Immediate Effects of Instrument-Assisted Soft Tissue Mobilization on Hydration Content in Lumbar Myofascial Tissues: A Quasi-Experiment

The effectiveness of instrument-assisted soft tissue mobilization on pain and function in patients with musculoskeletal disorders: a systematic review and meta-analysis

BACKGROUND

Instrument-assisted soft tissue mobilization (IASTM) is popular in the treatment of musculoskeletal disorders. However, the current literature has produced varying results. The purpose of this study was to collect the most recent studies to evaluate the effectiveness of IASTM on pain and function in patients with musculoskeletal disorders.

METHODS

The researchers searched the PubMed, Embase, Web of Science, and Cochrane Library databases from inception to February 25, 2025, to identify randomized controlled trials comparing treatment groups receiving IASTM combined with other treatments to those receiving other treatments among participants with musculoskeletal disorders. The outcomes were pain intensity, pain pressure threshold and function. The Cochran Q and I² indices were used to estimate heterogeneity. The data were analyzed as the standardized mean difference (SMD). The Cochrane Risk of Bias tool was used to assess the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation system was used to rate the quality of evidence. Trial sequential analysis and sensitivity analyses were also performed.

RESULTS

Eleven trials (involving 427 participants) were included in the quantitative analysis. Six trials had a high risk of bias; three, unclear; and two, low. There was moderate-certainty evidence indicating that IASTM was effective in reducing patient-reported pain (n = 11) (n = 427, SMD = 0.60, 95% CI: 0.41 to 0.80, p < 0.01), and there was low-certainty evidence indicating that IASTM was effective in improving patient-reported function (n = 8) (n = 333, SMD = 0.40, 95% CI: 0.03 to 0.77, p < 0.05). Only one data point was extracted for the pain pressure threshold, and a meta-analysis was not performed. Trial sequential analysis revealed that the cumulative z score crossed the monitoring boundary for superiority for patient-reported pain in patients with nonspecific chronic neck pain and cervicogenic headache at the 4-week IASTM.

CONCLUSIONS

IASTM can reduce patient-reported pain (with moderate certainty) and improve patient-reported function (with low certainty) in patients with musculoskeletal disorders. Future clinical studies do not need to explore the short-term effects of IASTM on patient-reported pain in patients with nonspecific chronic neck pain and cervicogenic headache.

TRIAL REGISTRATION

The PROSPERO registration ID is CRD42024534643 (April 10, 2024).

Instrument-assisted soft tissue mobilization in healthy adults acutely changes the tissue stiffness

This study clarified whether instrument-assisted soft tissue mobilization (IASTM) on the plantar surface changes abductor hallucis and plantar fascia stiffness at rest and medial longitudinal arch height under low- and high-loading conditions. IASTM was performed to one foot of the twenty-eight young men (IASTM condition), and the other foot of them was assigned to the control condition. Using ultrasonography, the resting shear wave propagation velocity of the abductor hallucis and plantar fascia and navicular height in a seated posture were determined. The foot contact area during quiet standing was measured using a foot-scan system. The shear wave propagation velocity of the plantar fascia significantly decreased by 10.8% in the IASTM condition but did not change significantly in the control condition. The magnitude of change in the shear wave propagation velocity of the plantar fascia was negatively correlated (r=- 0.660) with the shear wave propagation velocity of the plantar fascia before IASTM. The interaction of time and condition was not significant for the shear wave propagation velocity of the abductor hallucis, navicular height, or foot contact area. The current study revealed that IASTM on the plantar surface affected tissue stiffness but did not change the structure of the foot.

Acute local and non-local morphological, sensory and fluid responses to stretching and foam rolling in young females

Background

This study aimed to compare and examine the local and non-local effects of a foam rolling (FR) and static stretching (SS) intervention applied to the plantar flexor (PF).

Methods

Fourteen female participants were investigated. Each participant underwent three conditions in a random order at least 48h apart and at the same time of the day: Control (CC), SS, and FR. Each condition was performed unilaterally in the dominant PF for 4 sets (apart from CC). SS was performed for 30 s. The FR included 30 rolls (15 in each direction) over a period of 30 s. A rest of 30 s was provided between each set for all conditions. Outcome variables were ankle dorsiflexion range of movement (ROM), tissue hardness, localized bioimpedance analysis at 50 kHz (L-BIA), and pain pressure thresholds (PPT). Tissue hardness, L-BIA, and PPT were measured in the lower leg and thigh. Measures were assessed pre (T0), immediately post (T1), and 10-min after (T2) the intervention.

Results

No differences were found for time for the CC or between the T0 of each condition. Concerning the lower leg, ROM improved for SS and FR from T0 to T1 while returning to baseline in T2. A significant increase in PPT was observed only for SS in T1. L-BIA showed a significant increase for both phase angle and impedance only for FR in T1. Tissue hardness did not change for any group at any time-point. Concerning the thigh, no measure at any time point showed significant differences.

Conclusion

Both, FR and SS were able to acutely improve ankle ROM. The observed changes were probably caused by a change in viscoelastic properties and local pain perception, without any variation in tissue morphology. FR was the only intervention to improve the intracellular-to-extracellular ratio and decrease fluids. Non-local effects were not observed.

The effectiveness of instrument-assisted soft tissue mobilization on range of motion: a meta-analysis

BACKGROUND

To evaluate the effectiveness of instrument-assisted soft tissue mobilization (IASTM) on range of motion (ROM).

METHODS

We performed a literature search of the PubMed, Embase, Web of Science, and Cochrane Library databases from inception to December 23, 2023. Randomized controlled trials that compared treatment groups receiving IASTM to controls or IASTM plus another treatment(s) to other treatment(s) among healthy individuals with or without ROM deficits, or patients with musculoskeletal disorders were included. The Cochrane risk of bias tool was used to assess the risk of bias.

RESULTS

Nine trials including 450 participants were included in the quantitative analysis. The IASTM was effective in improving ROM in degree in healthy individuals with ROM deficits and patients with musculoskeletal disorders (n=4) (MD = 4.94, 95% CI: 3.29 to 6.60), and in healthy individuals without ROM deficits (n=4) (MD = 2.32, 95% CI: 1.30 to 3.34), but failed to improve ROM in centimeter in healthy individuals with ROM deficits (n=1) (MD = 0.39, 95% CI: -1.34 to 2.11, p=0.66, I2 = 88%).

CONCLUSIONS

IASTM can improve ROM in degree in healthy individuals with or without ROM deficits, or in patients with musculoskeletal disorders (with very low to low certainty).

TRIAL REGISTRATION

The PROSPERO registration ID is CRD42023425200.

Fascia Tissue Manipulations in Chronic Low Back Pain: A Pragmatic Comparative Randomized Clinical Trial of the 4xT Method® and Exercise Therapy

BACKGROUND

The 4xT method is a protocolized practice in treating musculoskeletal disorders. The 4xT method consists of four components: Test (functional diagnostic test), Trigger (fascia tissue manipulations), Tape (elastic taping), and Train (exercise). There is a lack of clinical studies evaluating the treatment effects of the use of the 4xT method.

METHODS

A randomized controlled trial was conducted to compare the effectiveness of the 4xT method and exercise therapy-only in patients with chronic nonspecific low back pain. Based on a priori sample size calculation, fifty-one individuals with chronic nonspecific low back pain were randomly assigned to either the 4xT or exercise group. Both groups underwent a six-week rehabilitation program with two treatments per week. The primary outcomes were trunk flexion and extension mobility, trunk flexion, and extension mobility-dependent pain, and quality of life evaluated during a 6-week therapy period and after a 6-week therapy-off period.

RESULTS

Interaction effects were noted in all outcomes. The 4xT group showed significant improvements over time for trunk flexion and extension mobility, trunk flexion and extension mobility-dependent pain, and quality of life (p < 0.05), with no significant relapse post-therapy (except for extension mobility). The exercise group exhibited significant within-time changes in the quality of life, as measured with the VAS (p < 0.05), but not for EQ-5D-3L.

CONCLUSIONS

The results of this study demonstrate that the 4xT method stands out as a promising and impactful treatment option for chronic nonspecific low back pain individuals, as it demonstrated significant reductions in mobility-dependent pain, increased trunk mobility, and improved quality of life compared to exercise-only treatments.

Examination of Myofascial Stiffness and Elasticity in the Upper Trapezius Region in Patients with Unilateral Neck Pain: A Cross-Sectional Study

(1) Background: Globally, neck pain is prevalent, affecting around thirty percent of the population annually. To better understand the influence of pain on the myofascial layers, the present study investigated these on the upper trapezius muscle in unilateral, more severe neck pain. (2) Methods: This study was a cross-sectional study. Forty patients (42.2 ± 14.7) with a confirmed diagnosis of unilateral neck pain were examined using durometry and indentometry. This study evaluated the stiffness, elasticity, and pressure pain threshold of both sides of the neck (symptomatic side: SS; healthy side: HS). Furthermore, the range of motion of the cervical spine (lateral flexion, rotation) was quantified using a digital goniometer. (3) Results: A significant lateral discrepancy was observed in stiffness between groups (durometry: SS-33.76 ± 7.78, HS-29.75 ± 7.45, p < 0.001; indentometry: SS-59.73 ± 33.93, HS-4.18 ± 12.69, p = 0.024). In contrast, no differences were found between the comparison sides of the upper trapezius for the parameter's elasticity (SS-0.101 ± 1.09, HS--0.006 ± 0.29, p = 0.416), cervical spine mobility (lateral flexion: SS-37.08 ± 8.15, HS-37.73 ± 7.61, p = 0.559; rotation: SS-73.55 ± 12.37, HS-72.85 ± 11.10, p = 0.660), and algometry (SS-36.41 ± 17.53, HS-37.22 ± 17.00, p = 0.657). (4) Conclusion: Overall, it can be concluded that more severe neck pain unilaterally shows differences in stiffness on the same side. Future research is needed to investigate the links.

Immediate Effects of Myofascial Release Treatment on Lumbar Microcirculation: A Randomized, Placebo-Controlled Trial

(1) Background: Inflammatory processes in the thoracolumbar fascia (TLF) lead to thickening, compaction, and fibrosis and are thought to contribute to the development of nonspecific low back pain (nLBP). The blood flow (BF) of fascial tissue may play a critical role in this process, as it may promote hypoxia-induced inflammation. The primary objective of the study was to examine the immediate effects of a set of myofascial release (MFR) techniques on the BF of lumbar myofascial tissue. The secondary objectives were to evaluate the influence of TLF morphology (TLFM), physical activity (PA), and body mass index (BMI) on these parameters and their correlations with each other. (2) Methods: This study was a single-blind, randomized, placebo-controlled trial. Thirty pain-free subjects (40.5 ± 14.1 years) were randomly assigned to two groups treated with MFR or a placebo intervention. Correlations between PA, BMI, and TLFM were calculated at baseline. The effects of MFR and TLFM on BF (measured with white light and laser Doppler spectroscopy) were determined. (3) Results: The MFR group had a significant increase in BF after treatment (31.6%) and at follow-up (48.7%) compared with the placebo group. BF was significantly different between disorganized and organized TLFM (p < 0.0001). There were strong correlations between PA (r = -0.648), PA (d = 0.681), BMI (r = -0.798), and TLFM. (4) Conclusions: Impaired blood flow could lead to hypoxia-induced inflammation, possibly resulting in pain and impaired proprioceptive function, thereby likely contributing to the development of nLBP. Fascial restrictions of blood vessels and free nerve endings, which are likely associated with TLFM, could be positively affected by the intervention in this study.

Influence of high-energy laser therapy to the patellar tendon on its ligamentous microcirculation: An experimental intervention study

Laser therapeutic applications, such as the use of high energy lasers (HILT), are widely used in physical therapy, but basic studies on the mechanisms of action of HILT on tendinous/ligamentous tissue are largely lacking. The aim of this study was to investigate microcirculatory changes of the patellar tendon by HILT. 21 healthy volunteers were included in the present investigation. Before and after HILT, as well as 10 minutes later, the microcirculation was measured by noninvasive laser Doppler and white light spectroscopy (O2C device). Tissue temperature was recorded at the measurement time points using thermography. Blood flow increased significantly by 86.38 arbitrary units (AU; p < 0.001) after the intervention and by 25.76 AU (p < 0.001) at follow-up. Oxygen saturation increased by 20.14% (p < 0.001) and 13.48%, respectively (p < 0.001), whereas relative hemoglobin decreased by 6.67 AU and 7.90 AU, respectively. Tendon temperature increased by 9.45° and 1.94° Celsius, respectively. Acceleration of blood flow by improving the flow properties of erythrocytes and platelets may have caused the results. HILT could be a therapeutic perspective for tendon pathologies with impaired microcirculation, although further studies are needed to validate the experimental results.