The scraping tool used by many manual therapists, including chiropractors, is formally part of a technique called Instrument-Assisted Soft Tissue Mobilization (IASTM). This non-invasive manual therapy utilizes specialized instruments to detect and treat soft tissue dysfunctions. IASTM aims to improve musculoskeletal function by targeting restrictions in muscles, tendons, ligaments, and fascia. The technique applies targeted pressure and shearing force to the skin, helping to locate and address areas of chronic inflammation or fibrosis. This approach is a common modality for individuals seeking to reduce pain, enhance mobility, and accelerate recovery from soft tissue injuries.
Identifying the Instruments and Technique
The instruments used in IASTM are typically made of materials that allow for effective tissue manipulation and provide feedback to the practitioner. Surgical-grade stainless steel is the most common material because of its durability and ability to resonate, which lets the clinician feel subtle texture changes within the tissue layers. Tools can also be made from other materials, including high-impact plastic, jade, or stone, with each offering a slightly different feel and effect.
These tools are not uniform; they come in a variety of shapes designed to conform to different areas of the body. Instruments feature various concave, convex, and beveled edges to allow the practitioner to apply specific pressure and strokes to both large muscle groups and smaller, more intricate joints. While IASTM is the general category, specific branded techniques like the Graston Technique and HawkGrips utilize these instruments and methodologies.
Physiological Mechanism of Action
The mechanism behind IASTM involves a sophisticated interplay of mechanical and neurological responses in the body’s soft tissues. The application of the instrument creates controlled microtrauma to the targeted soft tissue structures. This intentional, low-level irritation initiates a mild, local inflammatory response, which is necessary for the body’s natural healing cascade to begin.
The localized pressure and friction from the tools increase blood flow, a phenomenon known as hyperemia, bringing essential nutrients and oxygen to the injured area. This stimulation promotes the activity of fibroblasts, the cells responsible for creating collagen, the primary component of connective tissue. By promoting fibroblast proliferation and encouraging the realignment of collagen fibers, IASTM helps to remodel scar tissue, making it less dense and more organized.
Applying the instruments also stimulates mechanoreceptors, which are sensory nerve endings found abundantly in the skin and fascia. This stimulation can have a neurophysiological effect, helping to modulate pain perception and reduce excessive muscle tone or tension in the treated area. The combined action of tissue remodeling and nervous system input works to release fascial restrictions and improve the overall flexibility and extensibility of the soft tissues.
Specific Conditions Treated
IASTM is frequently applied to a wide range of musculoskeletal conditions where soft tissue restrictions, scarring, or chronic inflammation are present. Tendinopathies are among the most common diagnoses treated, as the technique helps reorganize the damaged collagen fibers characteristic of these chronic injuries. The technique is also effective in addressing fascial restrictions and managing pain related to various conditions, including:
- Achilles tendinitis and patellar tendinitis (runner’s knee).
- Lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer’s elbow).
- Fascial restrictions in the low back and neck.
- Plantar fasciitis, carpal tunnel syndrome, and iliotibial band (IT band) syndrome.
- Post-surgical or traumatic scars, helping to break down dense, less elastic scar tissue.
- Ligament sprains and muscle strains, speeding recovery and reducing adhesion formation.
Safety Considerations and Expected Reactions
A primary consideration during IASTM treatment is the potential for temporary skin reactions at the site of application. The most common reaction is the appearance of petechiae, which are small, red or purple spots caused by the disruption of tiny capillaries beneath the skin surface. This visible sign of increased localized blood flow indicates that the treatment has adequately stimulated the inflammatory healing response.
In some instances, more noticeable bruising, known as ecchymosis, may occur, which is a larger area of discoloration that typically resolves within a few days. Practitioners must use clinical judgment to avoid overtreatment, as excessive pressure can lead to unnecessary discomfort or prolonged bruising. There are several contraindications where IASTM should be avoided, including directly over open wounds, acute deep vein thrombosis, or in areas affected by certain blood disorders. The clinician will assess a patient’s full medical history to ensure the technique is safe and appropriate before proceeding.