Soft tissue-oriented relaxation techniques in physiotherapy: a narrative review of randomized controlled trials

Soft tissue restrictions have been linked to poor flexibility and decreased range of motion (ROM). To decrease the soft tissue restrictions and ultimately increase ROM/flexibility, myofascial release techniques, such as foam rolling (FR) and instrument-assisted soft tissue mobilization (IASTM), have been used. However, the benefit regarding which technique is more beneficial remains unknown. To examine the effects of myofascial release techniques (FR vs the instrumented portion of IASTM) on knee joint ROM, rectus femoris (RF) and biceps femoris (BF) fascial displacement, and patient satisfaction. Randomized controlled clinical trial. Mid-Atlantic University. Twenty moderately active participants (age 21.1 [2.0]y) with variable levels of soft tissue restriction in the quadriceps and hamstrings started and completed the study. Participants were randomly assigned to 2 groups, FR or IASTM. All participants completed the same warm-up prior to the intervention. The FR group followed the proper FR protocol for gluteals/iliotibial band, quadriceps, and hamstrings/adductors, and the participants were monitored while the protocol was completed. The IASTM group received treatment on the gluteals/iliotibial band followed by the quadriceps, adductors, and hamstrings. Participants in both groups attended intervention sessions twice per week for 3 weeks. Prior to the start, knee ROM measurements were taken, along with fascial displacement measured via ultrasound. Upon completion of the study, posttest measurements were completed. A patient satisfaction survey was also administered at this time. Pretest to posttest knee ROM measurements, RF and BF fascial displacement, and patient satisfaction. Both groups improved pretest to posttest for knee-extension ROM, with a slight trend toward increased knee-extension ROM for the FR group. Both groups improved pretest to posttest for BF and RF fascial displacement, in favor of the IASTM group for BF fascial displacement. Both groups were equally satisfied. As both groups improved pretest to posttest, either treatment could be used.

We designed this study to investigate the effects of 2 myofascial release techniques, Instrument-Assisted Soft Tissue Mobilization (IASTM) and Foam Roller (FR), on pain, joint range of motion, and muscle strength in athletes suffering from iliotibial band (ITB) tightness. A total of 39 male soccer players were enrolled in this randomized controlled trial, aged between 18 and 23years who were divided into 3 groups: Only Exercise, IASTM, and FR. All participants performed daily strengthening and stretching exercises, while 1 group added IASTM, and the other added FR to the exercise program. We evaluated ITB tightness with the Ober test and an inclinometer, pressure pain threshold, using an algometer, and we evaluated muscle strength with the Cybex Norm Isokinetic device. We found that all 3 groups exhibited an increase in the Ober inclination angle after the interventions (P = .001), but the increase was greater for participants in the IASTM and FR groups, compared with exercise alone. Additionally, both the IASTM and FR groups displayed an increased pressure pain threshold (P = .001), whereas there was no change in the control group. Moreover, while all 3 groups experienced an increase in hip muscle strength (P = .001), the IASTM and FR groups exhibited a greater increase compared with exercise alone (P = .001). Based on these findings, exercise improves pain, range of motion, and muscle strength in athletes with ITB tightness, and IASTM, and FR techniques enhanced exercise effects but did not differ from one another. While our study demonstrated that both IASTM and FR techniques significantly enhance the benefits of exercise for athletes with ITB tightness, further research could delve into the long-term effects of these interventions.

To determine the overall effectiveness of instrument-assisted soft tissue mobilization (IASTM) in improving range of motion (ROM), pain, strength, and patient-reported function in order to provide recommendations for use. We also sought to examine the influence of IASTM on injured and healthy participants, body part treated, and product used. We searched the Academic Search Premier, Alt Healthwatch, CINAHL Complete, Cochrane Library, MEDLINE with full text, NLM PubMed, Physical Education Index, Physiotherapy Evidence Database (PEDro), SPORTDiscus with full text, and Web of Science databases for articles published from 1997 through 2016. The Boolean string advantEDGE OR astym OR graston OR iastm OR "instrument assist* soft tissue mobil*" OR "augment* soft tissue mobil*" OR "myofascial release" OR "instrument assist* massage" OR "augment* massage" OR "instrument assist* cross fiber massage" was used. Included articles were randomized controlled trials that measured ROM, pain, strength, or patient-reported function and compared IASTM treatment with at least 1 other group. Thirteen articles met the inclusion criteria. Four independent reviewers assessed study quality using the PEDro and Centre for Evidence-Based Medicine scales. Twelve articles were included in the effect-size analysis. The average PEDro score for studies of uninjured participants was 5.83 (range = 5 to 7) and that for studies of injured participants was 5.86 (range = 3 to 7). Large effect sizes were found in outcomes for ROM (uninjured participants), pain (injured participants), and patient-reported function (injured participants). The different IASTM tools used in these studies revealed similar effect sizes in the various outcomes. The current literature provides support for IASTM in improving ROM in uninjured individuals as well as pain and patient-reported function (or both) in injured patients. More high-quality research involving a larger variety of patients and products is needed to further substantiate and allow for generalization of these findings.

Myofascial pain syndrome (MPS) is a muscle pain disorder characterized by the presence of Myofascial Trigger Point (MTrP) within a taut band, local tenderness, referral of pain to a distant site, restricted range of motion, and autonomic phenomena. The upper trapezius is the muscle most often affected by MTrPs. Manual myofascial release (MFR) and Instrument-Assisted Soft Tissue Mobilization (IASTM) are techniques of soft tissue release that are used to resolve MPS. Fifty six percent of physiotherapists complain of pain in multiple areas due to the massage and manual therapy that they have to perform. The objective of this study is to find whether IASTM is better than manual MFR in treating patients with MPS in upper trapezius. This study was a single-blinded randomized controlled trial that included 31 participants, both males and females between the age groups of 18-50 years. Participants were randomly divided into two groups. Three sessions were given over a period of one week for both groups. Group A received IASTM along with conventional treatment and Group B received Manual MFR along with the conventional treatment. The outcome measures evaluated were pain, cervical range of motion, pain pressure threshold (PPT) of trigger points, and the neck disability index. Pre- and post-measurements were taken and the analysis was done. Both the treatment methods significantly reduced pain, improved PPT, range of motion, and function. The effects between the groups showed that IASTM was significantly better than manual MFR to reduce pain. The improvement in PPT, range of motion and function were equal in both the groups. IASTM and manual MFR both are effective individually as treatment procedures for pain, PPT, range of motion, and function. Neither of the treatment options can be considered better that the other. The clinician can decide based on the availability of the instrument, training, patient's preference, and his/her comfort whether which of the two treatment methods should be used.

Background: Myofascial pain syndrome is characterized by the presence of activated myofascial trigger points (Nodules in skeletal muscles that are painful on palpation). IASTM is a technique that uses instrumentation to correct musculoskeletal disorders and promote soft tissue healing. Dry needling involves the insertion of thin needles, analogous to acupuncture, without any injection of substances. Dry needling is generally used to palliate colorful neuro- musculoskeletal pain treatment. Aim of the study: To determine the effect of IASTM and DRY NEEDLING in Upper Back Myofascial Pain Syndrome. Methodology: The patients was selected through inclusion and exclusion criteria and diagnosed with UBMPS by the Orthopedician. The patient named. And age of 20 and belongs from Delhi. He is student of Department of RIT, Faculty of Paramedical Sciences (FPS), (UPUMS). He is suffering from pain from more than 4weeks. After that he receives 2 sessions of Dry Needling and IASTM in the clinical lab of Department of Physiotherapy (FPS, UPUMS).Results: Both groups showed significant improvement in pain levels, with a reduction in NPRS scores following the treatments. The overall pain reduction in the Dry Needling group (average reduction of 4 points) was slightly greater than that observed in the IASTM group (average reduction of 3 points).Conclusion: This case study will provide valuable insights into the effectiveness of dry needling and IASTM in managing upper back MPS. Dry needling is more effective than IASTM in treating the Upper Back Myofascial Pain Syndrome. Dry needling has immediate effects in trigger point releasing and pain reduction.Originality/value: Modified new interventional study to progress in treatment.

Ankle dorsiflexion range of motion (ADF-ROM) deficits has been linked to impaired function, altered gait, and injury risk. This study's objective was to examine the acute effects of static self-stretching (SSS), foam rolling (FR), and instrument-assisted soft tissue mobilization (IASTM) of the posterior lower-leg on ADF-ROM and functional ankle outcomes in individuals with ADF-ROM deficits. Thirteen healthy, physically active college students with active ADF-ROM ≤ 13°, assessed in a non-weight-bearing position, completed all three interventions in a randomized, within-subject repeated-measures design. Pre- and post-intervention assessments included ADF-ROM, ankle plantar flexor isometric strength (APF-IS), single-leg countermovement vertical jump (SLCVJ), anterior reach distance in the Y-Balance Test (A-YBT), and gait parameters (contact time and plantar pressure). A two-way repeated-measures ANOVA with Bonferroni post hoc tests was used. Effect sizes reported as partial eta squared (ηp2) and Cohen dz. All interventions significantly improved ADF-ROM (p < 0.001; ηp2 = 0.885), with IASTM showing the largest increase (50.7%, dz = 2.15), followed by FR (35.4%, dz = 2.20) and SSS (21.5%, dz = 1.82). Differences between IASTM and FR (p > 0.05, dz = 0.40) and between FR and SSS (p > 0.05, dz = 0.69) were nonsignificant, while IASTM was significantly greater than SSS (p < 0.05, dz = 0.92). Significant gains were also seen in A-YBT (p < 0.05; ηp2 = 0.302) and rearfoot plantar pressure (p < 0.01; ηp2 = 0.482), although pairwise comparisons were nonsignificant and demonstrated small-to-moderate effect sizes (dz = 0.35-0.52). No significant changes occurred in APF-IS, SLCVJ, or contact time and mid- and forefoot plantar pressures during roll-off. In conclusion, all interventions improved ADF-ROM, with IASTM and FR being comparably effective. However, only slight improvements in dynamic balance and certain gait parameters were noted, with no effect on strength or power.

Effectiveness of instrument assisted soft tissue mobilization versus foam rolling on trigger point release in calf muscles

Background: Instrument-assisted soft tissue mobilization (IASTM) is an emerging intervention in physical therapy. With the increasing prevalence of pain and disability associated with musculoskeletal impairments, it is essential to identify the most effective treatment strategies. Objective: To systematically examine evidence on the effectiveness of IASTM, compared to other interventions on patients with pain and disability resulting from musculoskeletal impairments. Methods: Numerous databases were searched using the terms Instrument Assisted Soft Tissue, Pain, Function, Graston, and soft tissue mobilization (STM). Inclusion criteria included: randomized clinical trials on patients with musculoskeletal impairments, STM had to be a treatment intervention, performed on human subjects, and had to capture a measure of pain or function. Articles were excluded if they were not published in English or if the subjects were of the pediatric or geriatric populations. Included articles were appraised using the Physiotherapy Evidence Database (PEDro) scale. Results: Seven studies met the inclusion criteria. All seven articles scored a minimum 4/10 on the PEDro scale. The studies involved treatment of numerous anatomical locations and the majority of the studies demonstrated significant improvements in pain and/or range of motion when compared to control or other conservative treatment groups. Conclusions: These outcomes support the idea that IASTM may have an impact on physiological changes by providing an increase in blood flow, reduction in tissue viscosity, myofascial release, interruption of pain receptors, and improvement of flexibility of underlying tissue. It is suggested that IASTM is an effective treatment intervention for reducing pain and improving function in less than a three-month period.

Instrument assisted soft tissue mobilization (IASTM) is the use of specially designed instruments that provide a mobilizing effect to soft tissue to help with decreasing pain and improving range of motion.Over the years, there has been an increase in the use of IASTM as well as an increase in research for its effects on soft-tissue injuries, range of motion (ROM), and pain management; however, the results have not been supported as a whole.Evidence for the positive outcomes from the use of IASTM, in conjunction with therapeutic exercise or other interventions, has been lacking in many studies.As a result, clinicians question its effectiveness.The purpose of this evidence-to-practice review was to summarize the results of the systematic review and apply it to clinical practice.The authors of the guiding systematic review aimed to investigate the current state of available literature on the topic of IASTM, specifically using studies that compared IASTM pre & post-treatment and compared the IASTM group to other intervention or control groups.Seven total studies were included in the final review, and of those, five focused on IASTM treatment for musculoskeletal pain and two focused on IASTM treatment for joint ROM.Each study varied in methodology, interventions, treatment times, and outcome measures.Therefore, the systematic review was unable to make a direct comparison between all studies and results were deemed inconclusive.In conclusion, using IASTM as a stand-alone treatment is not recommended in any case.However, in the event the treatment is not contraindicated and the clinician is inclined to use the treatment for physiological improvement, then implementation and use of IASTM is not unreasonable and could potentially benefit the patient when used in conjunction with therapeutic exercise or other form of treatment.

Introduction: Instrument-assisted soft tissue mobilization (IASTM) is a relatively recent method that has been shown to help reduce muscular tension, increase flexibility and prevent tissue adhesion. Nevertheless, there is a paucity of awareness and knowledge about the benefits of IASTM, especially following injury rehabilitation, despite its many advantages. The study aimed to investigate the awareness, practice and perception of instrument- assisted soft tissue mobilization (IASTM) among Malaysian physiotherapists (PTs). Methods: The cross-sectional study included 133 PTs who answered an online questionnaire via a google link on their awareness and perception of IASTM in their practice. The Google link was given to the participants through email and the official Malaysian Physiotherapy (MPA) social media group. Results: Majority of the respondents (73.7%) are aware of IASTM technique. Despite being aware on IASTM, 74.4% of respondents reported not practicing the technique. Furthermore, 73.7% of respondents stated that the main reason they don’t practice is because fingers have better force adjustment than IASTM. Over 80% of respondents revealed that practicing IASTM can save energy and convenient during myofascial release. Moreover, 82.7 % of respondents stated that one of the benefits of IASTM for PTs is that it helps alleviate stress on fingers and wrists during soft tissue mobilization. Beyond 55% of respondents stated that they will incorporate IASTM in practice in near future. Conclusion: According to the findings, the majority of Malaysian physiotherapists are aware of the IASTM. However, fewer than half of respondents declined to incorporate it into their future practice due to the PTs preference for feeling the patient’s muscle texture. More emphasis can be given to the IASTM techniques among the PTs as the participants have mentioned that IASTM has better force exertion and saves energy when applying soft tissue massage.

Background: Previous studies have been reported that when instrument assisted soft tissue mobilization (IASTM) and the self-myofascial release technique were used on the muscles. However, studies that applied the IASTM and self-stretching to the gastrocnemius muscle are thought to be necessary but there is no such previous study. Objectives: To investigate the effects of IASTM and self-stretching on gastrocnemius muscle thickness and the range of motion of joint in dorsiflexion in healthy college student. Design: Quasi-experimental design (single blind). Methods: The subjects were healthy college students in their 20s with a healthy body. As for the experimental method in this study, comparison between before and after the experiment was performed to compare the effects of myofascial release using IASTM and stretching. The preliminary survey investigated the range of motion (ROM) of ankle joint of the subjects. The thicknesses of gastrocnemius muscles were measured using ultrasonography. One day after the preliminary survey, IASTM interventions and self-stretching interventions were randomly selected. If IASTM intervention is selected, the IASTM of the gastrocnemius muscle was applied for 5 minutes. After than, muscle thickness and the ankle dorsiflexion ROM were measured. Subjects were asked to take a break for about one day after performing the intervention. Self-stretching was applied to the gastrocnemius muscle for 5 minutes identically. After than, muscle thickness and the ankle dorsiflexion ROM were measured. Results: The thickness of the gastrocnemius muscle decreased significantly IASTM intervention, and the ankle dorsiflexion ROM increased significantly IASTM intervention. Ankle dorsiflexion ROM increased significantly the selfstretching intervention. The amounts of change in ankle dorsiflexion ROM through the IASTM was significantly greater than that through self-stretching. Conclusion: In order to immediately increase muscle flexibility in a short time, the IASTM is more effective although the self-stretching method is also effective.

Myofascial compression interventions have become popularin rehabilitation and fitness.To date, no studies have directly compared foam rolling, instrument assisted soft-tissue mobilization, and floss band among unexperienced individuals.The primary purpose of this investigation was to compare the immediate post intervention effects of foam rolling, instrument assisted soft-tissue mobilization, and floss band on passive knee joint range of motion (ROM) among inexperienced individuals using a standard treatment time.The secondary purpose was to determine the interchangeability of the interventions and to provide preliminary research for long-term comparison studies.This pretest-posttest randomized controlled trial was conducted in a university laboratory.Thirty participants (M=15, W=15) were randomly assigned to three groups: (1) foam rolling, (2) instrument assisted soft-tissue mobilization, and (3) floss band.The intervention time for each group was 2-minutes.The outcome was passive knee joint ROM.Between group analysis revealed a statistically significant post-intervention difference between the three interventions for passive knee flexion ROM (p <.001).Within group comparison for ROM revealed a 2 degree (p<.001) post-intervention increase for foam rolling, a 3.5-degree (p<.001) increase for the instrument assisted soft-tissue mobilization, and a 4-degree (p<.001) increase for the floss band.The three interventions produced similar immediate post intervention effects on passive knee joint ROM among inexperienced individuals.Clinically, these interventions may be interchangeable by producing similar effects on knee ROM.Clinicians may want to consider these finding prior to administering these interventions with their patients.

Introduction Knee osteoarthritis (KOA) is a common joint disease that affects mobility and daily activities. Instrument-assisted soft tissue mobilization (IASTM) is widely used as a conservative treatment due to its potential effects on soft tissues. This study evaluates the effects of IASTM on pain, range of motion (ROM), health status, and gait kinetics in KOA patients. Methods Thirty individuals with unilateral KOA were randomized into two groups: IASTM with routine exercises and sham IASTM with exercises, over four sessions in two weeks. Pain, ROM, and WOMAC scores were assessed pre-treatment and 48 hours post-treatment. Gait kinetics, including vertical ground reaction force and knee adduction moment, were measured at three walking speeds (preferred, fixed, and fast) before and after treatment. Results Mixed ANOVA revealed significant improvements in pain, ROM, and WOMAC scores in both groups. The IASTM group showed greater improvements in pain, knee flexion, ankle plantarflexion, and WOMAC pain scores, as indicated by a significant group*time interaction. For kinetics, the only significant finding was a longer time to heel strike transient in the IASTM group. At fast speed, most kinetic variables increased significantly in both groups. Conclusion Both IASTM and sham interventions with exercise improved pain and ROM. However, the IASTM group experienced greater improvements. Additionally, IASTM led to a longer time to heel strike transient, suggesting improved shock absorption. Overall, IASTM may serve as a beneficial adjunctive intervention for alleviating symptoms in KOA patients and improving gait under challenging conditions, such as fast-speed walking.

Background &amp; objective: Low back pain (LBP) is a common musculoskeletal disorder in the general population. The most common etiological factors are overuse syndromes, postural issues, and bad working environment. The conservative management using physical agents can be more satisfactory and beneficial before the interventional techniques. We aimed to compare manual myofascial release and instrument-assisted soft tissue mobilization (IASTM) techniques for improving pain, lumber mobility, and functional index in patients with chronic LBP. Methodology: This non-randomized trial was conducted on 40 chronic low back pain patients and data was collected from Chaudhry Akram Research and Teaching Hospital, Lahore, Pakistan. We included patients with LBP for more than 3 months, ages 22-45 y. Group A received manual myofascial release (MFR), and Group B received instrument-assisted soft tissue mobilization (IASTM). The outcomes assessed were pain, low back functional index, and lumber range of motion. The data was analyzed using SPSS V.23. Repeated measurement ANOVA was used for within group comparison. While an Independent sample t-test was applied for inter-group comparison at a significance level of P &lt; 0.05. Results: There were 26 males and 14 females in the study. The study comprised of 20 participants in each group with mean ages of 33.17 ± 7.46 and 33.45 ± 7.63 y respectively. The results showed that pain improvement was more in group B compared to group A. While the disability and range of motion, including flexion, extension, and lumber right-side flexion, showed a statistically significant improvement (P &lt; 0.05). Mean difference was 1.75 for pain, 8.65 for disability index and -5.15 for lumber flexion, -1.25 for extension, and 1.30 for right side flexion, but no statistical differences (P &gt; 0.05) were found for left lumber flexion (P &gt; 0.05) in both groups. Conclusion: The results of our study show that chronic low back pain can be managed by myofascial release techniques but better effects can be achieved using instrument-assisted soft tissue mobilization technique. Keywords: Chronic Low Back Pain; IASTM; Low Back Disability Index; Manual Myofascial Release; Pain; Range of motion; Well-being Citation: Mahmood T, Abrar A, Atif MM, Mahmood W, Batool F. Effect of instrument-assisted soft tissue mobilization versus myofascial release therapy for pain, mobility, and disability in chronic low backache patients: a quasi-experimental study. Anaesth. pain intensive care 2024;28(2):452−458; DOI: 10.35975/apic.v28i3.2459 Received: August 28, 2023; Reviewed: December 09, 2023; Accepted: March 23, 2024

Introduction Muscle tightness is frequently identified as a potential precursor to muscle injuries. Reclaiming flexibility and enhancing range of motion (ROM) is crucial for preventing injuries and achieving improvements in performance.The present study examines the immediate effects of instrument-assisted soft-tissue mobilization (IASTM) and dry needling (DN) in reducing trigger point pain and calf tightness in long-distance runners. Methodology A total of 40 long-distance runners were recruited in the study (30 males and 10 females). The procedure was performed under the author's surveillance at the sports complex. These recruited players were placed into two groups: the IASTM (n=20) and the DN (n=20) group.The outcome measures used were the pressure algometer for assessing pain pressure threshold and the lunge test. An iPhone Measure app (Measure app, Apple App Store 2023) is used to assess ankle dorsiflexion ROM. The evaluation took place both prior to and immediately following the interventionand 48 hours after the intervention. Result The analysis within each group revealed a significant alteration in pain pressure threshold for both the IASTM and DN groups (p≤0.05), along with a relative enhancement in ankle dorsiflexion ROMobserved in the IASTM group (p≤0.05). Between-group analysis revealed a notable difference with an effect size difference of Cohen's d=1.06 (large difference) in pain pressure threshold, d=0.21 (small difference) in lunge test, and d=0.57 (medium difference) in ankle dorsiflexion ROM. Conclusion The present study concludes that both groups, IASTM and DN, showed significant effects in improving pain pressure threshold in long-distance runners. However, DN showed better results. IASTM showed significant results in enhancing the ankle dorsiflexion ROM immediately. This implies thatit can be used in conjunction with stretching to decrease pain and enhance flexibility, hence improving performance and preventing injuries.