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Instrument Assisted
Soft Tissue
or Graston Technique


Instrument-Assisted Soft Tissue Mobilization

Have you heard of Graston? What about Gua Sha? Some call it ASTM. What all these treatments have in common is that they are tool-assisted soft tissue mobilization.


At Muscle IQ physical therapy in Provo, we use a special unique tool to help us perform treatments on tight or painful tissues that are preventing normal motion and strength. The history behind these techniques goes all the way back to China hundreds of years ago. Here in the U.S. this tool-assisted treatment became more common in the 1980's, and early 1990's. When applied appropriately, this treatment technique can be an effective way to release what feels like adhesions in the fascia, improve circulation to the area, and decrease pain.

Patients who benefit from this treatment include those with back pain, neck pain, total knee replacements, plantar Fascitis, and even rotator cuff strains. The treatment can give pain relief and increase motion. This treatment is usually applied with an oil or cream to help with friction. Some patients are amazed by how it feels afterwards. It is normal to have localized skin redness at the treatment site after this treatment. This redness is a desired effect. We want to see increased blood flow to the area. The redness usually goes away that same day.  These treatments are always followed up by the best low back pain exercises, or neck, shoulder, and knee exercises.



What is ASTYMTM or ASTM and gua sha?

ASTYMTM and gua sha are techniques that utilize a plastic, jade or horn tool to scrape the skin.

The ASTYMTM System is a new approach in manual therapy that uses instruments to target problems in the 'fibrous net' of soft tissues. It stimulates the natural healing process, so instead of treating symptoms we actually treat the pain-generator.

The ASTYMTM System could be compared to combing out a clump of "tangled" strands frequently found in long hair. With this analogy, the instruments can be compared to a comb, and the macrophages (white blood cells that work like PACMAN chomping down on the damaged collagen fibers) and the fibroblasts (that lay down new collagen fibers) could be thought of as the body's own detangler spray used to unlock knots and snarls of fibrosis or scar adhesions.

Just like combing long hair frequently and using conditioner helps prevents tangles, the patient is asked to stretch and exercise during the healing process so the new collagen being laid down does not end up in "tangles" but instead lines up in parallel with the line of tension.

Fibrosis (excessive formation of tangled collagen) is thought to "strangle" the capillary blood vessels in the region. If capillary blood supply is limited or restricted by excessive collagen fibers then cells in the area become unhealthy. This is like the difference in water quality in a mountain stream versus a swamp.

Muscles may also become "strangled" by fibrosis (scar tissue formation). If these muscles are not able to fully contract (i.e., shorten their length and thicken), they become dysfunctional and weak and range motion is restricted.

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