antagonist&lt;/div&gt;Muscles that oppose the prime mover and synergists for a given joint action.&lt;br /&gt;&lt;br /&gt;That is, all the muscles that can perform the opposing joint action.&lt;br /&gt;&lt;br /&gt;Example: The triceps and anconeus are antagonists during elbow flexion.">Antagonists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/psoas/">Psoas</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/iliacus/">iliacus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/tensor-fascia-latae-tfl/">tensor fascia latae</a> (TFL),<a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-femoris/"> rectus femoris</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">anterior adductors (especially pectineus)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/sartorius/">sartorius</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Neutralizer" href="https://brentbrookbush.com/glossary/neutralizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Neutralizer&lt;/div&gt;Muscles that oppose unwanted joint motions created by the prime mover and/or synergists, and/or muscles that prevent unwanted ancillary motion.&lt;br /&gt;Example: The teres minor and infraspinatus neutralize the internal rotation force created by the pectoralis major during horizontal adduction of the shoulder.">Neutralizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-minimus/">Gluteus minimus</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-medius/">anterior fibers of gluteus medius</a> neutralize external rotation force of <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-maximus/">gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Stabilizer" href="https://brentbrookbush.com/glossary/stabilizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Stabilizer&lt;/div&gt;Muscles whose primary role is to improve arthrokinematics by maintaining optimal alignment of joint surfaces.&lt;br /&gt;&lt;br /&gt;Most often these muscles are the most intrinsic muscles of a joint, have a larger percentage of Type I muscle fibers and are rich in proprioceptors.&lt;br /&gt;Example: The muscles of the rotator cuff act as stabilizers for most shoulder motions.">Stabilizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/deep-rotators-of-the-hip/">Deep rotators of hip</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Fixator" href="https://brentbrookbush.com/glossary/fixators/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Fixator&lt;/div&gt;Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.&lt;br /&gt;Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.">Fixators</a>: <a href="https://brentbrookbush.com/articles/core-subsystems/intrinsic-stabilization-subsystem/">Intrinsic stabilization subsystem</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-abdominis/">rectus abdominis</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/internal-obliques/">internal</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/external-obliques/">external obliques</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/quadratus-lumborum/">quadratus lumborum</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/erector-spinae/">erector spinae</a></li>
</ul>
&nbsp;

Example from: <a href="https://brentbrookbush.com/articles/anatomy-articles/introduction-to-functional-anatomy/kinesiology-of-the-hip/" target="_blank" rel="noopener">Introduction to Functional Anatomy: Kinesiology of the Hip</a>

Intramuscular coordination refers to the coordinated recruitment of motor units within a single muscle. This concept is used to explain increases in maximal strength and power; however, the coordinated and sequential recruitment of motor units is also essential to strength endurance and smooth coordinated motion.  Related terminology may include; motor unit recruitment, preferential recruitment, rate coding, sequence, etc..

Example: It is hypothesized that the "shaking" noted during a novice exercisers attempt at an activity like the <a href="https://brentbrookbush.com/vimeo_videos/ball-crunch-and-progressions/" target="_blank">stability ball crunch</a> may be due to relatively poor intramuscular coordination. Rather than smooth, sequential firing of rectus abdominis motor units, groups of motor units turn on and off in an uncoordinated manner.

Pertaining to the same side

Example, the quadratus lumborum performs ipsilateral flexion; lateral flexion toward the same side as the muscle.

An isoform, or variant, is a member of a set of similar proteins, that originate from the same gene, or gene family.
<ul>
 	<li>Example, the variations in myosin heavy chain proteins (MHC I, MHC IIA, MHC IIB/X) that contribute to the characteristic differences between muscle fiber types.</li>
</ul>

“The Prime Assumption”
Everything crossing a joint will influence joint motion during every joint action.

A concept that has expanded over the past several decades to describe the integration of 4 body systems (muscle, joints, fascia and nerves), as well as, the coordinated function of various body segments (e.g. hip, knee and ankle) to produce motion. Kinetic referring to motion, and chain being an analogy for the interdependent link between systems.

Example, the posterior kinetic chain, refers to the integrated function of nerves, muscles, fascia and joints on the posterior side of the body.

The concept of the kinetic chain was originally adapted from the work of a mechanical engineer named Franz Reuleaux (Kinematics of Machinery (1875)) by Dr. Arthur Steindler in 1955 (Steindler A: Kinesiology of the Human Body. Springfield, IL, Charles C. Thomas Co.. 1955).

Latent Trigger Point - A myofascial trigger point that is not painful at rest, only painful when palpated, and may or may not exhibit a characteristic referral pain pattern when palpated.  Latent trigger points do result in an acute point of sensitivity, in a taut band of muscle, and may restrict range of motion (1).

Note: Based on the clinical experience, the Brookbush Institute suggests that latent trigger points (sometimes refereed to as Tender Points) are more common than active trigger points. Further, they are likely addressed more often than trigger points; being the intended target of many soft-tissue mobility techniques.
<ol>
 	<li>David G. Simons, Janet Travell, Lois S. Simons, Travell &amp; Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens</li>
</ol>

An anatomical direction; further from the midline

Example, the anterior deltoid is lateral to the pectoralis major

Length/Tension Relationship - The amount of force generated by a muscle is dependent on sarcomere length.
<ul>
 	<li>The ability of sarcomere to maximally produce force occurs when sarcomere length results in optimal overlap between actin and myosin. Stretching a sarcomere decreases overlap between actin and myosin filaments and reduces force production (1-3). When length is less than optimal, actin from opposite ends overlap and interfere with cross-bridging, and myosin filament are compressed as they contact the the Z-disk also reducing force (4)</li>
</ul>
<ol>
 	<li>Gordon, A. M., Huxley, A. F., &amp; Julian, F. J. (1966). The variation in isometric tension with sarcomere length in vertebrate muscle fibres. The Journal of physiology, 184(1), 170-192.</li>
 	<li>Edman, K. A. P. (1966). The relation between sarcomere length and active tension in isolated semitendinosus fibres of the frog. The Journal of Physiology, 183(2), 407-417.</li>
 	<li>Lieber, R. L., Loren, G. J., &amp; Friden, J. (1994). In vivo measurement of human wrist extensor muscle sarcomere length changes. Journal of neurophysiology, 71(3), 874-881.</li>
 	<li>Lieber, R. L. (2002). Skeletal muscle structure, function, and plasticity. Lippincott Williams &amp; Wilkins.</li>
</ol>
&nbsp;

Levels of Evidence - Relative to evidence-based practice, levels of evidence are an attempt to describe the strength of the results measured in a clinical trial or research study.  Note: levels of evidence do not supersede the critical evaluation of an experienced professional, and should be viewed as guidelines - a meta-analysis may be poorly constructed (Level IA), and a comparative study (Level III) may employ new technologies and a strong methodology.


The Levels of Evidence used by the Brookbush Institute, as described by Shekelle et al.(1):
<ul>
 	<li class="p1">IA - Evidence from meta-analysis of randomized controlled trials</li>
 	<li class="p1">IB - Evidence from at least one randomized controlled trial</li>
 	<li class="p1">IIA - Evidence from at least one controlled study without randomization</li>
 	<li class="p1">IIB - Evidence from at least one other type of quasi-experimental study</li>
 	<li class="p1">III - Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case-control studies</li>
 	<li class="p1">IV - Evidence from expert committee reports or opinions or clinical experience of respected authorities, or both</li>
</ul>
<ol>
 	<li>Shekelle, P. G., Woolf, S. H., Eccles, M., &amp; Grimshaw, J. (1999). Developing clinical guidelines. Western Journal of Medicine, 170(6), 348.</li>
</ol>

Likelihood Ratios - Likilihood ratios are used for assessing the value of performing a diagnostic test. They use sensitivity and specificity to determine whether a test result usefully changes the practitioner's chance (probability) of reaching the correct assessment. Calculation of likelihood ratios is based on Baye's theorem.
<ul>
 	<li>Positive Likelihood Ratio (LR+) - The ratio of a positive test result in people with the pathology to a positive test result in people without the pathology.</li>
 	<li>Negative Likelihood Ratio (LR-) - The ratio of a negative test result in people with the pathology to a negative test result in people without the pathology.</li>
</ul>

Longitudinal Study - a research design that involves observing the same variables, several times over a period of time.
<ul>
 	<li>Example, the study by Hewett et al. (1) is a type of longitudinal study called a "cohort study." This study investigated whether excessive knee valgus during landing was a predictor of knee injury risk in adolescent females over the course of a season.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/research-review-increased-valgus-during-landing-predicts-acl-injury-in-adolescent-female-athletes/" target="_blank" rel="noopener noreferrer">Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., &amp; Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. The American journal of sports medicine, 33(4), 492-501</a></li>
</ol>

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