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Ins umen assis ed so issue mobiliza ion in imp o ing hams ing muscle
lexibili y: A scoping e iew
Ma. Jesusa Mae F. Gae lan*, K is ian Raelli F. Jaa a , Cla isse June E. Villanue a, Roland L. Sa dan
Physical The apy Depa men , School o Heal h Science P o essions, S . Dominic College o Asia,
Bacoo , Ca i e, Philippines
*Co esponding au ho : ma iajesusamaegae [email protected]
Abs ac
Ins umen Assis ed So Tissue Mobiliza ion (IASTM) is an eme ging echnique de eloped
by James Cy iax o u he imp o e p ac ices among clinicians unde he ehabili a ion
se ing in managemen o a ious myo ascial and endinous pa hologies. Nume ous s udies
ha e been conduc ed o iden i y i s e ec s on he di e en egions o he body; howe e ,
he e ec s o his in e en ion in imp o ing hams ing muscle lexibili y emains
unde s udied. This s udy aims o de e mine he esul o using IASTM in imp o ing
hams ing muscle lexibili y by analyzing, colla ing and syn hesizing exis ing s udies and
p o ide an o e iew o he esea ch s udies. A sys ema ic li e a u e sea ch was conduc ed
using eigh da abases: Google Schola , CORE, Resea chGa e, PED o, PubMEd, B i ish
Medical Jou nal, ScienceDi ec , and Coch ane. Speci ic keywo ds inco po a ed wi h
Boolean ope a o s a e used in he ollowing da abase o ele an esul s. Twel e s udies
we e included a e e iewing all 283 s udies in he ini ial esea ch. Sc eening o quali ied
s udies we e also done based on he gi en inclusion and exclusion c i e ia p o ided by he
esea che s. S udies ha we e included we e colla ed and comp ised o in o ma ion i al
in his s udy, such as esea che s a ge ed subjec s wi h hams ing igh ness, ou come
measu e p ocedu es, ype o ool used, and p o ocols ollowed in each expe imen al g oup.
T adi ional managemen s used as a compa ison we e ou lined. The indings o each s udies
we e emphasized as well. The esea che s iden i ied ha almos all quali ied s udies
included desc ibed he posi i e e ec s o IASTM applica ion in he hams ing muscle
g oup, based on he esul s and conclusion ha hey de i ed. Each s udy concluded ha
IASTM eally does ha e an e ec in ea ing hams ing muscle igh ness, imp o ing one’s
knee ange o mo ion and dec easing pain pe cei ed by he pa ien , which hen con ibu es
o o e all imp o emen in quali y o li e. All s udies commended IASTM as an al e na i e
managemen in ea ing hams ing muscle igh ness and an adjunc o so issue
mobiliza ion.
Keywo ds: Ins umen assis ed so issue mobiliza ion; Hams ing muscle; Flexibili y;
Range o mo ion; Quali y o li e.
To ci e his a icle:
Gae lan, M. J. M. F., Jaa a , K. R. F., Villanue a, C. J. E., & Sa dan, R. L. (2022). Wo k- ela ed
musculoskele al pain among wo k- om-home employees o a medical billing company. SDCA
Jou nal o Physical The apy, 3, 12-22.
In oduc ion
As he wo ld con inues o p og ess, heal h- ela ed disco e ies con inue o escala e. One example
o his is he ield o ehabili a ion medicine owa ds mode n me hods o ea men which con inuously
imp o es he quali y o li e o pa ien s wi h exis ing condi ions. Ne e heless, no e e yone in his ield no
he ci ilians in hei communi y a e awa e o hese exis ing esea ch s udies. These esea che s can change
ou da ed app oaches o a con en ional and e olu ionized one ha is mo e upda ed and sui able o i s
cu en s a e.
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One o he mos ecen and ad anced in e en ions is called Ins umen Assis ed So Tissue
Mobiliza ion (IASTM) which con inues o gain popula i y and makes i s wa e in e na ionally because o i s
unique app oach on a ce ain echnique ha was being used adi ionally in ehabili a ion. IASTM is an
adjunc in p o iding manual applica ion o o ce in pe o ming so issue mobiliza ion.
Muscle igh ness is a common condi ion ha g ea ly a ec s ou mobili y and unc ion speci ically
du ing walking, unning o jumping. I is because muscles a e a g ea con ibu o in ca ying ou hese
locomo ion ac i i ies. Consequences include mo emen s which may be es ic ed (Koulou is & Connell,
2005) and may a ec he quali y o p oduced ac ions applicable o ou daily li e (Radwan e al., 2014).
Res ic ed ange o mo ion due o sho ening o hams ing muscles speci ically, may lead o di icul y in
ambula ion such as p esen a ion o an an algic gai ha de elops o minimize mobiliza ion o he in ol ed
muscle mass which shows dec eased hip ex ension and knee lexion (E nlund & Viei a, 2017). This speci ic
g oup o muscles is esponsible o hese ac ions as well as p o iding s abili y in bo h hip and knee join
needed o he desi ed ac ion (Kim e al., 2014). Acco ding o he s udy o Van de Ho s e al. (2015) and
Askling e al. (2013), inju ies o hams ing muscles a e he mos common in spo s ela ed ield. A hle es
who play ack & ield, oo ball o socce accoun o 37% muscula inju y s a ed in his spo alone. Se e al
como bidi ies may be acqui ed as well when he e is hams ing igh ness o any o he pa hologies in ol ing
his g oup o muscles including high isk o inju y o auma on o he muscula u e due o de eloped muscle
imbalances, leading o pos u al de ia ions ha may esul in pain and may hinde mobili y (Ma ko ic,
2015).
Mul iple adi ional managemen s a e being p esc ibed o add ess muscle igh ness o dec eased
lexibili y o hams ing muscles, such as passi e s a ic s e ching, use o modali ies like ul asound and
many mo e (F ei as e al., 2015). So issue mobiliza ion (STM) is also known in ehabili a ion medicine
o i is used as a manual echnique in applying manually low- load o ces on a speci ic muscle a ea in he
body; i also includes endons, ligamen s, join capsules and o he connec i e issues such as ascia. STM
p omo es change and imp o es issue healing and adap i e sho ening o he s uc u es (A e s & Wong,
2019). Acco ding o Chea ham e al. (2016), he e is an exis ing modi ica ion o STM based on he
disco e y o James Cy iax ha is con inuously eme ging, which uses ins umen s ha helps in p o iding
deepe pene a ion and helps o de ec ascial es ic ions and ea a eas exhibi ing in lamma ion, ib osis
and degene a ion o dec ease pain and imp o e ange o mo ion (ROM) and e en ually in luence muscle
pe o mance and unc ion. This ool can also minimize he s ess on clinician’s hand in pe o ming
nume ous manual manipula ions unlike STM (Ba es, 2016).
Ins umen assis ed so issue mobiliza ion (IASTM) became a popula in e en ion o
indi iduals who su e om musculoskele al condi ions such as muscle igh ness and o he so issue
inju ies. IASTM is designed o mobilize sca issue o hose people who o e ly uses a speci ic muscle in
hei body (Hamme , 2008; C o he s e al., 2008). In Ame ica, he e a e al eady se e al s udies abou
ins umen assis ed so issue mobiliza ion (IASTM) ha is used commonly by a hle es who su e om
cons an issue sca ing du ing ac i i ies such as playing o aining, including hose who ha e muscle
s ains, ligamen ous s ains, and excessi e issue.. They use IASTM o imp o e mobili y, dec ease pain,
and imp o e eco e y. As o now, ins umen assis ed so issue mobiliza ion is s ill no in oduced in he
Philippines bu he e a e al eady semina s scheduled by p o essional o ganiza ions ha in oduce IASTM
as a di e en app oach in he ea men o so issue and ascial es ic ions and adhesions. These semina s
co e he ideas and heo ies in es o ing op imal so issue quali y and help he body’s na u al abili y o
espond and eco e om inju ies. They also include how a licensed physical he apis can use ins umen -
assis ed so issue mobiliza ion as a me hod o ea mo emen p oblems, pain, and muscle issues in
di e en musculoskele al condi ions.
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The e a e se e al s udies ha ocuses on he applica ion o IASTM and i s e ec i eness on
di e en ypes o musculoskele al condi ions, bu he e ec s o ins umen assis ed so issue mobiliza ion
in imp o ing hams ing lexibili y speci ically emain unde s udied. The goal o his esea ch is o ind ou ,
de e mine, and summa ize in o ma ion abou how ins umen -assis ed so issue mobiliza ion imp o es
hams ing lexibili y.
Me hods
Resea ch Ques ion
The esea ch ques ion was o mula ed by using Popula ion, In e en ion, Con ols and Ou comes
(PICO) me hod (Schia ena o & Chu, 2021). Using his me hod, he esea che s we e able o o m his
ques ion: “Does ins umen assis ed so issue mobiliza ion imp o e he lexibili y o hams ing muscles
in pa ien s wi h hams ing igh ness?”
Sea ch S a egy
A scoping e iew is a me hod ha uses a s uc u ed way o ind, examine, and summa ize
a ailable in o ma ion, and i also helps o spo a eas whe e mo e esea ch is needed (A ksey & O’Malley,
2005). Be o e his e iew, i was no clea wha esea ch had been done on he e ec s o ins umen -assis ed
so issue mobiliza ion on hams ing lexibili y o how e ec i e i eally is. Using a scoping e iew me hod
also allows o a b oade look a all ele an s udies (Munn e al., 2018; Pe e s e al., 2015) on his opic.
Li e a u e sea ch was done using di e en da abases o concisely e iew he opic o in e es
which was o de e mine he e ec i i y o ins umen assis ed so issue mobiliza ion in imp o ing
hams ing lexibili y, as o ensu e no e iew had been done be o e on he subjec and done o gain a
sys ema ized sea ch s a egy. Eigh da abases we e used in he sea ch s a egy and included he ollowing:
Google Schola , CORE, Resea chGa e, PED o, PubMed, B i ish Medical Jou nal, ScienceDi ec and
Coch ane. Keywo ds used on he ollowing da abases o ele an a icles by inco po a ing o Boolean
ope a o s as well a e “IASTM” OR “Ins umen Assis ed So Tissue Mobiliza ion” AND “hams ing
lexibili y” OR “imp o ed hams ing muscle igh ness.”
S udy Selec ion
The included s udies consis ed o pa icipan s wi h signi ican limi a ions o knee lexion and/o
musculoskele al disease a ec ing he hams ing muscles. The in ol ed s udies should examine he use o
ins umen assis ed so issue mobiliza ion as he in e en ion. The s udies could use o he o ms o
mul imodal in e en ions, bu ins umen assis ed so issue mobiliza ion had o be included. Only s udies
published in English we e included in his esea ch. S udies ha had pa ial English ansla ions o we e
w i en in ano he language we e no included. The e we e no es ic ions on he ype o se ing whe e he
s udies we e conduc ed, such as acu e ca e, long- e m ca e, o communi y-based ehabili a ion. Only high-
quali y esea ch me hods we e used and combined in his s udy, such as sys ema ic e iews, me a-analyses,
andomized con olled ials, and s udies wi h a high le el o e idence. S udies wi h lowe le els o e idence
(below 3), such as expe opinions, we e no included. Commen a ies and le e s o he edi o we e also no
used as hey did no p o ide much ele an in o ma ion o he opic being s udied. Only esea ch published
in 2010 onwa ds we e included. Any s udy ha was ele an bu published la e he a ge ed da e we e
excluded. The summa ized inclusion and exclusion c i e ia a e lis ed on Table 1 below.
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Table 1. Cha ac e is ics o inclusion and exclusion c i e ia used in his s udy
Inclusion
Exclusion
• Pa icipan s wi h hams ing muscles
igh ness
• U iliza ion o ins umen assis ed so issue
mobiliza ion as an in e en ion
• S udies published in English language, o
s udies wi h comple e English ansla ions
• S udies published in 2010 up o p esen
• Only high le els o esea ch s a egies a e
included such as sys ema ic e iews,
andomized con ol ial & case s udies.
• Pa icipan s wi h igh ness on o he muscle
• Absence o ins umen assis ed so issue
mobiliza ion as an in e en ion
• S udies published in non-English language, o
s udies wi h incomple e English ansla ions
• S udies published be o e 2010
• S udies below 3 on he le el o esea ch
e idence.
A e iew o he abs ac s and ull ex a icles and da a ex ac ion was done by he e iewe s
hemsel es. Each s udy will be discussed wi hin he g oup, while conside ing he inclusion and exclusion
c i e ia. Da a will be ex ac ed pe aining o e e ence i le, au ho , yea , ype o esea ch design, ins umen
assis ed so issue mobiliza ion, e ec i eness o ins umen assis ed so issue mobiliza ion, limi a ion o
mo ion p oduced by he hams ing, and signi ican esul s ega ding hams ing lexibili y. Da a we e cha ed
in a abula o ma , which would hen be syn hesized o he indings.
Resul s and Discussion
A o al o 283 s udies we e ini ially iden i ied om he sea ch, and 14 s udies we e excluded due
o duplica ion. As a esul , 226 a icles we e excluded o no mee ing bo h he inclusion and exclusion
c i e ia, and a eco d o 43 a icles we e sc eened ho oughly. Resea ch s udies ha we e no a ailable in
ull ex and unable o download we e excluded as well. Only 28 s udies we e downloaded in ull ex .
Resea che s e iewed and analyzed each a icle acco ding o he gi en inclusion c i e ia (Table 1). Thus,
16 s udies we e excluded, making he inal eco d o 12 s udies o be included in his scoping e iew. The
summa y o he signi ican da a ex ac ed by he esea che s om he quali ied s udies a e ou lined in Table
2, wi h a o al o wo case epo s and 10 RCTs ( andomized con olled ials). Each s udy highligh ed he
ype o ins umen hey used and hei applica ion as well as he p ocedu e o add ess hams ing igh ness.
Table 2. Summa y o quali ied s udies
Au ho /
Yea o
Ci a ion
Resea ch
Design
Subjec s
Ou come
Measu es
Technique
In e en ion
Findings
Nejo
(2014)
RCT
N=45
(30M,
15F)
ROM
(goniome e )
G as on®
(GT1,
GT3, GT4)
Compa ed
G as on
Technique®
(GT®) alone
s. GT® wi h a
ho pack,
s e ching, &
s eng hening
(Whole GT) s.
a sham
ea men .
GT® was mo e e ec i e
han sham bu adding
s e ching/s eng hening
("Whole GT") showed no
ex a bene i o e GT®
alone.
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Chi amani
e al.
(2019)
RCT
N=212
Popli eal
angle, AKE
Tes , Si &
Reach,
Lumba
Lo dosis
Index
M2T
Compa ed
IASTM (M2T
blade) +
s e ching s.
Ben Leg
Raising (BLR)
+ s e ching.
Bo h g oups imp o ed
signi ican ly in mos
measu es; only he BLR
g oup imp o ed he
lumba lo dosis index.
Kim e al.
(2018)
RCT
N=45
(21M,
24F)
AKE es ,
S eng h,
S i ness, Pain
h eshold
D . YOU
STM Y1
Compa ed
IASTM s.
Hold-Relax
(HR) s. S ain-
Coun e s ain
(SCS) o 2
minu es.
The IASTM g oup
showed g ea e
imp o emen s in
s eng h, s eng h a io,
passi e s i ness, and
pain h eshold.
Ho meie
(2014)
RCT
N=30
Isokine ic
dynamome e
GT1
A 5-minu e
IASTM (GT1)
sweeping s oke
on he
hams ing s. a
con ol g oup
(si ing).
The IASTM g oup had
signi ican ly g ea e
ROM 30 minu es pos -
in e en ion.
Pa hania
and
Mu agod
(2018)
Case
Repo
N=12
Passi e Knee
ex ension, Si
& Reach Tes
M2T
(Case Repo )
IASTM (M2T
blade) applied
o 60 seconds
(30 ubs) om
he glu eal line
o he popli eal
ossa.
Hams ing lexibili y
signi ican ly imp o ed
pos - ea men .
Ma ko ic
(2015)
RCT
N=20M
Passi e knee
lexion es ,
Passi e
S aigh leg
es
FAT- ool
P o la ge
Compa ed
IASTM (FAT-
ool) o 2 mins
s. Foam
Rolling (FR)
o 2 mins on
quad iceps and
hams ings.
Bo h imp o ed ROM, bu
he IASTM g oup had
highe gains (10-19%) s.
he FR g oup (5-9%), and
he e ec s las ed 24h.
Gunn e
al. (2018)
RCT
N=40
(18M,
22F)
Passi e
s aigh leg
aise (PSLR)
GTR
Compa ed PNF
s e ching s.
s a ic s e ching
wi h IASTM
(GTR) s. s a ic
s e ching
alone.
Bo h PNF and IASTM-
assis ed s e ching
esul ed in g ea e hip
lexion ROM han s a ic
s e ching alone.
Moon e
al. (2017)
RCT
N=24
Si ing T unk
Flexion Me e ,
Visual Analog
Scale
GT® 1
Compa ed
IASTM (GT®
1) o 60
seconds s.
s a ic
s e ching.
The IASTM g oup
showed signi ican ly
mo e imp o emen in
hams ing ex ensibili y.
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Fousekis
e al.
(2019)
RCT
N=60
(40M,
20F)
Passi e
S aigh leg
aising (SLR)
E gon®
A single 15-min
IASTM
(E gon®)
ea men
applied o A)
uppe body, B)
lowe body, o
C) Con ol.
G oups A (uppe body)
and B (lowe body) bo h
showed signi ican
inc eases in SLR
pe o mance, while he
con ol g oup did no .
Mu agod
and
Pa hania
(2019)
RCT
N=45
Si and each
es (SRT),
Passi e knee
ex ension
(PKE)
M2T
(4-week ial)
Compa ed
s a ic s e ching
s. oam olling
s. IASTM
(M2T blade),
all pe o med
h ice a week.
All g oups imp o ed (P<
0.001), bu a be ween-
g oup compa ison
showed IASTM (M2T)
was mo e e ec i e han
he oam olle .
Bake e
al. (2015)
Single
case
epo
N=1F
Ac i e SLR,
Pain scale, Si
& each es
Técnica
Ga ilán®
(Case Repo )
Week 1: To al
Mo ion
Release®
(TMR) alone.
Week 2:
TMR®
combined wi h
IASTM.
TMR alone imp o ed
ROM. Adding IASTM in
week 2 p o ided
addi ional ROM gains
and educed pain o 0/10.
Ba ge
(2013)
RCT
N=20M
Passi e
s aigh leg
aise (SLR)
GT®1
Compa ed a 4-
minu e G as on
Technique®
(GT®)
applica ion s.
Myo ascial
Decomp ession
(MFD /
cupping).
While o e all
imp o emen s we e seen,
he e was no signi ican
di e ence be ween he
GT® and MFD g oups
o lexibili y o s eng h.
Legend: BLR: Ben Leg Raising; FAT: Fascial Ab asion Technique; F: Female; FR: Foam Rolling; GT: G as on
Technique®; HR: Hold-Relax; IASTM: Ins umen Assis ed So Tissue; M: Male; MFD: Myo ascial
Decomp ession MTS: Muscuo endinous S i ness; PNF: P op iocep i e Neu omuscula Facili a ion; RCT:
Randomized Con ol T ial; SCS: S ain-Coun e s ain; TMR: To al Mo ion Release® Mobiliza ion
Imp o emen in Hams ing Muscle Flexibili y
Almos all s udies esul ed wi h an imp o emen in hams ing lexibili y be ween hei con ol and
ea men g oups emphasizing he applica ion o IASTM in e en ion, such as in Kim e al. (2018), in which
IASTM using D . YOU STM Y1 ool was compa ed o Hold-Relax s e ching (HR) and S ain-
Coun e s ain (SCS) g oups. The esul be ween hese g oups showed g ea e esponse by using IASTM in
enhancing passi e knee join s i ness, he implemen ed pos hoc analysis suppo ed he compa ison wi hin
he h ee g oups and he IASTM g oup eme ged o exhibi a lowe passi e knee s i ness da a (0.21±0.06
N·deg-1) han he HR g oup (0.23±0.06 N·deg-1) (p = 0.004) and he SCS g oup (0.24±0.07 N·deg-1) (p
= 0.001). Mo eo e , IASTM g oup also showcased signi ican e ec s in imp o ing pain h eshold,
quad iceps and hams ing s eng h.
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Meanwhile, in a s udy by Mu agod and Pa hania (2018), only one expe imen al g oup was used,
and hey ound a signi ican and eliable s a is ical di e ence be ween he alues be o e and a e ea men .
The p- alue was less han 5%, which suppo ed hei al e na i e hypo hesis ha using he M2T blade ool
imp o ed hams ing lexibili y a e ea men . In addi ion, esea che s es ablished ano he s udy a yea
a e in which hey a ge ed he same muscle g oup bu his ime conduc ing i wi h a compa ison g oup.
This ime, IASTM was iden i ied o be mos e ec i e han sel -myo ascial echnique using oam olle in
dec easing hams ing igh ness in e ms o passi e knee ex ension es and si & each es .
Compa ed o s a ic s e ching, enhancing hams ing ex ensibili y using IASTM in G as on
echnique shows mo e po en ial as desc ibed by Moon e al. (2017). On he o he hand, bo h IASTM using
M2T blade and Mulligan’s BLR echnique, wi h bo h g oups accompanied by con en ional physical
he apy, shows a sho - e m imp o emen in educing igh ness o hams ing muscle because o he s udy
by Chin amani e al. (2019). Ano he s udy by Gunn e al. (2018) shows ha IASTM is e ec i e o ea ing
igh hams ings by a ge ing and b eaking up adhesions in he muscle’s ascia, which can limi how much
he muscle can s e ch. Fousekis e al. (2019) also ound ha using E gon® IASTM on ei he he uppe o
lowe pa o he supe icial myo ascial back line imp o ed hams ing lexibili y using he s aigh leg
aising es .
Imp o emen in Range o Mo ion o Hams ing Muscle
Inclined wi h hams ing lexibili y, he esea che s in each s udy also iden i ied he e ec o IASTM
in he esul ange o mo ion (ROM) o he hams ing muscle g oup, subsequen ly g ossly a ec ing one’s
quali y o mo emen . In he s udy o Ma ko ic (2015) which ocuses on he acu e e ec s o IASTM
compa ed wi h oam olling (FR) in imp o ing ROM o bo h knee and hip in socce playe s, his uses supine
passi e knee lexion es and passi e s aigh leg es as an ou come measu e. The esul s shown a e wo
minu es o applica ion o bo h in e en ions we e an inc eased in knee and hip ROM. Howe e , e ec s in
FAT/IASTM g oup we e highe p e o pos - es gains in knee and hip ROM: 13.1˚ and 15.2˚; o 10% and
19%) han FR g oup (p e o pos - es gains in knee and hip ROM: 6.6˚ and 7.0˚; o 5% and 9%). A e 24
hou s a e he o e all in e en ion, FAT g oup s ill consis en ly had a highe ROM esul (p e o 24h pos -
es gains in knee and hip ROM: 9˚ and 10.1˚ o 7% and 13%).
Ano he s udy ha showed g ea e impac on inc eased ROM o hip lexion was desc ibed by Gunn
e al. (2018), bo h PNF s e ching and he use o IASTM had g ea e inc emen s in hip lexion ROM han
s a ic s e ching alone. Pos hoc analyses made by Fousekis e al. (2019) showed a signi ican inc ease in
bo h g oups A and B in e ms o SLR pe o mance compa ed wi h p e- alue o week 1 om 6.2% o 18.2%,
and om 6.6% o 17.0%, espec i ely. Bake e al. (2015) p esen ed an addi ional inc eased alue o 7.5˚
bila e ally a e an applica ion o IASTM a week a e unde going To al Mo ion Release® (TMR) alone
which also shows inc eased ange o mo ion (ROM) om baseline.
Ba ge (2013), by means o compa ing wo in e en ions, IASTM and Myo ascial Decomp essi e
The apy o as desc ibed in he s udy as comp essi e e sus decomp essi e he apy, ound ha bo h
ea men g oups had a s a is ically signi ican di e ence o an o e all imp o emen in ROM ( =-5.41,
p<0.001) as well as in hei peak o ce ( =-3.26, p=0.004), a e age o ce ( =-3.47, p=0.003), o que ( =-
3.24, p=0.004) and s eng h ( =-3.34, p=0.003), howe e , no signi ican di e ences we e iden i ied in e ms
o all aspec s in s eng h and lexibili y be ween wo g oups as a esul o wo-way ANOVA. Bo h
in e en ions we e e ec i e in inc easing hams ing lexibili y, he e o e, ecommending IASTM as a
ea men op ion in ea ing hams ing igh ness.
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Imp o emen in Func ional Ou comes
Func ional ac i i ies may be a ec ed once hams ing lexibili y is limi ed, hus i may be he eason
why some s udies include unc ional ou comes o be es ed alongside wi h o he ou come measu es in
pa ien s wi h hams ing igh ness. One speci ic example ha has consis en ly been used in he s udy o
Pa hania and Mu agod (2019) was he measu emen o hams ing lexibili y in elde ly popula ion using Si
and Reach Tes (SRT). On he pilo s udy o hei esea ch in 2018, i was no ed ha hams ing lexibili y
was measu ed, and p e-pos da a ou lined he imp o emen in SRT, as well as on hei 2019 s udy in which
IASTM was compa ed wi h s a ic s e ching and oam olle . SRT as well as Passi e Knee Ex ension (PKE)
shows imp o emen in IASTM g oup highe han he wo compa ison g oup. In he case epo o Bake e
al. (2015), a younge subjec was measu ed wi h SRT and pos applica ion showed addi ional inc ease in
SRT a e second week o ea men using IASTM. Chin amani e al. (2019) also concluded s a is ically
signi ican changes in all ou come measu es namely, popli eal angle es , ac i e knee ex ension es , si and
each es excep lumba lo dosis index which we e all measu ed p e & pos in e en ion o bo h IASTM
and Mulligan’s ben leg aising (BLR).
Dec ease in Pain
In o he s udies, hey also included an ou come measu e o pain which can be co ela ed because
o low back pain associa ed wi h hams ing igh ness. As desc ibed by a s udy om Kim e al. (2018), an
imp o ed pain h eshold (p = 0.017) was eco ded using isual analog scale (VAS), highe han he Hold-
Relax and S ain-Coun e s ain g oups. The esul o pain in ensi y g ea ly imp o ed a e applica ion o
IASTM. Howe e , he e is no signi ican di e ence in pain h eshold be ween IASTM g oup and s a ic
s e ching in he s udy o Moon e al. (2017). Acco ding o Bake e al. (2015), he esea che s used pain
nume ic a ing scale as an ou come measu e and om a p e- es sco e o 5/10, 0/10 was eco ded a e all
ea men schedules and ollow-up we e done.
Ins umen assis ed so issue mobiliza ion (IASTM) is an eme ging in e en ion ha seeks o
p o ide mul iple bene icial e ec s ha helps in p omo ing he in eg i y o he myo ascial and endinous
egions in he human body. I s po en ial as an al e na i e o o he manual manipula ion echniques, ha
has been used o he longes ime in he heal hca e se ing, mos ly in he physical he apy ehabili a ion, is
slowly making i s wa e as clinicians and esea che s con inue o ga he enough e idence ega ding i s
e ec i i y as pa o he clinical managemen . As men ioned, he numbe o s udies including IASTM is
s ill limi ed and lacking. Many esea che s a e s ill de e mining i s sho e m and long- e m e ec s on
di e en pa s o he body. Fu he mo e, addi ional local s udies mus be conduc ed, which is i al o
appealing his mode n app oach in he p og ess o he ehabili a ion discipline. Ha ing said, he esea che s
ocused on iden i ying s udies ha p o ide necessa y in o ma ion and esul s ha his newly eme ging
echnique o e s. The esea che s wan ed o de e mine he esul o using IASTM in imp o ing hams ing
muscle lexibili y by analyzing, colla ing and syn hesizing exis ing s udies and p o iding an o e iew o
he esea ch.
Almos all a ailable s udies iden i ied by he esea che s desc ibed he posi i e e ec s o IASTM
applica ion in he hams ing muscle g oup. Based on he esul s and conclusions ha hey de i ed, he
esea che s can conclude ha IASTM eally does ha e an e ec in ea ing hams ing muscle igh ness and
imp o ing one’s knee ange o mo ion, which con ibu es o o e all imp o emen in quali y o li e. Pain
pe cei ed by he pa ien s, dec ease ange o mo ion and a ec a ion in one’s s eng h and unc ion we e also
aken in o conside a ion o u he analyze he e ec s o he in e en ion. As iden i ied by he signi ican
di e ences in compa ison o con ol and ea men g oups, he esul in he implemen a ion o IASTM
u ned ou o ha e a g ea e e ec in enhancing muscle lexibili y o he hams ing muscle compa ed o
con en ional exe cises o ea men p o ocols.
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The adi ional managemen s used as compa isons a e s a ic s e ching, oam- olling exe cise, hold-
elax s e ching and s ain-coun e s ain echnique. On he o he hand, in e en ions such as Mulligan’s ben
leg aising (Chin amani e al., 2019) and Myo ascial decomp ession (Ba ge , 2013) ha e been eco ded o
p esen an equal e ec like IASTM in imp o ing hams ing muscle s i ness, as i was desc ibed s a is ically
ha no signi ican di e ence was ound in compa ison. Each s udy also s esses he applica ion o IASTM
in which di e en kinds o model/b ands o ins umen and p o ocol we e used, such as M2T blade, E gon
ool, D . YOU STM Y1, Fascial Ab asion echnique (FAT) and G as on ool (GT), a e he mos common
ools ha many esea che s use in hei p ac ice. Each s udy, howe e , ollows a di e en app oach in
applica ion, such as he numbe o s okes applied and he leng h o applica ion, as well as supplemen a y
con en ional exe cises ha we e added in unison o he o e all p o ocol o each expe imen .
Conclusion
This e iew ocuses on de e mining he e ec o IASTM as a mode n and inno a i e echnique
as an adjunc in pe o ming ou da ed in e en ions ha help imp o e hams ing lexibili y. Al hough s udies
ega ding IASTM we e ampan , esea ch pape s ha aim o disco e he e ec o his ecen p ac ice
conce ning hams ing igh ness and i s e ec s a e s ill limi ed up o his da e.
This scoping e iew aims o p o ide necessa y in o ma ion abou he in luence o IASTM in
imp o ing hams ing lexibili y. This e iew summa izes and desc ibes he po en ial o IASTM as an
al e na i e managemen o hams ing muscle igh ness, which causes inc eased pain, dec eased ange o
mo ion and impai ed quali y o li ing. The di e en ypes o ins umen used in he p ocedu e we e also
highligh ed, in oducing he comple ely new o m o me hod in an ad anced and e olu ionizing way o
ehabili a ion in di e en indi iduals wi h acqui ed hams ing pa hology. IASTM may be ecommended o
clinicians as an adjunc o adi ional so issue mobiliza ion. Recen s udies in ol ed in his e iew
e ealed o be limi ed, he e o e u u e esea che s may widen hei pe spec i e abou his e ol ing
in e en ion, and his esea ch may se e as an o e iew on he numbe o s udies conce ning his subjec ,
p o iding adequa e e idence is equi ed o he imminen use o his echnique in he p ac ice o an
upg aded so issue mobiliza ion.
Recommenda ions
This e iew may be limi ed o a speci ic scope o in o ma ion only, due o he inadequa e numbe
o published s udies exhaus ed om a ailable da abases ha he esea che s ha e access o. To imp o e
his subjec ma e , u u e esea che s may conside he ollowing aspec s and disco e u he da abases
ha he esea che s we e no able o access ye . The esea che s we e no also able o ind local s udies
ega ding he implemen a ion o IASTM in he Philippines. Con e sely, he s udies acqui ed in his e iew
ha e di e ences in e ms o he subjec s included in each s udy, such as he ange o hei age and he
cha ac e is ics o hei symp oms. Di e en ou come measu es we e used in each s udy, as e lec ed by he
me hod o how hey pe o med IASTM and he ype o ool hey used. Some s udies acqui ed in his e iew
has only conduc ed hei p ocedu e in single sessions and only moni o s he e ec s in a sho - e m pe iod,
unlike o he s udies in which hey pe o med p e-pos - ial o se e al sessions hey p e e . A limi a ion o
his scoping e iew is he ac ha only esea ch published in English we e included. A icles o o he
languages could also ha e been bene icial o his e iew howe e hey we e no included.
