Approved for {{credits}} CEUs by CPTA #CPTAAP-36

California Physical Therapy Association

This activity is provided by the Texas Board of Physical Therapy Examiners Accredited Provider 2309052TX and meets continuing competence requirements for physical therapist and physical therapist assistant licensure renewal in Texas.

Texas Physical Therapy Association

New York Physical Therapist just a disclaimer The Brookbush Institute (B2C Fitness) is recognized by the New York State Education Department's State Board for Physical Therapy as an approved provider of physical therapy and physical therapist assistant continuing education.

New York State Education Department's State Board for Physical Therapy

Providers of Approved Continuing Education

The Brookbush Institute (BOC AP# P10038) is approved by the Board of Certification, Inc. to provide continuing education to Athletic Trainers (ATs). This program is eligible for a maximum of {{credits}} hours/ Category A CEUs. ATs should claim only those hours actually spent in the educational program.

Board Of Certification

Learn about Instrument Assisted Soft Tissue Mobilization (IASTM), a skilled myofascial intervention adapted from GuaSha and popularized by Graston. This course focuses on IASTM techniques for treating the Fascia Lata (thigh).

IASTM: Fascia Lata

Access to all courses with monthly membership

Brookbush Institute

I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

Brookbush Institute has the most detailed, specific and effective tools for online learning for movement and/or bodywork professionals. I love the combination of the videos as well as the text available online.

I recently completed the CPT course. It was demanding yet practical. I would highly recommend it for anyone wanting an education about human movement.

I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

The H.M.S. is the most valuable certificate I have earned and was a fraction of the the cost of my others. Define the best bang for your buck!

Brookbush is the most efficient Personal Training Certification I have ever come across. All the lessons are well thought out and very straight to the point.

I am getting my Master's degree in Kinesiology, and I would like to say that I have benefited greatly from the rich, comprehensive, well-documented scientific content of Brookbush Institute that links theory to practical applications. Proudly I've got my CPT certificate, and I am on my way to get my HMS certificate.

Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



I have been a member of BBI for years and every course I have taken has been incredibly informative. I learn more from these courses than I do at local CEU courses for my PTA license. I also earned my CPT and HMS certifications through the platform. It was so convenient and the content was top notch! Forever member.

We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

Brookbush has been incredibly helpful since I was in massage school and now as I’m in my career! I run my own practice and it gives me the resources I need to not only improve what I already know, but also help me navigate better, more efficient ways of treatment.

Totally loving the convenience and affordability of this program with my crazy lifestyle! I feel like I am getting a quality education without a massive cost! My favorite part is the videos I can watch in the courses. I learn so much better that way. Once I really spent more time on the site, I figured out how to maneuver around a lot better! I enjoy the sense of humor, as well as the easy explanation, and short tests. And if I am really tired, I can have the computer read me the lessons. 😁

Challenging concepts are explained in very understandable terms without dumbing down the material, and I find this program to be superior in quality to other personal training programs.

Home

Courses

Course Summary: Fascia Lata (Thigh) Instrument Assisted Soft Tissue Mobilization (IASTM)

This course describes instrument-assisted soft tissue mobilization (IASTM) of the fascia lata (thigh fascia), including the IASTM intended for the superficial fascial sheaths overlying the quadriceps (vastus lateralis, rectus femoris, and vastus medialis), the hamstrings (semitendinosus, semimembranosus, and biceps femoris), and the adductors (adductor longus, gracilis, and adductor Magnus). Additionally, modifications of these techniques are discussed, including specific techniques for addressing trigger points, and pin and stretch (a.k.a. active or dynamic release) techniques with IASTM tools. This course does not cover the fascial sheaths below the knee, which are covered in a separate course (

Unfortunately, it is easy to be confused by a large number of synonyms for the techniques in this course. Instrument-assisted soft tissue mobilization (IASTM) is a technique that generally includes the application of shear force (scraping) to skin and superficial fascia using a tool with a rounded, but relatively acute edge. IASTM could be viewed as a Western approach to a Traditional Chinese Medicine (TCM) technique called Gua Sha. While the application of IASTM is most commonly based on orthopedic assessment with stainless steel tools, the application of Gua Sha is based on TCM-specific assessments with jade or stone tools. Graston is the most well-known brand of IASTM stainless steel tools; however, we do prefer 

 based on their quality, edge, and price. Note, historically the origin of these techniques is undoubtedly Gua Sha, which is perhaps 1000s of years old, Graston popularized IASTM in the Western world, and now there are many brands and tools to choose from.

The IASTM techniques in this course are recommended as an adjunct mobility technique, included in an integrated program that already includes, or has considered, soft-tissue release techniques, joint mobilization and manipulation techniques, and/or stretching techniques. The addition of the techniques described in this course may be especially beneficial for individuals assessed with range of motion (ROM) restriction of the hip or knee. Additionally, they may be included in a program designed to address low back pain, adductor strain, hamstring strain, or knee pain. Further, these techniques may be beneficial for those with assessed impairments, including hamstring flexibility issues (hamstring length test, straight leg raise test, or sit-and-reach test), or a loss of hip abduction, adduction, or extension ROM.

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.) who intend to develop an 

, patient-centered, and outcome-driven approach.

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

Introduction: Fascia Lata (Thigh) IASTM

When fascia lata (thigh) IASTM is performed on healthy individuals with the intent to address an assessed reduction in mobility, improvements are likely similar to those achieved with manual release, massage, vibration, manual stretching, self-myofascial release, and flossing. Additionally, IASTM may improve force production, strength, power, agility, delayed onset muscle soreness, and swelling. However, fascia lata IASTM may be most effective when added to a therapeutic intervention plan with the intent to address injury and pain. Several studies have demonstrated that adding fascia lata IASTM to exercise, stretching, and/or "conventional modalities" results in significantly larger improvements in tissue healing, pain pressure threshold, strength, passive joint stiffness, functional outcome measures, and potentially 2-point discrimination and fascial mobility. The Brookbush Institute recommends adding plantar and crural fascia IASTM to an integrated intervention plan, designed to address movement impairments assessed with reliable objective outcome measures, to enhance carry-over from session to session and client/patient outcomes.

Correlated Postural Dysfunction and Movement Impairment

Knee Extension with Hip Flexion Goniometry (Hamstring Length Test 

Hip Internal Rotation in Supine (with hip and knee at 90°/90°)

Hip External Rotation in Supine (with hip and knee at 90°/90°)

Gluteus Medius Manual Muscle Testing (MMT)

: Weak with compensation (bias toward flexion implying synergistic dominance of 

Gluteus Maximus Manual Muscle Testing (MMT

): With Compensation ((excessive lumbar extension, knee flexion, and/or adduction implying synergistic dominance of erector spinae, biceps femoris, and/or adductor magnus)

Patient: 25-year-old athletic female with a history of ACL reconstruction and chronic knee pain.

: Weak or weak with compensation (bias toward flexion implying synergistic dominance of 

Gastrocnemius and Soleus Static Manual Release

Instrument Assisted Soft Tissue Mobilization

 Light to Moderate (60 - 85% of 1-RM), focus on form and ROM

 Circuit training, 1 min rest between exercises

 5 - 15 minutes (excluding mobility interventions)

Quick Tibialis Anterior and Tibial Internal Rotator Activation

Resisted Single-Leg Balance and Heel Touch to Step

Static Lunge to Unilateral Row (Front Foot on Unstable Surface)

When fascia lata (thigh) IASTM is performed on healthy individuals with the intent to address an assessed reduction in mobility, improvements are likely similar to those achieved with manual release, massage, vibration, manual stretching, self-myofascial release, and flossing. Additionally, IASTM may improve force production, strength, power, agility, delayed onset muscle soreness, and swelling. However, fascia lata IASTM may be most effective when added to a therapeutic intervention plan with the intent to address injury and pain. Several studies have demonstrated that adding fascia lata IASTM to exercise, stretching, and/or "conventional modalities" results in significantly larger improvements in tissue healing, pain pressure threshold, strength, functional outcome measures, and potentially 2-point discrimination and fascial mobility. The Brookbush Institute recommends adding fascia lata IASTM to an integrated intervention plan, designed to address movement impairments assessed with reliable objective outcome measures, to enhance carry-over from session to session and client/patient outcomes.

Research Summary: Fascia Lata (Thigh Fascia)

IASTM compared to Manual Soft Tissue Techniques

IASTM compared to Manual Release, Massage, and Vibration: 

When performed on healthy individuals, IASTM, manual release, massage, and vibration result in similar improvements in hamstring extensibility. However, when treating an adductor strain, improvements in pain, tissue healing, ROM, and strength are likely to occur more following a combination of exercise and IASTM, when compared to a combination of exercise and stretching, massage, or ultrasound.

Healthy individuals may exhibit similar improvements in hamstring flexibility following IASTM or stretching for the hamstrings; however, IASTM may result in improvements in hamstring power. Further, individuals with low back pain may exhibit similar improvements in pain following IASTM or stretching of the hamstrings; however, IASTM is likely to result in larger improvements in hamstring flexibility.

IASTM compared to Active Stretching, Hold-Relax Stretching, and Strain-Counterstain: 

Tensor fascia lata (TFL) IASTM alone is likely less effective than an active hip flexor stretch for increasing hip adduction ROM. However, IASTM may be more effective than hold-relax stretching and strain-counter strain, for improving pain pressure threshold, peak quadriceps strength, peak quadriceps to hamstring muscle strength ratio, and passive knee stiffness.

IASTM and Stretching/Exercise Compared to PNF Stretching, Stretching with TENS, and Mulligan's Bent Leg Raise: 

IASTM and stretching, PNF stretching, and TENS and stretching likely result in similar improvements in hamstring and/or abductor extensibility. However, individuals with low back pain may exhibit larger improvements from a combination of Mulligan's Bent Leg Raise and manual hamstring stretching when compared to IASTM and stretching of the hamstrings.

IASTM compared to Self-myofascial Release

IASTM Compared to Foam Rolling or "The Stick": 

It is likely reasonable to suggest that IASTM, foam rolling, and "The Stick," when used alone, result in similar improvements in mobility, strength, and power.Note that Sandrey et al. (2020) demonstrated that IASTM may be more effective than foam rolling for improving biceps femoris fascial mobility, which may imply a more specific application of IASTM worthy of additional research.

IASTM compared to Foam Rolling, Stretching, or Flossing: 

When IASTM, foam rolling, stretching, and flossing are compared, flossing and IASTM may result in larger improvements in mobility. However, research also demonstrates that all of these interventions are effective, and often result in similar improvements in mobility.

IASTM and Exercise Compared to Exercise: 

The addition of IASTM to an exercise program intended for the treatment of injury and/or pain, is likely to result in significantly larger improvements in pain, mobility, strength, and function.

Additional Comparisons: Kinesiology Tape, Mobilizations, and Microcurrent:

 Adding kinesiology tape or IASTM to "conventional physical therapy" is likely to result in better low back pain outcomes. The addition of IASTM to the lumbar spine and nerve mobilizations may also improve low back/SIJ pain outcomes. And, IASTM likely has a larger effect on post-exercise fatigue than microcurrent.

Comparing IASTM for Different Body Parts: 

IASTM for the posterior trunk and posterior thigh may result in similar improvements in passive straight leg raise ROM, IASTM for the upper lateral line and lower lateral line may result in similar improvements in hip adduction ROM, and IASTM for the quadriceps or calves may result in similar small improvements in vertical jump height and peak power. Additionally, Kasakos et al. (2020) demonstrated that scalene IASTM may improve active hip abductor ROM more than adductor IASTM, potentially implying a systemic neurological response.

Individuals with assessed reductions in hamstring ROM exhibit significant improvements in extensibility following posterior thigh IASTM.

The Effects of IASTM on Strength, Peak Force, and Power: 

Lower extremity IASTM, performed on injured or healthy individuals, may result in significant improvements in concentric and eccentric strength and power (e.g., during a manual muscle test), dynamic postural stabilization (e.g., reduction in knee valgus), maximal force output (e.g., during a leg press), and may result in improvements in peak power, vertical jump height, agility, and sprint times.

IASTM with Active ROM and IASTM with Stim: 

These studies suggest that IASTM with active ROM (similar to the IASTM pin-and-stretch techniques demonstrated in the videos below), and IASTM with TENS are likely to improve ROM, strength, endurance, balance, agility, and power; however, research is needed to compare these modifications to more conventional IASTM protocols.

Additional Findings: Skin Temperature, 2-point Discrimination, DOMS, and Swelling:

 These studies demonstrate that IASTM may increase skin temperature for more than an hour, increase 2-point discrimination, increase pain pressure threshold (decrease pain), and potentially decrease post-exercise (delayed onset muscle soreness) DOMS and swelling.

Position Statement and Research Summary

Research Review: Fascia Lata IASTM

IASTM compared to Massage, Manual Release, and Vibration

IASTM compared to Massage and Manual Release

Several studies have compared instrument-assisted soft tissue mobilization (IASTM) to massage and manual release techniques. Hampton et al. compared 30 males and females (age: 23.9 ± 3.3 years) with less than 80° hip flexion during a passive straight leg raise test (hamstring flexibility), and no history of femur fractures, hip fractures, or skin allergies. Participants were randomly assigned to a massage group, or an IASTM group for 1 session. The manual massage protocol was performed for 17 min, in a prone and supine position, beginning with effleurage for 5 min, petrissage for 5 min with the hamstring relaxed, petrissage for 5 min with the hamstring on light stretch, and effleurage again for 2 min. The IASTM protocol included 5 min of riding a stationary bike as a warm-up, 10 min of IASTM (with an additional 3 min if necessary for restrictions in the hamstrings), in a prone and supine position, with the stainless steel GT5, GT4, and GT3 tools from Graston, using 2 min of scanning strokes with the hamstring relaxed, 4 min of fanning strokes with the hamstring relaxed, 4 min of fanning strokes with the hamstring on light stretch, and an additional 3 min of J-strokes as determined by the clinician, followed by 30 sec of manual static stretching of the hamstrings. The findings demonstrated that both groups exhibited statistically significant and similar increases in hamstring flexibility (measured with a digital inclinometer in a passive straight leg raise), and improvements in the Global Rating Scale of Change scores (1). An RCT, Spinoso et al., compared 45 healthy female university students (age: 24.30 ± 3.10 years) with no history of degenerative diseases, injuries, or trauma of the lower extremities. Participants were randomly assigned to a control group, a manual release group, or an IASTM group for 1 session. The control group did not receive any intervention. Manual release was performed for 10 min in a prone position, with the thumbs and fingers of the therapist, with emollient, using proximal to distal and distal to proximal strokes, with moderate pressure, over the hamstring of the dominant leg. IASTM was performed for 10 min in a prone position, with a stainless steel tool from Gustavo Pilon, with emollient, using proximal to distal and distal to proximal strokes, with uniform and moderate pressure over the hamstring of the dominant leg. The findings demonstrated that both intervention groups exhibited statistically significant and similar increases in range of motion (ROM) during the sit and reach test, and forward bending (measured with the third finger to the ground test). The IASTM group exhibited a statistically significant increase in popliteal angle (measured with a digital camera), and despite the manual release group not achieving a statistically significant increase in popliteal angle, the differences between groups were not significant. Note, that the control group did not exhibit significant differences in any outcome measure (2). These studies imply that IASTM, massage, and manual release result in similar improvements in hamstring extensibility when performed on healthy individuals.

IASTM compared to Massage, Vibration, Ultrasound, and Exercise

Additional studies compared the effects of massage and IASTM, as well as vibration, ultrasound, and exercise. Koumantakis et al. compared 16 healthy males (age: 23.7 years) with no history of injury to the lower extremity or any injury in the previous 12 months. Participants were randomly assigned to a massage group, a vibration group, or an IASTM group for 1 session. Massage was performed for a total of 8 min in a prone position, applied by hand, with emollient, effleurage with light pressure, over the hamstring of the dominant leg. The vibration protocol included 3 min of massage, followed by 5 min of vibration, in a prone position, with a vibration device from Beurer, at 47 Hz, using distal to proximal strokes, over the hamstrings of the dominant leg. The IASTM protocol included 3 min of massage followed by 5 min of IASTM in a prone position with a stainless steel handlebar tool from ArthroTools, emollient, at a 30-60° angle to the skin, using sweeping strokes in all directions, with moderate pressure, over the hamstrings of the dominant leg. The findings demonstrated that all 3 groups exhibited statistically significant and similar increases in ROM during the single-leg sit-and-reach test and a trend toward improvements in joint position sense (measured with a smartphone level) (3). Zaghloul et al. compared 46 females (age:19-37 years) with evidence of hip adductor injuries, including palpation of the adductor muscles resulting in severe tenderness, moderate ecchymosis, and edema over the medial thigh, with no history of previous orthopedic injuries, corticosteroid injections, or skin allergies. Participants were randomly assigned to an exercise-only group, an ultrasound and exercise group, a deep friction massage and exercise group, or an IASTM and exercise group for 5 weeks, 3 sessions/week, for a total of 15 sessions. The exercise included manual static stretching for 5 min (deep squatting, frog leg stretch, and abdominal stretch in prone) and strengthening for 10 min, including 5 exercises (ball squeeze with both knees, tube around the ankles, hip adduction away from a wall, hip extension, and push against a ball on a wall with the leg turned out). Note this publication was translated into English, resulting in some poor descriptions. Details of the protocols used were not reported for Ultrasound and Deep Friction Massage. The first 6 sessions of the IASTM protocol included 8 min/session (approximately 5 min prior to exercise and 3 min after exercise), with 350-550 grams of pressure, and sessions 7 - 15 included 5 min/session (approximately 3 min before exercise and 2 min after exercise), with 500-750 grams of pressure. All IASTM sessions were performed with a stainless steel tool from M2T Blade using inferior to superior strokes and a slow (80 strokes/min) tempo over the hip adductors. The findings demonstrated that the IASTM and exercise group exhibited the largest decreases in pain intensity, increases in passive hip adduction range of motion (ROM), increases in adduction strength, and increases in tissue healing (measured with ultrasound imaging). The exercise and ultrasound group exhibited the next largest and also statistically significant improvements in outcomes. The deep friction massage and exercise group did not exhibit significant changes in pain intensity, passive hip adduction ROM, or hip adduction strength, but did exhibit significant increases in tissue healing when compared to the exercise-only group. The exercise-only group exhibited the least improvement (4). These studies imply that IASTM, vibration, and massage may result in similar improvements in hamstring extensibility when performed on healthy individuals. However, when treating an adductor strain, improvements in pain, tissue healing, ROM, and strength are likely to occur more following a combination of exercise and IASTM when compared to a combination of exercise and stretching, massage, or ultrasound.

A surprising number of studies compare IASTM to stretching. Osailan et al. compared 23 non-athletic males (age: 22.2 ± 1.3 years) with a straight leg raise test of 65° or less and no history of injury to the hamstrings, radiating symptoms in the back or lower extremities, and no history of lower extremity fracture. Participants were randomly assigned to a manual static stretching group, or an IASTM group for 1 session. Manual static stretching was performed for a total of 3 min, in a supine position, with the therapist passively moving the participant's hip into flexion and knee into extension, for 3 sets, 30-sec hold/set, with a short (30 sec) rest between sets. IASTM was performed for 2 min in a prone position, using a stainless steel handlebar tool, with emollient, and proximal to distal and distal to proximal strokes over the hamstrings. The findings demonstrated that both groups exhibited statistically significant and similar increases in active hip ROM (measured with a goniometer), only the IASTM group exhibited a significant increase in hamstring power (measured with a dynamometer), but neither group exhibited significant improvement in hamstring peak torque (5). Moon et al. compared 24 males and females (age: 35.25 ± 5.86 years) with nonspecific low back pain for at least 2 months, more than 3/10 pain intensity, a passive straight leg raise of 70° or less, and no history of neurological disorders. Participants were randomly assigned to a manual static stretching group or an IASTM group for 1 session. Manual static stretching was performed for a total of 65 sec, in a supine position with the involved hip flexed, knee extended, and the opposite hip and lumbar spine stabilized, with the initial stretch held for 5 sec, followed by 3 additional increases in knee extension, each held for 5 seconds, with the final increase in knee extension maintained for 45 seconds ("and then the antagonist muscle was stimulated” after the stretch). IASTM was performed for 60 sec, in a prone position with the knee flexed 30 - 60°, using the GT1 stainless steel handlebar tool from Graston, massage cream as an emollient, using proximal to distal strokes, with a slow tempo (30 strokes/min), over the hamstrings. The findings demonstrated that both groups exhibited statistically significant and similar decreases in low back pain intensity (measured with the visual analog scale). Both groups also exhibited significant increases in hamstring flexibility (measured with the sit and reach test); however, the IASTM group exhibited significantly larger increases (6). These studies suggest that healthy individuals may exhibit similar improvements in hamstring flexibility following IASTM or stretching for the hamstrings; however, IASTM may result in improvements in hamstring power. Further, individuals with low back pain may exhibit similar improvements in pain following IASTM or stretching of the hamstrings; however, IASTM is likely to result in larger improvements in hamstring flexibility.

IASTM compared to Active Stretching, Hold-Relax Stretching, and Strain-Counterstain

Additional studies compare IASTM to a variety of stretching techniques. An RCT by Lim et al. compared 20 males (age: 30.70 ± 5.03 years) with shortened tensor fascia latae (TFL) muscles, a positive Ober's test, and no history of surgery or lower extremity abnormality. Participants were randomly assigned to an active stretching group, or an IASTM group for 1 session. The active stretching protocol was performed for a total of 10 min, with the participant holding a dowel for balance, in a kneeling position on the knee of the target hip, while actively extending, adducting, and externally rotating the hip until a stretch was felt in the TFL, for 10 sets, 30 sec hold/set, with a short (30 sec) rest between sets. IASTM was performed for approximately 5 min, in a side-lying position with the hip flexed to 45° and the knee flexed to 90°, with a stainless steel tool from Dr. YOUSTM, using emollient, and horizontally applied strokes from proximal to distal, over the tensor fascia lata. The findings demonstrated that both interventions resulted in statistically significant increases in hip adduction ROM (measured with a smartphone goniometer); however, active stretching resulted in significantly larger increases. Neither intervention significantly improved TFL stiffness (measured with the Myosin device) (7). Kim et al. compared 45 non-athletic males and females (age: 21.96 ± 2.20 years ) with a 

 of 20° or more and no history of neuromuscular or skeletal impairments (e.g., muscle weakness, numbness, pain), or lower extremity surgery. Participants were randomly assigned to a hold-relax stretch group, a strain-counterstain group, or an IASTM group for 1 session. The hold-relax stretch was performed in a supine position (strap over the ASIS and mid-thigh of the opposite leg) by passively extending the knee to the first resistance barrier, holding at the first resistance barrier for 7 sec, and then returning to the starting position, and relaxing for 5 sec. Strain-counterstain was performed for about 90 sec in a prone position, with sustained pressure over hamstring tender points until the practitioner felt a release, and repeated until passive knee extension ROM improved. IASTM was performed for 1-2 min in a prone position, using the Y1 stainless steel tool from Dr. YOUSTM, with massage cream as an emollient, using proximal to distal strokes, with pressure insufficient to induce pain, over the hamstring. The findings demonstrated that all groups exhibited statistically significant decreases in pain pressure threshold (measured with an algometer), increases in peak quadriceps strength, peak quadriceps to hamstring muscle strength ratio (measured with a dynamometer), and decreases in passive knee stiffness (measured with a dynamometer). However, the IASTM group exhibited significantly larger improvements in all outcome measures (8). These studies imply that tensor fascia lata (TFL) IASTM alone is likely less effective than an active hip flexor stretch for increasing hip adduction ROM. However, IASTM may be more effective than hold-relax stretching and strain-counter strain for improving pain pressure threshold, peak quadriceps strength, peak quadriceps to hamstring muscle strength ratio, and passive knee stiffness.

IASTM with Stretching or Exercise Compared to PNF Stretching, Stretching with TENS, and Mulligan's Bent Leg Raise

Additional studies compare combinations of techniques, including IASTM and stretching. An RCT by Chintamani et al. compared 212 healthy males and females (age: 18-25 years) with more than 20° of active knee extension, no history of injury to the lumbar spine or knee in the previous 6 months, and no sign of systemic disease (e.g. neurological disease). Participants were randomly assigned to a Mulligan's Bent Leg Raise and manual static stretch group, or an IASTM and manual static stretch group for 1 session. Mulligan's Bent Leg Raise was performed for approximately 9 min in a supine position, with the participant's leg on the therapist's shoulder. The participant's hip was flexed (with the knee extended) until discomfort was felt, followed by a 5-sec isometric contraction by the participant, followed by an increase in hip flexion, etc., repeated until a new pain-free end ROM was achieved. IASTM was performed for 10 min, in a prone position, with a stainless steel tool from M2T Blade, with vaseline as an emollient, at a 45° angle to the skin, using superior and inferior strokes, for 30 strokes over the hamstrings. Manual static stretching was performed after each intervention, in the supine position, for 5 reps, 90-sec hold/rep, and a short (30 sec) rest. The findings demonstrated that both groups exhibited statistically significant increases in passive knee extension, active knee extension (measured with a goniometer), and sit and reach ROM; however, the Mulligan Bent Leg Raise group exhibited larger improvements. Further, the Mulligan Bent Leg Raise group exhibited statistically significant increases in the lumbar lordosis (measured with a tape measure as the lumbar lordosis index), and the IASTM group did not (9). An RCT by Gunn et al. compared 40 healthy males and females (age: 32 ± 14.2 years) with less than 80° of hip flexion during a straight leg raise test and no history of recent trauma, open wounds, or serious pathology. Each participant had one leg randomly assigned to a PNF post-isometric relaxation stretch protocol or an IASTM and stretch protocol, and the other leg assigned to a self-administered stretch group for 1 session. The self-administered stretch was performed for a total of 3 min in a supine position, with a strap placed across the plantar surface of the foot, held with both hands, with the knee fully extended, to a stretch at 100% intensity, for 4 reps, 30 sec/rep, with a short (15 sec) rest between reps. PNF stretching was performed for approximately 160 sec in a supine position, with the participant's leg on the therapist's shoulder. The participant's hip was flexed (with the knee extended) to 100% intensity for 30 sec. followed by a 10-sec isometric contraction at 20% of the participant's maximal effort, and this cycle was repeated 4 times. IASTM was performed for a total of 3 min during a self-administered hamstring stretch of the same leg, in a supine position, with an unspecified stainless steel tool, at a 45° angle to the skin, using distal-to-proximal and lateral-to-medial linear strokes, with constant pressure, over the hamstrings. The findings demonstrated that when compared to the self-administered stretch-only leg, both groups exhibited a significantly larger increase in hip flexion ROM (measured with a passive straight leg raise test using an inclinometer). Note that this study did not compare the IASTM and PNF groups, likely due to the large differences in flexibility between groups prior to the intervention (10). Mubashar et al. compared 30 males and females (age: 36.18 ± 5.02 years) with anterior knee pain for 1 month, limited hip abduction, less than 26° of hip adduction, and no history of knee osteoarthritis, symptomatic disc herniation, or surgery of the lower extremity. Participants were randomly assigned to a stretching with electric stim (TENS) group, or an IASTM and exercise group for 2 weeks, 3 sessions/week, for a total of 6 sessions. The stretching with TENS protocol included 2 "iliotibial band stretches," including a manual static stretch in a supine position with the hip over-pressured into adduction by the therapist, and a self-administered stretch in a standing position, with the target leg crossed behind the other leg, shifting the hips toward the target leg, and laterally bending the spine to the opposite side, for 4 sets, of 30 sec hold/set. TENS was applied during both stretches with the electrodes placed over the greater trochanter and the lateral knee (intensity and frequency were not discussed). IASTM was performed in a side-lying position with the hip flexed to 45° and the knee flexed to 90°, using the stainless steel GT3 and GT5 tools from Graston, using emollient, and brushing and strumming strokes over the lateral knee, anterior and posterior to the iliotibial band, Gerdy's tubercle, and the lateral patellar retinaculum. The exercise protocol included side-lying clamshells and side-lying leg raises for 2 sets, 20 reps/sets, with no added resistance. The findings demonstrated that both groups exhibited significant and similar decreases in pain (measured with the numeric pain scale), increased hip abduction ROM (measured with a goniometer), and improved Lower Extremity Function Scale scores. The IASTM and exercise group exhibited significantly larger improvements in hip abduction strength following 3 treatments, and the increase in strength persisted during reassessment at 1 month. Note that the increase in strength is likely attributable to the exercise program (11). These studies imply that IASTM and stretching, PNF stretching, and TENS and stretching likely result in similar improvements in hamstring and/or abductor extensibility. However, individuals with low back pain may exhibit larger improvements from a combination of Mulligan's Bent Leg Raise and manual hamstring stretching, when compared to IASTM and stretching of the hamstrings.

Studies have compared outcomes following IASTM and foam rolling of the thigh muscles. Noreen et al. compared 30 males and females (age: 18-25 years) with straight leg raise ROM between 30-45°, and no history of hamstring injury within the last 2 months, and no surgery to the lower extremities or lumbar disc herniations within the last 6 months. Participants were randomly assigned to a foam rolling group, or an IASTM group for 6 weeks, 2 sessions/week, for a total of 12 sessions. Foam rolling was performed in a seated position, using a 3 ft long and 5.5-inch wide foam roller, over the hamstrings. IASTM was performed in a prone position, using a stainless steel handlebar tool, with emollient, over the hamstrings. The findings demonstrated that both groups exhibited statistically significant increases in hamstring flexibility (measured with the straight leg raise test with a goniometer); however, the IASTM group exhibited a significantly larger increase in flexibility (12). An RCT by Sandrey et al. compared 20 healthy, moderately active males and females (age: 21.2 ± 2.0 years) with soft tissue restriction in the quadriceps and hamstrings, and no history of lower extremity injuries or surgery within the last 6 months. Participants were randomly assigned to a foam rolling group, or an IASTM group, with the non-dominant limb used as a control in both groups, for 3 weeks, 2 sessions/week, for a total of 6 sessions. The foam rolling protocol was performed for 8 min/session, with a dense foam roller, using proximal to distal motions, with pressure insufficient to induce pain, over the gluteals and iliotibial band region, quadriceps region, hamstrings, and adductor regions for 2 sets, 1 min/set over each of the 3 treated areas, with a short (30 sec) rest between sets. IASTM was performed for 8 min/session, in a position dictated by the area being treated (i.e., side-lying, supine, or prone), with the stainless steel Graston GT1, GT2, GT3, GT4, and GT5 tools (dependent on the area being treated), using emollient, beginning with light pressure gradually increased to deeper pressure, over the same regions as the foam rolling protocol. Both groups (foam rolling and IASTM) exhibited an increase in knee extension ROM, but the increase was not statistically significant. The foam rolling group exhibited a trend toward a slightly larger increase when compared to the IASTM group. Additionally, both groups exhibited an increase in rectus femoris and biceps femoris fascial displacement, with a trend toward a larger increase in biceps femoris fascial displacement following IASTM (13). An RCT by Zutshi et al. compared 27 healthy male soccer players (age: 14-18 years) with no history of neuromuscular, orthopedic, or cardiovascular conditions. Participants were randomly assigned to a control group, a foam rolling group, or an IASTM group for 2 sessions. Foam rolling was performed for 5 min/session, using a VPK plain foam roller, for 3 sets/session, 60 sec/set, with a moderate (60 sec) rest/set, over the quadriceps, hamstrings, gastrocnemius, and soleus. IASTM was performed for 9 min/session, using the M2T blade stainless steel teardrop-shaped tool, over the quadriceps, hamstrings, gastrocnemius, and soleus, with muscles relaxed, contracted, and lengthened. The findings demonstrated that the IASTM and foam rolling groups exhibited significant and similar increases in strength (measured with a dynamometer), flexibility (measured with sit and reach), power (measured with a vertical jump), agility (measured with the Illinois Agility Test), and 20m sprint times (14). In summary, 1 study demonstrated that IASTM resulted in larger improvements, 1 study demonstrated that neither IASTM nor foam rolling resulted in statistically significant improvements, and 1 study demonstrated that foam rolling resulted in larger improvements. It is likely reasonable to suggest that IASTM and foam rolling, when used alone, result in similar improvements in mobility, strength, and power. Note that Sandrey et al. (2020) demonstrated that IASTM may be more effective than foam rolling for improving biceps femoris fascial mobility, which may imply a more specific application of IASTM worthy of additional research.

Two studies compared outcomes following either IASTM or self-myofascial release with "The Stick" performed on thigh muscles. An RCT by Lee et al. compared 16 active males and females (age: 23.4 ± 2.4 years) with a hamstring length test of more than 20°, passive hip flexion of less than 70°, and no history of lower extremity injury or surgery in the past 6 months. Each leg of the participants was randomly assigned to either a roller massage group or an IASTM group for 1 session. Roller massage was performed for 3.5 min, in a prone position, using "The Stick" roller massage tool, using proximal-to-distal and lateral-to-medial strokes, pressure within a pain rating between 4-6/10 intensity based on the Wong-Baker FACES Pain Rating Scale, over the hamstrings. IASTM was performed with the same protocol used for "The Stick" roller massage protocol, using the GT1 handlebar tool from Graston. The findings demonstrated that both groups exhibited statistically significant and similar increases in ROM during the hamstring length test and passive hip flexion test (measured with a digital inclinometer) immediately and 48 hours after the intervention (15). An RCT by Stroiney et al. compared 49 male and female recreational athletes (age: 18-25 years) with no known health risk factors or history of musculoskeletal injuries. Participants were randomly assigned to a self-myofascial release group, or an IASTM group for 1 session. All participants performed a warm-up on a cycle ergometer for 5 min. Self-myofascial release was performed for 13.5 min, in a seated position, using "The Stick" hand-held roller, with participant selected stroke pressure, over the gastrocnemius, soleus, quadriceps, and hamstrings. IASTM was performed for 13.5 min in prone and supine positions, using the stainless steel Tecnica Gavilan PTB Garra S-shaped tool or Ala crescent-shaped tool, with ultrasound gel as an emollient, strokes from origin to insertion, over the same muscles as the self-myofascial release group. The findings demonstrated that the amount of pain reported by the participants during each intervention was similar. Neither group exhibited a significant difference in post-intervention sprint performance (40-yd dash); however, the self-myofascial release group exhibited a statistically significant increase in post-intervention vertical jump performance (16). These studies imply that IASTM and "The Stick" may result in similar improvements in flexibility; however, "The Stick" may result in larger improvements in vertical jump performance. Note, considering the study by Stroiney et al. (2020) demonstrated that "The Stick" significantly improved vertical jump performance, but not 40-yd dash times, and mobility was not an outcome measure in this study, conclusions from this study alone should be limited.

IASTM compared to Stretching, Foam Rolling, or Flossing

Several studies compare outcomes following IASTM, foam rolling, stretching, or flossing. Simatou et al. compared 30 healthy university males and females (age: 20.6 ± 0.7 years) with no history of injury in the upper or lower part of the body for at least 1 year and no participation in sports involving increased hip ROM (e.g., martial arts). Participants were randomly assigned to 1 of 6 groups: manual static stretching, lower lateral line foam rolling, upper lateral line foam rolling, whole lateral line IASTM, lower lateral line IASTM, and upper lateral line IASTM, with each participant's non-dominant side acting as a control, for 12 weeks, 1 session/week, for a total of 12 sessions. Manual static stretching was performed for 10 min/session, for the whole lateral line. Foam rolling was performed for 10 min/session, over the assigned region of the dominant-side lateral line. IASTM was performed for 10 min/session, using an unspecified ERGON tool, over the assigned region of the dominant-side lateral line. The findings demonstrated that all groups exhibited statistically significant increases in passive hip adduction (measured with a goniometer). The 3 IASTM intervention groups exhibited significantly larger increases in passive hip adduction ROM compared to the other intervention groups. The upper lateral line IASTM group exhibited the largest increase in ROM, followed by the lower lateral line IASTM group, and then the whole lateral line IASTM group (17). An RCT by Pathania et al. compared 45 males and females (age: 65-75 years) with a 

 ROM of 20-50°, and no history of sutures or fractures in the lower extremities, no history of systemic disease (i.e. neurological, vascular, metabolic, etc.), and no physiotherapy prior to the study. Participants were randomly assigned to a manual static stretching group, a foam rolling group, or an IASTM group for 4 weeks, for 3 sessions/week. Manual static stretching was performed for 3.5 min/session, in a supine position, with the therapist passively moving the participant's hip into flexion and knee into extension, with the ankle in a neutral position, to the first resistance barrier with insufficient force to induce pain, for 3 sets, 30 sec hold/set, with a short (10 sec) rest/set. Foam rolling was performed for 10-15 min/session, with rest periods as needed, in a seated position on the foam roller, with a high-density foam roller, using proximal to distal and distal to proximal strokes, with the position held for 10-15 sec if a trigger point was discovered, over the hamstrings. IASTM was performed for 30-40 sec/session, in a prone position, with a stainless steel tool from M2T Blade, vaseline as an emollient, at a 45° angle to the skin, using multidirectional strokes, with moderate pressure until redness occurred, performed over the hamstrings. The findings demonstrated that all groups exhibited statistically significant increases in ROM during the sit-and-reach test. Additionally, the foam rolling group and IASTM group exhibited statistically significant increases in passive knee extension; however, the manual static stretching group did not. The IASTM group exhibited the most improvement in ROM during both the sit-and-reach test and passive knee extension (18). An RCT by Cheatham et al. compared 30 healthy, active males and females (age: 25.43 ± 2.46 years) with no history of musculoskeletal, systemic, neurosensory, or metabolic conditions. Participants were randomly assigned to a foam rolling group, a floss band group, or an IASTM group, for 1 session. The foam rolling protocol was performed for 2 min, guided by a video demonstration, in a plank position, using a foam roller from Triggerpoint (14 cm diameter, grid surface, hard-hollow core, moderately firm outer EVA foam), using proximal to distal motions, at a slow (1 in/sec) tempo, for 4 reps, followed by knee flexion for 4 reps, over two zones of the left quadriceps (zone 1 from the top of the patella to the middle of the quadriceps, and zone 2 from the middle quadriceps to the anterior inferior iliac spine). The flossing band was applied for 2 min, guided by a video demonstration while performing standing hip flexion/extension for 30 sec, seated knee flexion/extension for 30 sec, and bodyweight squats for 1 min, using a 2-inch wide, latex RockFloss band from RockTape, with 50% overlap, 50% stretch, wrapped from distal to proximal over the left quadriceps. IASTM was performed for 2 min, in a supine position, with the stainless steel Smart Tools crossbar tool, a gel emollient, at a 45° angle to the skin, using superior to inferior and inferior to superior strokes, with 423 grams of pressure, with a moderate, 1 stroke/2 sec tempo, over the left quadriceps. The findings demonstrated that all groups exhibited statistically significant increases in passive knee flexion ROM (measured using The Clinometer Smartphone Application). The floss band group exhibited the largest increase in knee flexion (4.0 ± 0.03°), followed by the IASTM group (3.51 ± 0.81°), and then the foam rolling group (2.33 ± 0.40°) (19). These studies suggest that when IASTM, foam rolling, stretching, and flossing are compared, flossing, and IASTM may result in larger improvements in mobility. However, these studies also demonstrate that all of these interventions are effective, and often result in similar improvements in mobility.

Three studies compare outcomes following the combination of IASTM and exercise to exercise alone. As mentioned above, Zaghloul et al. compared 46 females (age:19-37 years) with evidence of hip adductor injuries, randomly assigned to an exercise-only group, an ultrasound and exercise group, a deep friction massage and exercise group, or an IASTM and exercise group for 5 weeks, 3 sessions/week, for a total of 15 sessions. The findings demonstrated that the IASTM and exercise group exhibited the largest decreases in pain intensity, increases in passive hip adduction range of motion (ROM), increases in adduction strength, and increases in tissue healing (measured with ultrasound imaging). The exercise and ultrasound group exhibited the next largest and also statistically significant improvements in outcomes. The deep friction massage and exercise group did not exhibit significant changes in pain intensity, passive hip adduction ROM, or hip adduction strength, but did exhibit significant increases in tissue healing when compared to the exercise-only group. The exercise-only group exhibited the least improvement (4). An RCT by Lee et al. compared 30 males and females (age: 40.6 ± 14.6 years) with chronic low back pain for less than 12 weeks, with no history of back surgery, spinal fracture, or other trauma within the last 6 months. Participants were randomly assigned to an exercise-only group, or an IASTM and exercise group for 4 weeks. The exercise protocol included 10-15 min/session of stretching exercises (specific exercises were not discussed), for 3 sets, 15 reps/set, with a short (1 min) rest between sets, followed by stationary cycling. IASTM was performed for approximately 40 sec/area/session, for a total of approximately 5 min/session, in a position dictated by the area being treated (i.e., kneeling, prone, and side-lying), with a stainless steel tool from DR. YOUSTM, at a 45° angle to the skin, using strokes parallel and perpendicular to the muscle fibers for 20 sec/area/session, over the posterior fascia of the lumbar spine, the sacrum, the lateral rotators of the hip, and the hamstrings. The findings demonstrated that both groups exhibited statistically significant increases in lumbar flexion, extension, lateral flexion, and hip flexion ROM (measured using an unnamed smartphone inclinometer application); however, the addition of IASTM resulted in significantly larger increases in all measured ROMs. Note, that the exercise-only group exhibited a decrease in pain that failed to reach statistical significance (20). An RCT by McCormack et al. compared 16 males and females (age: 38-69 years) with insertional Achilles Tendinopathy including posterior heel pain for at least 6 weeks, a Victorian Institute of Sport Assessment Achilles-Specific Questionnaire (VISA-A) score less than or equal to 78, and no history of previous Achilles surgery, neuropathy, pregnancy, or previous treatment for Achilles tendinopathy with eccentric exercise or ASTYM. Participants were randomly assigned to an exercise-only group, or an IASTM and exercise group, for 12 weeks, 2 sessions/week, for a total of 24 sessions. The exercise protocol included eccentric exercises for 2 sessions/day, including heel raises beginning on the unaffected leg, transferring weight to the affected leg, and then slowly lowering the heel of the affected leg, for 3 sets, 15 reps/set, using bodyweight. IASTM was performed for 20-30 min/session, in a prone position, using ASTYM acrylic tools, over the foot, ankle, and knee. Findings demonstrated that both groups exhibited statistically significant and similar decreases in pain, and significant improvements in VISA-A scores and Global Rating of Change (GROC) scores; however, the IASTM and exercise group exhibited significantly larger improvements in VISA-A and GROC scores (21). These studies suggest that the addition of IASTM to an exercise program intended for the treatment of injury and/or pain, is likely to result in significantly larger improvements in pain, mobility, strength, and function.

Additional Comparisons: Kinesiology Tape, Mobilizations, and Microcurrent

Additional studies have compared the effects of IASTM, kinesiology tape, mobilizations, and microcurrent. An RCT by Cakmak et al. compared 30 males and females (age: 37.33 ± 7.14 years) with chronic non-specific low back pain for at least 12 weeks, at least 3/10 pain intensity, and no history of orthopedic disease, structural spinal abnormalities (i.e. scoliosis, kyphosis, or stenosis), neurological disease, and no treatment within the past 6 months. Participants were randomly assigned to a kinesiology tape and conventional therapy group, or an IASTM and conventional therapy group for 3 weeks. Kinesiology tape and IASTM were performed for 2 sessions/week, for 6 total sessions, and conventional therapy was performed for 5 sessions/week, for 15 sessions. Kinesiology tape was applied using Kinesio Tex Tape by KinesioTape, 5 cm wide, with 10-25% stretch, using a "Y" strip and an "I" strip over the lumbar region and a "Y" strip over the hamstrings. IASTM was performed for 11 min/session, with a stainless steel tool by FizyoTools, at a 45° angle to the skin, using vertical, horizontal, and diagonal strokes, over the lumbar paraspinal muscles and the hamstrings. Conventional therapy included 15 min/session of hot packs over the lumbar region, 7 min/session of TENS, with a frequency of 50-100 Hz, duration of 0.05-0.07 msec, 7 min/session of ultrasound, with an intensity of 1.5 W/cm², and a home exercise program including posterior pelvic tilts, prone trunk hyperextensions, bridges, and the cat/camel stretch for 3 sets/session and 10 reps/set. The findings demonstrated that both groups exhibited statistically significant and similar improvements in pain intensity, Roland Morris Disability Index scores, and Beck Depression Inventory scores (22). Qadree et al. compared 20 males (age: 40.30 ± 3.74 years) with sciatica, radicular pain in the lower back for less than 12 weeks, pain with an active straight leg raise between 30-70° (and no pain outside of this range), positive sacroiliac joint dysfunction tests (compression, distraction, and Gaenslen's tests), and no history of a spinal fracture. Participants were randomly assigned to a lumbar traction and nerve mobilization group with and without IASTM for 4 weeks, 3 sessions/week, for a total of 12 sessions. Lumbar traction was performed for 10 min/session, in a supine position, using 30-45 kg of force. Nerve mobilization of the sciatic nerve was performed in a supine position, with the hip flexed, the knee extended, and the ankle dorsiflexed. IASTM was performed for a total of 4 min/session (40 sec/area), in a kneeling and prone position (depending on the area being treated), with the stainless steel Mallet tool from Rocktape, at a 45° angle to the skin, using perpendicular and parallel strokes, over the posterior fascia of the lumbar region, the sacrum, the lateral rotators of the hips, and the hamstrings bilaterally. The findings demonstrated that the addition of IASTM to lumbar traction and nerve mobilization resulted in significantly larger improvements in pain (measured with the numeric pain rating scale), and Oswestry Disability Index (ODI) scores (23). An RCT by Son et al. compared 56 healthy males and females (age: 22.61 ± 0.92 years) able to perform squats, with no history of musculoskeletal disease or pain in the past 2 years, and had not been performing more than 2 sessions/week of high-intensity exercise. Participants were randomly assigned to a control group, a microcurrent group, or an IASTM group for 1 session. To induce muscle fatigue in the quadriceps, participants performed 100 bodyweight squats, without rest, in less than 5 min, with their feet shoulder-width apart, arms crossed in front of their chest, and the trunk straight. The control group did not receive any intervention and rested in a seated position for 15 min. Microcurrent was performed with an EMDOMED682 microcurrent device, with a frequency of 30 pps and an intensity of 100 μA, with two electrodes over the distal vastus lateralis and vastus medalis. IASTM was performed for a total of 6 min, in a supine position, with a stainless steel handlebar tool from FROG, massage cream as an emollient, using proximal to distal strokes, over the vastus lateralis, rectus femoris, and vastus medialis (in that order). The findings demonstrated that neither intervention group exhibited statistically significant decreases in rectus femoris or vastus medialis fatigue (measured with a surface electromyogram), and only the IASTM group exhibited a statistically significant decrease in vastus lateralis fatigue (24). In summary, these studies demonstrate that adding kinesiology tape or IASTM to "conventional physical therapy" is likely to result in better low back pain outcomes, the addition of IASTM to the lumbar spine and nerve mobilizations can also improve low back pain outcomes, and IASTM likely has a larger effect on post-exercise fatigue than microcurrent.

Some studies have compared outcome measures following IASTM on different body segments. An RCT by Fousekis et al. compared 60 healthy males and females (age: 24.4 ± 4.39) with a score of less than 22 on the Sit-and-Reach test, and no history of injury within the last year. Participants were randomly assigned to a control group (no intervention), an IASTM trunk group, and an IASTM lower body group, for 4 weeks, 1 session/week, for 4 total sessions. The IASTM Trunk group received 15 min of "ERGON method" IASTM, in a prone position, with the Ergon stainless steel handlebar tool, over the posterior trunk muscles including the cervical, thoracic, and lumbar paraspinal muscles. The IASTM lower body group received the same protocol using the Ergon stainless steel shark fin tool over the hamstrings, gastrocnemius, and plantar surface of the foot. The findings demonstrated both experimental groups exhibited statistically significant and similar increases in passive hip flexion during a straight leg raise test, and the control group did not exhibit a significant change (25). As mentioned above, Simatou et al. compared 30 healthy university males and females (age: 20.6 ± 0.7 years). Participants were randomly assigned to 1 of 6 groups: manual static stretching, lower lateral line foam rolling, upper lateral line foam rolling, whole lateral line IASTM, lower lateral line IASTM, and upper lateral line IASTM, with each participant's non-dominant side acting as a control, for 12 weeks, 1 session/week, for a total of 12 sessions. The findings demonstrated that all groups exhibited statistically significant increases in passive hip adduction (measured with a goniometer). The 3 IASTM intervention groups exhibited significantly larger increases in passive hip adduction ROM compared to the other intervention groups. The upper lateral line IASTM group exhibited the largest increase in ROM, followed by the lower lateral line IASTM group, and then the whole lateral line IASTM group (17). An RCT by Kazakos et al. compared 40 healthy males and females (age: 29.3 ± 6.3 years) with less than 40° of hip abduction, and no history of spine or lower extremity injury in the last 12 months. Participants were randomly assigned to a scalene or hip adductor IASTM group for 1 session, with the contralateral side used as a control. IASTM was performed for 15 minutes with a stainless steel Ergon tool using short and long linear strokes over the scalenes or the hip adductors (depending on the assigned group). The findings demonstrated that both groups exhibited statistically significant increases in active and passive hip abductor ROM at 0° and 90° of hip flexion (both measured with a goniometer). The scalene IASTM group exhibited significantly larger increases in active hip abduction ROM; however, no significant difference was found in the passive hip abductor ROM, and there was no significant difference exhibited in the control limb in either group (26). An RCT by MacDonald et al. compared 48 physically active males and females (age: 19-39 years) without current soft-tissue injury, skin pathology, dizziness, chest pain, or known heart condition. Participants were randomly assigned to a control group (6 min of seated rest), an IASTM quadriceps group, or an IASTM calf group for 1 session. All participants performed a 5 min warm-up on a Monark cycle ergometer. IASTM for the quadriceps was performed for 6 min, in a long sitting position, with the Tecnica Gavilan stainless steel tools, and ultrasound gel, at a 45° angle to the skin, with sweeping strokes from origin to insertion, with about 250 grams of pressure, over the quadriceps. IASTM for the calves received the same protocol in a prone position, with the foot in slight plantar flexion, over the gastrocnemius and the soleus. The findings demonstrated that both IASTM groups exhibited similar trends toward an increase that failed to reach statistical significance for jump height and peak power (measured with the Vertec Vertical Jump Training System and the Tendo Power Analyzer) (27). These studies imply that IASTM for the posterior trunk and posterior thigh may result in similar improvements in passive straight leg raise ROM, IASTM for the upper lateral line and lower lateral line may result in similar improvements in hip adduction ROM, and IASTM for the quadriceps or calves may result in similar small improvements in vertical jump height and peak power. Additionally, Kasakos et al. (2020) demonstrated that scalene IASTM may improve active hip abductor ROM more than adductor IASTM, potentially implying a systemic neurological response.

As mentioned in several comparative studies above, IASTM for the posterior thigh can significantly improve hamstring flexibility. The following studies demonstrate similar findings; however, they only include comparisons to control groups. Boyer et al. compared 32 healthy young adults (age: 21.2 ± 3.9 years) with a passive knee extension test of less than 60°, no history of lower extremity injury within the past year, and no high-intensity leg workouts 48 hours prior to testing. Participants were randomly assigned to a control group, or an IASTM group for 1 session. The control group received no intervention. IASTM was performed for 12 min, in a supine and prone position, using scanning strokes over the hamstrings. The findings demonstrated that IASTM resulted in a statistically significant increase in hamstring flexibility (measured during hamstring length test with a digital inclinometer) and perceived hamstring flexibility (measured with the visual analog scale) (28). Pathania et al. compared 12 males and females (age: 65-75 years) with a hamstring length test of 20-50°, less than 70° of hip flexion during a passive straight leg raise, no history of sutures or fractures in the lower extremities, and no history of systemic disease (i.e. neurological, vascular, metabolic, etc.). All participants received IASTM for 1 session. IASTM was performed for 1 min, in a prone position with the knee flexed between 30-60°, with a stainless steel M2T Blade tool, vaseline as an emollient, at a 45° angle to the skin, using proximal to distal strokes, with a slow (30 beats/min) tempo, over the hamstrings. The findings demonstrated that IASTM resulted in a statistically significant increase in hamstring length test and passive straight leg raise ROM (measured with a goniometer) (29). Last, Toscaro et al. compared 23 healthy, active males (age: 18-30 years) with no history of lower extremity bone, joint, or muscular injuries. Participants were randomly assigned to a control group, or an IASTM group for 1 session. The control group received no intervention. IASTM was performed for a total of 15 min, in a prone or supine position (depending on the area being treated), with a stainless steel Myotools Edge tool, using emollient, over the quadriceps, hamstrings, and calf muscles. The findings demonstrated that IASTM resulted in statistically significant increases in sit-and-reach test ROM, both 24 and 48 hours after intervention (30). These studies are congruent with studies mentioned previously, demonstrating that individuals with assessed reductions in hamstring ROM exhibit significant improvements in extensibility following posterior thigh IASTM. Author's note, the amount of time IASTM was performed in these studies varied between 1 min and 15 min, implying that the amount of time required to achieve optimal results should be researched further.

The Effects of IASTM on Strength, Peak Force, and Power:

Several studies mentioned above have investigated the effects of lower extremity IASTM on strength and power. Osailan et al. compared 23 non-athletic males (age: 22.2 ± 1.3 years) with a straight leg raise test of 65° or less and no history of injury to the hamstrings, radiating symptoms in the back or lower extremities, and no history of lower extremity fracture. Participants were randomly assigned to a manual static stretching group, or an IASTM group for 1 session. The findings demonstrated that both groups exhibited statistically significant and similar increases in active hip ROM (measured with a goniometer), only the IASTM group exhibited a significant increase in hamstring power (measured with a dynamometer), but neither group exhibited significant improvement in hamstring peak torque (5). An RCT by MacDonald et al. compared 48 physically active males and females (age: 19-39 years) without current soft-tissue injury, skin pathology, dizziness, chest pain, or known heart condition. Participants were randomly assigned to a control group (6 min of seated rest), an IASTM quadriceps group, or an IASTM calf group for 1 session. The findings demonstrated that both IASTM groups exhibited similar trends toward an increase that failed to reach statistical significance for jump height and peak power (measured with the Vertec Vertical Jump Training System and the Tendo Power Analyzer) (27). Last, the RCT by Zutshi et al. compared 27 healthy male soccer players (age: 14-18 years) with no history of neuromuscular, orthopedic, or cardiovascular conditions. Participants were randomly assigned to a control group, a foam rolling group, or an IASTM group for 2 sessions. The findings demonstrated that the IASTM and foam rolling groups exhibited significant and similar increases in strength (measured with a dynamometer), flexibility (measured with sit and reach), power (measured with a vertical jump), agility (measured with the Illinois Agility Test), and 20m sprint times (14). These studies suggest that lower extremity IASTM (and/or foam rolling) is likely to improve hamstring strength and power, and may result in improvements in peak power, vertical jump height, agility, and sprint times.

Again, several of the studies mentioned above, as well as a few noncomparative studies, have investigated the effects of IASTM on strength and force production. As mentioned above, Kim et al. compared 45 non-athletic males and females (age: 21.96 ± 2.20 years ) with a 

 of 20° or more and no history of neuromuscular or skeletal impairments (e.g., muscle weakness, numbness, pain), or lower extremity surgery. Participants were randomly assigned to a hold-relax stretch group, a strain-counterstain group, or an IASTM group for 1 session. The findings demonstrated that all groups exhibited statistically significant decreases in pain pressure threshold (measured with an algometer), increases in peak quadriceps strength, peak quadriceps to hamstring muscle strength ratio (measured with a dynamometer), and decreases in passive knee stiffness (measured with a dynamometer). However, the IASTM group exhibited significantly larger improvements in all outcome measures (8). An RCT by Pisirici et al. compared 44 recreationally active females (age: 21.39 ± 1.79 years) with 10° or more of knee valgus (frontal plane projection angle) during the single-leg squat test. Participants were randomly assigned to a control group or an IASTM group for 6 weeks, 2 sessions/week, for a total of 12 sessions. The control group received no intervention. IASTM was performed for 5 min/session, with an unspecified Graston tool, over the gluteus medius. The findings demonstrated that IASTM resulted in a statistically significant increase in gluteus medius eccentric peak torque (measured with the Spark Motion 2D motion analysis system), and dynamic postural stabilization (measured with the Biodex Stability System) (31). Also mentioned above, Zaghloul et al. compared 46 females (age:19-37 years) with evidence of hip adductor injuries, including palpation of the adductor muscles resulting in severe tenderness, moderate ecchymosis, and edema over the medial thigh, with no history of previous orthopedic injuries, corticosteroid injections, or skin allergies. Participants were randomly assigned to an exercise-only group, an ultrasound and exercise group, a deep friction massage and exercise group, or an IASTM and exercise group for 5 weeks, 3 sessions/week, for a total of 15 sessions. The findings demonstrated that the IASTM and exercise group exhibited the largest decreases in pain intensity, increases in passive hip adduction range of motion (ROM), increases in adduction strength, and increases in tissue healing (measured with ultrasound imaging) (4). Kivlan et al. compared 45 males and females (age: 40 ± 13 years) with a unilateral lower extremity injury, but no history of lumbar spine, shoulder injury, bilateral lower extremity condition, or neuropathy. Participants were randomly assigned to a control group, an IASTM group, or a sham IASTM group for 1 session. The control group received no intervention. IASTM was performed using the ASTYM protocol for 12 min, in the supine and prone positions (depending on the area being treated), with an ASTYM tool, using distal to proximal strokes, over the gluteus maximus, gluteus medius, quadriceps, hamstrings, anterior and lateral lower leg, gastrocnemius, and soleus. Sham IASTM used the same protocol as IASTM with very light "effleurage-like" pressure. The findings demonstrated that the IASTM group exhibited a statistically significant increase in maximal force output (measured during a unilateral isometric leg press machine). No significant changes were exhibited in maximal force output in the sham IASTM group or control group (no intervention) (32). In summary, these studies imply that lower extremity IASTM, performed on injured or healthy individuals, may result in significant improvements in concentric and eccentric strength (e.g., during a manual muscle test), dynamic postural stabilization (e.g., reduction in knee valgus), and maximal force output (e.g., during a leg press).

IASTM with Active ROM and IASTM with Stim

Two studies have investigated the effects of modified IASTM techniques. Kim et al. compared 40 healthy male soccer players (age: 15-17 years) with no history of pathology. Participants were randomly assigned to a control group, or an Active-IASTM group for 12 weeks, 5 sessions/week, for a total of 60 sessions. The control group received no intervention. The IASTM protocol included a jogging warm-up for 10 min/session, and finished with a stretching cool-down (stretching techniques were not reported) for 10 min/session. Active-IASTM was performed for 40 min in a supine and seated position, with the stainless steel Graston GT3 and GT4 tools, at a 45° angle to the skin, using strumming, fanning, and sweeping strokes with light, constant pressure, over the hamstrings, quadriceps, gastrocnemius, and soleus muscles, during active knee extension, knee flexion, calf raises, dorsiflexion, plantar flexion, inversion, and eversion. The findings demonstrated that the IASTM protocol resulted in statistically significant increases in isokinetic power during bilateral ankle plantar flexion and dorsiflexion at a velocity of 30°/sec and 120°/sec, bilateral knee flexion and extension at a velocity of 60°/sec and 180°/sec with the exception of left knee extension. Additionally, there was a decrease in muscle fatigue (measured with an isokinetic force dynamometer), and improvements in all fitness outcome measures (i.e. sit and reach, side step, vertical jump, balance test, ball slalom, slalom, and shuttle run) (33). Another study by Kim et al. compared 32 males (age: 28.63 ± 3.01 years) with low back pain, a pain intensity of 4/10 or more, lasting at least 3 months, and no history of radiating pain in the legs, spinal surgery, or treatment in the past 3 months. Participants were randomly assigned to a control group, or a TENS and IASTM group, for 3 weeks, 2 sessions/week, for a total of 6 sessions. The control group received no intervention. TENS and IASTM were performed simultaneously for a total of 6 min/session, in a standing position with the participant bent forward with elbows on a table, using the Famuscle device that combined TENS and IASTM, a water-based cream as an emollient, using "scratching" strokes, with mild pressure, over the hamstrings for 1 min each, the gluteus maximus muscles for 1 min each, and lumbar region for 2 min. The intensity of electric stimulation was subjectively determined using stimulation insufficient to induce pain. The findings demonstrated that the control and TENS and IASTM group exhibited statistically significant decreases in pain (measured with the visual analog scale and face pain rating scale), increases in hamstring flexibility (measured as hip flexion ROM with an inclinometer during passive straight leg raise), increases in core muscle endurance (measured with the supine bridge test), and improvements in the Oswestry Disability Index score; however, the combination of TENS and IASTM resulted in significantly larger differences in all outcome measures (34). These studies suggest that IASTM with active ROM (similar to the IASTM pin-and-stretch techniques demonstrated in the videos below), and IASTM with TENS are likely to improve ROM, strength, endurance, balance, agility, and power; however, research is needed to compare these modifications to more conventional IASTM protocols.

The studies in this section investigated the effects of interesting outcome measures, that likely deserve further research. Fousekis et al. compared 30 healthy males and females (age: 20 ± 4 years) with a body mass index (BMI) of less than 24. Participants were randomly assigned to a 20° angle IASTM group, a 60° angle IASTM group, or a 90° angle group for 3 weeks, 1 session/week, for a total of 3 sessions, with the non-dominant limb used as a control in each group. IASTM was performed for 10 min/session, in a prone position, with a stainless steel tool from Ergon, at 20°, 60°, and 90° angle to the skin, depending on each participant's assigned group, using circular, diagonal, multidirectional, and linear strokes, with mild (20°), moderate (60°), and high (90°) pressure depending on each participant's assigned group, with a slow (50 bpm) tempo, over the hamstrings of the dominant leg. The findings demonstrated that IASTM at all experimental angles (20°, 60°, 90°) resulted in statistically significant increases in surface temperature (measured using a manual wireless infrared thermometer). IASTM at a 90° angle to the skin resulted in a significantly longer surface temperature retention time (79 min) compared to 20° (64.5 min). The difference in surface temperature retention time was not statistically significant between 90° and 60° (72.5 min) and 60° and 20°. The control limb did not exhibit significant differences in surface temperature (35). Ge et al. compared 23 healthy males and females (age: 25.7 ± 6.4 years) with no history of sensory impairment or conditions that would imply IASTM is contraindicated (e.g., chronic regional pain syndrome, fractures, acute inflammation). Participants received IASTM for 1 session. IASTM was performed for 10 min, in a supine position, with a stainless steel Graston handlebar tool, over the anterior thigh. The findings demonstrated that IASTM resulted in a statistically significant increase in two-point touch discrimination (measured with digital calipers). IASTM also resulted in a trend toward (not statistically significant) increased pain pressure threshold (measured with a hand-held dynamometer) and decreased mean mid-thigh circumference (measured with a tape measure) (36). Cheatham et al. compared 23 healthy, recreationally active males and females (age: 24.22 ± 3.07 years) with no history of musculoskeletal, metabolic, neurosensory, or systemic disease. All participants were assigned to receive an IASTM intervention 24 and 48 hours following exercise-induced delayed onset muscle soreness (DOMS), for a total of 2 sessions. The exercise-induced DOMS protocol included a 5 min warm-up (walking on a treadmill), and drop jumps from a 0.5 m box, for 5 sets, 20 reps/set. IASTM was performed for 90 sec/session, in a supine position, with the stainless steel Mohawk tool from Rocktape, at a 30° angle to the skin, using proximal to distal strokes, with 208 grams of pressure, at a moderate (120 beats/min) tempo over the rectus femoris. The findings demonstrated that 24 and 48 hours post-exercise, IASTM resulted in statistically significant and similar decreases in pain pressure threshold (measured with an algometer) and increases in two-point touch discrimination (measured with an aesthesiometer) (37). These studies demonstrate that IASTM may increase skin temperature for more than an hour, increase 2-point discrimination, increase pain pressure threshold (decrease pain), and potentially decrease post-exercise DOMS and swelling.

IASTM: Technique and Emollient Recommendations

Technique: Instrument Assisted Soft Tissue Mobilization (IASTM)

 Pressure should be sufficient to feel resistance from the target tissue; that is, pressure should be applied to the "first resistance barrier".

 It may be beneficial to increase tissue tension 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 shear force to the target tissue.

The tool angle to the skin should be approximately 30° - 45°.

 Start with long, slow strokes over the full length of the target tissue to note irregularities in tissue consistency.

 Treatment strokes should be shorter, performed at a moderate tempo, in multiple directions, and over tissue assessed as irregular. The goal is to disrupt connective tissue that may be impeding optimal extensibility.

 10 - 30 strokes per region is likely sufficient, with the total dose dependent on the size of the area and the individual's tissue tolerance. Note, that scanning strokes should be included in total strokes.

 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).

 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 "Gua Sha" considered petechiae the goal of treatment, IASTM as taught by the Brookbush Institute, is performed with the intent to increase mobility and potentially decrease tissue sensitivity. 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.

 Addressing active and latent trigger points 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 integrated treatment plan may aid in maintaining the reduction in trigger point over-activity and sensitivity that results from a session.

Advanced Technique - IASTM with Pin and Stretch:

 This technique is "more aggressive" and should likely be used in small doses to address "stubborn" mobility 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 "pin" the tissue in the opposite direction of lengthening (generally, pressure has a distal to proximal vector). This technique may be progressed in intensity with the following additions:  

Static IASTM tool with passive lengthening (manual lengthening by the practitioner)

Dynamic IASTM tool (strokes in the opposing direction) with passive lengthening

Static IASTM tool with active or active-assisted lengthening (lengthening by the client or patient)

Dynamic IASTM tool with active or active-assisted lengthening

Static IASTM tool with active-assisted lengthening and over-pressure (client/patient and practitioner force)

Dynamic IASTM tool with active-assisted lengthening and over-pressure

 As with all techniques, IASTM should only be recommended when indicated by a reliable objective assessment (e.g. goniometry), and continued use should be based on a significant improvement on that assessment (> 5° improvement in ROM). Note, "feelings are not facts".

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.

Choose an emollient that is hypoallergenic, and/or has as few ingredients as possible. Although a fragrance or "moisturizing agent" 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 sensitivity or allergy.

 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 reliability. The best method for improving outcomes is through continuous refinement, based on comparison using a reliable objective outcome measure, following the consistent implementation of a technique.

 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.

If you perform IASTM techniques as part of an integrated 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 kinesiology 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 base 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.

Video and Instruction: Anterior and Medial Fascia Lata

Video and Instruction: Lateral Fascia Lata

Technique and Videos: Fascia Lata IASTM

Case Study: Knee Valgus

Hampton, C. F., Demchak, T. J., Games, K. E., & Eberman, L. E. (2017). Massage and Instrument-assisted Soft Tissue Mobilization Acutely Increase Hamstring Flexibility. 

Spinoso, D. H., Goulart, M., Ferreira, A., & Navega, M. (2022). Analysis of the relationship between hamstring flexibility with muscular strength and its response to myofascial release. 

Manual Therapy, Posturology & Rehabilitation Journal

Koumantakis, G. A., Roussou, E., Angoules, G. A., Angoules, N. A., Alexandropoulos, T., Mavrokosta, G., ... & Papadopoulou, M. (2020). what: A pilot study. 

Journal of Bodywork and Movement Therapies

Zaghloul, H. M. S., Ali, H. A., Ghally, S. A. O., & Abdelsamee, M. Y. A. (2020). Comparison of The Effectiveness of Instrument-Assisted Soft Tissue Mobilization Technique, Ultrasound therapy, or Deep Friction Massage on Fast Recovery and Accelerating Tissue Healing in Groin Strain. 

Osailan, A., Jamaan, A., Talha, K., & Alhndi, M. (2021). Instrument assisted soft tissue mobilization (IASTM) versus stretching: A comparison in effectiveness on hip active range of motion, muscle torque and power in people with hamstring tightness. 

Journal of bodywork and movement therapies

Moon, J. H., Jung, J. H., Won, Y. S., & Cho, H. Y. (2017). Immediate effects of Graston Technique on hamstring muscle extensibility and pain intensity in patients with nonspecific low back pain. 

Lim, J. Y., Nam, S. H., & Kim, K. D. (2022). Effect of Active Stretching and Instrument-Assisted Soft Tissue Mobilization on the Hip Joint Range of Motion and Stiffness of the Tensor Fascia Lata in Subjects with Shortened Tensor Fascia Lata. 

Journal of Musculoskeletal Science and Technology

Kim, D. H., & Lee, J. J. (2018). Effects of instrument-assisted soft tissue mobilization technique on strength, knee joint passive stiffness, and pain threshold in hamstring shortness. 

Journal of back and musculoskeletal rehabilitation

Chintamani R, Metgud S, Heggannavar A. short term effects of instrument assisted soft tissue mobilisation technique versus Mulligan’s bent leg raise technique in asymptomatic subjects with hamstring tightness- a randomised clinical trial. Int J Health Sci Res. 2019; 9(10):50-64.

Gunn, L. J., Stewart, J. C., Morgan, B., Metts, S. T., Magnuson, J. M., Iglowski, N. J., ... & Arnot, C. (2019). Instrument-assisted soft tissue mobilization and proprioceptive neuromuscular facilitation techniques improve hamstring flexibility better than static stretching alone: a randomized clinical trial. 

Mubashar, H., Hassan, D., & Bushra, M. (2022). Effects of Instrumented Assisted Soft Tissue Mobilization (IASTM) Technique Versus Stretching on Ililotibal Band in Patients with Anterior Knee Pain. 

Pakistan Journal of Medical & Health Sciences

Noreen, A., Rashad, A., Iqbal, K., Younas, A., Hassan, M. F., Iqbal, U., & Baby, W. (2021). Comparative effects of graston technique and foam roller on the flexibility of hamstring muscle. Journal of Orthopaedics Trauma Surgery and Related Research, 16(8).

Sandrey, M. A., Lancellotti, C., & Hester, C. (2020). The effect of foam rolling versus IASTM on knee range of motion, fascial displacement, and patient satisfaction. 

Zutshi, K., SK, M. E., & 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)

Lee, J., Young, A., Erb, N. J., & Herzog, V. W. (2020). Acute and residual effects of IASTM and roller massage stick on hamstring range of motion. 

Stroiney, D. A., Mokris, R. L., Hanna, G. R., & Ranney, J. D. (2020). Examination of self-myofascial release vs. instrument-assisted soft-tissue mobilization techniques on vertical and horizontal power in recreational athletes. 

The Journal of Strength & Conditioning Research

Simatou, M., Papandreou, M., Billis, E., Tsekoura, M., Mylonas, K., & Fousekis, K. (2020). Effects of the Ergon® instrument-assisted soft tissue mobilization technique (IASTM), foam rolling, and static stretching application to different parts of the myofascial lateral line on hip joint flexibility. 

Pathania, T., & Muragod, A. R. (2019). Comparative effect of foam roller and M2 T blade on hamstring flexibility in elderly population: A randomized control trial. Indian Journal of Health Sciences and Biomedical Research kleu, 12(2), 160-165.

Cheatham, S., Martinez, R., Montalvo, A., Odai, M., Echeverry, S., Robinson, B., ... & Viecco, K. (2020). Comparison of Roller Massage, Instrument Assisted Soft-Tissue Mobilization, and Floss Band on Passive Knee Motion Among Inexperienced Individuals. Clinical Practice in Athletic Training, 3(3), 24-36. 

Lee, J. H., Lee, D. K., & Oh, J. S. (2016). The effect of Graston technique on the pain and range of motion in patients with chronic low back pain. 

McCormack, J. R., Underwood, F. B., Slaven, E. J., & Cappaert, T. A. (2016). Eccentric exercise versus eccentric exercise and soft tissue treatment (Astym) in the management of insertional Achilles tendinopathy: a randomized controlled trial. 

Additional Comparisons: Kinesiology Tape, Mobilizations, and Microcurrent 

ÇAKMAK, Ö., ATICI, E., & GÜLŞEN, M. THE EFFECTS OF INSTRUMENT-ASSISTED SOFT TISSUE MOBILIZATION AND KINESIO TAPING ON PAIN, FUNCTIONAL DISABILITY AND DEPRESSION IN PATIENTS WITH CHRONIC LOW BACK PAIN: A RANDOMIZED TRIAL. 

Türk Fizyoterapi ve Rehabilitasyon Dergisi

Qadree, M. S., Shakil-Ur-Rehman, S., Riaz, M. U., Anees, M., & Rajput, H. (2022). EFFECTS OF GRASTON INSTRUMENT SOFT TISSUE MOBILIZATION IN PATIENTS WITH SCIATIC NERVE ENTRAPMENT. 

Son, H. H. (2018). Effect of graston technique on fatigue recovery after High-Intensity exercise of the quadriceps femoris. 

Journal of the Korean Society of Physical Medicine

Fousekis, K., Eid, K., Tafa, E., Gkrilias, P., Mylonas, K., Angelopoulos, P., ... & Tsepis, E. (2019). Can the application of the Ergon® IASTM treatment on remote parts of the superficial back myofascial line be equally effective with the local application for the improvement of the hamstrings’ flexibility? A randomized control study. 

Kazakos, D., Liapis, A., Mylonas, K., Angelopoulos, P., Koubetsos, A., Tsepis, E., & Fousekis, K. (2020). Treatment of scalene muscles with the Ergon technique can lead to greater improvement in hip abduction range of motion than local hip adductor treatment: a study on deep front line connectivity. 

MacDonald, N., Baker, R., & Cheatham, S. W. (2016). The effects of instrument assisted soft tissue mobilization on lower extremity muscle performance: a randomized controlled trial. 

International journal of sports physical therapy

Boyer, S., Novack, J., Madsen, L. P., Kingma, J. J., Schrader, J. W., & Docherty, C. L. (2017). The immediate effects of graston technique© on hamstring flexibility compared to a control. 

Pathania, A. R. M. T. (2018). Immediate effects of M2T blade on hamstring flexibility in elderly population: A pilot study. IJAR, 4(1), 265-267.

Toscaro, C. G., Gonçalves, R., Quarto, B. F., Neto, L. F. M., Braz, I. A., & Jambassi Filho, J. C. (2022). Effects of Myofascial Mobilization on Flexibility in Young Men Adults. 

Pişirici, P., & Şakul, B. U. (2020). Investigation the effect of Graston Technique on strength and postural stabilization in individuals with asymptomatic dynamic knee valgus. Gait & Posture, 81, 279-280.

Kivlan, B. R., Carcia, C. R., Clemente, F. R., Phelps, A. L., & Martin, R. L. (2015). The effect of Astym® Therapy on muscle strength: a blinded, randomized, clinically controlled trial. 

Kim, J., & Yim, J. (2018). Instrument-assisted soft tissue mobilization improves physical performance of young male soccer players. 

Kim, Y. K., Cho, S. Y., & Lee, K. H. (2021). Effects of transcutaneous electrical nerve stimulation and instrument-assisted soft tissue mobilization combined treatment on chronic low back pain: a randomized controlled trial. 

Journal of Back and Musculoskeletal Rehabilitation

Fousekis, K., Varda, C., Mandalidis, D., Mylonas, K., Angelopoulos, P., Koumoundourou, D., & Tsepis, E. (2020). Effects of instrument-assisted soft-tissue mobilization at three different application angles on hamstring surface thermal responses. 

Ge, W., Roth, E., & Sansone, A. (2017). A quasi-experimental study on the effects of instrument assisted soft tissue mobilization on mechanosensitive neurons. 

Cheatham, S. W., Kreiswirth, E., & Baker, R. (2019). Does a light pressure instrument assisted soft tissue mobilization technique modulate tactile discrimination and perceived pain in healthy individuals with DOMS? The Journal of the Canadian Chiropractic Association, 63(1), 18.

IASTM: Fascia Lata

Related Courses:

Course Summary: Fascia Lata (Thigh) Instrument Assisted Soft Tissue Mobilization (IASTM)

Introduction: Fascia Lata (Thigh) IASTM

Position Statement and Research Summary

Research Review: Fascia Lata IASTM

IASTM: Technique and Emollient Recommendations

Technique and Videos: Fascia Lata IASTM
2 Sub Sections

Case Study: Knee Valgus

Bibliography

Related Courses:

Comments

Guest

IASTM: Fascia Lata

Related Courses:

Course Summary: Fascia Lata (Thigh) Instrument Assisted Soft Tissue Mobilization (IASTM)

Introduction: Fascia Lata (Thigh) IASTM

Position Statement and Research Summary

Research Review: Fascia Lata IASTM

IASTM: Technique and Emollient Recommendations

Technique and Videos: Fascia Lata IASTM2 Sub Sections

Case Study: Knee Valgus

Bibliography

Related Courses:

Comments

Guest

Technique and Videos: Fascia Lata IASTM
2 Sub Sections