Thursday, August 2, 2012

Compatible care
Instrument-assisted soft tissue mobilization is changing the way clinicians view treatment of chronic and sub-acute soft tissue injuries

By Scott Huelskamp

It is estimated that more than 30,000 chiropractors, physical therapists, occupational therapists, hand therapists, and athletic trainers have integrated instrument-assisted technology into their treatment and rehabilitation protocols due to its effectiveness and efficiency.

The use of manual therapy has long been a staple of those who understand the value of treating the tissue in addition to the adjustment. They follow the kinetic chain to locate the cause of an injury, and do not just treat the source of the pain. But the use of an instrument — versus the use of hands only — was something many had trouble “getting their arms around.”

Ted Forcum, DC, DACBSP, a private practitioner in Beaverton, Ore., remembers the day he was asked to take an instrument-assisted treatment seminar and he begrudgingly completed the initial course. “I didn’t feel a strong need to learn anything with an instrument. I felt confident in my own ability to use my hands,” he says.

An eye-opening experience
At the time, Forcum was working for the Professional Golfers’ Association of America (PGA) and decided to apply instrument-assisted soft tissue mobilization (IASTM) with a golfer who was having difficulty restoring range of motion. Other clinicians had tried various other methods with him to no avail. Yet, after only one IASTM treatment, the golfer improved his range of motion by 30 percent, Forcum says.

I thought that if it worked in this one case in one session, imagine what else it could do if I worked on perfecting the treatment,” Forcum says.

Forcum, who has been exposed to numerous instrument-assisted systems, uses Graston Technique (GT) clinically. He also is an instructor for GT.

Graston Technique pioneered instrument-assisted technology in an outpatient facility in 1994. Research was initiated early in the 1990s at Ball State University and Ball Memorial Hospital in Muncie, Ind.

Today, there are about 20 instrument-assisted systems available. The most notable are Graston Technique (which has about 13,000 trained clinicians), ASTYM, and SASTM. Neither ASYTM nor SASTM publish their number of users. Of the systems available to professionals, only two, Graston Technique and ASTYM, require professional education prior to acquiring or using the instruments.

The availability of continuing education (CE) credits typically interests healthcare professionals; however, most IASTM systems do not offer CE across the board, with GT as the exception. ASTYM does not train chiropractors, and SASTM, like most other IASTM systems, does not offer CEU for all professions.

Colleges embrace IASTM
GT is used in more than 1,400 outpatient facilities and 34 industrial sites by more than 200 professional and amateur sports organizations. It is also part of the curriculum at 51 colleges and universities, including 16 chiropractic colleges.

Clinicians can use GT as an adjunct to treat pain in the neck, lower back, hips, knees, ankles, shoulders, and wrists. The technique can also address conditions such as cervical and lumbar sprains and strains, carpal tunnel syndrome, lateral and medial epicondylosis, rotator cuff tendinosis, Achilles tendinosis, plantar fasciitis, and patellofemoral disorders. It has even been used with post-surgical breast cancer survivors to break up scar tissue around the chest and shoulders.

For clinicians, it can improve diagnostic treatment, detect major and minor fibrotic changes, and reduce manual stress. For patients, it decreases overall treatment time, fosters faster rehab and recovery, and can resolve chronic conditions thought to be permanent.

Instruments reduce physical stress
Sheila Wilson, DC, ICSSD, is a certified chiropractic sports physician in Indianapolis. She treats professional, amateur, and recreational athletes, and started using IASTM in her sports medicine practice 10 years ago after she began suffering from medial epicondylitis from excessive use of her hands during manual therapy.

“I was treated with the Graston Technique by a mentor of mine and it worked so well that I knew it was something I needed to add to my practice. The benefit then became two-fold because, after I started using IASTM in my practice, I stopped having the physical strain that the hands-on manual therapy alone was causing,” Wilson says.

In many cases, it’s difficult to get deeper into the tissue with just finger palpation to create a more refined treatment.

“It has allowed me to treat a lot faster and in greater depth in the kinetic chain,” Forcum says. “Before, with my hands, I could only work isolated areas. IASTM allows me to cover ground quickly as both an evaluation tool and a treatment tool. You can find problem areas that you can’t find with your hands alone.”

As a key component of his practice, Forcum uses IASTM in combination with electric stimulation treatments, ultrasound, laser therapy, and elastic therapeutic taping. He applies the techniques primarily on fascial planes and sheaths to prompt stimulation to help the healing cycle.

Hundreds of athletes at all levels have already benefited from Forcum’s expertise. He was a staff chiropractor for the PGA and the Champions Tour, and was on the medical staff for the U.S. Olympic Team at the 2007 Pan American Games and 2008 Summer Olympics.

The American Chiropractic Association Council on Sports and Physical Fitness has honored Forcum as Sports Chiropractor of the Year three times. He is the team chiropractor for the Portland Timbers soccer club and the Portland Winterhawks hockey team. In addition, he has worked as an event physician and as the medical director for numerous national sporting events.

Old injuries respond
One of Forcum’s more memorable cases involved a woman who had developed a hematoma after a horse stepped on her. With the passage of time, the old injury had solidified and scarred over, leaving three silver dollar-sized outcrop- pings on her hip. Although previous treatment methods had failed to reduce or eliminate the cosmetic issue, the problem disappeared after two IASTM sessions. “I have been impressed with a lot of responses, but I wasn’t expecting big results with that case,” Forcum says.

Wilson has experienced similar impressive results. Several patients with long-term symptoms who have tried numerous therapies without result have responded to IASTM. For example: One of Wilson’s recent patients presented with anterior leg pain that kept him from running for two months. One treatment of IASTM resolved his problem. Wilson too is a GT instructor.

“I’ve treated several patients successfully with histories of plantar fascial pain from several months up to two years for whom IASTM was their last hope,” Wilson says. “I had a young patient who was scheduled for a second surgery on her Achilles because of scar tissue and with IASTM treatment the scar tissue was released and the surgery was cancelled, allowing her to have a normal summer without being on crutches [along with] the ability to play fall sports.”

Wilson is past president of the ACA Council on Sports Injuries and Physical Fitness and president of the Federation Internationale de Chiropratique du Sport. She is team physician for the Indiana Invaders track and field team, sports committee chair for the Indiana State Chiropractic Association, and is editor of the Sports Talk Newsletter.

In tandem with adjustments
“When a chiropractic adjustment is also needed in treatment, it is much easier following IASTM and the results last longer,” Wilson says.

After using IASTM, clinicians should stretch and strengthen the area as part of an overall treatment protocol, which contributes to tissue healing. It’s common to experience minor discomfort during the procedure and some bruising can occur afterward — both normal responses and part of healing.

The results are part of the reward, Forcum says. For highly competitive athletes, he considers IASTM a form of “performance care,” which gives him the opportunity to investigate areas where athletes may notice restrictions or range of motion limitations during workouts. With these elite performers, a mere 2-percent change in performance can mean the difference between finishing in first place or sixth.

“It’s nice to be part of something that’s a little bigger than you,” Forcum says. “You feel like you’re part of the team and contributing to an athlete’s individual success.”

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