To comply with professional boards/associations standards:• I declare that I (or my family) do have a financial relationship in any amount, occurring in the last 12 months with a commercial interest whose products or services are discussed in my presentation. Additionally, all planners involved do not have any financial relationship.•Requirements for successful completion are attendance for the full session along with a completed session evaluation.•Vyne Education and all current accreditation statuses does not imply endorsement of any commercial products displayed in conjunction with this activity.

Session 403: IASTM Redefined: Basic, Gentle Soft Tissue Techniques for Patient Care

Shante Cofield, PT, DPT, OCS, CSCS, CF‐L1

Leading the Way in Continuing Education and Professional Development. www.Vyne.com

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Take Home

Messages

Human Navigation

Sensory system

Mechanical vs. Neurological models

Stroke rate, depth, dosage

Fascial Glide – Dry Technique

Fascial Glide – Dry Technique

Risk Management

Why?

“Never be sure of what you think”

“You think, but are you sure of what

you think?”

Dr. Jean-Claude Guimberteau

Personal and professional reflection

What I Think We Are Doing

Feeding the Sensory System to

Improve Motor Output

Sensori-Motor Re-Training

Limits exist only in the mind

Pain Science – Paradigm Shift in Rehab

SIMPLE SOLUTIONS TO COMPLEX PROBLEMS IS NOT

WORKING

Biomedical

SocialPsychological

We are fearfully and wonderfully complex

Lorimer Moseley

IANSM

Instrument Assisted Neuro-Sensory Modulation

How to make chronic changes in tissues?

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Compliant+

mobile

Stiff+

Springy

+

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Chronic Changes

compliant REACTIVE efficiency+ =

mobility motor control

+ stiff

STABILITY

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corrective exercise - Used to normalize human movement before increasing training or exercise demands

kinesiology tape- A special sports tape that provides support while allowing full range of motion. Tape is used to decrease pain, unload tissue via decompression, and provide a novel stimulus that improves body awareness.

iastm - Instrument - Assisted Soft Tissue Massage - A manual therapy technique designed to provide direct, mechanical manipulation of irregular tissue.

rolling/balls/bands - A collection of tools used by athletes for manipulation of the myofascial system to normalize muscle tone.

assessment- The act of making a judgment about the quality of human movement

screening- The act of examining people to decide if they are suitable for a particular movement or exercise

Movement Pyramid

Mechanical Neurological

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Mechanical Effects

Dr. Robert Schleip • Debunked the idea of fascial release

(mechanical deformation of fascia)

• Dismisses the traditional explanations of thixotropy and peizoelectric-effect-mediated adaptation, and thoroughly describes fascial toughness.

• Concludes that plastic fascial change in response to moderate loading is “impossible to conceive.”

Superhuman

How much pressure necessary to distort tissue?

2000 LBS/SQ”

Dr. Geoffrey Bove • “It’s all about the interfaces”• Interfaces are essentially the fascial planes between

muscles, nerves, fascia, etc..• Lack of gliding is the enemy • Positive treatment effects are at the loose connective

tissue and not in the fascia • Early intervention is the key

Bove GM, Chapelle SL. Visceral mobilization can lyse and prevent post-surgical adhesions. Journal of Bodywork and Movement Therapies, 16, 76-82, 2012 doi: 10.1016/j.jbmt.2011.02.004

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www.mindray.com

Beneath the SkinSkin

Superficial Fascia

Deep Fascia

Muscle

Bone

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Langevin study : thoraco-lumbar fascial movement

Wet Dry

• Allows for Skin Glide • Stimulation of Sensory

Nerves

• Improves tangential forces• Improves gliding between

layers

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Dry Method

Pathological Adhesion?

Pre Blades Post Blades

Old School

Aggressive and intense manual therapy with no regard for the state of the patient’s nervous system is problematic

No Pain, No Gain

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NeurologicalEffects

Peripheral Effects

Central Effects

Body Maps

Connect the Dots• Redefining the maps

• Modern rehabilitation will be via normalization of sensation, motor control and the congruence of these factors

Smudging

Tactile Acuity and Pain

Science of touch

Making the Invisible Visible

Kinesthetic Cueing

Autonomic Nervous System -

Brain

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hypothalamic tuning

global muscle tone

intra-fascial smooth muscles

palpable tissue response

tissue manipulation

stimulation of mechanoreceptors

Robert Schleip

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1golgi receptors

(type Ib)

2

3

pacinian corpuscles (type

II)

ruffini endings(type II)

interstitial (type Iii/iv)

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4 types of fascial receptors

Fascial Tone Modulation

Pain Mitigation

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How to Navigate the Human Body

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Fascia Joint by Joint

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fascia as our roadmap

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Via the ectoderm

connected both mechanically and

neurologically

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it’s alive

fascia sensesrichest sensory organ

fascia transmits force globallycommon myofascial pathways for transmitting stability, strain, and responsedistributes strain

continuous interconnected weba GPS system of strain distribution

what is fascia

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mobility - ripple effect

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where you think it is, it ain’t.

Ida Rolf

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ankle restriction

• ripple:• calf/shin/hamstrings

• target tissue – ankle• ripple:

• foot

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Wainner, RS, et al. Regional Interdependence: A Musculoskeletal Examination Model Whose Time Has Come. J Orthop Sports Phys Ther 2007;37(11):658-660

“when the assessment is initiated from the perspective of a movement

pattern, the clinician is able to identify meaningful impairments that may

seem unrelated to the main complaint”

regional interdependence

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mobility vs. stability

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Foot StableAnkle** MobileKnee Stable (control)Hip** MobilePelvis/Sacrum/L-Spine Stable (Control)Thoracic Spine** MobileCervical Spine Stable (Control) Shoulder complex MobileElbow Stable (Control) Wrist Mobile

** key mobility centers

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movement screening methods

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all movement is a screen

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multi-planar approach

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1joint restriction:• Banded

distractions • Joint Mobilizations• Joint Adjustments 2

soft tissue shortening:

• Foam rolling• Ball release• Instrument assisted• Hands on release

Mobility Restrictions

ProtectiveBarrier

TissueGlide

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corrective exercise - Used to normalize human movement before increasing training or exercise demands

kinesiology tape - A special sports tape that provides support while allowing full range of motion. Tape is used to decrease pain, unload tissue via decompression, and provide a novel stimulus that improves body awareness.

iastm - Instrument - Assisted Soft Tissue Massage - A manual therapy technique designed to provide direct, mechanical manipulation of irregular tissue.

rolling/balls/bands - A collection of tools used by athletes for manipulation of the myofascial system to normalize muscle tone.

assessment- The act of making a judgment about the quality of human movement

screening- The act of examining people to decide if they are suitable for a particular movement or exercise

Movement Pyramid

1. Driver’s Education

2. The Method

– Graded Exposure Model

3. Treatment Strokes

– Pain Mitigation

– Movement Priming

– Relaxation

– Gliding (Dry)

4. Fascial Case Study

How?

Pain Science Community

To start: Have a Plan1. What do you WANT?

2. Find your BASELINE

3. PLAN your progression

4. Be PERSISTENT

5. Educate

Graded Myofascial Release

1. Slow Progressions

2. Avoid Flare Ups – Reduce the risk of undue trauma

3. Improve Tissue Tolerance

4. Distraction Therapy

Graded Exposure TherapySystematic desensitization, also known as graduated exposure therapy is a type of behavior therapy used in the field of psychology

Recently adopted to address Musculoskeletal conditions

Distraction Method

Driver’s Education

Treatment Edges

Hard Rock

Groovy Rock

Bottle Opener

Soft Rock

Alternative Rock

NarrowEdge

BluntEdge

Fine Tuning Edge

Finger Pads

Grip

Indications • Limited motion

• Pain during motion

• Motor dysfunction (poor motor patterns)

• Lack of tissue glide

• Poor body representation

Contraindications • Compromised tissue integrity (open wound, infection,

tumor)

• Active implants (pacemaker, internal defibrillator, picc/pump lines)

• DVT (Deep Vein Thrombosis)

• Cervical carotid sinus

• Inability to communicate

Disclaimer

Not necessary

5 Treatment Strokes:

1. Feathering = Pain Control 2. Rapid = Stimulation 3. Slow = Relaxation 4. Dry = Tissue Glide 5. Fluid Capture = Fluid Management

Treatment Strokes

SUPERFICIAL 

DEEP

Depth

Interoception/Pain Relief

Pain = FeatheringInterstitial Stimulation

Manual Therapy myofascial therapists are usually concerned with direct biomechanical effects

ORwith the stimulation of specific proprioceptive nerve endings such as muscle spindles, golgi receptors

• Advisable that manual therapists target the interoceptive receptors (Interstitial Fibers) and their related upstream effects

Interstitial receptors

• Free Nerve Endings (Unmyelinated C-Fiber afferents)

• Low Mechanical Threshold

• Present in human hairy skin

• Project to the insular cortex

– Trigger a general sense of well-being/Pain Relief

– Increase vagal tone – Global relaxation

Pain – Feathering1. SCAN tissues targeted within

workout.2. IDENTIFY areas of

tenderness/tightness = TARGET TISSUE

3. SUPERFICIALLY FEATHER pressure on target tissue for 30 seconds to tolerance

4. ADDRESS tissues up/down stream to target tissue = RIPPLE

SCAN + IDENTIFY + FEATHER STROKE + RIPPLE

Pre Tension Model

Rate

Pacinian Receptors = FAST

Ruffini Receptors = SLOW

Contractile Properties of Fascia• Sensory and motor dimension• Dr. Staubesand:

– Network of smooth muscle-like cells (Myofibroblasts)

– Rich intra-fascial supply of sympathetic nerve tissue and sensory nerve endings

PRIMING= FASTPacinian Stimulation

Increasing Tone

Tactile AcuityBody

Representation

Smudging

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pacini mechanoreceptors:

• these receptors are primarily responsive to rapid pressure changes.

• Stimulating these receptors can result in improved proprioceptive feedback and controlled motor movement.

Body Map receptors

Tactile Acuity

PRIMING – FAST/Oscillating

1.SCAN tissues that will be targeted in specific workout out.

2.IDENTIFY areas of tightness/tenderness = TARGET TISSUE

3.QUICKLY oscillate over the area for 30 SECONDS = RAPID RELEASE

4.ADDRESS tissue up/down stream to target tissue = RIPPLE

SCAN + IDENTIFY + RAPID STROKES + RIPPLE

Beneath the SkinSkin

Superfiscial Fascia

Deep Fascia

Muscle

Bone

relaxation

Relaxation = SLOW

Ruffini Stimulation

decreasing Tone

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ruffini mechanoreceptors:stimulation of ruffini corpuscles is assumed toresult in a lowering of sympatheticnervous system activity (van den Berg & Capri1999).

slow deep tissue techniques tend to have arelaxing effect on local tissues as well as on thewhole organism.

It therefore appears that deep manual pressure– specifically if it is slow or steady- stimulatesinterstitial and Ruffini resulting in global musclerelaxation, as well as a more peaceful mind andless emotional arousal.

inhibitory receptors

Relaxation

Relaxation – SLOW/Deep1. SCAN tissues targeted within

workout.2. IDENTIFY areas of

tenderness/tightness = TARGET TISSUE

3. Deep/Slow pressure on target tissue for 30 seconds to tolerance

4. ADDRESS tissues up/down stream to target tissue = RIPPLE

SCAN + IDENTIFY + RECOVERY RELEASE + RIPPLE

gliding

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interlayer gliding

Dr. Geoffrey Bove • “It’s all about the interfaces”• Interfaces are essentially the fascial planes between

muscles, nerves, fascia, etc..• Lack of gliding is the enemy • Positive treatment effects are at the loose connective

tissue and not in the fascia • Early intervention is the key

Bove GM, Chapelle SL. Visceral mobilization can lyse and prevent post-surgical adhesions. Journal of Bodywork and Movement Therapies, 16, 76-82, 2012 doi: 10.1016/j.jbmt.2011.02.004

136

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www.mindray.com

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139

Langevin study : thoraco-lumbar fascial movement

Wet vs. Dry Treatment Dry Treatment – Improve Skin Drag to

create tangential load to skin/fascia

– Stimulating RuffiniEndings that respond best to skin shear

– Improved gliding effect (fascial interface)

Wet Treatment – Allow for superficial

skin/fascial stimulation at a faster rate (Pacinian Corpuscle)

– Allow for feathering effect on interstitial fibers (interoception)

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Rx

Tool Assisted Mobilization:

Target Tissue Tx = 10-30 secsRipple above and below = 10-30 secs90 secs (approx) region

90 Seconds – Curative Dosage

Goals:

ScreenPain ReliefprimingrelaxationROM – gliderippleFascial/jxjre-screen

Case Study

PerformanceBackChain

Sagittal Plane Correction

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Sagittal planar dysfunction

In Summary • New perspective of manual therapy

• Neurological tweaking of the brain

• Navigating the human body

• Fascial IANSM

• Dry Instrument assisted method

• Scrape, tape, train model (movability)

• LESS IS MORE (limits flair ups)