Physical therapy utilizes a wide array of techniques to manage musculoskeletal health issues, including hands-on manual therapy. One specialized manual technique, often called “scraping,” is a non-invasive method for addressing soft tissue dysfunction. This article will explain the mechanics of this technique, detailing the tools used, the body’s response, and the conditions it helps treat.
Instrument Assisted Soft Tissue Mobilization (IASTM) Explained
The formal name for the manual therapy technique colloquially known as scraping is Instrument Assisted Soft Tissue Mobilization (IASTM). This method uses specialized tools to mobilize soft tissues, including muscles, tendons, ligaments, and fascia. The technique targets scar tissue, fascial restrictions, and adhesions that develop following injury or chronic overuse.
The concept has roots in traditional Chinese medicine, where a similar practice called Gua Sha has been used for centuries. Modern IASTM, such as the Graston Technique, adapted these principles in the 1990s for contemporary physical therapy practice. The goal of this adaptation is to restore normal texture, flexibility, and function to soft tissues that have become stiff or restricted. Addressing these underlying issues helps accelerate the healing process and reduces associated pain and stiffness.
The Tools and Procedure
IASTM relies on instruments made from materials like stainless steel, ceramic, or specialized plastic. These tools come in various shapes and sizes, featuring flat, curved, or beveled edges to conform to different body contours and muscle groups. The different edges allow the therapist to apply varying levels of pressure and depth, depending on the area being treated.
The procedure begins with applying a topical lubricant, such as oil or lotion, to the skin. The therapist then uses the instrument to glide over the skin, applying controlled pressure and friction. They often stroke the tissue in a direction that runs against the grain of the muscle fibers or fascia. This action allows the therapist to detect areas of abnormal tissue texture, which may feel like a gritty or gravelly sensation under the tool.
The pressure applied is intentional and controlled, designed to create a therapeutic effect. Treatment sessions are typically brief, often lasting only a few minutes per affected area, and are integrated into a larger rehabilitation plan. This approach allows for a targeted treatment on specific points of tissue dysfunction.
Understanding the Physiological Response
The mechanical action of the scraping tool on the skin and underlying tissues initiates a biological response. The controlled friction and pressure create microtrauma to the affected soft tissues. This microscopic damage stimulates a localized, temporary inflammatory response.
The inflammatory process triggered by IASTM increases blood flow (hyperemia) to the treatment site. This surge in circulation delivers nutrients and oxygen while encouraging the removal of metabolic waste products. This localized response helps to break down and remodel disorganized tissue, such as old scar tissue and fibrotic adhesions, by activating fibroblasts. This process encourages the formation of new, correctly aligned collagen fibers, contributing to tissue regeneration and strength.
There is also a neurological component to the therapy, as the pressure and friction can help modulate pain perception. The sensory input from the scraping motion may activate large-diameter nerve fibers, which inhibit the transmission of pain signals to the brain, aligning with the pain gate theory. Following a session, the treated area may display redness or petechiae (tiny spots of superficial bruising caused by capillary rupture). This is a visible sign of the intended microtrauma and subsequent increase in blood flow.
Conditions That Benefit from Scraping Therapy
IASTM is applied to musculoskeletal complaints that involve soft tissue restrictions. It is a common intervention for chronic tendinopathies, which are characterized by failed healing and tissue degeneration within tendons. The technique is also used to treat plantar fasciitis, a condition causing heel pain from chronic strain on the foot’s fascia.
IASTM is effective for addressing limitations caused by excessive scar tissue and fascial restrictions resulting from muscle strains or post-surgical recovery. Other conditions frequently treated include:
- Achilles tendinosis
- Patellar tendonitis (runner’s knee)
- Lateral epicondylitis (tennis elbow)
- Carpal tunnel syndrome
- IT band syndrome
- Persistent tension in the neck and lower back
IASTM is rarely used as a standalone treatment but is incorporated into a comprehensive rehabilitation program that includes therapeutic exercises and strengthening.