Thoracic, Infraspinatus and Deltoid 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:

• Thoracic, Infraspinatus, and Deltoid Fascia: 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 (superficial layer of fascia over the scapula) and deltoid fascia.
  • Increasing Tension/Lengthening: Cervical and thoracic spine flexion, scapula protraction, and shoulder horizontal adduction will increase tension. Additionally, cervical rotation, scapular upward rotation, and shoulder flexion or rotation may increase tension in regions of this fascial sheath.

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 upper back 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 chest). Depending on the region assessed as exhibiting irregularities in tissue consistency, these areas may be addressed with the patient in a prone position on a table (aiding in covering the chest during the intervention). Additionally, the clever selection of attire (e.g. a tank top, sports bra with an open back, etc.) may allow for treatment to commence with minimal adjustment to clothing, even in a sitting or standing position. 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

• The ideal patient position for this technique is either prone on a table with a headrest set to allow for some cervical and upper thoracic flexion, and hands resting underneath the face, or sitting with the patient cued into cervical spine and thoracic spine flexion and the target arm held in horizontal adduction by the other arm.

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

• 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.
• Rhomboids: The most common rhomboid trigger points are near the insertion along the vertebral border of the scapula. Most often trigger points exist close to the superior and inferior angle, and one or two additional trigger points closer to the center of the vertebral border of the scapula.
• Infraspinatus: The most common trigger points in the infraspinatus are along the spine of the scapula, closer to the vertebral border.
• Teres minor: The most common trigger points in the teres minor are in the middle of the muscle, just medial to the apex of the axillary crease.
• Posterior Deltoid: The most common trigger points in the posterior deltoid  are located in the middle of the muscle belly.