Download - NATA National IASTM (Final)
6/10/2021
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Instrument-Assisted Soft-Tissue Mobilization: New Research and
Updated Clinical Standards
Speaker Bio
Scott Cheatham PhD, DPT, PT, ATC
• Educator/Researcher
• Several related studies and publications
• Credentials
• Graston® Technique
• RockTape®
• Tecnica Gavilan®
• Other related CE courses
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• Permission provided for images of products used in this presentation.
• There are no conflicts of interest with this presentation.
• We are still learning about IASTM. This presentation share’s the latest theories, research, and clinical knowledge.
Disclaimer Learning Outcomes
Participants will be able to:
• Discuss the latest scientific theories and best practices for IASTM.
• Describe updated evidence based clinical standards for IASTM.
• Discuss strategies for including IASTM as part of a comprehensive treatment strategy for various musculoskeletal conditions.
Learning Modules
• Module I: Myofascial Science
• Module II: Clinical Practice Patterns
• Module III: IASTM Research Review
• Module IV: IASTM Treatment Patterns
Levels of EvidenceEvidence Levels
Grading Criteria
Level 1A: Systematic Review of RCT’sB: Individual RCT with narrow CIC: Series of cases (all or none)
Level 2A: Systematic review of cohort studiesB: Individual cohort study, RCT with dropouts >20%C: “Outcomes” Research or ecologic studies
Level 3 A: Systematic Review (case‐controls)B: Individual case‐control
Level 4 Case Series
Level 5 Expert’s opinion
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Module I: Myofascial Science
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What is the basic science of the myofascial system?
Defining the Myofascial System
• Definition: • Fascia is connective tissue fibers, primarily
collagen, that form sheets or bands beneath the skin to attach, stabilize, enclose, and separate muscles and other internal organs.
• Fasciae are classified according to their distinct layers, their functions and their anatomical location.
Training principles for fascial connective tissues: Scientific foundation and suggested practical applications Schleip & Muller J. of Bodywork and Movement Therapies (2012)
Superficial Fascia
Deep Fascia
Epimysium
Classification
Sensory Receptors
Image: Cheatham SW, Kolber MJ. Orthopedic Management of the Hip and Pelvis ‐ E‐Book. Elsevier Health Sciences; 2015.
Afferent Receptors
Muscle
Muscle spindle GTO
Skin/Myofascia
Merkel discs Pacinian corpuscles Ruffini corpuscles
Meissner corpuscles
Myofascia Layers
Aδ fibers Nociceptors
Free nerve endings Mechanoreceptors
C‐fibers
Merkel Discs (Type II)
(mechanoreceptor)
Location: Epidermis/dermis (hands/fingers)
Adapt: Slow response
Receptor: Small/defined area
Stimulus: Light pressure/vibration (5‐15 Hz)
Pacinian Corpuscles (Type I)
Location: Subcutaneous, deep dermis, joint capsule, periosteum, organs
Adapt: Rapid response
Receptor: Large area
Stimulus: Deep pressure/ vibration (250‐300 Hz)
Meissner Corpuscles (Type II)
Location: Epidermis/dermis (hands, sole)
Adapt: Rapid response
Receptor: Small/defined area
Stimulus: Light touch/pressure, vibration (30‐50 Hz)
Ruffini Corpuscle (Type I)
Location: Deep epidermis, ligaments, tendons
Adapt: Slow response
Receptor: Large area
Stimulus: Sustained pressure, skin (tangential) stretch, joint movement (gripping)
Skin Receptors
* Cutaneous free nerve endings: nociception, hot and cold, and light touch
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Fascia and Movement
F. Promotes sliding and reduces compartment friction during motion
E. Adapts its fiber arrangement, length, and density according to local demand
D. Interconnected tensional network for stability and communication
C. Rich in contractile cells, proprioceptors and nociceptors
B. Pre‐tension
A. Force transmission
What are the current scientific theories behind myofascial
dysfunction?
Cumulative Injury CycleCumulative injury cycle
Repetitive pattern
overload
Tissue trauma
Inflammation
Muscle spasm
Myofascial restriction
Trigger points
Altered neuromotor
control
Muscle imbalances
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What are the scientific theories behind myofascial
interventions?
Thixotropy
Myofascial Intervention Soup Bowl
Three main levels of the somatosensory system
1. Receptor level
2. Circuit level (ascending)
3. Perceptual level (cortex)
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Mechanical Compression of the Myofascia
Myofascial Compression
Stimulation of local tissues and afferent
receptors
CNS process information
CNS responds with a local and global efferent response
Observable changes
1. Joint ROM
2. Pain modulation
3. Movement efficiency
4. Performance
Scientific TheoriesScientific Theories
Neuro-PhysiologicalNeuro-Physiological
Mechanical compression influences tissue relaxation and pain reduction in the local
and surrounding tissues through CNS afferent input from the golgi tendon reflex, mechanoreceptors, nociceptors, and other
CNS pathways.
Parasympathetic Effect?
Mechanical compression influences tissue relaxation and pain reduction in the local
and surrounding tissues through CNS afferent input from the golgi tendon reflex, mechanoreceptors, nociceptors, and other
CNS pathways.
Parasympathetic Effect?
MechanicalMechanical
Mechanical compression to the local myofascia effects the tissue viscoelastic properties. Other mechanisms involved
may include changes in thixotropy, reduced MF restriction, trigger points, fluid changes,
cellular responses, and fascial inflammation.
Mechanical compression to the local myofascia effects the tissue viscoelastic properties. Other mechanisms involved
may include changes in thixotropy, reduced MF restriction, trigger points, fluid changes,
cellular responses, and fascial inflammation.
Summary
MF compression
Activation of group III/IV afferents via
mechanoreceptors, metaboreceptors, proprioceptors
Global pain modulation: gate control theory, diffuse noxious inhibition, PNS
Pain Modulation
MF compression
Changes in tissue viscoelasticity, thixotropy, MF restriction, trigger
points, cellular fluids, and fascial inflammation.
Changes in local tissue stiffness, stretch tolerance,
ROM
MF compression
Ruffini/Pacinian modulate SNS
Group III/IV modulate SNS/PNS
GTO/alpha motor modulated
Non‐local effects
Crossover
Recip. inhibition
Local Effects
Global Effects
Bottom Line
• The scientific research suggests two theories: • Mechanical • Neurophysiological
• Based on the evidence, the myofascial compression interventions may or may not:
• Release myofascia• Break up adhesions• Promote tissue healing• Etc.
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Module II: IASTMClinical Practice Patterns
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What are the common IASTM terms?
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Background
• Common Terms in the Literature
• Instrument assisted soft-tissue mobilization (IASTM)
• Instrument assisted soft-tissue treatment
• Instrument assisted cross fiber massage
• Instrument assisted neuromobilization
• ASTYM®
• Graston®
Bottom Line
• Issue: Researchers and clinicians often describe the specific paradigm (e.g. Graston®) but only do the IASTM tool technique.
• Solution: Describe either the instrument technique or paradigm
• Proposed tool technique description:
• “Instrument assisted soft-tissue mobilization is a skilled intervention that includes the use of specialized tools to manipulate the skin, myofascia, muscles, and tendons by various direct compressive stroke techniques”.
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How are professionals using IASTM in their clinical practice?
IASTM Survey Research• Cheatham SW, Baker RT, Larkin L, Baker J, Casanova M. Instrument assisted
soft-tissue mobilization: a survey of practice patterns among health care professionals. J Athl Train. 2021 [In print]
N=853
Education
86% report formal and informal
trainingTreatment
recommendations
66% followed professional
recommendations
19% rarely or never followed
Tool pressure
71% reported not knowing amount of applied pressure
IASTM treatment time
Local region (1-5 min)
Average time (14 min)
Combined interventions
31 different pre & post IASTM interventions
Clinical outcomes
94% reported using some type of measure
What are common IASTM tools being used by clinicians?
Instruments
• Stainless Steel • (+) Hypoallergenic• (+) Smooth surface• (-) May not grip skin when
used with emollient
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Instruments
• Stainless Steel/Rubber• (+) Hypoallergenic• (+) Smooth surface• (-) May not grip skin when used
with emollient
• Jade/Stone/Plastic • (�) Hypoallergenic?? • (-) Mainly for Gua Sha not IASTM
Instruments
• Stainless Steel + NMES • (+) Hypoallergenic• (+) Smooth surface• (+) Neurophysiological effect?• (-) May not grip skin when used
with emollient
• Textured Surface • (+) Hypoallergenic?• (+) Rough surface• (-) May grip the skin and feel
rough to the patient
Bottom Line
• Professional should consider the following for instruments:
• Material
• Hand grip
• Ability to clean
• Instrument weight, shape, and size
• Edge radius and type of bevel (single/double) ��
Hajzl M. IASTM Primer. Available at www.myobar.com
What are IASTM precautions and contraindications?
Precautions Petechiae, bony landmarks Patient intolerance, hypersensitivity,
high pain sensation
NSAIDS, steroids, narcotics Anti‐coagulants, hormone replacement, fluoroquinolone antibiotics
Herbal supplements Lymphadema
Patient age, flu or flu like symptoms Osteoporosis
Cancer, pregnancy, Diabetes Vericose veins, polyneuropathy
Hypertension, kidney dysfunction Burn scars, body art
Acute inflammatory conditions RA, ankylosing spondylitis
Post injection (e.g. steroid) Allergies to metals, emollients, latex
Unhealed closed factures Autoimmune disorders, RSD/CRPS
Congestive heart disease, circulatory disorders
Pacemaker or insulin pumps (treatment around devices)
Contraindications Acute or recent injury, infection or
fever Petechiae (severe) or ecchymosis
Skin rash, open wounds, blisters, local tissue inflammation, or tumors
Treatment over surgical hardware
Recent surgery or Osteoporosis Cancer or malignancy
Unhealed bone fracture or myositis ossificans
Hypertension (uncontrolled)
Acute/ severe cardiac, liver, or kidney disease
Congestive heart disease/circulatory disorders
Neurologic conditions Bleeding disorders
Metabolic conditions (e.g. diabetes) Unhealed surgical site
Connective tissue disorders Peripheral vascular disease
Blood thinners or narcotics Thrombophlebitis or osteomyelitis
Chronic pain conditions Direct pressure over face, eyes, arteries, vessels, or body regions
Severe pain felt by patient Epilepsy
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Most Obvious Concerns
Precautions
• Petechiae
• Patient intolerance
• Bones/nerves/vessels
• Healing skin (scars/wounds)
• Skin allergies
• Meds effecting sensation
• Diabetes/neuropathy
• Etc.
Contraindications
• Severe petechiae
• Skin rash/open wounds
• Blisters/tissue inflammation
• Cancer/malignancy
• Over eyes/sensitive areas
• Healing surgical/injury site
• Severe pain
• Neurological conditions
• Etc.
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The medical literature is beginning to document injuries from aggressive IASTM treatments
2016- Buntinx & Greenwald , 2015- Aprile A et al., 2013- Odhav et al, 2000- Amshel & Caruso
Bottom Line
•We need to educate patients prior to TX•Potential side effects•Pain during or after treatment•Precautions/contraindications
•*Respect cultural beliefs but educate
What are the current recommendations for instrument
hygiene?
Instrument Hygiene • Instrument disinfecting:
• Use intermediate-level disinfectant.
• Flush instrument with soap and water before treatment.
• If the tool contacts blood, bodily fluids, etc. then a high-level disinfectant or sterilization should be done.
Center for Disease Control Levels of Disinfection
High‐level disinfection These disinfectants kill all organisms, except high levels of bacterial
spores, and is effected with a chemical germicide cleared for marketing
as a sterilant by FDA. Typically, they are not used for generalized
disinfecting.
Intermediate‐level disinfection These disinfectants kill mycobacterium, most viruses, and bacteria with
a chemical germicide registered as a "tuberculocide" by EPA.
Low‐level disinfection These disinfectants kill some viruses and bacteria such as HIV and HBV
with a chemical germicide registered as a hospital disinfectant by the
EPA.
EPA: Environmental Protective Agency
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Bottom Line
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• Professionals should develop standard cleaning procedures.
• Use an intermediate-level disinfectant to clean instruments.
• Clorox® and Lysol® brand wipes, 70% isopropyl alcohol
• Follow the recommended “wet time” (e.g. 4 min to disinfect)
• Wear proper PPE per the product recommendations • At minimum, gloves and maybe a mask (e.g. harmful odor)
Module III: IASTMResearch Review
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Literature Reviews
20002000 20182018
Systematic/Literature Reviews
Reviews:
• 2018- Hussey et al. J Sport Rehabil
• 2017- Kim et al. J Exerc Rehabil
• 2016- Cheatham et al. J Can Chiropr Assoc
Consensus:
• Mixed methods = mixed results
• Named paradigm (e.g. Graston®) but didn’t do it
• Weak evidence for therapeutic benefits
• 25+ case studies
Evidence Grade = 1
Literature Reviews
20192019 20212021
Systematic/Literature Reviews
Reviews:
• 2019- Seffrin et al. J Athl Training• (+) outcomes: ROM (uninjured), pain (injured), function (injured)
• 2019- Nazari et al. Arch Phys Med Rehabil• (-) outcomes: ROM, Pain, and Function
• 2019- Cheatham et al. Int J Sports Phys Ther
Consensus:
• Reviews used diverse search criteria
• Found mixed methods = mixed results
• Still weak evidence for therapeutic benefits
Evidence Grade = 1
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Module IV: IASTMTreatment Patterns
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Literature Reviews
20152015 20212021
Treatment Categories
ROM, pain, muscle performance,
& functional movements
Musculoskeletal pathologies
Tissue healing & blood flow
Neurophysiological effects
What are the latest IASTM studies on ROM, muscle performance, and
functional movements?
Range of Motion: (+ outcomes)
• 2020‐ Lee et al. J Allied Health• 2020‐ Simatou et al. J Phys Ther Sci• 2019‐ Rowlett et al. J Bodyw Mov Ther• 2019‐ Ikeda et al. Med Sci Sports Exerc• 2018‐ Stanek et al. J Athl Train• 2017‐ Kim et al. J Back Musculoskelet Rehabil
Muscle Performance/Functional Movements: (+ outcomes)
• 2020‐ Stroiney et al. J Strength Cond Res• 2019‐ Gamboa et al. Int J Exerc Sci• 2018‐ Rhyu et al. Technol Health Care• 2017‐ Kim et al. J Back Musculoskelet Rehabil
Evidence Grade = 2
Related Studies
What are the latest IASTM studies on treating different MSK
conditions?
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MSK Pathology: (+ outcomes)
• 2020‐ Park et al. J Exerc Rehabil (Chronic ankle instability)
• 2019‐ Jones et al. J Am Podiatr Med Assoc (Plantar heel pain)
• 2018‐ Crane et al. Physiother Theory Pract. (Axillary Web Syndrome)
• 2018‐ Gulick. J Bodyw Mov Ther (Myofascial trigger points)
• 2017‐ Coviello et al. J Sports Med Phys Fitness (Shld. Impingement)
• 2016‐ Hoon Lee et al. J Allied Health (LBP)
Evidence Grade = 2
Related Studies
What is the evidence that IASTM produces a local mechanical effect
to promotes tissue healing and blood flow?
Laboratory studies: (rat models)
• IASTM: Increased fibroblast proliferation and collagen repair in cases of enzyme-induced tendinitis.
• IASTM: Increased damaged ligament healing via healing factor and vascular changes.
Research• 2013‐ Loghmani et al. BMC Complement Altern Med
• 2009‐ Loghmani et al. J Orthop Sports Phys Ther
• 1999‐ Gehlsen et al. Med Sci Sports Exerc
• 1997‐ Davidson et al. Med Sci Sports Exerc
��2013‐ Loghmani et al. BMC Complement Altern MedEvidence Grade = ?
Local Blood Flow: (+ outcomes)
• 2020‐ Fousekis et al. J Phys Ther Sci (Human‐hamstrings)
• 2014‐ Portillo‐Soto et al. J Altern Complement Med (Humans)
Evidence Grade = 2
Related Studies
What is the evidence that IASTM produces neurophysiological effects
such as PPT & TPD?
Does a light pressure instrument assisted soft tissue mobilization technique modulate tactile discrimination
and perceived pain in healthy individuals after strenuous exercise?
Cheatham, Kreiswirth (2019)
• Purpose: To measure the effects of light pressure IASTM on TPD and PPT in healthy individuals after strenuous exercise.
• Design: Pretest, posttest observations study
• Subjects: 23 healthy, active adults(M=14,W=9) (24.22 � 3.07 yrs)
• IASTM Tool: RockTape® Mohawk
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Study Protocol Methods• DOMS protocol:
• 5-min warm-up
• 100 drop jumps from 0.5m box
• IASTM (90 sec):
• Quadriceps (pre-marked)
• Light pressure (wt. of tool 208 g), stroke (120 bpm), 30◦angle
• Stimulate Pacinian receptors
• Outcomes:• NRS to confirm DOMS• PPT (algometry)• TPD
Subjects (N=23)
Day I
Baseline MeasuresDOMS Protocol
Day II (24-hrs post)
IASTM TXPost measures
Day III (48-hrs post)
IASTM TXPost measures
• Results
• TPD- Significant difference between all time points (p <.001). • Baseline to 24 hours post (p <.001) and 48 hours post (p <.001).
• PPT- Significant difference between all time points (p <.001). • Baseline to 24 hours post (p=.005) and 48 hours post (p=.003).
• No significant change between 24 to 48 hours post for TPD and PPT (p=1.00).
Baseline and post‐intervention descriptive results (N=23)
Baseline 24 hours P‐value Baseline 48 hours P‐value
Two Point
Discrimination
(cm)
4.33 ± 1.12 2.98 ± 1.28 *p<.001 4.33 ± 1.12 2.83 ± 1.57 *p<.001
Pressure Pain
Threshold (kPa)
1132.08 ±
244.26
1214.91 ±
261.25
*p=.005 1132.08 ±
244.26
1207.22 ±
248.80
*p=.004
*IR: inter Data reported as mean ± SD, kPa= kilopascals; cm: centimeters
• Limitations• Healthy subjects, no control group
• One specific DOMS protocol and IASTM technique
• Pre-determined body region and a small area
• *Study considered preliminary
• Conclusions• A light IASTM technique may produce a short-term
neuromodulation effect on local TPD and PPT after DOMS.
• Future research needs to focus on the neurophysiological effects of different instruments, treatment protocols, and on different body regions (different receptor geography)
Evidence Grade = 2
PPT/TPD:(* insignificant outcomes)
• *2018‐ Gulick. J Bodyw Mov Ther (PPT)
• *2017‐ Ge et al. J Phys Ther Sci (TPD)• 2017‐ Kim et al. J Back Musculoskelet Rehabil (PPT)
• Limitations: • *Researchers reported using the Graston® concept but did
not follow the protocol• Researchers did not report any specific treatment
parameters such as: tool angle, stroke rate, predetermined area, and pressure.
Evidence Grade = 2
Related Studies
Is IASTM Interchangeable with other myofascial interventions?
Myofascial compression interventions: comparison of roller massage, instrument assisted soft‐tissue mobilization, and floss band on passive knee
range of motion among non‐experienced individuals Cheatham SW, Martinez RE, Montalvo A, Odai M, Echeverry S,
Robinson B, Bailum E, Viecco, K. Clin Pract Athl Train. 2020;3(3):24‐36.
Subjects (N=40)
Roller Massage
N=15
2‐min intervention
ROM: Left knee flexion
IASTM
N=10
2‐min intervention
ROM: Left knee flexion
Floss Bands N=15
2‐min intervention
ROM: Left knee flexion
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Results: (pretest, posttest)
• ROM: Gains in ROM were made• RM (Foam Rolling): 2° (p<.001)• IASTM: 3.5° (p<.001) • Floss Band: 4° (p<.001)
• The three MF compression interventions may be interchangeable by producing similar immediate effects.
Evidence Grade = 2
IASTM vs. Tissue Flossing vs. KT: (+ outcomes)
• 2021‐Mylonas et al. J Sport Rehabil
IASTM vs. Self‐Myofascial Rolling:(+ outcomes)
• 2020‐ Lee et al. J Allied Health • 2020‐ Stroiney et al. J Strength Cond Res • 2020‐ Lee et al. J Allied Health• 2020‐ Sandrey et al. J Sport Rehabil
IASTM vs. Static/PNF/Active Stretching: (+ outcomes)
• 2019‐ Rowlett et al. J Bodw Mov Ther• 2019‐ Gunn et al. J Man Manip Ther• 2018‐Myburgh et al. J Rehabil Med Clin Commun
IASTM vs. Massage: (+ outcomes)
• 2020‐ El‐Hafez et al. J Taibah Univ Med Sci• 2020‐ Koumantakis et al. J Bodw Mov Ther
• 2021‐Mylonas et al. JBMC Musculoskelet Disord (IASTM + Therex)
Evidence Grade = 2
Related Studies
What are some of the emerging IASTM research?
Quantification of IASTM Force:• Stevenson et al. J Athl Training. 2021 [In‐review] (2‐handed)• Duffy S et al. J Athl Training. 2021 [In‐review] (1‐handed)• Martonick et al. J Sport Rehab. 2021 [In‐press] (Simulated treatment)
Evidence Grade = 2
Related Studies
Research Recommendation
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Instrument Assisted Soft-Tissue Mobilization: A Commentary on Clinical Practice Guidelines for Rehabilitation Professionals.
Cheatham, Baker, Kreiswirth (2019)
• PubMed Link: IASTM Studies (2015-2021)• https://pubmed.ncbi.nlm.nih.gov/?term=IASTM&filter=years.2015-
2021&show_snippets=off&sort=pubdate&size=100
Suggestions: Future Research
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• Compare the therapeutic effects of different instruments:• Graston®
• HawkGrips®
• Fascial Abrasion Technique®
• RockBlades®
• Instrument hygiene/cleaning standards
• Myofascial interchangeable interventions
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Bottom Line
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Known Effects • IASTM improves:
• Joint ROM• Pain modulation• Tissue temp change• Muscle performance • Functional movement
Unknown Effects• IASTM may (humans):
• Release myofascia• Breaks-up adhesions • Promote healing
Final Thoughts: IASTM
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• Researcher and clinicians both need to described either the instrument technique or paradigm.
• IASTM research continue to produce human studies with mixed methods which produces mixed results.
• Standard research and practice guidelines are needed.
• Interchangeable: IASTM may produce similar effects as other interventions.
Final Evidence Grade =
Thanks!!!
Scott [email protected]
• Cheatham SW, Baker R. Gender differences in pressure pain thresholds of the ipsilateral agonist, antagonist, and contralateral muscle groups after a bout of foam rolling: A comparison study. J Bodywork Mov Ther [In Review]
• Cheatham SW, Kolber MJ, Hanney WH, Mokha GM. Concurrent Validation of a Pressure Pain Threshold Scale for individuals with Myofascial Pain Syndrome and Fibromyalgia. JMMT [In Review]
• Cheatham SW, Kolber MJ, Mokha GM, Hanney WJ. Concurrent Validity of Pain Scales in Individuals with Myofascial Pain and Fibromyalgia. J Bodywork Mov Ther. 2017 [Accepted]
• Cheatham SW, Kolber MJ, Cain M. Comparison of a video‐guided, live‐instructed, and self‐guided foam roll intervention on knee joint range of motion and pressure pain threshold: A randomized controlled trial. Int J Sports Phys Ther. 2017;12(2):1‐8
• Cheatham SW, Kolber MJ. Does self‐myofascial release with a foam roll change pressure pain threshold of the ipsilateral lower extremity antagonist and contralateral muscle groups? An exploratory study. J Sports Rehab. 2017 [Epub Ahead of Print]
• Cheatham SW, Lee MD, Cain M, Baker RT. The Effects of Instrument Assisted Soft Tissue Mobilization: A Systematic Review. J of Can Chiropr Assoc.2016; 60 (3): 200‐211
• Cheatham SW, Kolber MJ, Cain M, Lee MD. The Effects of Self‐Myofascial Release on Joint Range of Motion, Muscle Recovery, and Performance: A Systematic Review. Int J Sports Phys Ther. 2015, 1(6);827‐838
• Hotfiel T, Swoboda B, Krinner S, Grim C, Engelhardt M, Uder M, Heiss RU. Acute Effects of Lateral Thigh Foam Rolling on Arterial Tissue Perfusion Determined by Spectral Doppler and Power Doppler Ultrasound. Journal of strength and conditioning research / National Strength & Conditioning Association. 2017;31:893‐900. Epub 2016/10/18.
• Monteiro ER, Skarabot J, Vigotsky AD, Brown AF, Gomes TM, Novaes JD. ACUTE EFFECTS OF DIFFERENT SELF‐MASSAGE VOLUMES ON THE FMS OVERHEAD DEEP SQUAT PERFORMANCE. International journal of sports physical therapy. 2017;12:94‐104. Epub 2017/02/22.
• Monteiro ER, Skarabot J, Vigotsky AD, Brown AF, Gomes TM, Novaes JD. MAXIMUM REPETITION PERFORMANCE AFTER DIFFERENT ANTAGONIST FOAM ROLLING VOLUMES IN THE INTER‐SET REST PERIOD. International journal of sports physical therapy. 2017;12:76‐84. Epub 2017/02/22.
References
References• Nazari G, Bobos P, MacDermid JC, Birmingham T. The Effectiveness of Instrument‐Assisted Soft Tissue Mobilization in
Athletes, Participants Without Extremity or Spinal Conditions, and Individuals with Upper Extremity, Lower Extremity, and Spinal Conditions: A Systematic Review. Arch Phys Med Rehabil. 2019 [Epub ahead of print].
• Kim J, Sung DJ, Lee J. Therapeutic effectiveness of instrument‐assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application. J Exerc Rehabil. 2017;13(1):12‐22.
• Hussey MJ, Boron‐Magulick AE, Valovich McLeod TC, Welch Bacon CE. The Comparison of Instrument‐Assisted Soft Tissue Mobilization and Self‐Stretch Measures to Increase Shoulder Range of Motion in Overhead Athletes: A Critically Appraised Topic. J Sport Rehabil. 2018;27(4):385‐389.
• Cheatham SW, Lee M, Cain M, Baker R. The efficacy of instrument assisted soft tissue mobilization: a systematic review. J Can Chiropr Assoc. 2016;60(3):200‐211.
• Aprile A, Pomara C, Turillazzi E. Gua Sha a traditional Chinese healing technique that could mimick physical abuse: a potential issue with forensic implications. A case study. Forensic Sci Int. 2015;249:e19‐20.
• Odhav A, Patel D, Stanford CW, et al. Report of a case of Gua Sha and an awareness of folk remedies. Int J Dermatol. 2013;52(7):892‐893.
• Aprile A, Pomara C, Turillazzi E. Gua Sha a traditional Chinese healing technique that could mimick physical abuse: a potential issue with forensic implications. A case study. Forensic Sci Int. 2015;249:e19‐20.
• Odhav A, Patel D, Stanford CW, et al. Report of a case of Gua Sha and an awareness of folk remedies. Int J Dermatol. 2013;52(7):892‐893.
• Netter FH. 1997. Atlas of Human Anatomy 2nd. Friesens Corporation: Canada.
• Floyd RT and Thompson C. Manual of Structural Kinesiology. McGraw‐Hill Education, 2011.
• Sahrmann SA. Diagnosis & Treatment of Movement Impairment Syndromes. Mosby: St Louis, MO.2002
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