Thoracolumbar 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:

• Posterior Layers of the Thoracolumbar Fascia (TLF): The TLF can be described as a 3-layer system (posterior, middle, and anterior), with the posterior layer having deep and superficial laminae (layers). The superficial lamina of the posterior layer is continuous with the fascias of the latissimus dorsi, serratus posterior inferior, and gluteus maximus, as well as part of the external obliques, and lower trapezius. Medially, the majority of the superficial layer invests in the supraspinous ligament and spinous processes cranial to L4, but fibers do cross to attach to the contralateral sacrum, PSIS, and iliac crest. Some of the TLF fibers arising from the gluteus maximus also cross the mid-line to attach to the opposite sacrum, PSIS, or lateral raphe. The deep lamina of the posterior layer is continuous with the fascias of the splenius capitis and cervicis, superficial rhomboids, envelops the erector spinae (acting as a retinaculum), and is continuous with the sacrotuberous ligament and potentially the biceps femoris. This video discusses IASTM with the intent to treat the posterior layers, and does not assume that this technique has a significant effect on the middle or anterior layers of the TLF.
  • Increasing Tension/Lengthening: Increased tension in the posterior layers of the TLF may be achieved via flexion, contralateral flexion, and contralateral rotation of the lumbar spine. Further, shoulder flexion may increase TLF tension due to fascial continuity with the latissimus dorsi, and hip flexion may increase TLF tension due to fascial continuity with the gluteal fascia.

Clothing and Covering:

• IASTM cannot be done over the clothing. It is advised that the client/patient wear clothing that allows access to the lumbar spine, thoracic spine, and sacrum region (e.g. a loose shirt or a sports bra, and shorts or pants with an adjustable waistband, 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 areas of assessed tissue inconsistency with the client/patient on a table in a prone position. However, most often the best position for this technique is in the child's pose , or a modified version of the child's pose .

Potentially Sensitive Tissues

• Spinous Processes and Ribs: Although it is not a contraindication, performing IASTM with significant pressure over relatively superficial bone can result in significant pain and skin abrasion. Reducing pressure is most often sufficient to continue IASTM over superficial bone.

Trigger Points

• Lumbar Erectors: Because the erector spinae and multifidus are segmentally innervated, trigger points may occur in any fascicle along their length.
  • A common site for multifidus trigger points occurs adjacent to the L4/L5 segment, just medial to the posterior superior iliac spine (PSIS).
  • A common erector spinae trigger point occurs adjacent to the mid-lumbar spine and thoracolumbar junction, perhaps where these fascicles originate on the thoracolumbar fascia.
• Quadratus Lumborum (QL): The most common trigger points in the QL occur at the "base" of the muscle, just superior to the sacroiliac joint, and in the middle of the muscle adjacent to the L2 - L4 segments.