IASTM: Thoracolumbar Fascia

This course describes instrument assisted soft tissue mobilization (IASTM) of the thoracolumbar fascia (TLF), with a focus on treatment of the posterior superficial layer of the TLF (summary of TLF anatomy below). Additionally, modifications of IASTM techniques are discussed, including specific techniques for addressing trigger points, different treatment positions used to increase tissue tension, and pin-and-stretch techniques with IASTM tools (a.k.a. active or dynamic release). This course does not assume that IASTM treatment addresses the middle or anterior layers of the TLF, and this course does not include treatment of the gluteal fascia or cervicothoracic fascia (covered in a separate course).

Pre-approved credits for:

• Integrated Manual Therapist (IMT) Certification

Pre-approved for Continuing Education Credits for:

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

This Course Includes:

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

• Summary of Thoracolumbar Fascia Anatomy (TLF): The TLF can be described as a 3-layer system, with the posterior layer having deep and superficial laminae (layers). The superficial lamina of the posterior layer is continuous with the latissimus dorsi, serratus posterior inferior, gluteus maximus, as well as part of the external obliques and lower trapezius. Medially, the majority of the superficial layer is bordered by the supraspinous ligament and spinous processes cranial to L4, but fibers do cross to attach to the contralateral sacrum, PSIS, and iliac crest. Some fibers of the TLF, arising from the gluteus maximus, also cross the mid-line attaching to the opposite sacrum, PSIS, or lateral raphe. The deep lamina of the posterior layer run continuously from the splenius capitis and cervicis, superficial rhomboids, envelops the erector spinae (acting as a retinaculum) and is continuous with the sacrotuberous ligament and potentially the biceps femoris. The middle layer of the TLF extends from the transverse processes, between the quadratus lumborum and erector spinae, and is continuous with the aponeurosis of the transverse abdominis and internal obliques. The deep laminae of the posterior layer and middle layer fuse to form the lateral raphe, which may be thought of as a thickening of the middle layer to reinforce the attachment of the abdominal tourniquet muscles.

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 (sharp) edge. IASTM could be viewed as a Western approach to a Traditional Chinese Medicine (TCM) technique called Gua Sha. While the application of IASTM is most commonly based on orthopedic assessment with stainless steel tools, the application of Gua Sha is based on TCM-specific assessments with jade or stone tools. Graston is the most well-known brand of IASTM stainless steel tools; however, we do prefer Smart Tools based on their quality, edge, and price. Note, historically the origin of these techniques is undoubtedly Gua Sha, which is perhaps 1000s of years old, Graston popularized IASTM in the Western world, and now there are many brands and tools to choose from.

The IASTM techniques in this course are recommended as an adjunct mobility technique, included in an integrated program that already includes, or has considered soft-tissue release techniques, joint mobilization and manipulation techniques, and/or stretching techniques. The addition of the techniques described in this course may be especially beneficial for individuals assessed with range of motion (ROM) restriction of the lumbar spine, hip, scapula, and shoulder. Further, they may be included in a program designed to address chronic low back pain, lumbar instability, sacroiliac joint pain, trunk muscle strain (e.g. rectus abdominis strain, external oblique strain, erector spinae strain, etc.), or trunk mobility issues (e.g. a loss of lumbar rotation). Additionally, these techniques may be beneficial for those with assessed impairments including an anterior pelvic tilt, asymmetrical weight shift, sway back posture, excessive lordosis, loss of the lordotic curve, sacroiliac joint dysfunction (SIJD) , lumbo pelvic hip complex dysfunction (LPHCD) , or lower extremity dysfunction (LED) .

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

Topics Covered in this Course

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

Techniques Covered in this Course:

• Thoracolumbar Fascia IASTM

Additional IASTM Courses

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

For more on an integrated approach:

• Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

Thoracolumbar Fascia

No Comparison Group

1. Brandl, A., Egner, C., Schwarze, M., Reer, R., Schmidt, T., & Schleip, R. (2023). Immediate Effects of Instrument-Assisted Soft Tissue Mobilization on Hydration Content in Lumbar Myofascial Tissues: A Quasi-Experiment. Journal of Clinical Medicine, 12(3), 1009.
2. Gohil, D., Swami, A., Baxi, G., Tai, Z., Edgaonkar, R., & Palekar, T. (2020). Effectiveness of Instrument-Assisted Soft Tissue Mobilization in Management of Athletes with Gleno-Humeral Internal Rotation Deficit. Indian Journal of Physiotherapy & Occupational Therapy Print-(ISSN 0973-5666) and Electronic–(ISSN 0973-5674), 14(1), 88-93.
   • Compared to Controls
3. Saha, F. J., Brummer, G., Lauche, R., Ostermann, T., Choi, K. E., Rampp, T., ... & Cramer, H. (2019). Gua Sha therapy for chronic low back pain: a randomized controlled trial. Complementary therapies in clinical practice, 34, 64-69.
4. Laudner, K., Compton, B. D., McLoda, T. A., & Walters, C. M. (2014). Acute effects of instrument assisted soft tissue mobilization for improving posterior shoulder range of motion in collegiate baseball players. International journal of sports physical therapy, 9(1), 1.
5. 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, 34(5), 895-902.
6. 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. BMC musculoskeletal disorders, 16(1), 1-10.
   • Comparing Interventions With and Without IASTM
7. 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. Journal of physical therapy science, 28(6), 1852-1855.
8. 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. Pakistan Journal of Rehabilitation, 11(2), 83-91.
   • Comparing IASTM on Different Segments
9. Fousekis, K., Eid, K., Tafa, E., Gkrilias, P., Mylonas, K., Angelopoulos, P., ... & Tsepis, E. (2019). Can the application of the Ergon® IASTM treatment on remote parts of the superficial back myofascial line be equally effective with the local application for the improvement of the hamstrings’ flexibility? A randomized control study. Journal of physical therapy science, 31(7), 508-511.
10. Lauche, R., Wübbeling, K., Lüdtke, R., Cramer, H., Choi, K. E., Rampp, T., ... & Dobos, G. J. (2012). Randomized controlled pilot study: pain intensity and pressure pain thresholds in patients with neck and low back pain before and after traditional East Asian" gua sha" therapy. The American Journal of Chinese Medicine, 40(05), 905-917.
    • Comparing IASTM to Other Therapeutic Interventions
11. Weber, P., Klingler, W., Schleip, R., Weber, N., & Joisten, C. (2022). The Influence of a Single Instrument-Assisted Manual Therapy (IAMT) for the Lower Back on the Structural and Functional Properties of the Dorsal Myofascial Chain in Female Soccer Players: A Randomised, Placebo-Controlled Trial. Journal of Clinical Medicine, 11(23), 7110.
12. 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, 33(3), 179-186.
13. Fousekis, K., Kounavi, E., Doriadis, S., Mylonas, K., & Kallistratos, E. (2016). The effectiveness of instrument-assisted soft tissue mobilization technique (ergonš technique), cupping and ischaemic pressure techniques in the treatment of amateur athletes΄ myofascial trigger points. J Nov Physiother S, 3(2), 1-7.