Pectoral 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:

• Pectoral Fascia: The pectoral fascia is continuous with the deltoid, axillary, and brachial fascias, with some continuity with the investing layer of the deep cervical fascia and the superficial layer of the fascia of the rectus abdominis and external obliques.
  • Increasing Tension/Lengthening: Shoulder flexion, abduction, horizontal abduction, and external rotation will increase the tension of the pectoral fascia. Some cervical extension, and/or thoracic extension may also increase pectoral fascia length; however, it is likely to have little effect.

Clothing and Covering:

• IASTM cannot be done over the clothing. It is advised that the patient remove the target arm from their top, that the entire pectoral region is exposed, and that the patient's opposite hand is used to hold clothing or a towel in place over sensitive regions (e.g. the nipple region). Holding clothing in place with a hand covering sensitive regions also blocks the sensitive region from being accidentally grazed or bumped by the proximal parts of the practitioner's hand or wrists. It can be challenging for the therapist to address target tissues in multiple directions, while simultaneously trying to avoid accidental contact with sensitive areas. Although this should never be used as an excuse to inappropriately touch a patient/client or to make a patient/client uncomfortable, we also do not want unnecessary embarrassment to impede great therapy. Having the patient cover and "block" sensitive regions with their hands is the best way we have found to optimize patient and practitioner comfort.

Patient Position

• The ideal patient position for this technique is likely supine with the hand of the target arm underneath the head (shoulder abducted and externally rotated), while the other hand is used to hold clothing and block sensitive regions.

Potentially Sensitive Tissues

• No Sensitive Tissues: Assuming that these techniques are directed at the superficial layers of fascia, it is unlikely they will compress or abrade any sensitive or delicate structures. However, responsible application of this technique is still expected. The client/patient's response should be carefully monitored, as there is always a chance of compressing or abrading a less common presentation of a sensitive structure (e.g. a cutaneous nerve that is abnormally superficial or sensitized over a common trigger point site).

Trigger Points

• Pectoralis Major Trigger Points: The common trigger points for the pectoralis major are in the middle of the muscle bellies of each fascicle.Trigger points may be found in any fiber of the clavicular and sternal heads. Occasionally, a lateral  trigger point may develop along the axillary border of the muscle .