Lateral Fasciae Latae Instrument Assissted 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). The fascia lata thickens on the lateral side of the thigh, developing into the iliotibial band and lateral intermuscular septum. These thicker lateral structures invest in a complicated fascial network at the lateral knee, including the lateral retinaculum, patellar tendon, lateral collateral ligament, fibular head, and anterior tibiofibular ligament. The techniques in this video intend to affect the fascia over the tensor fascia lata (TFL), vastus lateralis, and iliotibial band.
  • 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/client in side-lying, with hips and knees slightly flexed for comfort and stability (Side-sleeper's position). The practitioner should be behind the patient, adjacent to the thigh. The patient's hip and knee may be passively flexed and extended to increase or decrease tissue tension. Additionally, the hip and knee of the top leg can be flexed more than the bottom leg, the foot of the top leg positioned just behind the calf of the bottom leg, and the knee of the top leg can be allowed to descend onto the table, resulting in additional hip adduction and internal rotation, which may result in additional tissue tension.

Potentially Sensitive Tissues

• The lateral femoral cutaneous nerve (superficial to the origin of the sartorius and belly of the TFL) may be compressed or stretched during this technique. Generally, this would result in a burning, tingling, or searing pain. The nerve is fairly small and a slight adjustment anterior or posterior should be sufficient to avoid continued pressure on the nerve.

Trigger Points

• Tensor fascia lata (TFL) trigger points are commonly located near the center of the muscle belly.
• Gluteus minimus trigger points are commonly located just superior to the greater trochanter.
• Vastus lateralis trigger points are commonly located either a few inches from the knee or close to the middle of the muscle's length.