The Efficacy of Instrument-aided soft tissue mobilization

(IASTM) versus manual stretching in treatment of myofascial

pain in subjects with Osteoarthritis knee – A Randomized

Control Trial.

 Introduction :-

Knee osteoarthritis (OA) is degenerative and chronic disease of knee joint resulting from damage to

hyaline cartilage and is most common type of arthritis affecting mainly older population.[1]It has a prevalence of 12.5% in population aged 45 year and above and is a multifactorial etiology which includes acute and / or chronic insults from normal wear and tear, age, obesity, and joint injury. [1],[2]

The pain and stiffness, motion limitations, motor and sensory dysfunction and functional impairments, can be severe in advanced stages which might interfere with day to between patients reports of pain and their radiographic findings with a plausible explanation of the pain originating from the myofascial trigger points (MTrPs) in the surrounding muscles[myofascial pain] which cannot be visualized by imaging. [4][5][6] Myofascial hyperirritable spots found in the skeletal muscle are associated with sensitive palpable nodule located in a taut bands, which are painful on compression and may produce characteristic referred pain, referred tenderness, motor dysfunction ,and autonomic phenomena. Two different types of MTrPs have been

[Page : 2] described: 1) active MTrPs which are associated with spontaneous pain; 2) latent MTrPs which elicit pain only on palpation and do not cause pain spontaneously. It has been speculated that these latent MTrPs are responsible for altered motor recruitment pattern and restriction in ranges. [7][8]

The most common sites of MTrPs is include Vastus lateralis, Vastus medialis, Biceps femoris, Semitendinosus, Gastrocnemius. With a better understanding of the myofascial component of OA knees,

treatments focusing on it is effective in reducing pain and improving function in patients with knee OA. [9]

Conventionally the soft tissue restrictions have been treated with superficial heat/cold along with manual stretching.With advent of soft tissue mobilization, various manual MFR (Myofascial release) techniques have gained popularity. MFR techniques focus directly on these restricted myofascial elements, thus releasing the resulting restrictions and pain. Instrument assisted soft tissue mobilization (IASTM) is emerging as a popular treatment for myofascial restriction. The rationale of treatment is based on the concept of James Cyriax, but instead of using digital cross-friction, specially designed instruments are used to give the myofascial mobilization.[10]These tools give the therapist an added advantage of more deeper penetration

and reduced the stress on the hands. The tools also increase the perception of vibrations when moved over altered tissues[eg adhesions/restrictions] and help direct specific treatment towards it. [11][12][13]

The IASTM treatment is hypothesized to stimulate the remodeling of connective tissues through resorption of excessive fibrosis along with inducing repair and regeneration of collagen. This will result in the release and breakdown of scar tissue, adhesions, and fascial restrictions. In laboratory studies using a rat model,

these changes have been documented and similar studie [Page : 3] also found significant short-term (4 weeks) increase in ligament strength and stiffness. Although these changes are not confirmed in human trials. 14][15][16]  There are various IASTM tools used in practice today. The Edge tool has been ergonomically designed to offer several different hand holds and eliminate operator fatigue. The

protocol usually involves treating each restriction for 30-60 seconds with post treatment icing. This is followed by appropriate exercises to the myofascia and the general principle of IASTM is to enhance myofascial mobility with limited adverse effects such as discomfort during or bruising (eg. petechiae) after treatment. [17-26] Even though the treatment method is gaining popularity amongst therapists, there are limited good quality studies documenting the efficacy of IASTM.