Cervical 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:

• Superficial cervical and cervicothoracic: The superficial layers of the fascia of the cervical spine and thoracic spine create a fascial sheath that has similarities to the thoracolumbar fascia, with continuity into the infraspinatus fascia (superficial layer of fascia over the scapula) and deltoid fascia. Note, the pectoral fascia invests into the periosteum of the clavicle with continuity to the deep cervical fascia enveloping the sternocleidomastoid. The superficial fascia of the anterior cervical spine invests in the platysma and is continuous with the subcutaneous tissue over the clavicle and chest.
  • Increasing Tension/Lengthening: Increased tension in the posterior cervical fascia can be achieved via cervical and thoracic spine flexion, cervical rotation, and cervical contralateral flexion. Increased tension in the anterior cervical fascia can be achieved via cervical and thoracic spine extension, cervical rotation, and cervical contralateral flexion.

Clothing and Covering:

• IASTM cannot be done over the clothing. It is advised that the client/patient is instructed to wear clothing that allows access to the cervical spine, thoracic spine, and shoulder region on the affected side (e.g. a tank top, sports bra with an open back, etc.). 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

• It may be possible to address assessed areas of tissue inconsistency with the client/patient on a table in a prone position. However, most often the best position for access to the entire cervical region and control of tissue tension is with the client/patient in a seated position, facing away from the practitioner.

Potentially Sensitive Tissues

• Brachial Plexus: The brachial plexus may be stretched/stressed if excessive posterior-to-anterior pressure is used near the transverse processes of the cervical spine, or if excessive superior-to-inferior pressure is used on the cranial or anterior aspects of the upper trapezius.

Trigger Points

• Upper Trapezius: The most common trigger points in the upper trapezius muscles are on the posterior aspect of the superior portion of the middle of the muscle and assessed with superior-to-inferior and slight posterior-to-anterior force.
• Levator Scapulae: The most common trigger points for the levator scapulae are at the insertion, near the superior angle of the scapula, and the center of the muscle belly at approximately the level of C5 and C6.
• Splenii: The most common trigger point for the splenius cervicis is approximately in line with C7, and the most common trigger point for splenius capitis is approximately in line with C2.