Comparison of Compressive Myofascial Release and the Graston Technique for Improving Ankle-Dorsiflexion Range of Motion

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.

Study on the effect of blood flow restriction training combined with IASTAM on ankle strength and function intervention in athletes with chronic ankle instability in sport dance events

BACKGROUND

Athletes engaged in sports dance frequently encounter the potential for ankle injuries and instability, factors that may contribute to diminished training efficacy, compromised athletic performance, prolonged recuperation, and heightened susceptibility to recurring injuries.

OBJECTIVE

The objective of this study was to investigate the impact of an exercise intervention (comprising blood flow restriction training combined with low-load ankle muscle strength training and balance training) as well as instrument-assisted soft tissue mobilization (IASTM) on the foot and ankle function, strength, and range of motion in sports dance athletes exhibiting ankle instability (CAI).

METHODS

Thirty participants exhibiting ankle instability, restriction, or discomfort were recruited and randomly assigned to two groups: the Test group (comprising blood flow restriction training combined with IASTM, n = 15) and the traditional ankle strength training group (n = 15). The intervention spanned 4 weeks, with one session per week. Assessment of the Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure (FAAM), and ankle range of motion occurred at three time points: pre-intervention, immediately following the initial intervention, and after 4 weeks of intervention. Ankle strength testing was conducted solely before and after the intervention for comparative analysis.

RESULTS

There were no significant variances in baseline characteristics between the two intervention groups. In terms of CAIT scores, both groups exhibited notably higher scores following the initial intervention and after 4 weeks of intervention compared to pre-intervention (P < 0.05). The Test group displayed higher CAIT scores than the control group, signifying a more pronounced enhancement in ankle stability among patients in the Test group. Concerning FAAM scores, both groups significantly enhanced ankle function in CAI patients (P < 0.05), with the Test group demonstrating notably higher FAAM-SPORT scores than the control group (P < 0.05), indicating superior restoration of athletic capability in the Test group. As for improvements in ankle range of motion, both groups demonstrated significant enhancements compared to pre-intervention (P < 0.05). The Test group exhibited significantly superior improvements in dorsiflexion, eversion, and inversion range of motion compared to the control group (P < 0.05), while the control group did not exhibit significant enhancements in plantarflexion and eversion range of motion (P > 0.05). Both groups displayed enhanced ankle strength in CAI patients following the intervention (P < 0.05), with the Test group manifesting notably higher dorsiflexion and inversion strength than the control group (P < 0.05).

CONCLUSION

Both blood flow restriction training combined with IASTM and traditional ankle strength and stability training have shown significant improvements in stability, function, strength, and range of motion in CAI patients. Furthermore, the Test group exhibits superior efficacy in ankle stability, daily functional movement, dorsiflexion, and eversion range of motion compared to the control group.

CLINICAL TRIAL REGISTRATION

9 February 2024, ClinicalTrials.gov, ID; NCT06251414.

Effect of the Graston Technique and Cupping Therapy on Pain and Functions in Individuals With Medial Tibial Stress Syndrome: A Randomized Clinical Trial

Background The discomfort in the mid-shaft and distal end of the tibia caused by shin splints or tibial periostitis also known as medial tibial stress syndrome (MTSS) is frequently induced by participating in sports or other strenuous activities. The two treatment methods used in this study are the Graston technique and cupping therapy; we have compared cupping with the Graston technique. Method It was an interventional study at Ravi Nair Physiotherapy College and Acharya Vinoba Bhave Rural Hospital. A total of 46 participants with MTSS were included in the study. The participants were randomly divided into two groups and treated for three weeks with four weekly sessions. Result Statistical analysis was done after the completion of sampling. Paired and unpaired t-tests were used. A p-value of <0.05 was considered significant. The result was obtained after comparing the pre and post values of the visual analog scale (VAS), treadmill test, step-up and step-down tests, manual muscle testing (MMT), and range of motion (ROM) of the ankle joint. After three weeks of treatment, pain with a p-value of 0.01 S showed a significant effect, and improved functions were reduced in the cupping and Graston technique groups. When compared, cupping therapy showed better results than the Graston technique. Conclusion We saw that the cupping therapy might be better than the Graston technique in reducing pain and improving functions.

Acute effects of foam rolling on ankle dorsiflexion and squat exercise patterns in extreme conditioning program practitioners: A randomized clinical trial

BACKGROUND/OBJECTIVES

Joint and muscle overloads commonly occur in extreme conditioning programs (ECP), which require great physical fitness for their practice. For its execution, good functional performance, mobility and adequate movement patterns are required. The fascial system plays a fundamental role in performance in ECP and one of the techniques used to improve joint mobility and movement pattern is the self-myofascial release using a foam roller (FR). Our objective of this study was to evaluate the effect of FR in ankle dorsiflexion (DF) range of motion (ROM), assessed with the Lunge Test, and also in the squat movement pattern, assessed using the Technique smartphone application, in ECP practitioners.

METHODS

The study was carried out with 18 ECP practitioners who practiced for over four months and had a mean age of 30.94 years. The participants were randomized and allocated into two groups: control and intervention. The FR was self-applied bilaterally in the sural triceps region for 90 seconds. Tests to assess DF ROM and squat movement pattern were applied before and immediately after using FR (intervention group) or after three-minute rest (control group).

RESULTS

The use of the FR promoted an immediate increase in ankle DF ROM during the Lunge Test and during the squat and a decrease in dynamic knee valgus during the squat.

CONCLUSION

The FR can be used as a tool for an acute increase in DF ROM and a decrease in dynamic knee valgus, having a positive impact in improving movement patterns.

Acute effects of thoracolumbar fascia release techniques on range of motion, proprioception, and muscular endurance in healthy young adults

PURPOSE

This study investigates the acute effects of Graston and myofascial release on thoracolumbar fascia (TLF) on lumbar range of motion (ROM), lumbar and cervical proprioception, and trunk muscle endurance in healthy young adults.

METHOD

Twenty-four healthy young individuals were included in the study. Individuals were randomly divided into two groups as Graston technique (GT) (n = 12) and myofascial release (MFR) (n = 12). GT group received a fascial treatment with a graston instrument and the MFR group (n = 12) received manual myofascial treatment. Both techniques were applied for 10 min and as a single session. Lumbar ROM (goniometer), lumbar proprioception (digital inclinometer), cervical proprioception (CROM device), and trunk muscle endurance (with McGill Endurance Test) were evaluated before and after treatment.

RESULTS

Age, gender and body mass index of individuals in both groups were similar (p > 0.05). In both GT and MFR groups, an increase in ROM in the flexion direction (p < 0.05) and a decrease in the angle of deviation in proprioception in the flexion direction were determined (p < 0.05). Neither technique had a significant effect on cervical proprioception and trunk muscle endurance (p > 0.05). In addition, no difference was found between the effectiveness of Graston and myofascial release (p > 0.05).

CONCLUSION

This study showed that Graston and myofascial release applied to TLF in healthy young adults effectively improve lumbar ROM and proprioception in the acute period. Considering these results, both Graston and myofascial release can be used to provide elasticity of TLF and improve proprioceptive return.

Instrument-assisted soft tissue mobilization versus myofascial release therapy in treatment of chronic neck pain: a randomized clinical trial

OBJECTIVE

The purpose of this study was to investigate the effect of instrument-assisted soft tissue mobilization (IASTM) versus myofascial release therapy (MRT) on college students with chronic mechanical neck pain (CMNP).

METHODS

Thirty-three college students with a mean age of 21.33 ± 0.98 involved in distance learning due to the Corona Virus 2019 (COVID-19) restriction were randomized to receive either IASTM on the upper trapezius and levator scapulae muscles or MRT. Researchers measured their pain with a visual analog scale (VAS), function with neck disability index (NDI), and pain pressure threshold (PPT) with a pressure algometer. The subjects received eight therapy sessions over four weeks and outcome measures were assessed pre and post-intervention. The study was registered as a clinical trial on clinicaltrials.gov (registration number: NCT05213871).

RESULT

Unpaired t-test showed no statistical significance between the two groups post-intervention regarding improvement in pain, function, and PPT (p > 0.05).

CONCLUSION

This study showed insignificant differences between groups. However, we did not use a control group, indicating that the improvement in outcomes may not have been caused by the intervention.

STUDY DESIGN

Quasi-experimental two groups pre-posttest clinical trial.

LEVEL OF EVIDENCE

Therapy, level 2b.

Acute effects of instrument assisted soft tissue mobilization technique on pain and joint position error in individuals with chronic neck pain: a double-blind, randomized controlled trial

PURPOSE/AIM

The aim of this study was to determine the acute effects of IASTM on cervical joint position error and pain in individuals with chronic neck pain.

METHODS

A total of 39 individuals with chronic neck pain were included in this study. Participants were randomized into three groups: Instrument-assisted soft-tissue mobilization(IASTM (n = 13), sham (n = 13), and control (n = 13). In the IASTM group, intervention was applied to the sternocleidomastoid and trapezius muscles with an application time of 45 s and a frequency of 60 beats/min. In the sham group, IASTM was applied at a 90° angle without pressure. The control group did not receive any intervention. The pain severity and joint position error(JPE) were evaluated before and after the intervention, by using the visual analogue scale and a cervical range of motion device.

RESULTS

The effects of time and treatment group on visual analogue scale(VAS) score were statistically significant (p = .001). Instrument-assisted soft-tissue mobilization was more effective in VAS score than sham and control group (p < .001). Significant improvement was found in JPE in all range of motions of the cervical region in the instrument-assisted soft-tissue mobilization group (p < .05). In the sham group, significant improvements were observed in cervical extension, left rotation, and left lateral flexion movements in JPE during each cervical spine active movement (p < .05). Instrument-assisted soft-tissue mobilization group was more effective in JPE all directions than sham and control group.

CONCLUSIONS

Instrument-assisted soft-tissue mobilization may be a useful technique in individuals with chronic neck pain. Instrument-assisted soft-tissue mobilization decreases VAS and improves JPE.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04882397 (05 August 2021).

Instrument-Assisted Soft Tissue Mobilization Increased Hamstring Mobility

CONTEXT

Limited research reveals that the use of different soft tissue mobilization techniques increases tissue mobility in different regions of the body.

OBJECTIVE

The purpose of this study was to determine whether there is a difference between administering instrument-assisted soft tissue mobilization (IASTM) and therapeutic cupping (TC) on hamstring tightness.

DESIGN

Subjects attended one session wherein treatment and leg order were randomized before attending the session. A statistical analysis was completed using a 2 (intervention) × 2 (time) repeated-measures analysis of variance at α level ≤ .05.

PARTICIPANTS

Thirty-three subjects between the age of 18-35 years old with bilateral hamstring tightness participated in this study.

INTERVENTIONS

The IASTM and TC were administered on different legs for 5 minutes and over the entire area of the hamstring muscles. One TC was moved over the entire treatment area in a similar fashion as the IASTM.

MAIN OUTCOME MEASURES

The intervention measurements included soreness numeric rating scale, Sit-n-Reach (single leg for side being tested), goniometric measurement for straight-leg hip-flexion motion, and superficial skin temperature. The timeline for data collection included: (1) intervention measurements for the first randomized leg, (2) 5-minute treatment with the first intervention treatment, (3) intervention measurements repeated for postintervention outcomes, and (4) repeat the same steps for 1 to 3 with the contralateral leg and the other intervention.

RESULTS

There was a main effect over time for Sit-n-Reach, measurement (pre-IASTM-29.50 [8.54], post-IASTM-32.11 [8.31] and pre-TC-29.67 [8.21], post-TC-32.05 [8.25]) and goniometric measurement (pre-IASTM-83.45 [13.86], post-IASTM-92.73 [13.20] and pre-TC-83.76 [11.97], post-TC-93.67 [12.15]; P < .05).

CONCLUSION

Both IASTM and TC impacted hamstring mobility during a single treatment using only an instrument-assisted soft tissue mobilization technique without any additional therapeutic intervention.

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

BACKGROUND

Instrument-assisted soft tissue mobilization (IASTM) is thought to alter fluid dynamics in human soft tissue. The aim of this study was to investigate the influence of IASTM on the thoracolumbar fascia (TLF) on the water content of the lumbar myofascial tissue.

METHODS

In total, 21 healthy volunteers were treated with IASTM. Before and after the procedure and 5 and 10 min later, lumbar bioimpedance was measured by bioimpedance analysis (BIA) and TLF stiffness was measured by indentometry. Tissue temperature was recorded at the measurement time points using an infrared thermometer.

RESULTS

Bioimpedance increased significantly from 58.3 to 60.4 Ω (p < 0.001) at 10-min follow-up after the treatment. Temperature increased significantly from 36.3 to 36.6 °C from 5 to 10 min after treatment (p = 0.029), while lumbar myofascial stiffness did not change significantly (p = 0.84).

CONCLUSIONS

After the IASTM intervention, there was a significant increase in bioimpedance, which was likely due to a decrease in water content in myofascial lumbar tissue. Further studies in a randomized control trial design are needed to extrapolate the results in healthy subjects to a symptomatic population as well and to confirm the reliability of BIA in myofascial tissue.

Acute effect of diagonal stretching using the posterior oblique sling system on contralateral ankle dorsiflexion

BACKGROUND

A significant increase in the dorsiflexion range of motion (DFROM) after calf muscle stretching has been widely studied. However, it has been shown that the upper body is connected to the ankle joint by passive connective tissues.

OBJECTIVE

The purpose of this study was to examine the effect of upper-back stretching on the mobility of the contralateral ankle.

METHODS

In the supine position, DFROM in the contralateral leg was measured. In the sitting position with and without trunk rotation, DFROM was measured in both legs. In the sitting position with trunk rotation, dorsiflexion was measured only in the contralateral leg. Static diagonal stretching combining trunk rotation with slight trunk flexion was performed in the sitting position with a neutral pelvis.

RESULTS

After stretching, DFROM in contralateral and ipsilateral legs were measured in the sitting position with a neutral pelvis. In the contralateral leg, significant differences in ΔDFROM were observed between the sitting position with trunk rotation and the supine position and between the sitting position with trunk rotation and the sitting position after stretching.

CONCLUSION

In clinical settings, diagonal stretching of the unilateral posterior trunk causes a significant increase in the DFROM of the contralateral lower limb.

Effects of Myofascial Release Using Finding-Oriented Manual Therapy Combined with Foam Roller on Physical Performance in University Athletes. A Randomized Controlled Study

Sport is a science of constant reinvention that is always searching for strategies to improve performance. Objective: This study seeks to compare the effects of myofascial release with Findings-Oriented Orthopedic Manual Therapy (OMT) combined with Foam Roller (FR), versus FR by itself, on the physical performance of university athletes. A randomized controlled study was conducted with a total of twenty-nine university athletes, measuring Range of Motion (ROM), jump height and flight time, strength and dynamic flexibility using Goniometer pro, CMJ protocol in OptoGait, 1 Repetition Maximum (1RM) and Mean Propulsive Velocity (MPV) and the Sit and Reach (V) test, correspondingly. This study was registered at clinicaltrials.gov prior to the initial measurement of the participants under the code NCT05347303. Through a univariate analysis, together with an analysis of independent groups with ANOVA and an analysis of covariance, it was evidenced that OMT combined with FR generated more and better effects in all the evaluated ROM, jump height and flight time, RM and VMP tests. Finally, it was found that OMT combined with FR is better when it is desired to improve ROM, muscle power, strength and flexibility, while FR alone only improves dynamic flexibility.

Manual myofascial release and muscle energy enhances trunk flexibility and strength in recreationally resistance-trained women: Cross-over study

The purpose of this study was to compare the effects of myofascial release and muscle energy on acute outcomes in trunk extensors active range-of-motion and strength in recreationally resistance-trained women. Seventeen apparently healthy women performed three experimental protocols using a cross-over, randomized (counterbalanced in Latin Square format), and within-subjects design: a) range-of-motion and strength test after a manual myofascial release protocol (MFR); b) flexibility and strength test after a muscle energy protocol (ME); and c) range-of-motion and strength test without myofascial release or muscle energy (control condition). Active trunk range-of-motion was measured via a sit-and-reach test and trunk extension strength via isometric dorsal dynamometer. A significant increase in range-of-motion was found for MFR (p = 0.002; d = 0.71) and ME (p < 0.001; d = 0.47) when comparing post-intervention with baseline values. Similarly, a significant increase for strength was found for MFR (p = 0.018; d = 0.10) when comparing post-intervention with baseline values. In conclusion, both techniques (MFR and ME) improved trunk range-of-motion with the sit and reach test immediately post-intervention; however, MFR showed greater magnitude increases in range-of-motion (MFR: (medium magnitude) vs ME: small magnitude). Due to the potential health implications, both (MFR and ME) responses should be among the many considerations for rehabilitation and performance exercise prescription when prescribing an exercise regimen.

A systematic review of chiropractic care for fall prevention: rationale, state of the evidence, and recommendations for future research

BACKGROUND

Falls in older adults are a significant and growing public health concern. There are multiple risk factors associated with falls that may be addressed within the scope of chiropractic training and licensure. Few attempts have been made to summarize existing evidence on multimodal chiropractic care and fall risk mitigation. Therefore, the broad purpose of this review was to summarize this research to date. BODY: Systematic review was conducted following PRISMA guidelines. Databases searched included PubMed, Embase, Cochrane Library, PEDro, and Index of Chiropractic Literature. Eligible study designs included randomized controlled trials (RCT), prospective non-randomized controlled, observational, and cross-over studies in which multimodal chiropractic care was the primary intervention and changes in gait, balance and/or falls were outcomes. Risk of bias was also assessed using the 8-item Cochrane Collaboration Tool. The original search yielded 889 articles; 21 met final eligibility including 10 RCTs. One study directly measured the frequency of falls (underpowered secondary outcome) while most studies assessed short-term measurements of gait and balance. The overall methodological quality of identified studies and findings were mixed, limiting interpretation regarding the potential impact of chiropractic care on fall risk to qualitative synthesis.

CONCLUSION

Little high-quality research has been published to inform how multimodal chiropractic care can best address and positively influence fall prevention. We propose strategies for building an evidence base to inform the role of multimodal chiropractic care in fall prevention and outline recommendations for future research to fill current evidence gaps.

The Biomechanical Effects of Percussive Therapy Treatment on Jump Performance

Percussive therapy treatment is one form of myofascial release that has gained popularity amongst the sport community. It has been suggested that percussive therapy treatment may improve range of motion and improve athletic performance, but these claims are largely anecdotal. Currently, the effects of percussive therapy treatment on performance of athletic tasks is relatively unknown. Therefore, the purpose of this research was to assess the effects of percussive therapy treatment on jump performance and passive range of motion. Twenty-six recreationally active college individuals performed countermovement jump and drop jump activities on two different days (one day with and one day without the use of percussive therapy treatment). Three-dimensional kinematics and kinetics were assessed during the jump activities. Passive range of motion was additionally assessed before and after warm up. A significant decrease in peak ankle eversion (2.0° during landing and 2.4° during take-off) was evident during the drop jump following the use of percussive therapy. All other frontal/sagittal plane peak joint angle and moment changes were nonsignificant. The hip and knee flexors and ankle extensors all showed increases in passive range of motion following treatment. Athletes who use percussive therapy treatment prior to physical activity will not have any adverse effects on performance or increased risk of injury. Muscles with lower levels of flexibility might be more susceptible to strain or injury. Percussive therapy treatment increased range of motion, which might help decrease the risk of injury.

Effectiveness of instrument-assisted soft tissue mobilization for the management of upper body, lower body, and spinal conditions. An updated systematic review with meta-analyses

PURPOSE

To critically appraise randomized controlled trials (RCTs) on Instrument-Assisted Soft Tissue Mobilisation (IASTM) and quantify the effects of IASTM compared with other treatment individuals with or without pathologies on function, pain, and range of motion.

MATERIALS AND METHODS

We search four electronic databases from January 1999 to January 2022 and included RCTs of healthy participants/athletes and people with upper, lower, or spinal conditions, who received IASTM versus other active treatment for clinical outcomes (function, pain, and range of motion).

RESULTS

Forty-six RCTs were considered eligible for data analysis. Effects of IASTM plus other treatment versus other treatment on function and pain intensity were not statistically significant or clinically meaningful (very low quality, SMD -0.28, 95% CI -0.66 to 0.09) and (very low quality, SMD -0.05, 95% CI -0.53 to 0.43) at up to one-year follow-up respectively. No clinically meaningful improvements were found on range of motion outcomes. Out of the 46 included RCTs, only 10 assessed and reported IASTM-related adverse events.

CONCLUSION

Evidence of very low-quality certainty does not support the efficacy of IASTM in individuals with or without various pathologies on function, pain, and range of motion in the management of upper body, lower body, or spinal conditions. IMPLICATIONS FOR REHABILITATIONThe included RCTs had a high risk of bias and were assessed as very-low quality evidence for all the included outcomes.IASTM does not lead to clinically meaningful improvements in function, pain, or range of motion in individuals with upper body, lower body, and spinal conditions.The publication of IASTM trials in suspected predatory journals is increasing.The available evidence on IASTM does not support its use to improve function, pain, or range of motion in individuals with upper body, lower body, and spinal conditions.Health care practitioners should consider other evidence-based management strategies (physical activity and exercise) to improve function, pain, or range of motion in individuals with musculoskeletal injuries and disorders.Given the rise of publications on IASTM in suspected predatory journals, health care practitioners should be judicious to examine the legitimacy of a journal when searching for evidence on IASTM treatment technique.

Effects of Instrument Assisted Soft-Tissue Mobilization on Dynamic Balance in Those with Chronic Ankle Instability

Our objective was to examine the effectiveness of IASTM application to the FL on dynamic balance in individuals with CAI. Fifteen individuals (seven females, eight males, age = 26.07 ± 9.18 years, mass = 87.33 ± 24.07 kg, height = 178.83 ± 12.83 cm) with CAI, as determined by the Ankle Instability Instrument (AII) volunteered to participate. Participants completed two counterbalanced sessions (experimental and control), and we recorded measurements at two time points (pre- and post-). The application of IASTM to the FL muscle was carried out using Técnica Gavilán® instruments for 90 s during the intervention, and participants sat for 2 min during the control session. Dynamic balance was assessed using the Y-balance test (YBT). The interaction between session and time for anterior reach was significant (F1,14 = 5.26, p = 0.04, η2 = 0.27). Post-hoc tests revealed farther reach distances at post-test (71.02 ± 9.45 cm) compared to pre-test (66.57 ± 10.87 cm) when IASTM was applied (p = 0.02, Mean Difference = 4.45 cm, CI95 = 0.71–8.19 cm, Cohen’s d = 0.44). The interaction between session and time was not significant for posteromedial (F1,14 = 0.25, p = 0.62, η2 = 0.02, 1 − β = 0.08) or posterolateral reaches (F1,14 = 1.17, p = 0.30, η2 = 0.08, 1 − β = 0.17). The application of IASTM to the FL improved anterior reach of the YBT, but not posterolateral or posteromedial reaches in individuals with CAI. However, the 4.45 cm increase in anterior reach could have clinical implications for improved function.

Instrument-Assisted Soft Tissue Mobilization Forces Applied by Trained Clinicians During a Simulated Treatment

CONTEXT

Instrument-assisted Soft Tissue Mobilization (IASTM) is a therapeutic intervention used by clinicians to identify and treat myofascial dysfunction or pathology. However, little is known about the amount of force used by clinicians during an IASTM treatment and how it compares to reports of force in the current literature.

OBJECTIVE

To quantify the range of force applied by trained clinicians during a simulated IASTM treatment scenario.

DESIGN

Experimental.

SETTING

University research laboratory.

PARTICIPANTS

Eleven licensed clinicians (physical therapist = 2, chiropractor = 2, and athletic trainer = 7) with professional IASTM training participated in the study. The participants reported a range of credentialed experience from 1 to 15 years (mean = 7 [4.7] y; median = 6 y).

INTERVENTION

Participants performed 15 one-handed unidirectional sweeping strokes with each of the 5 instruments for a total of 75 data points each. Force data were collected from a force plate with an attached skin simulant during a hypothetical treatment scenario.

MAIN OUTCOME MEASURES

Peak force and average forces for individual strokes across all instruments were identified. Averages for these forces were calculated for all participants combined, as well as for individual participants.

RESULTS

The average of peak forces produced by our sample of trained clinicians was 6.7 N and the average mean forces was 4.5 N. Across individual clinicians, average peak forces ranged from 2.6 to 14.0 N, and average mean forces ranged from 1.6 to 10.0 N.

CONCLUSIONS

The clinicians in our study produced a broad range of IASTM forces. The observed forces in our study were similar to those reported in prior research examining an IASTM treatment to the gastrocnemius of healthy individuals and greater than what has been reported as effective in treating delayed onset muscle soreness. Our data can be used by researchers examining clinically relevant IASTM treatment force on patient outcomes.

The Application of Manual Techniques in Masticatory Muscles Relaxation as Adjunctive Therapy in the Treatment of Temporomandibular Joint Disorders

Temporomandibular disorders (TMD) are primarily characterized by pain as well as disorders concerning the proper functioning of individual elements of the stomatognathic system (SS). The aim of the study was to compare the degree of relaxation of the anterior part of the temporal muscles and the masseter muscles, achieved through the use of post-isometric relaxation and myofascial release methods in patients requiring prosthetic treatment due to temporomandibular joint disorders with a dominant muscular component. Sixty patients who met the inclusion criteria were alternately assigned to one of the two study groups, either group I—patients received post-isometric relaxation treatment (PIR), or group II—patients received myofascial release treatment (MR). The series of ten treatments were performed in both groups. The comparative assessment was based on physiotherapeutic examination, a surface electromyography (sEMG) of the anterior temporal and masseter muscles and the intensity of spontaneous masticatory muscle pain, assessed using the Visual Analogue Scale (VAS). We observed a significant decrease in the electrical activity of examined muscles and a significant drop in the intensity of spontaneous pain in the masticatory muscles both in group I and II. There were no significant differences between groups. Both therapeutic methods may be used as successful forms of adjunctive therapy in the prosthetic treatment of TMD. The trial was registered with an international clinical trials register.

Descriptive Analysis of Forces Applied by Trained Clinicians During Two-Handed Instrument-Assisted Soft Tissue Mobilization

Instrument-assisted soft tissue mobilization (IASTM) is a common intervention among clinicians. Despite the popularity, little is known about the forces applied by the clinician with the instruments during treatment. The purpose of this investigation was to examine the forces applied by trained clinicians using IASTM instruments during a simulated treatment. Eleven IASTM trained (Graston Technique, Técnica Gavilán, or RockBlades) clinicians (Physical Therapist = 2, Chiropractor = 2, Athletic Trainer = 7) participated in the study. Each clinician performed 75 two-handed strokes distributed evenly across five different IASTM instruments on a skin simulant attached to a force plate. IASTM stroke application was analyzed for peak normal forces (Fpeak) and mean normal forces (Fmean) by stroke. We observed an average Fpeak of 8.9N and Fmean of 6.0N across all clinicians and instruments. Clinicians and researchers may use the descriptive values as a reference for application of IASTM in practice and research.

Myofascial release versus other soft tissue release techniques along superficial back line structures for improving flexibility in asymptomatic adults: A systematic review with meta-analysis

OBJECTIVE

Our review is aimed to find out the efficacy of Myofascial Release Technique (MFRT) based on the Randomised Controlled Trials, on flexibility when given along superficial back line (SBL) structures and to compare it with other soft tissue release techniques.

DATA SOURCES

A systematic literature search on MEDLINE (Pubmed), Google Scholar, Science direct, Cochrane Library, Physiotherapy Evidence Database (PEDro) and Clinical Trial Database in English; up to April 2020 was undertaken.

STUDY SELECTION

PRISMA (The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) was used for screening the relevant citations and reviewing the relevant studies. The literature searched total of 6,938 articles, however, only 68 were screened for eligibility. In the further screening, 16 studies fulfilled the inclusion criteria for our systematic review.

DATA EXTRACTION

Data were extracted into a table containing sample size, mean age of subjects, types of intervention, area to be treated, outcome measures used, and results of the accepted studies.

DATA SYNTHESIS

16 randomized controlled trials and cross-over trials were found to be eligible for our review. Quality assessment of the RCTs was done with the PEDro scoring method. Randomised clinical trials that studied the comparative effect of Myofascial Release (MFRT) technique with different MFRT techniques, control/sham, and other soft tissue release techniques like stretching, were included. Results of this analysis showed little evidence proving the additional effectiveness of MFRT treatment compared to other soft tissue release techniques for improving flexibility so as to consider it as the preferred treatment. Methodological aspects of selected studies for further research are suggested. Study was registered in the PROSPERO database (CRD42020179118).

CONCLUSION

MFRT appears to be a good technique for improving flexibility. However, in comparison with other soft tissue release techniques, this therapy becomes less successful. More research is needed regarding its effectiveness.

Comparative effects of different manual techniques on electromyography activity, kinematics, and muscle force in limited ankle dorsiflexion syndrome

BACKGROUND

Although the instrument-assisted manual (IM) technique has been widely utilised to improve soft tissue and joint mobility, its therapeutic benefits and underlying neuromechanical mechanisms remain unknown compared to those of conventional static stretching (SS) and hold-relax (HR) manual techniques.

OBJECTIVE

This study aimed to compare the effects of the SS, HR, and IM techniques on muscle activity, kinematics, and strength during deep squatting in limited ankle dorsiflexion (DF) syndrome.

METHODS

This was a cross-sectional randomised controlled study including 39 adults divided into three groups: SS group: 13, HR group: 13, IM group: 13. Outcome measures were the tibialis anterior (TA): gastrocnemius (GCM) balance ratio and ankle, knee, hip and thoracolumbar junction angles. TA muscle strength was analysed to evaluate the limited ankle DF. Analysis of variance was performed, with P< 0.05.

RESULTS

The TA:GCM balance ratio, ranges of motion of ankle DF and knee flexion, and TA muscle strength in the IM group improved significantly compared to that in either the SS group or HR group (P< 0.05).

CONCLUSIONS

Our novel results demonstrated that IM was most effective in normalising TA:GCM balance, ankle DF range of motion, and TA muscle strength during deep squatting in adults with limited ankle DF.

A novel manual therapy technique is effective for short-term increases in tibial internal rotation range of motion

The coupled motions of tibial internal rotation (T-IR) and ankle dorsiflexion (DF) are necessary for proper lower-limb function. Anecdotally, clinicians have been performing techniques to restore T-IR to improve ankle DF, however, no evidence exists to support their efficacy. Therefore, the two objectives were to: (a) determine the effectiveness of a manual therapy technique for improving T-IR range of motion (ROM) and (b) Examine the relationship between ankle DF and T-IR ROM. Twenty-four participants qualified to participate and were randomly allocated to either the control (n=12) or manual therapy (n=12) group. Closed-chain ankle DF and T-IR ROM were assessed at baseline and immediately posttreatment. Control group participants sat quietly for 5 minutes. The experimental group performed 3 sets of 15 repetitions of a manual therapy, mobilization with movement technique. With the patient in a kneeling lunge position, the examiner wrapped an elastic band around the tibia and fibula and was instructed to lunge forward while the examiner simultaneously manually internally rotated the lower leg. T-IR ROM significantly increased following the intervention for the manual therapy group when compared to the control group. There were no significant changes in standing or kneeling DF ROM. No significant correlation was found between T-IR and both standing and kneeling DF ROM. A single mobilization with movement treatment is effective for improving tibial IR ROM in the short-term compared to no treatment. However, active tibial IR and end-range dorsiflexion range of motion do not appear to be correlated based on these methods.

Effect of Instrument-Assisted Soft Tissue Mobilization on Ankle of Range of Motion and Balance in Older Women: A Preliminary Study

OBJECTIVES This study aims to investigate the effects of instrument-assisted soft tissue mobilization (IASTM) on ankle range of motion (ROM) and balance in older women.METHODS The 20 older women with a history of falls participated in the study, and the study subjects were randomly divided into the IASTM group (n=10) and control group (n=10).RESULTS There were no significant interactions between group and time for ankle ROM and functional reach after 8 weeks of IASTM on older women (P>0.05). Meanwhile, there were significant interactions between group and time for one-leg standing and star excursion balance (P<0.05), and in particular, the IASTM group had greater improvements compared to the control group.CONCLUSION In conclusion, the regular application of IASTM has been shown to improve the balance of older women with a history of falls.

Acute effect of different duration times of application of myofascial release on quadriceps femoris strength: A randomized clinical trial

OBJECTIVES

To evaluate the effect of Miofascial Release (MFR) on knee extensors strength, at different duration times of application.

METHOD

51 healthy individuals were randomly assigned to one of three groups (3min, 5min or placebo) in this randomized clinical trial. The knee extensors strength was assessed in two conditions: pre and post-intervention, using an isokinetic dynamometer, at speeds of 60° and 120°/s. MFR was applied on the anterior surface of the thigh for 3min or 5 min, according to the experimental groups. The placebo group underwent through the application of a non-therapeutic gel, associated with 3min of a light touch on the skin. Peak torque, total work and mean power were the isokinetic variables analyzed through a multivariate analysis of variance (MANOVA) with p ≤ 0.05.

RESULTS

Our findings suggest a main effect and interaction between moments (pre and post-intervention) and speeds (60° and 120°/s) for total work and mean power (p < 0.01). Likewise, main effect and interaction of speed were observed for peak torque (p < 0.01). There were no significant differences for the other analyzed variables.

CONCLUSION

No significant main effect of MFR were detected in any of the proposed application time on peak torque, total work and mean power, in the knee extensors, compared to the placebo group.

The effects of instrument-assisted soft tissue mobilization rehabilitation exercise on range of motion, isokinetic strength, and balance in chronic ankle instability taekwondo players

We aimed to investigate change the instrument-assisted soft tissue mobilization (IASTM) rehabilitation exercise on range of motion (ROM), isokinetic ankle strength, and balance. We included 20 elite taekwondo players (chronic ankle instability) in Korea. They were divided into the IASTM group (n=10), control group (n=10). IASTM group were exercised with IASTM rehabilitation exercise four times per week for 8 weeks. The remaining control group did not receive exercise intervention between tests and served as the control. A goniometer was used to measure dorsi-flexion (D/F), plantar-flexion (P/F), a dynamometer was used to measure ankle isokinetic strength, and plantar foot pressure was used to measure static balance. The data were analyzed using repeated-measures analysis of variance. Significant differences were observed between the two groups in IASTM group and control group: ROM (right P/F, P<0.001; right D/F, P<0.01; left P/F, P<0.000; left D/F, P<0.000), isokinetic strength (right P/F 60°, P<0.000; right D/F 60°, P<0.000; left P/F 60°, P<0.000; left D/F 60°, P<0.000; right P/F 180°, P<0.000; right D/F 180°, P<0.000; left: P/F 180°, P<0.000, left D/F 180°, P<0.000), and balance test (static eye open, P<0.000; static eye close, P<0.000; postural stability, P<0.041). These results suggest that IASTM rehabilitation exercise improves ankle stability, muscle power, and body balance in chronic ankle instability taekwondo players.

Manual Therapies for Posterior Thigh Muscles Enhanced Ten-Repetitions Maximum Test Performance and Hip Flexibility in Young Soccer Players

This study investigated how different manual therapies applied to the posterior thigh muscles affect the ten-repetitions maximum performance test (10 RM) and hip flexion range-of-motion among young soccer players. Seventeen non-professional male soccer players performed the 10RM and range of motion pre-testing, and, in separate laboratory visits, they underwent three different experimental activities presented to each participant in a randomized order: (a) rest control activity with no intervention, (b) manual massage, and (c) muscle energy. Comparing pre-testing performances to repeated tests after each intervention condition, participants increased their maximum load lift on the 10-repeitions maximum test following manual massage and muscle energy interventions (p < 0.05), but not following the control condition. They also increased their hip range-of-motion on flexibility testing following manual massage and muscle energy (p < 0.05), but not following the control condition. Thus, both manual massage and muscle energy therapies applied to the posterior thigh were beneficial to performance. This finding has clear implications when preparing athletes for competition.

Comparison of the Graston Technique® With Instrument-Assisted Soft Tissue Mobilization for Increasing Dorsiflexion Range of Motion

CONTEXT

Limited dorsiflexion (DF) range of motion (ROM) is commonly observed in both the athletic and general populations and is a predisposing factor for lower extremity injury. Graston Technique® (GT) is a form of instrument-assisted soft tissue mobilization (IASTM), used commonly to increase ROM. Evidence of the long-term effects of GT on ROM is lacking, particularly comparing the full GT protocol versus IASTM alone.

OBJECTIVE

To evaluate the effectiveness of 6 sessions of the GT or IASTM compared with a control (CON) group for increasing closed-chain DF ROM.

DESIGN

Cohort design with randomization.

SETTING

Athletic training clinic.

PATIENTS OR OTHER PARTICIPANTS

A total of 23 physically active participants (37 limbs) with <34° of DF. Participants' limbs were randomly allocated to the GT, IASTM, or CON group.

INTERVENTION

Participants' closed-chain DF ROM (standing and kneeling) were assessed at baseline and 24-48 hours following their sixth treatment. Participants in the CON group were measured at baseline and 3 weeks later. The intervention groups received 6 treatments during a 3-week period, whereas the CON group received no treatment. The GT group received a warm-up, instrument application, stretching, and strengthening of the triceps surae. The IASTM group received a warm-up and instrument application.

MAIN OUTCOME MEASURES

Closed-chain DF was assessed with a digital inclinometer in standing and kneeling.

RESULTS

A significant difference between groups was found in the standing position (P = .03) but not in kneeling (P = .15). Post hoc testing showed significant improvements in DF in standing following the GT compared with the control (P = .02).

CONCLUSIONS

The GT significantly increases ankle DF following 6 treatments in participants with DF ROM deficits; however, no differences were found between GT and IASTM. The GT may be an effective intervention for clinicians to consider when treating patients with DF deficits.

The effectiveness of Ergon Instrument-Assisted Soft Tissue Mobilization, foam rolling, and athletic elastic taping in improving volleyball players' shoulder range of motion and throwing performance: a pilot study on elite athletes

[Purpose] The purpose of this pilot study was to investigate the effectiveness of instrument-assisted soft tissue mobilization (IASTM), foam rolling, and athletic elastic taping on improving elite volleyball players' shoulder range of motion (ROM) and throwing performance. [Participants and Methods] Fifteen elite male volleyball players (mean age: 24 ± 4.54 years; mean height: 177 ± 0.08 cm; mean weight: 81 ± 7.71 kg) received shoulder Ergon IASTM, foam rolling, and elastic taping treatment in random order on both upper extremities once a week for three weeks. Pre-and post-treatment assessments of their shoulders' ROM and functional throwing performance were performed. [Results] Ergon IASTM technique resulted in significantly higher shoulder flexion ROM values than foam rolling and elastic taping. Foam rolling, in turn, showed better results than athletic elastic taping. Moreover, the Ergon IASTM technique resulted in significantly higher OSP values than athletic elastic taping. No significant differences were observed between the therapeutic interventions in terms of FTPI. [Conclusion] This pilot study on elite athletes provides evidence that both IASTM and foam rolling techniques may improve their passive shoulder ROM compared to elastic athletic taping while Ergon IASTM can also enhance their shoulder throwing performance.

Effectiveness of clinician- and patient-applied mobilisation with movement technique to increase ankle dorsiflexion range of motion

Background/aims

Restricted ankle dorsiflexion has the potential to cause acute and chronic injuries. One method for increasing dorsiflexion range of motion is the application of joint mobilisation with movement. An alternative to clinician-applied mobilisation with movement is self-applied mobilisation with movement; however, this technique has not been previously studied. The objective of this study was to evaluate the effectiveness of self-applied and clinician-applied mobilisation with movement technique for improving dorsiflexion range of motion in participants with ≤34° of dorsiflexion.

Methods

A total of 42 typically healthy participants qualified and were randomly assigned to the control, self-applied, or clinician-applied mobilisation with movement group. Closed chain ankle dorsiflexion range of motion was assessed using a modified weight-bearing lunge test.

Results

Both mobilisation groups showed significant increases in standing and kneeling dorsiflexion range of motion when compared to the control group, with no differences between treatment groups.

Conclusions

These findings suggest clinicians can teach patients to apply mobilisation with movement and receive similar benefits to a clinician-applied mobilisation with movement treatment.

INSTRUMENT ASSISTED SOFT-TISSUE MOBILIZATION: A COMMENTARY ON CLINICAL PRACTICE GUIDELINES FOR REHABILITATION PROFESSIONALS

Instrument assisted soft-tissue mobilization (IASTM) has become a popular myofascial intervention for sports medicine professionals. Despite the widespread use and emerging research, a consensus on clinical standards, such as a describing the intervention, indications, precautions, contraindications, tool hygiene, safe treatment, and assessment, does not exist. There is a need to develop best practice standards for IASTM through a universal consensus on these variables. The purpose of this commentary is to discuss proposed clinical standards and to encourage other sports medicine professionals and researchers to contribute their expertise to the development of such guidelines.

LEVEL OF EVIDENCE

5.

Roller massage: is the numeric pain rating scale a reliable measurement and can it direct individuals with no experience to a specific roller density?

This investigation measured the reliability of the numeric pain rating scale (NPRS) for roller massage (RM) over two sessions and compared it to pressure pain threshold (PPT) during a third session. Twenty-five subjects participated. Session one, subjects rolled on 3 different rollers and filled out the NPRS for each roller then chose their preferred roller. Session two, subjects repeated the testing blind-folded to eliminate visual biases. Session three, subjects repeated testing but were measured with PPT. For the NPRS, there was poor to moderate reliability for the soft roller (ICC=0.60) and good reliability for the moderate (ICC=0.82) and hard density (ICC= 0.90) rollers. For preferred roller, there was no significant difference between sessions (t (24) =.00, p=1.00). For NPRS and PPT, there was a fair relationship for all rollers (Rho=0.34-0.49, p = 0.11-0.28). The NPRS appears to be a reliable measure and may help direct individuals to a specific roller. The NPRS and PPT should be used independently.