Anterior and Medial Fascia Latae Instrument Assisted Soft-tissue Mobilization (IASTM)

IASTM Instructions

• Pressure: Pressure should be sufficient to feel resistance from the target tissue; that is, pressure should be applied to the "first resistance barrier".
  • Tissue Tension: 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.
• Angle: The tool angle to the skin should be approximately 30° - 45°.
• Scanning Strokes: Start with long, slow strokes over the full length of the target tissue to note irregularities in tissue consistency.
• Treatment Strokes: Treatment strokes should be shorter, performed at a moderate tempo, in multiple directions, and over tissue assessed as irregular. The goal is to disrupt connective tissue that may be impeding optimal extensibility.
• Total Strokes: 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.
• Treatment Direction: Perform 2-5 strokes in each direction. It can be helpful to visualize a clock or compass face and perform strokes in line with each number or direction (e.g. N, NW, W, SW, S, SE, E, NE).
  • Redness and Patechiae: 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 Trigger Points: 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:
  1. Static IASTM tool with passive lengthening (manual lengthening by the practitioner)
  2. Dynamic IASTM tool (strokes in the opposing direction) with passive lengthening
  3. Static IASTM tool with active or active-assisted lengthening (lengthening by the client or patient)
  4. Dynamic IASTM tool with active or active-assisted lengthening
  5. Static IASTM tool with active-assisted lengthening and over-pressure (client/patient and practitioner force)
  6. Dynamic IASTM tool with active-assisted lengthening and over-pressure
• Assess, Address, and Reassess: 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".

Anatomy:

• Fascia lata: The fascia lata is the deep fascia enveloping the muscles of the thigh. This fascial structure originates from the iliac crest, inguinal ligament, ramus of the ischium, and ischial tuberosity (deep to the gluteus maximus). The fascia lata courses distally thickening at the knee and then continues beyond the knee as the crural fascia (fascia enveloping the lower leg). Further, the fascia lata is continuous with the medial, lateral, and posterior intermuscular septa. The fascia lata is thickest on the lateral side of the thigh (e.g., the iliotibial band) and thinnest on the medial side (superficial to the adductor muscles). The techniques in this video intend to affect the anterior and medial fascia lata, superficial to the quadriceps and adductors.
  • Increasing Tension/Lengthening: Increased tension in the anterior fascia lata may be achieved with a combination of hip extension and knee flexion, and may be affected by hip internal or external rotation. Increased tension in the medial fascia lata may be achieved with a combination of hip abduction and flexion and may be affected by hip internal rotation, external rotation, or extension.

Clothing and Covering:

• IASTM cannot be done over the clothing. It is advised that the client/patient is informed prior to the session to wear clothes that enable them to expose their thigh up to the inguinal line and gluteal fold. Tight and secure undergarments and loose shorts are likely the best choice for these techniques. Note, although loose and or small undergarments may make it easy to expose the thigh, they can also result in unintended exposure of sensitive areas when the thigh is being adjusted during treatment. Although it is never our intent to make a client uncomfortable, we also do not want embarrassment to impede great therapy. Often, authentic communication, a little empathy, and some planning can reduce or eliminate potentially embarrassing moments.

Patient Position

• This technique is likely easiest to perform with the patient in a supine position with the hip of the target leg abducted enough so that the lower leg hangs off the table, with the knee flexed to approximately 90°. It is likely most comfortable for the practitioner to stand at the side of the table facing the patient's hip, just beyond the patient's knee. This position allows the practitioner to use their thigh to control the amount of hip abduction and knee flexion to increase or decrease the amount of tension in the anterior fascia lata. The patient may also be adjusted on the table so that the lower leg abutting the side of the table controls the amount of hip abduction. Alternatively, better access to the medial fascia lata may be achieved by placing the foot of the patient's target leg on the table next to the opposite knee, similar to a FABER test .

Potentially Sensitive Tissues

• The inguinal lymph nodes, femoral artery and vein, femoral and saphenous nerve, and additional distributions of these vessels and nerves in the femoral triangle and adductor canal may be compressed during this technique. If the patient complains of numbness, tingling, burning, or searing pain, or pain that is diffuse and uncomfortable and unlike trigger point pain, it is likely best to avoid repeated strokes over the sensitive region. Keep in mind, lymph nodes, nerves, veins, and arteries are fairly narrow, a small adjustment should be sufficient to continue performing this technique without further insult to delicate structures.

Trigger Points

• Gracilis and adductor longus trigger points are commonly located about 1/3rd and 2/3rd the length of the inner thigh.
• Pectineus and adductor brevis trigger points are commonly located in the middle of the floor of the femoral triangle.
• Rectus femoris and sartorius trigger points are commonly located either a few inches distal of the ASIS or close to the middle of the length of the thigh.