Manual Physical Therapy

Manual Physical Therapy: 6 facts about IASTR 

For a long time, hot packs, ice packs and/or exercises, maybe even ultrasound machines were central to an effective physiotherapy session. While these are all good treatment modalities which have been in use for decades, are they enough? 

In our experience both as practitioners and recipients of services, we know the above-mentioned methods provide temporary relief. When the source of pain or injury is not addressed, unfortunately for you (the patient), the pain usually returns. Sometimes its worse than when it first showed up.  

Physiotherapists are skilled professionals fully equipped with tools and strategies to get to the root of the problem and formulate a treatment plan accordingly. With a thorough assessment, treatment plan, and patient education, we will root out your pain.  

That’s where manual therapy techniques come in; they are used to assist with movement in many musculo-skeletal conditions. These techniques guide a thorough approach to your discomfort and unease. 

In the case of pain, stiffness, and movement restriction, Manual Physical Therapy gives us several options; Instrument Assisted Soft Tissue Release (IASTR) is a big one in the physiotherapist’s arsenal. 

Manual Physical Therapy Facts

Let’s go through a breakdown of Manual Physical Therapy 6 facts about IASTR technique so you know what to expect during your appointment:

1. Instrument Assisted Soft Tissue Release (IASTR) is used for releasing scar tissue. 
  • Scar tissue is usually formed after surgery or an injury to the soft tissue structures in your body, such as muscles, tendons, fascia, etc. Injuries can be caused by a cut or a tear. The formation of scar tissue is a natural healing process initiated by the body. 
  • Sometimes the body can be in a hurry to heal and get it over with it. In such cases, the collagen fibers, a helpful but stubborn kind of cell, can result in restricted movement instead of complete, functional movement. 
  • Imagine them to be superglue, instead of the regular glue needed to fix a broken object. This superglue is tough and once fixed, can be very hard to move around. In the absence of a good gluing strategy this superglue- collagen fibers- can clump up and cause superglue balls- called adhesions.  
  • These adhesions are holding on to too many structures without providing flexibility for movement. They are not very elastic and cannot be easily broken. What that looks like on the outside of your body is stiffness and pain.  
  • The good news is that scar tissues and adhesions are not permanent. They can be remodeled. The best way would be to stretch the stubborn superglue balls until they are elastic and loose again.

IASTM is a great way to reach scar tissue, apply pressure on them to break down these clumps of collagen/Adhesions. It is also referred to as the Graston technique.  

IASTM involves the use of objects, usually metal, to apply pressure, manually stretch and mobilize scar tissue.

2. Instrument Assisted Soft Tissue Release (IASTR) works on the principle of cross friction massage. 
  • The principles of cross friction massage, first described by James Cyriax, were developed to prevent the formation of these superglue balls or clumps. 
  • Regular massage, like the one used for relaxation, is intended to improve blood flow and circulation to different parts of the body. That means the direction of massage is along the circulatory pathways of the body, usually towards the heart or towards the hands/feet. 
  • On the other hand, a cross friction massage as the name implies, is directed differently. The direction of the massage in this case is transverse to the particular part of the muscle or tendon.

The IASTM tools are designed, sized and contoured in a way to reach deep adhesions in different parts of the body effectively. 

Your physiotherapist will complete a thorough assessment to identify the location of the adhesions. Following which one or more of the metal tools will be used to break down the scar tissue, by applying pressure and stretching across the fibers.

3. Instrument Assisted Soft Tissue Release (IASTR) causes red spots; but you have nothing to worry about.  
  • After treatment you can expect some soreness, redness and bruising. There will be red spots on your skin, they are called petechiae. These bright red spots are considered a good response to the treatment. 
  • The goal of treatment is to introduce controlled microtrauma to the adhesion. 
  • Petechiae are an indication that the instrument caused microbleeds within the scar tissue- a good sign that the particular area is healing.

Soft Tissue Release

4. Instrument Assisted Soft Tissue Release (IASTR) is sometimes contraindicated. 

IASTM is a highly effective technique for soft tissue release in conditions like tennis elbow, golfers’ elbow, plantar fasciitis, any type of ligament sprain or muscle strain. However, it cannot always be used. 

IASTM is contraindicated under the following circumstances: 

  • Open wounds 
  • Unhealed fractures 
  • Hypertension 
  • Patient intolerance 
  • Hematoma 
  • Hemophilia and more. 
5. Instrument Assisted Soft Tissue Release (IASTR) is used in conjunction with other methods. 
  • A thorough assessment, in addition to a detailed history, will help your physiotherapist exact the location of the adhesion and scar tissue. The treatment is carried out for up to 2 minutes, and as such will break down the scar tissue, but it does not stop there.  

There is strong evidence to suggest that IASTR, when used with other methods, has proven to be effective. 

Following the treatment, you will be taught to do some stretches and strengthening exercises to ensure the superglue is spread out to avoid re-clumping. These steps are vital to reinforce new tissue and to prevent re-occurrence. 

Some cryotherapy, ice packs are used after intervention to ease the discomfort.

6. Instrument Assisted Soft Tissue Release (IASTR) uses a variety of tools. 
  • There is no one size that fits all approach to IASTR. The design of the human body is so wonderfully complex, and tools are designed in a way to reach deep scar tissue in different parts of the body. 
  • The choice of instrument can vary depending on location of scar tissue, patient tolerance and physiotherapist’s preference.

Manual Physical Therapy 6 facts about IASTR 

For all these reasons IASTR is a highly effective technique for chronic tendinopathies. At Revere, we specialize in Manual Physical Therapy 6 facts about IASTR techniques. We respect and value your time and that’s we why offer the best hands-on, individualized therapy with no extra charges for IASTM. 

If you have a long-standing injury or pain, reach out to us at We are offering a free 10-minute consultation call with our expert physiotherapists. Call us at (604) 566-5108.  

If you feel ready, book an appointment with our expert physiotherapists. Share this article with friends and family who also have chronic pain and could benefit from the best physiotherapy services at Revere Physiotherapy. 

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