Plantar Fascia 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:

• Plantar Fascia: The plantar fascia is a thick layer of connective tissue, superficial to the plantar muscles of the foot. The function of the plantar fascia is to support the longitudinal arch, the tendons, and ligaments of various plantar structures, and act as an aponeurosis for the flexors, adductors, and abductors of the toes. The proximal attachment of the plantar fascia may have some continuity with the Achilles tendon; however, most of the fibers invest in the tuberosity of the calcaneus. The distal attachment invests in the metatarsal heads and fibrous sheaths enveloping the flexor tendons of the toes. There are medial, central, and lateral components of the plantar fascia, with the central component being the largest and most well-developed.
  • Increasing Tension/Lengthening: Increased tension in the plantar fascia may be achieved with a combination of toe extension, transverse tarsal joint dorsiflexion or pronation, and ankle dorsiflexion. Toe extension is likely to result in the largest increase in tension, followed by transverse tarsal joint dorsiflexion and pronation, and the least tension may result from ankle dorsiflexion.

Clothing and Covering:

• IASTM cannot be done over clothing. It is advised that the client/patient is informed prior to the session that they will be asked to remove shoes, socks, and/or stockings covering the feet. 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 the plantar fascia with the practitioner sitting at the patient's feet, the feet off the end of the treatment table, and the patient in supine. However, it is likely most comfortable for the practitioner to stand or sit with the patient in prone, and the knee flexed to 30° - 45°.

Potentially Sensitive Tissues

• Soles of the feet: Usually, this section of the written instructions provides information on structures that have the potential to be injured or damaged with careless implementation (nerves, lymph nodes, or vessels). In the plantar aspect of the foot, these structures are well protected by the plantar fascia and/or course between the metatarsal bones. However, the sole of the foot itself is a densely innervated area. Light, feathery strokes may trigger a "tickle response," and excessive pressure may be extremely painful. It takes some practice, but tickling and excessive discomfort may be avoided by starting with "moderate/firm pressure" that progressively increases to the appropriate treatment pressure.

Trigger Points

• Fascia does not develop trigger points. Most IASTM techniques address connective tissue that is relatively thin and superficial to muscles that are likely to develop trigger points. The plantar fascia is connective tissue; and therefore, cannot develop trigger points. Further, most of the muscle mass of the toe flexors lies in the deep posterior compartment of the lower leg, with only tendons that cross the bottom of the foot. Most of the muscles with muscle mass in the plantar aspect of the foot are too deep to effectively treat with IASTM. In summary, it is unlikely that trigger points will be addressed while administering plantar fascia IASTM.