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To comply with professional boards/associations standards:• I declare that I (or my family) do not have a financial relationship in any amount, occurring in the last 12 months with a commercial interest whose products or services are discussed in my presentation. Additionally, all planners involved do not have any financial relationship.•Requirements for successful completion are attendance for the full session along with a completed session evaluation.•Vyne Education and all current accreditation statuses does not imply endorsement of any commercial products displayed in conjunction with this activity.

Session 104: IASTM Redefined: Improving Function & Performance with Gentle Soft Tissue Techniques

Milica McDowell, MS, DPT

Leading the Way in Continuing Education and Professional Development. www.Vyne.com

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A Movement Company

That Dabbles in Tape

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We are going to challenge your current understanding

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RockBlades

New model in soft tissue manipulation

Neurological effects

Mechanical effects

Treatment vectors/rate/time/depth

Fascial Chains (Tracing)

Case Study

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Movement Pyramid

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1. Feeding the sensory system to improve motor output

2. Sensorimotor re-training

What We Think We Are Doing

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Limits Exist Only in the Mind

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Efficiency

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Criteria for Optimal Efficiency

Stiffness Compliance

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Debunked idea of fascial “release” (mechanical deformation of fascia)

Dismisses traditional explanations of thixotropy and piezoelectric-effect-mediated

adaptationFascial toughness

Concludes plastic fascial changes in response to moderate loading is “impossible to

conceive”

Dr. Robert Schleip

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Three-dimensional mathematical model for deformation of human fasciae in manual therapy. Chaudry H, et al. J

Am Osteopath Assoc. 2008 Aug; 108(8): 379-390.

2000lbs/sq”The amount of pressure necessary to distort fascial tissue

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www.noigroup.org

Aggressive and intense manual therapy with no regard for the state

of the patient’s nervous system is problematic

No pain, no gain

Old School

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NEW SCHOOL Neurological Effects

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David Nesmith - Alexander Technique

Body mapping is the conscious correcting and refining of one’s schema to produce

efficient, graceful and coordinated movement

Body map is one’s self-representation in one’s own brain… if representation is

accurate, movement is goodIf our representation is faulty, movement

suffers. When our map is corrected, movement improves

Movement & Faulty Maps

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Body Maps

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Improving the Cortical Map

Precision Training

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NOI Group (Moseley, Butler)

Redefining body mapsModern rehabilitation will be via normalization of sensation, motor control and congruence of these

factors

Connect the Dots

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Kinesthetic Cuing

Making the Invisible Visible

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Neurophysiological

Mechanical

Mechanisms

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Feed the Brain

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www.bettermovement.org

requires good perception

Good Movement

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The Science of Perception

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Satellite Systems

Visual

ProprioceptionVestibular 

Exteroceptive Interoceptive

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Sensory Receptor ClassificationProprioception: 

– is the kinesthetic sense that enables us to sense the relative position of the parts of the body, posture, balance, and motion. 

– Located in Muscles, tendons, joints, internal ear

Exteroception:

– pertains to the stimuli that originates from outside the body

– Located at or near the body surface

Interoception: 

– is defined as sensitivity to stimuli originating inside of the body.

–Interoceptors: Free nerve endings –Located in blood vessels, organs, and connective tissue (skin/Fascia) 

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Mechanoreception

Connective tissue and fascia are highly innervated

Often reported only to occur in muscles and joints

The fascial network possesses approximately 10 times the sensory receptors as compared to its muscular counterpart ( van der wall 2009)

Includes many types of receptors: – Golgi, Ruffini, Pacinian, Free nerve endings (Interoceptors)

Fascia considered more of a perceptual organ than a mechanical organ.

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“The nervous system is the most important target for influencing

posture and movement.” -Feldenkrais

“Fascia is the most important tissue for posture and movement.” - Rolf

BOTH!

What Are We Treating?

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The nervous system is the gate keeper to change.

Stacey Thomas, LMT

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Instrument Assisted Neurosensory Modulation

IANSM

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Pathological Adhesion?

Pre Blades Post Blades

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Driver’s Education

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Treatment VariablesTreatment Rate:

• Fast / Feathering • Slow• Fluid Capture• Shearing – Tangential  

Treatment Vector:

• Myofascial Chains• Linear• Non ‐ linear 

Treatment Depth:

• Angle of Approach• Pressure (Grading of Touch)

Grip:

• Standard• Thumb• Edge

Skin Prep:

• Wet – Emollient• Dry – No lubricant

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Tool Navigation

Hard Rock

Groovy Rock

Bottle Opener

Soft Rock

Alternative Rock

NarrowEdge

BluntEdge

Fine Tuning Edge

Finger Pads

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Skin

SubQ

Sup Fascia

Deep Fascia

Muscle

Trauma

Grades

Depth Gauge

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1-3: Very light (eyelid analogy)

4-6: Moderate

7-8: Firm

9-10: Deep

Depth Gauge Scale

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Depth does not require over-pressure.

Angle of Approach

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Limited motionPainful motion

Motor dysfunctionLack of tissue glide

Poor body representation

Indications

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Comprised tissue (open wound, infection, tumor)

Active implants (pacemaker, internal defibr., PICC/pump lines)

Deep vein thrombosisOver cervical carotid sinuses

Patient unable to communicate

Contraindications

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Treatment Strokes

Pain Modulation

Up‐Regulation

Down‐Regulation

Tissue Glide Fluid Capture

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G.K. Chesterton

It’s easy to be heavy; hard to be light.

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Not Necessary

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Sensory Receptor ClassificationProprioception:• The kinesthetic sense that enables us to sense the relative position of the

parts of the body, posture, balance, and motion. • Located in Muscles, tendons, joints, internal ear

Exteroception:• Pertains to the stimuli that originates from outside the body• Located at or near the body surface

Interoception: • Defined as sensitivity to stimuli originating inside of the body.

• Interoceptors: Free nerve endings • Located in blood vessels, organs, and connective tissue (skin/Fascia)

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Fascia as Interoreceptive Organ• Only a minority of the sensory nerve endings in MSK fascia are myelinated mechanoreceptors concerned with proprioception– Golgi Receptors, Paccini Corpuscles, or Ruffini

Endings. • 7 x more interoceptors than other mechanoreceptors • Higher concentration in hairy skin • Stimulation of these receptors result in activation of an

area of the brain (Insula) associated with pain relief and sense of well being

• 40% of these receptors are low threshold receptors which are responsive to light touch, – Painter’s Brush – Cotton Ball– Feather stroke

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Interoception/Pain Relief

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Interoreceptive PathwayInsula

Thalamus 

Prebrachial Nucleus 

Lamina I of Spinal Cord

Free Nerve Endings Interoceptive 

C‐Fiber Endings

Wellbeing Center of Brain

FasciaHairy Skin

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Use for painInteroreceptor Stimulation (free nerve endings)

Technique 1: Feathering

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Alternative Scanning ProcessUseful to pay attention to the autonomic responses of each

treatment Variable:

Neurological cues:– Warmth– lightheadedness – nausea – pulsation – sense of wellbeing – facial expression– breathing – pupil dilation/constriction – skin color changes – temperature changes

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Pain - Feathering

SCAN + IDENTIFY + FEATHER STROKES + RIPPLE

1. SCAN tissues targeted within workout.

2. IDENTIFY areas of tenderness/tightness = TARGET TISSUE

3. SUPERFICIALLY FEATHER pressure on target tissue for 30 seconds to tolerance

4. ADDRESS tissues up/down stream to target tissue = RIPPLE

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Depth Gauge

1…..3

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Feather Stroke

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Rate

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Use for pain/low activationPacinian Stimulation (low threshold sensation)

Technique 2: Up Regulation

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Pacinian corpuscles:

respond to rapid/oscillating mechanical pressure

This improves tactile acuity and motor control

Up-Regulation = Fast

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Explain Pain - Moseley/Butler

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Pacinian mechanorecptorsPrimarily respond to rapid pressure

changesStimulating these receptors can result in improved proprioceptive

feedback and controlled movement

Body Map Receptors & Tactile Acuity

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Up Regulation - Fast/Oscillating1. SCAN tissues that will be targeted in specific workout out. 

2. IDENTIFY areas of tightness/tenderness = TARGET TISSUE

3. QUICKLY oscillate over the area for 10 seconds = RAPID STROKES

4. ADDRESS tissue up/down stream to target tissue = RIPPLE

SCAN + IDENTIFY + RAPID STROKES + RIPPLE

Depth Gauge

2…..4

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Rate of Oscillation: 2‐6 Hz Level ‐ 200‐300 BPM

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Foot

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Ankle

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Lower Leg

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Knee

TissueResponse

UpRegulate

DownRegulate

PainMitigation

Shear

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painperformance

movement articular

muscularfascia

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Nervous System

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500 Years

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Future

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What is Fascia?it’s alive

fascia senses

richest sensory organ

fascia transmits force globallycommon myofascial pathways for transmitting stability, strain, and response distributes strain

continuous interconnected web

a GPS system of strain distribution

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Credit: Thomas Myers - Anatomy Trains

Muscular strain is applied along traceable “myofascial lines”

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1. New perspective in manual therapy

2. Neurological tweaking of the brain

3. Navigating the human body4. Fascial IASTM (IANSM)

5. Scrape and tape model6. Locking in the change via

corrective strategies

In Summary…