IASTM
Cupping & Scraping
Instrument Assisted Soft Tissue Mobilization or IASTM for short, is a type of manual therapy that uses specialized tools that gently traction, massage and scrape the skin. IASTM treats soft tissue injuries of: Fascia, Muscles, Tendons, Ligaments, Skin, Nerves and the outer membranous layer of Bones.
IASTM is the modern version of "Scraping Therapy", a traditional folk remedy that's been practiced for thousands of years all across Asia. In Traditional Chinese Medicine, it's called Gua Sha and is often a regular part of an acupuncturist's armamentarium. There are some differences between traditional and modern approaches to IASTM, both in technique and application, but for all intents and purposes, it's the same thing. IASTM can be a great adjunct to traditional manual therapy; prepare muscles for deeper work; loosen connective tissue; break down scar tissue and correct biomechanical imbalances.
How does IASTM work?
IASTM has been shown to effectively break down fascial restrictions and scar tissue.
It has also shown numerous clinical benefits, like improving joint range of motion (ROM), muscular strength and reducing pain perception after treatment. We have found that IASTM significantly improves and reduces fascial and scar tissue adhesions around joints and throughout the body.
IASTM can be especially helpful for tight, spastic muscles that are reactive and resistant to deep massage. Depending on how IASTM is used, different physiological effects can be obtained.
The Myo-Fascia
Using IASTM introduces controlled microtrauma into soft tissue and causes a local inflammatory response. This microtrauma stimulates the breakdown and re-alignment of disorganized fascial connections and remodeling of the collagen fibers of affected soft tissue.
The Nervous System
Slow stroking of a muscle inhibits the gamma motor system, stimulating mechanoreceptors and inducing a reflex response that lowers muscle tone and leads to both localized and whole-body relaxation. Reducing muscle tone can be particularly helpful for muscles that are resistant to deep massage. This makes IASTM a drugless or mechanical muscle relaxer.
As far as interventions go, IASTM and cupping are wonderful techniques with an elegantly genius mechanism of action. It's simply using biomechanical forces to reduce muscle tone and spasm.
The only thing your friendly neighborhood doctor has to reduce muscle tone and spasm are drugs which compromise physical and mental performance. You can't operate heavy machinery when taking muscle relaxers because you might accidentally kill yourself. But you can most certainly get scraped and cupped.
Cupping
Cupping is a form of IASTM. It has been practiced in one form or another by various cultures for hundreds and even thousands of years. While most people associate Cupping with Asia, it was also used in ancient Greece, Persia, India, and the Vikings.
There are two main forms of Cupping; Wet Cupping and Dry Cupping. Dry Cupping is further sub-divided into traditional Fire Cups and Plastic/Silicone Cups. Our office uses plastic cups with a vacuum pistol to create suction on the body's surface. These cups are either left in place (stationary) or moved over the skin while gently pulling up on the cup (sliding), The suctioning pulls-up the skin and it underlying tissues, reaching deep into the soft tissues and their attachments.
Wet Cupping is a form of blood letting. Our office does not perform Wet Cupping.
How Cupping Works
Connective tissue can normally be manipulated in all directions except one. It cannot be pulled away from the body. The suction from the cups reaches deep into the soft tissues, pulls them apart and separates individual layers of fascia, collagen, and connective tissue that have become stuck and adhered to one another.
Cupping can also pull inflammatory substances away from an injury and towards the skin where the lymphatic system can more readily eliminate them.
Another ingenious effect of cupping involves the side effects of redness and bruising that so often accompany cupping. When a skeletal muscle is in spasm, it's blood vessels are also in spasm. When blood is pulled to the surface of the skin, if the blood vessels also in spasm, the blood will remain pooled at the surface of the skin. If the blood vessels are not in spasm, only moderate skin discoloration occurs. So the bruising (ecchymosis) that often accompanies cupping is actually diagnostic of underlying vasoconstriction. Additionally, the mechanical suction of blood to the surface of the skin causes vasodilation within the surrounding blood vessels, also making it a therapeutic intervention.
A Word to Cupping Skeptics
The fact that people are skeptical of cupping but not other forms of IASTM is very interesting. Skeptics seem to not understand that IASTM and cupping both possess overlapping mechanisms of action. It's ironic that cupping is often dismissed as an archaic practice that's rooted in superstition and the placebo effect. Especially when IASTM and Cupping are now the first treatment of choice in many modern physical therapy clinics.
References
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Gehlsen, GM, Ganion, LR, and Helfst, RH, Fibroblast responses to variation in soft tissue mobilization pressure, Med Sci Sports ExercfckLR. 1999; 31:531-535.
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Melham, TJ, Sevier, TL, Malnofski, MJ, Wilson, JK, and Helfst, RH, Chronic ankle pain and fibrosis successfully treated with a new non-invasive augmented soft tissue mobilization (ASTM): A case report. Med Sci Sports Exerc. 1997; 30:801-804
Wilson, J., Sevier, T., Helfst, R., Honing, E., & Thomann, A. (2000). Comparison of rehabilitation methods in the treatment of patellar tendinitis. J Sports Rehabil, 9(4), 304-314.
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http://www.physio-pedia.com/Instrument_Assisted_Soft_Tissue_Mobilization#cite_ref-2
Threskeld AS 1992, The effects of manual therapy on connective tissue. Physical Therapy 72(12):893-901
https://www.iastm.club/2018/09/how-iastm-works.html
Behave, Robert M. Sapolsky:767-792