Clinical Practice Patterns Among Health Care Professionals for Instrument-Assisted Soft Tissue Mobilization

Abstract

Context Instrument-assisted soft tissue mobilization (IASTM) is a popular myofascial intervention used by health care professionals. Objective To document IASTM clinical practice patterns among health care professionals in the United States. Design Cross-sectional study. Setting Online survey. Patients or Other Participants A total of 853 members of the National Athletic Trainers' Association (n = 249) and the American Physical Therapy Association (n = 604). Main Outcome Measure(s) Responses to a 55-item electronic survey that assessed 4 areas, namely, IASTM training and experience, IASTM application, perception of IASTM in practice, and demographic information. Results Most (n = 705, 83%) of the 853 respondents used IASTM in their practice, and they had an average of 15 years of work experience. Approximately 86% (n = 731) reported completing some type of formal training, and 61% (n = 518) had completed some type of informal training. Respondents used >34 different IASTM tools. Seventy-one percent (n = 606) indicated either not knowing how to quantify the amount of force applied by the tool during treatment or not trying to quantify. Fifteen percent (n = 128) estimated a force ranging from 100 to 500g. The treatment time for a specific lesion and location ranged from 1 to ≤5 minutes, with an average total treatment time of 14.46 ± 14.70 minutes. Respondents used 31 different interventions before or after IASTM. Approximately 66% (n = 564) reported following treatment recommendations, and 19% (n = 162) described rarely or never following recommendations learned during training. A total of 94% (n = 801) recounted using some type of clinical outcome measure to assess their treatment. Cluster analysis identified 3 distinct cluster groupings among professionals, with most (89%, n = 729/818) indicating that IASTM was an effective treatment. Conclusions This survey documented the IASTM practice patterns of health care professionals. Cluster profiles characterized group differences in IASTM training and clinical application. The gaps among research, clinical practice, and training need to be bridged to establish IASTM best practices.

Effect of instrument type and one-handed versus two-handed grips on force application during simulated instrument-assisted soft tissue mobilisation

“…Most respondents estimated that they applied a moderate force (ie, 250–500 g; 2.45–4.90 N) during treatment, but responses were not reported as to whether that force varied when using different grip types or instruments. 5 Our data ( table 3 ) indicate two-handed F peak and F mean values averaged for all participants exceeds the previously reported moderate force range; similarly, one-handed F peak values also exceeded that range, while F mean values trended towards the upper boundaries of that range. Thus, clinicians may be producing more force than estimated during IASTM, with potentially greater underestimation occurring when two-handed grips are being performed.…”

“… 2 5 The wide variation of instrument designs and instrument application (eg, one hand or two hand grips) may influence the forces applied by clinicians during IASTM. 5 …”

“…Clinicians may use IASTM to increase tissue healing response, mobilise scar tissue, decrease tissue tension and enhance their ability to detect abnormalities in the soft tissue 1–4. A wide variety of instruments with numerous variations (eg, manufacturer, materials (eg, steel, bone, stone), shape, size, weight) have been used by clinicians with different types of training and levels of clinical experience 2 5. The wide variation of instrument designs and instrument application (eg, one hand or two hand grips) may influence the forces applied by clinicians during IASTM 5…”

“…Although a consensus on an ideal treatment force has not been reached, the amount of force used during treatment is a consideration for clinical application of IASTM 1 6 7. Inconsistencies in outcomes from the IASTM literature may result from variations in research methodologies,1 2 4 5 and variations across IASTM training courses 4 5. The discrepancies between methodologies and techniques taught in training courses may be the basis for clinician-reported estimates ranging from lighter forces (ie, 500 g or less) to more substantial forces (ie, more than 500 g) 4 5…”

Popular Complementary and Alternative Therapy Methods in Different Conditions

“…It may be effective in increasing range of motion in the uninjured individuals, while reducing pain and/or increasing patient-reported function in the injured ones. There is low evidence that it enhances short term joint range of motion 49 . Its effectiveness is not fully known due to the lack of evidence and heterogeneity.…”