Brachial and Forearm Fascia 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:

• Brachial Fascia: The brachial fascia is a continuation of the pectoral, clavipectoral, deltoid, and axillary fascias.
  • Increasing Tension/Lengthening: Shoulder flexion, abduction, horizontal abduction, and external rotation will increase the tension of these fascial tissues.
• Forearm Fascia: The forearm (antebrachial) fascia is a continuation of the brachial fascia.
  • Increasing Tension/Lengthening: The volar (back of the hand) side of the forearm is lengthened with a combination of pronation, wrist flexion, and potentially elbow extension.
  • Increasing Tension/Lengthening: The palmar (palm side of the hand) side of the forearm is lengthened with a combination of supination, wrist extension, and potentially elbow extension.

Patient Position

• The ideal client/patient position for this technique is likely supine with the arm and hand supported by the table. Often the practitioner will find it necessary to increase tension in the target area by manipulating the arm at the wrist, while simultaneously performing IASTM with the other hand. The client/patient in a prone position may be recommended for some areas over the triceps and forearms.

Potentially Sensitive Tissues

• Axilla and Medial Side of Arm: Carefully monitor IASTM dose and pressure near the axilla and on the medial side of the arm. The nerves originating from the brachial plexus, passing underneath the pectoralis minor, course through the axilla, and are more superficial on the medial side of the arm. These nerves course between the long head of the triceps brachii and biceps brachii, en route to innervating the muscles of the arm. Additionally, the brachial artery, basilic vein, and some lymph nodes follow a similar path. Although it is unlikely significant damage could be done with the responsible application of IASTM, it may be uncomfortable if these sensitive structures are excessively compressed or abraded.

Trigger Points

• Biceps Brachii: The most common trigger point locations for the biceps brachii occur in the middle of the muscle belly, approximately 1/3 to 1/2 the length of the muscle from its origin (shoulder).
• Triceps Brachii: The most common trigger points for the triceps brachii muscle group are also located in the middle of the muscle bellies; however, the distal 1/3 of this muscle is mostly tendon. Common trigger points in the medial heads and lateral heads are located a few inches distal of the shoulder (approximately 1/4 to 1/3 the length of the arm), and trigger points in the long heads are on the medial side of the arms, slightly distal the trigger points of the medial heads (approximately 1/3 to 1/2 the length of the arm).
• Brachioradialis: The most common trigger points in the brachioradialis are located approximately 4 - 6 cm distal of the lateral epicondyle of the elbow.
• Wrist extensor mass: The most common trigger points occur 6 - 10 cm distal of the lateral epicondyle of the elbow (approximately 1/3 the length of the forearm), in a "band" like region along the volar aspect of the forearm.
• Wrist flexor mass: The most common trigger points occur 8 - 12 cm distal of the lateral epicondyle of the elbow (approximately 1/3 - 1/2 the length of the forearm), in a "band" like region along the palmar aspect of the forearm.