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IASTM: Comprehensive Systematic Research Review Audio

The most comprehensive systematic research review ever performed on instrument-assisted soft tissue mobilizations (IASTM). The findings may surprise you. Is IASTM really better than massage, joint mobilizations, or foam rolling?

IASTM: Comprehensive Systematic Research Review

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What is Instrument Assisted Soft Tissue Mobilization (IASTM)? 

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.

 Research suggests that IASTM is best used for improving range of motion (ROM) when a loss of mobility has been assessed. However, research also suggests that IASTM is effective for improving pain, pain pressure threshold, disability, function, balance, exercise recovery, and altering fascial mobility.


Graston is the most well-known brand of IASTM stainless steel tools. Historically the origin of IASTM is undoubtedly Gua Sha, which is perhaps 1000s of years old, Graston popularized IASTM in the Western world with a western orthopedic medicine approach, and this course, and related courses (listed below), have refined this approach with the most comprehensive research reviews to date.

Does IASTM actually break up scar tissue?

 "Break up" is likely too simple of a term to describe the effect that IASTM has on scar tissue, fascial tissue, and the neuromuscular system. Research has demonstrated that IASTM affects fascial mobility, as well as resulting in changes in neuromuscular reflex, serum concentrations of inflammatory markers, and tissue remodeling.

 Studies suggest that IASTM will result in less improvement in range of motion (ROM) than specific manual techniques (e.g. static manual release techniques, dry needling, and joint mobilizations/manipulations), similar improvements as massage and tissue flossing, and larger improvements than self-administered mobility techniques and most modalities (self-myofascial release, stretching, kinesiology tape, vibration, TENS, shockwave, and heat). Most studies also demonstrate that IASTM is as effective or more effective than other techniques for improving pain, pain pressure threshold, disability, and function.

Brookbush Institute Research-based Summary Statement:

Studies suggest that IASTM will result in less improvement in range of motion (ROM) than specific manual techniques (e.g. static manual release techniques, dry needling, and joint mobilizations/manipulations), similar improvements as massage and tissue flossing, and larger improvements than self-administered mobility techniques and most modalities (self-myofascial release, stretching, kinesiology tape, vibration, TENS, shockwave, and heat). Most studies also demonstrate that IASTM is as effective or more effective than other techniques for improving pain, pain pressure threshold, disability, and function. The addition of IASTM to exercise, stretching, manual soft tissue techniques, joint mobilizations, and/or conventional therapy results in significant improvements in ROM, pain, and function. IASTM may also significantly improve strength and performance when used to address an assessed mobility restriction, and may significantly improve recovery from exercise, mitigate performance declines during a sporting season, and contribute to larger strength gains from a weight training program. The Brookbush Institute recommends that IASTM be used as an additional manual mobility technique following release techniques and joint mobilizations to address assessed ROM restrictions.

 manual release techniques, dry needling, and joint mobilizations/manipulations.

 self-myofascial release, stretching, kinesiology tape, vibration, TENS, shockwave, and heat

 Improvements in pain, pain pressure threshold, disability, function, balance, exercise recovery, and changes in fascial mobility.

 The Brookbush Institute recommends that IASTM be used as an additional manual mobility technique following release techniques and joint mobilizations to address assessed ROM restrictions.

This course is a comprehensive systematic review of all peer-reviewed and published original research investigating IASTM.

Comparisons when performed in combination

Effect of IASTM on exercise performance and recovery

Course Summary: IASTM Comprehensive Systematic Research Review

Course Study Guide: IASTM: Comprehensive Systematic Research Review

Course Summary Webinar: IASTM: Comprehensive Systematic Research Review

 IASTM may result in less improvement in ROM than static manual release (ischemic compression) techniques, dry needling, and joint mobilizations; however, IASTM may result in similar or larger improvements in pain, pain pressure threshold, and dysfunction.

 IASTM may result in similar improvements in ROM as massage therapy and tissue flossing, as well as similar improvements in pain, disability, and sports performance.

 IASTM may result in more improvements in ROM than self-myofascial release, stretching, kinesiology tape, heat, and vibration, as well as larger improvements in fascial mobility, muscle tone and stiffness, and post-exercise fatigue.

The addition of IASTM to exercise, stretching, manual soft tissue techniques, mobilization, and/or conventional therapy results in significant improvements in ROM, pain, and function. Additionally, when some time spent on massage is replaced with IASTM, outcomes are likely to be similar, which may be beneficial for manual therapists who experience hand fatigue and pain.

Neuromuscular Effects and Fascial Mobility:

 IASTM likely results in systemic neuromuscular effects and changes in fascial mobility that contribute to observed outcomes.

 IASTM may only improve strength and performance when used to address an assessed mobility restriction. However, IASTM may significantly improve recovery from exercise, and regular IASTM may mitigate performance declines during a sporting season and lead to larger strength gains from a weight training program.

Position Statement and Summary

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.

IASTM: Technique and Emollient Recommendations

Patient: 32-year-old athletic male, "CrossFitter" with a history of sacroiliac joint and hip pain.

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°)

Tibialis Anterior Manual Muscle Testing (MMT):

 Weak with compensation (bias toward eversion and toe extension)

Gluteus Medius Manual Muscle Testing (MMT)

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

Adductor Mangus Static Manual Release (Posterior Fibers)

Instrument Assisted Soft Tissue Mobilization

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

Rest between exercises: Circuit training, 1 min rest between exercises

Training Time: 5 - 15 minutes (excluding mobility interventions)

Single Leg Touchdown with Anterior to Posterior Pull

Case Study: Knees Bow Out

Static Release (Ischemic Compression) Techniques Compared to IASTM: 

IASTM is likely to result in larger improvements in pain sensitivity, pain pressure threshold, and function when compared to compressive manual release techniques. However, compressive myofascial release techniques may lead to significantly larger increases in dorsiflexion ROM.

 Dry needling may be more effective than IASTM for improving myofascial pain, ROM, and dysfunction. However, this conclusion is based on a single study, and should not be considered definitive.

Joint Mobilizations and Manipulations Compared to IASTM:

 Joint mobilizations may result in larger increases in ROM when compared to IASTM. However, IASTM may result in larger improvements in pain, and both interventions are likely to result in similar improvements in dysfunction.

 When performed alone, IASTM and massage result in similar improvements in ROM, pain, and disability scores.

 IASTM likely results in significantly larger improvements in ROM when compared to manual stretching. Additionally, IASTM is likely to lead to larger decreases in pain intensity, larger improvements in pain pressure threshold, and potentially larger improvements in antagonist strength.

Self-administered Stretching Compared to IASTM:

 IASTM likely leads to similar or slightly larger improvements in ROM compared to self-administered stretching. However, IASTM likely results in larger improvements in pain, Y-balance test scores, muscle tone, stiffness, and elasticity (measured with the Myoton Pro tool). It is important to note that this conclusion may not be generalizable to all self-administered stretches, as 3 of the 4 studies included in this section specifically compared IASTM to the leaning calf stretch.

Self-myofascial Release Compared to IASTM (Without Assessed Restriction): 

IASTM likely results in similar or slightly larger improvements in ROM compared to foam rolling. The effects of IASTM and foam rolling on performance are mixed, indicating that while these techniques may improve strength, power, and agility, they may not significantly improve sports-specific activities.

Self-myofascial Release Compared to IASTM (With Assessed Restriction):

 For individuals with reduced ROM, IASTM may result in slightly larger improvements in ROM than foam rolling. Note that these techniques may be more effective for superficial muscles, as demonstrated by the lack of results in the study investigating pectoralis minor mobility. Additionally, IASTM may result in significantly larger changes in fascial displacement.

These studies likely demonstrate that IASTM and "The Stick" result in similar improvements in ROM, but only when a restriction has been assessed.

One study demonstrated that IASTM resulted in larger improvements in ROM, and another study demonstrated that tissue flossing resulted in larger improvements, which likely implies that the improvements in ROM following the 2 techniques may be similar. Additionally, both techniques likely result in similar improvements in performance (strength, total work, and power).

 IASTM is likely to result in significant improvements in ROM, while kinesiology tape may not affect or even reduce ROM.

 IASTM results in significant improvements in cervical spine and lumbar spine pain, disability index scores, ROM, and fascial mobility, and heat does not result in significant improvements.

Vibration and Microcurrent Compared to IASTM: 

IASTM likely results in larger improvements in ankle dorsiflexion ROM when compared toTheragun (vibration). Additionally, IASTM may have a small effect on reducing post-exercise muscle fatigue, whereas microcurrent does not.

Static Manual Release/Massage and Exercise versus IASTM and Exercise: 

Compared to massage and exercise, IASTM and exercise may lead to larger improvements in tissue healing and similar improvements in ROM, pain, and dysfunction. However, when compared to IASTM and exercise, ischemic compression and exercise may result in larger improvements in ROM, pain pressure threshold, and certain aspects of function.

IASTM and Exercise versus Ultrasound and Exercise:

 Compared to combining ultrasound and exercise, IASTM and exercise led to significantly larger improvements in pain intensity and Foot and Ankle Ability Measure (FAAM) scores, both immediately after the final treatment session and during the 90-day reassessment.

Massage and Stretching versus IASTM and Stretching:

 Combining IASTM and stretching or massage and stretching may result in similar improvements in ROM, pain pressure threshold, and function. However, one study demonstrated that IASTM and stretching led to significantly larger improvements in pain and function for patients with chronic plantar heel pain.

Static Manual Release and Stretching versus IASTM and Stretching:

 These studies suggest that combining static manual release or IASTM with exercise results in similar improvements in ROM. However, other outcomes may differ, with IASTM resulting in larger improvements in pain, and static manual release techniques resulting in larger improvements in pain pressure threshold.

Shockwave and Stretching versus IASTM and Stretching:

 One study demonstrated that IASTM and shockwave therapy, when added to a self-administered stretching program, may provide similar short-term (post-intervention) improvements in pain and function. However, IASTM is likely to result in greater long-term (6-months) improvements in function.

Exercise and Stretching versus IASTM and Stretching (versus Exercise Only):

 One study suggested that either IASTM or exercise added to stretching results in larger improvements in ROM and ankle function, when compared to exercise alone.

Tissue Flossing, Stretching, and Exercise versus IASTM, Stretching, and Exercise:

 One study demonstrated that IASTM and tissue flossing when added to an integrated program of stretching and exercise, result in similar improvements in ROM for healthy individuals.

 Adding IASTM, kinesiology taping, or exercise to conventional therapy (e.g., heat, TENS, ultrasound, and/or home exercise) results in significant and similar improvements in ROM, pain intensity, and function. Additionally, adding manual stretching to conventional therapy may also significantly improve outcomes, but less than IASTM.

 The studies in this section demonstrate that Mulligan bent leg raises and manual stretching result in larger improvements in ROM than IASTM and manual stretching, IASTM and abductor strength exercises result in more abductor strength than stretching and TENS, and MET, manual stretching, and exercise may improve ROM and function as much as IASTM and exercise. Unfortunately, due to the methodology of these studies, more generalizable conclusions cannot be developed.

Static Manual Release/Massage and Exercise with and without IASTM:

 Replacing some time spent performing massage therapy with IASTM in a program that also includes exercise, is likely to result in similar improvements in ROM, pain, disability, and posture. However, adding additional time spent performing IASTM to a program including soft tissue release techniques and exercise, may result in significant improvements in outcomes.

Traction and Nerve Mobilization With and Without IASTM:

 One study demonstrated that the addition of IASTM to traction and nerve mobilization may significantly improve low back pain and function.

 The addition of IASTM to exercise can significantly improve ROM, pain, and function for individuals with chronic low back pain or Achilles tendinopathy.

 The addition of IASTM to stretching may significantly improve pain, ROM, and disability.

Exercise and Stretching With and Without IASTM:

 The addition of IASTM to an integrated intervention (e.g., passive ROM, stretching, exercise, posture correction, etc.) for cervical dysfunction or elbow tendonitis significantly improves outcomes for cervicogenic headache, pain, posture, ROM, strength, and function. Additionally, the addition of IASTM to balance training significantly improves outcomes for individuals diagnosed with chronic ankle instability (CAI). Conversely, the addition of IASTM to an integrated intervention plan for the treatment of plantar fasciitis may or may not improve outcomes.

Conventional Therapy With and Without IASTM:

 Although the definition of conventional therapy in this section was expanded to include hot packs, ultrasound, and TENS, as well as stretching, ROM, strengthening, and stabilization exercises, the addition of IASTM resulted in significantly larger improvements in ROM, pain intensity, strength, function, and quality of life, both immediately after treatment and up to 4 weeks post-treatment.

Comparing IASTM for Different Body Parts:

 Research demonstrates that more than one structure may be addressed with IASTM to improve a restriction in ROM, patient complaints of pain, or hyperalgesia (increased sensitivity to pain). Further, IASTM likely results in systemic neuromuscular effects that contribute to improvements in outcomes.

When assessed via ultrasound, IASTM results in a significant influence on fascial mobility, including an increase in biceps femoris fascial displacement and a decrease in the shear mobility of the superficial lamina and absolute mobility of the thoracolumbar fascia. Further, these effects are larger following IASTM when compared to foam rolling or heat. However, when the effects of IASTM on fascial mobility, stiffness, and elasticity are investigated using other measures (Myoton Pro tool, tissue indentometry, or a fourth-order polynomial regression model), or potentially when IASTM is performed on other structures, research findings are inconsistent.

Physical Rehabilitation and Strength Measures: 

Performing IASTM independently, or adding IASTM to a physical rehabilitation program (e.g., TENS, ultrasound, massage, stretching, exercise, and/or balance training) is likely to significantly enhance strength and balance outcome measures (e.g., grip strength, endurance, peak torque, max strength, plantar foot pressure measuring device for balance, etc.).

Healthy Individuals and Strength Measures:

 Performing IASTM to address an assessed mobility restriction is likely to result in significant improvements in strength, agonist/antagonist strength ratios, and postural stabilization. Conversely, healthy individuals without an assessed restriction are unlikely to exhibit significant strength improvements following IASTM.

 IASTM may or may not enhance power in healthy athletes, and is unlikely to result in larger increases in power than self-myofascial release. The author hypothesizes that IASTM is likely beneficial for performance improvement primarily when used to address an assessed mobility restriction.

 IASTM may result in a small improvement in immediate post-exercise fatigue and significant improvements in DOMS, ROM, and balance testing scores immediately, 24 hours, and 48 hours after exercise. Further, IASTM likely results in larger improvements in these recovery measures than self-administered stretching. Additionally, regular IASTM may help to mitigate performance declines during a sporting season and lead to larger strength gains from a weight training program. These benefits are potentially due to improvements in ROM, decreased muscle damage and inflammation (indicated by reduced serum concentrations of creatine kinase and IgA), enhanced recovery (indicated by better performance in subsequent sessions), and a lower rate of perceived exertion (RPE) during subsequent training sessions.

Research Findings

Manual Techniques Compared to IASTM

Stretching Compared to IASTM

Self-myofascial Release Compared to IASTM

Modalities Compared to IASTM

Research Review: Comparisons When Performed Independently

Comparisons When Combined with Stretching

Comparison When Combined With Exercise

Comparisons When Combined With "Conventional Therapy"

Research Review: Comparisons When Performed in Combination

Manual Therapy With and Without IASTM

Exercise or Stretching With or Without IASTM

Exercise and Stretching With and Without IASTM

"Conventional Therapy" With and Without IASTM

Research Review: With and Without IASTM

A few studies were identified that compared unique combinations of interventions in both tested groups, making it difficult to develop any conclusions. 

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. This study suggests that Mulligan's bent leg raise may be more effective than IASTM, when combined with manual stretching, for improving hip, knee, and lumbar spine ROM. 

However, Mulligan's bent leg raise is similar to a hamstring stretch, implying that one group received nearly 17 minutes of hamstring stretching, while the other group received IASTM and 8 minutes of hamstring stretching. Both were then assessed on hamstring extensibility. Given these conditions, it is unclear if a definitive conclusion can be drawn from this study (68). 

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 (69). 

Bhosale et al. compared 26 males and females (age: 39.77 - 42.38 years) with post-operative elbow stiffness, randomly assigned to a group receiving muscle energy technique (MET), manual stretching, and conventional therapy, or a group receiving IASTM and conventional therapy, for 3 weeks, 2 sessions/week. The MET group received post-isometric relaxation to increase ROM (elbow flexion and extension, and forearm supination and pronation) for 7-10 sec hold, 20% maximum voluntary contraction, followed by manual static stretching to move to a new end range, for 3-4 reps/set, 2 sets/joint action. 

The IASTM group received IASTM for 30-60 sec/restriction (around the elbow region), using "the Edge tool", with enough pressure to result in a tolerable 5/10 pain. The conventional therapy included active ROM exercises for the wrist, elbow, and shoulder (5-10 min/session), gentle manual static stretching (30-sec hold/rep, 3 reps/session), progressive low-load strengthening exercises for all major muscle groups of the upper limb, closed kinetic chain strengthening activities, and a home exercise protocol including ROM exercises (active and active assisted), and low load strengthening for the upper extremity. The findings demonstrated that both groups exhibited statistically significant improvements on all outcome measures, including similar improvements in ROM; however, the IASTM group exhibited significantly larger improvements in pain and DASH scores. In this study, because manual stretching was added to the MET group, it is not possible to infer a comparison of the effect of IASTM relative MET or manual stretching (70). 

In summary, these studies demonstrate that Mulligan bent leg raises and manual stretching result in larger improvements in ROM than IASTM and manual stretching, IASTM and abductor strength exercises result in more abductor strength than stretching and TENS, and MET, manual stretching, and exercise may improve ROM and function as much as IASTM and exercise. Unfortunately, due to the methodology of these studies, more generalizable conclusions cannot be developed.

Research Review: Unmatched Combinations

Comparing IASTM for Different Body Parts

Fascial Mobility and Stiffness

Strength and Performance

IASTM as a Post-exercise Recovery Aid

Research Review: Additional Findings

Additional Studies Not Included in the Review

The following studies were excluded from this review because they lacked comparison to another intervention, and generally did not assess unique outcome measures that would result in the ability to develop additional conclusions. In short, these studies would not have changed or added to the findings from this review. This annotated bibliography has been included here for purposes of transparency and maintaining a record of a comprehensive review of all available research at the time of publication.

Banerjee et al. compared 10 males and females (age: 18-30 years) with the presence of active TrPs in the sternocleidomastoid (SCM), upper trapezius, and/or suboccipital muscles, unilateral headache at least 1x/week for the past 3 months, a positive cervical flexion-rotation test (FRT) with restriction greater than 6°-10°, who used a smartphone 4+ hours/day and had no history of other nonspecific head and neck pain, recent cervical spine surgery or physical rehabilitation, or altered sensation, weight loss, or pregnancy. All participants received the same interventions including IASTM, infra-red radiation therapy, and exercise, for 2 weeks, 3 sessions/week, for a total of 6 sessions. Sessions started with Infrared radiation therapy for 15 min/session. This was followed by IASTM for 5 min/session, in “a comfortable position,” using the Mobility Edge stainless steel box-shaped tool, with emollient, at an angle to the skin of 30-60°, with longitudinal, sweeping, swiveling, and fanning strokes, over the SCM, upper trapezius, and suboccipital muscles. The exercise included craniocervical retraction in supine, for 3 sets/session, 5 reps/set, 10-sec rest between sets, and 10-sec hold/rep, with a blood pressure cuff at 20, 22, 24, 26, 28, and 30 mmHg, followed by dynamic strengthening of the shoulder and upper extremities for 1 set/exercise, 15 rep/set, and manual static stretching for 10 sets/session, 3 reps/set, of the sternocleidomastoid, upper trapezius, and “shoulder blades.” Additionally, the group was advised to perform a home exercise program including isometric exercises for the neck and shoulders, 1x/day, 1 set/session, 15 reps/set, and aerobic exercise 3x/week, for 30 min/session. Findings demonstrated that the participants exhibited statistically significant decreases in pain pressure threshold (measured with an algometer) and headache disability index scores.

Banerjee, R. (2021). Effectiveness of instrument assisted soft tissue mobilization technique on cervicogenic headache in smartphone-addicted college students: a pilot study.

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).

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. 

Bryant et al. compared 50 males and females (age: 20-55 years) with no prior history of cervical injury or dysfunction, fibromyalgia, blood disorders, open wounds in the trapezius region, contagious or infectious skin diseases, anticoagulant medication, or current pregnancy, and assigned to a normal or an abnormal trapezius group based on an algometric assessment of pain pressure sensitivity (> 7 lbs/cm2 designated as normal). All participants received 1 session of gua sha which included 4 min/session, using the convex edge of a water buffalo horn shark-fin-shaped tool, with ultrasound gel as a lubricant, at 45° angle to the skin, with infero-lateral strokes, at 108 BPM, bilaterally, in a seated position over the upper trapezius muscle. Findings demonstrated that both groups exhibited similar increases in pressure pain threshold (measured with an algometer); however, the abnormal group (due in part to lower initial values) exhibited a statistically significant change and the normal group did not achieve statistically significant values.

Bryant, T., Buczynski, M., Gant, C., & Gill, R. (2012). Algometric Characterization of Gua Sha in the Upper Trapezius.

Croft et al. compared 15 males and females (age: 26.07 ± 9.18 years) with a history of ankle sprains and CAI, and no history of lower extremity injury, low back injury, or concussion in the previous 6 months. All participants completed a control session and an IASTM session, in randomized order, 7 days apart. Both sessions began with a 5 min warm-up on a Monark Ergomedic 828E stationary bike. The control session followed the warm-up with 2 min of rest. The IASTM session included IASTM performed for 90 sec, in a side-lying position, using the Tecnica Gavilan stainless steel Garra S-shaped instrument, with cocoa butter moisturizing lotion as an emollient, sweeping strokes, at 30 beats/min, over the fibularis longus. The findings demonstrated that the IASTM session resulted in improvements in Y-balance test scores, including significantly increased anterior reach distance and a trend toward increased posteromedial and posterolateral reach distance.

IASTM: Comprehensive Systematic Research Review

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