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4 Myths of IASTM

Instrument assisted soft tissue mobilization (IASTM) is really a great manual therapy skill to have in your tool box.  However, there are many myths and misconceptions regarding IASTM that I really believe are holding people back from getting started and seeing the benefits of IASTM in their practice.

In this video, Erson Religioso and I discuss some of the myths of IASTM that led us to develop our online educational program at IASTMtechnique.com to teach people how and why we use IASTM:

4 Myths of IASTM

 

To summarize some of the myths of IASTM discussed in the video:

  • IASTM MythsIASTM does not have to be expensive to learn or perform.  You do not need to spend tons of money on certification courses and crazy expensive tools.  Erson and I have a quick and easy online educational program at IASTMtechnique.com that will get you started right away.  We even talk about how you can get useable tools for as little as $5!
  • IASTM does not have to be complicated to learn.  If you are already performing manual therapy or massage, you know everything you need to know to start using IASTM.
  • IASTM should not make everyone black and blue!  Let me actually rephrase that for emphasis, IASTM is not about being so aggressive that you leave large purple marks and essentially produce superficial capillary hemorrhage.  Some redness and petechia is OK, but the over aggressive black and blue is not ideal.
  • IASTM tools do not provide as much feedback as my hands.  IASTM is a way to compliment your hands, it is not a replacement!  In fact, it gives you a different feel that really helps your palpation skills.

 

 

Learn How to Start Performing IASTM Today!

Erson Religioso and I’s online educational program will teach you everything you need to know to start using IASTM today!  IASTM does not have to be complicated to learn or expensive to start using.  Learn everything about IASTM including the history, efficacy, tool options, different stroke patterns, basic techniques, advanced techniques, and how to integrate IASTM into your current manual therapy skills and treatment programs!

IASTM Technique 2.0 has now be released with updated research, new content, and now includes how to perform cupping and use mobility bands!  Get started today!

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Photo from Wikipedia

How and Why You Need to Learn IASTM

Learn IASTMErson Religioso and I have a nice video for you discussing why and how we both started using instrument assisted soft tissue mobilization (IASTM).  Like many people, I held out initially as I wanted to hear and see more.  However, the more I learned the more interested I became.

IASTM has now become a game changer for me and something I deeply integrate into my manual therapy techniques, and think you should too.  It doesn’t have to be complicated, expensive, or time consuming to start using IASTM.

In this video, Erson and I describe how and why they both started using IASTM, how we integrate IASTM with other manual techniques and exercise, the major benefits of IASTM, and then some brief technique demonstrations.

 

How and Why You Need to Learn IASTM

 

Learn How to Start Performing IASTM Today!

Erson Religioso and I’s online educational program will teach you everything you need to know to start using IASTM today!  IASTM does not have to be complicated to learn or expensive to start using.  Learn everything about IASTM including the history, efficacy, tool options, different stroke patterns, basic techniques, advanced techniques, and how to integrate IASTM into your current manual therapy skills and treatment programs!

IASTM Technique 2.0 has now be released with updated research, new content, and now includes how to perform cupping and use mobility bands!  Get started today!

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IASTM Technique 2.0 Now Available! Learn Advanced Techniques, Cupping, and Bands

Erson Religioso and I are super excited to announce the release of our brand new IASTM Technique 2.0 program at IASTMtechnique.com.  

IASTM Technique 2.0 is an add-on to our VERY popular program teaching you how you can quickly, easily, and affordably start using instrument assisted soft tissue mobilization in your manual therapy practice.

Since Erson and I released this program a few years ago, we have received amazing feedback. You don’t need to spend thousands on IASTM tools and loose a weekend attending a course.  Our program teaches you all you need in a simple online format.

This is no doubt your best opportunity to learn how to perform instrument assisted soft tissue mobilization AND now cupping too!

 

Advanced IASTM Techniques, Cupping, and More

iastm technique 2 cupping

 

And now with the additional content in IASTM Technique 2.0, not only will you be able to perform instrument assisted soft tissue mobilization, we also show you some of our advanced techniques to enhance movement patterns, how to use functional cupping, and how to use mobility bands!

  • Advanced IASTM Techniques – Learn our latest techniques designed to use IASTM to enhance movement patterns
  • Functional Cupping – Learn how we use cupping and combine IASTM and cupping together.  This has been a game changer for us!
  • Mobility Bands – Learn how to use mobility bands during manual therapy and self-mobility drills
  • Discounts on Edge Tools and Cupping kits – Anyone that purchases access to IASTM Technique 2.0 also gets a great discount on Edge IASTM tools, cupping kits, and mobility bands!

iastm tool cupping kit

 


Save $20 this week only!

IASTM Technique 2.0 is on sale for $20 off now through Sunday 8/28/16 (midnight EST).  Click the button below to learn more and start learning IASTM and cupping today!  

For people that have already purchased the original IASTM Technique 1.0, you can upgrade to 2.0 for a super low price. Click here to go to the IASTM Technique course page and you’ll find a link to upgrade to 2.0!
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How I Use Muscle Energy Techniques

Muscle Energy Techniques

The latest webinar recording for Inner Circle members is now available below.

Muscle Energy Techniques

This month’s Inner Circle webinars shifted gears a little bit.  Rather than talk about a specific injury or treatment focus, we discussed a general technique, muscle energy techniques.  I liked this approach as I think there are a lot of immediate clinical implications that will allow you to start using muscle energy techniques right away.  Here is just a few of the things we covered:

  • The history and background of muscle energy techniques from both the physical therapy and osteopathic fields
  • The effects and efficacy of muscle energy techniques
  • A review of some of the various different methods of using muscle energy techniques
  • How I use muscle energy techniques to increase motion, decrease guarding, reduce hypertonicity, perform joint mobilizations, and teach self-stretches
  • How you can start integrating muscle energy techniques into your current skill set.

 

To access the webinar, please be sure you are logged in and are a member of the Inner Circle program.

3 Tools to Get More Out of Your Programs in 2013

Ah, it’s that time of the year again, time for New Year’s resolutions!  While many people will be taking the plunge and dedicating some time and energy to fitness goals, the real challenge is sticking to these New Year’s resolutions for more than a month!  There are many reasons why people don’t stick to their workouts and fitness New Year’s Resolutions.  Some of them are just facts of life, such as time commitments, financial concerns, and lofty expectations.

Two common reasons for not sticking to your fitness resolutions that I have observed are soreness from the initiation of a new program and plateaus in your progress.  These are much more manageable and something that I think are sometimes related to mobility issues that can be addressed.

For the person just beginning a fitness program, muscle soreness and tightness after performing new exercises is essentially expected.  But there are some ways to reduce this soreness and get over the initial hump a little easier.  Movement and massage are two prime examples.  For the person that has some workout experience but aren’t working with a qualified professional, they often have some muscle imbalances and movement restrictions because someone isn’t helping them address their weaknesses.  Everyone wants to work on their strengths, right?

These are both obvious reasons as to why you want to work with a qualified strength and conditioning coach or personal trainer that can help identify and address your mobility concerns.  But what if you don’t have the access to a great coach and just want to start a home workout program or buy a generic gym membership?

Here are 3 tools that I recommend for you to get more out of your programs in 2013.  For a small amount of money, you can start your own package of tools that you can use at home between workouts.  Use these tools daily for 10 minutes and you’ll move and feel better between workouts, which will allow you to get more from your programs.

 

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Foam Roller

GRID foam roller Foam rollers are a staple for many people and certainly not anything new.  While foam rollers are popular at the gym before a workout, having one at home to use between workouts is a must as well.  Many people consider a foam roller a “self-myofascial release” tool.  I’m not sure if we are making any significant fascial changes when we foam roll, but the combination of the compression on the tissue and movement associated with foam rolling likely has a positive effect on neuromodulating tissue soreness and tightness.  What does this mean for you?  You’ll feel better and move better when you are done!

How to Use a Foam Roller

I recommend two uses for foam rollers – 1) as a generalized full body program, and 2) on specific sore muscles.  I would recommend rolling out the major hot sports of the body, such as:

  • Low back
  • Mid back
  • Posterior shoulder
  • Lats
  • Glutes
  • Hips
  • Quads
  • Hamstrings
  • Groins

I essentially recommend 5-10 full length rolls of each area, performed in a slow and controlled pace each day.  If specific muscles are sore after a workout, I would emphasize these and perform another 5-10 reps, however, if you find a specific point of discomfort, you can pause at that spot for 10 seconds.  Take a few deep breaths and try to relax.  I would also recommend performing a few thoracic spine extensions while rolling the mid back.  Here is a great video demonstration from Eric Cressey.  He hits a few different areas, however, the general concepts are the same and these are great examples.  There are also a few trigger point ball examples towards the end, but more on that later:

What Foam Roller to Buy?

I currently recommend two foam rollers, one for beginners that are just looking to incorporate foam rolling and another for more advanced uses that don’t mid spending a little more.

  • For Beginners: Perform Better Elite Molded Foam Rollers.  Pretty much a great basic foam roller that you can get for around $25
  • For Advanced Users: The Grid Foam Roller.  When you are ready to step up to a more firm roller, the Grid is by far the best on the market.  I don’t really think all those ridges and nubs do anything, but this is a great firm and durable roller that will last you a lifetime.  It’s a bit pricier between $30 and $40, but worth it.

 

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Massage Stick

theraband massage rollerWhile foam rollers are great, they aren’t perfect for every body part.  Essentially, if you can’t put a lot of weight through the foam roller, it doesn’t feel like you are doing much.  If you notice the above list of muscle areas does not include the entire body.  To hit more specific areas, a massage stick is a great tool and essentially a foam roller with handles!  You can use your hands to put more pressure into the movement when body weight isn’t available.  I see a foam roller and massage stick as complementary, and a massage stick is great for:

  • Calfs
  • Outer side of lower leg
  • Upper traps
  • Forearms

As you can see, pretty important areas, and spots that foam rollers really don’t hit well.  Not only do these areas get sore, but limitations often result in poor performance when training.

How to Use a Massage Stick

I use a massage stick just like a foam roller, with about 5 full length rolls on each area.  If sports are sore, which is pretty common in the calf and upper trap, I will pause there for about 10 seconds.  Here is a demonstration I have used in the past on how I use massage sticks for the forearm:

What Massage Stick to Buy?

I have used several massage sticks in the past and must say that there is only one I would currently recommend as it is by far superior to the others:

  • TheraBand Roller Massager+.  I was skeptical when I first used this massage stick, assuming that the ridges were just a way of separating themselves from the rest of the market.  However, the combination of the ridges and the material of the roller makes for a great combo and the best roller on the market!  The material grabs the skin well and the ridges create a drag sensation in addition to the compression.

 

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Trigger Point Ball

sklz reaction ballWe have progressed from a foam roller, to a massage stick, and now to a trigger point ball, the third component of a great self-help tool package!  Even with a roller and a stick, there are still some areas that are just too hard to get to.  As you can see, we are getting more specific with each tool.  Here is what I use trigger point balls for:

  • Specific trigger points in the glutes and hips
  • The QLs
  • Upper and middle trap areas
  • Posterior rotator cuff
  • Plantar fascia

If these are areas of concern for you, you’ll want to get some sort of trigger point ball to hit these spots with ease.

How to Use a Trigger Point Ball

Using a trigger point ball is a little different from a roller or a stick, I usually don’t recommend rolling the body on the ball, but rather just stick to a trigger point release.  These balls can get to a small specific spot, so you can hit multiple points in each area, holding each for about 10 seconds.  Here is an example of using a trigger point ball on the posterior shoulder:

What Trigger Point Ball to Buy?

I typically use a couple of different trigger point balls, depending on how firm I want the ball to be.  I would recommend the softer balls for beginners and firmer for advanced users.  I think lacrosse balls are great, but they are pretty firm and don’t have a small nub to use, making them less than ideal for some areas.  Here is what I recommend:

  • For Beginners: Trigger Point Therapy Massage Ball.  These are a little more expensive than lacrosse balls at about $15, but they are softer and have a little nub than you can wedge into different areas, which I like.  This is a good starting point, but if you weigh a lot or plan on using it exclusively for the glutes, the brand new Trigger Point Therapy X-Factor Ball is a little larger and more firm.  I use these a lot.
  • For Advanced Users: SKLZ Reaction Ball.  You know those little yellow reaction balls that you drop and bounce all over the place?  A friend just recently turned me on to these as trigger point tools!  They work great!  They are firm and have great little nubs to really get in to the tissue.  Plus you can usually find them for under $10.
  • You can always just go with a simple lacrosse ball as well.  But they are pretty firm for beginners some times and don’t have the added benefit of any points or nubs to emphasize an area.  That being said they are under $2!

 

By combining these 3 tools, you’ll have a perfect home kit to help you move better and feel better between workouts, which means you’ll get more out of your programs and hopefully stick to those New Year’s resolutions!

 

 

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Frontal Plane Stability, Soft Tissue Duration, and Cash Based Practice

This week’s stuff you should read comes from Chris Johnson, Patrick Ward, and Jarod Carter.

 

Inner Circle Update

This month’s Inner Circle webinar is actually happening later today!  We will be talking about how I integrate science and evidence into exercise selection.  I love topics like this and feel that little tweaks to exercise can you make you look like a rock star.

Inner Circle members can head over to the dashboard to sign up for the webinar.  I’ll get a recording of the video posted ASAP afterward as well.  Click here to learn more and join the program.

 

RehabWebinars.com Update

There were a few new webinars added to RehabWebinars.com this week!  We have a ton more coming too.  Here is what was new this week:

  • Part 2 of Kevin Wilk’s Current Concepts in ACL Rehabilitation covering several concepts of biomechanics, exercise, and neuromuscular training during the intermediate phase of rehabilitation from week 2 to week 10.
  • Peripheral Neuropathies by Dr. Mike Ellerbusch, who I have collaborated with in past EMG studies
  • Surgical Options for Knee Arthritis in Young Athletes by Dr. Lyle Cain.

And also working on a ton more webinars including kinesiology taping, integrating neuroscience, and more strength and fitness webinars.

 

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Frontal Plane Stability Drill

Chris Johnson shows a nice video of a frontal plane stability drill he uses in runners.  I like the thought and emphasis on the stability of the leg on the ground and the core.  Notice how well Chris performs the exercise and doesn’t allow a hip hike o r

 

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Cash Based Practice Advice 

Jarod Carter includes a nice video of his speech to a group of physical therapy students about cash-based practice.  Nice message and Q&A session.

 

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How Long Should We Spend on Soft Tissue

Patrick Ward answers a question he received regarding how much time we should spend on soft tissue.  To summarize, as long as we need to produce the desired effect!  But how many times in a crazy outpatient setting do we get rushed?

 

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Self Myofascial Release for the Forearm

I wanted to show a quick video of a technique I use for self-myofascial release of the forearm.  Obviously, this is a hard area to get with a foam roll and some of the techniques I have seen using the various trigger point balls don’t seem to apply enough pressure for me.  Here is a quick clip demonstrating:

 

The video uses the new Thera-Band Roller Massager+.  Obviously you can use you stick of choice, like the original Massage Stick or Tiger Tail, however I must admit that the Thera-Band stick is my current go-to massage stick device.  I was a little skeptical at first about the ridges, thinking it was just a way to differentiate itself from the competition, but it really does feel better than the other sticks.  The rubber surface with the ridges makes for a nice combination of compression and superficial drag.

 

Self Myofascial Release for the Forearm

In the video above you’ll notice a few things:

  • I position the stick at an ~45 degree angle and really wedge it into a firm surface.  This gives me a nice rigid platform to roll on.
  • I use this just like a foam roll.  I start with simply rolling back and forth the length of the muscle groups, then stop on any trigger points that I find and hold for a sustained released, then I progress to include multidirection movements that include fascial release techniques.
  • For the flexor and pronator group, I start with the wrist flexed and pronated and as I roll I extend and supinate.
  • This is reverse for the extensor and supinator group, I start with the wrist extended and supinated and as I roll I flex and pronate

This is a great warm-up for the forearm and also a great technique to include in home exercise programs for those with injuries such as medial epicondylitis and lateral epicondylitis.  Try it and let me know what you think about this or if you have any other self-myofascial release techniques for the forearm that you find to be helpful.

Trigger Point Dry Needling for Lateral Epicondylitis

Today’s guest post is from Ann Wendel on trigger point dry needling and the effect of dry needling for lateral epicondylitis. Dry needling is gaining more popularity and becoming another great option when dealing with trigger points. Ann went through Myopain Seminar’s dry needling certification. I have had the pleasure to get to learn from some of the instructors of the trigger point program, including Katie Adams, and definitely recommend them if this is of interest to you.

Trigger Point Dry Needling

 

 Trigger Point Dry NeedlingDry Needling is a physical therapy modality used in conjunction with other interventions to treat myofascial pain and dysfunction caused by trigger points. Myofascial trigger points (MTrP’s) are defined as hyperirritable nodules located within a taut band of skeletal muscle (Simons et al., 1999). Palpation of a MTrP produces local pain and sensitivity, as well as diffuse and referred pain patterns away from the affected area. Painful MTrP’s activate muscle nociceptors that, upon sustained noxious stimulation, initiate motor and sensory changes in the peripheral and central nervous systems. (Shah et al., 2008).

Trigger point dry needling can be used to achieve one of three objectives. First, trigger point dry needling can confirm a clinic diagnosis by relieving the patient’s pain or symptoms of nerve entrapment. Second, inactivation of a MTrP by needling can rapidly eliminate pain in an acute pain condition. Third, inactivation of the MTrP through needling can relax the taut band for hours or days in order to facilitate other therapeutic approaches such as physical therapy and self stretching (Dommerholt and Gerwin, 2006).

Universal precautions are always followed when utilizing dry needling in patient care. During the procedure, a solid filament needle is inserted into the skin and muscle directly at the myofascial trigger point. The trigger point is penetrated with straight in and out motions of the needle. The needle can be drawn back to the level of the skin and redirected to treat other parts of the trigger point not reached in the first pass (Dommerholt and Gerwin, 2006). During this procedure, it is essential to elicit twitch responses in the muscle. The local twitch response (LTR) is an involuntary spinal reflex contraction of muscle fibers within a taut band during needling. Research shows that biochemical changes occur after a LTR, which correlate with a clinically observed decrease in pain and tenderness after MTrP release by dry needling (Shah and Gilliams, 2008).

Trigger Point Dry Needling for Lateral Epicondylitis

Trigger point dry needling is an effective treatment modality for numerous acute and chronic musculoskeletal issues. One condition that responds favorably to dry needling is lateral epicondylitis. Therapists know that this problem has usually become chronic by the time the patient seeks treatment, and progress is usually frustratingly slow for both the patient and the therapist.

When dry needling is incorporated into the treatment plan, results are often seen after 2 or 3 visits. The entire forearm is easily treated with the patient supine on the treatment table, and multiple TrP’s can be treated in a matter of minutes. After a thorough history and physical exam, the therapist assesses the forearm for taut bands and trigger points. Muscles commonly involved in symptoms of lateral epicondylitis include: triceps, brachioradialis, extensor carpi radialis longus (and sometimes brevis), extensor digitorum, anconeus, and supinator. As always, the therapist should screen the neck and shoulder region for MTrP’s. Muscles that may refer pain to the lateral epicondyle include: supraspinatus, infraspinatus, teres major and scalenes.

The needling treatment is completed when all LTR’s are eliminated or the patient requests to stop the treatment. The needle is discarded in a sharps container and hemostasis is applied to the area to decrease bruising. The therapist provides manual therapy with a local stretch to the taut band, myofascial release and therapeutic stretch. The patient is taught a self stretch for home, and the treatment can be concluded with ice or heat to the area. The patient is instructed to stretch the area throughout the day and apply heat/ice as needed. It is not unusual to have some increased soreness at the needling site that may last for up to 48 hours. After 48 hours, most patients report a significant decrease in pain, increase in range of motion and some return of strength.

In conclusion, trigger point dry needling can be used in conjunction with other interventions to treat myofascial pain. At the current time, each state has made its own ruling with regard to the physical therapist’s ability to utilize dry needling. The therapist would be best served by reading the State Practice Act for the state in which they practice to determine their ability to use this modality. I went through 100 hours of classroom and practical training in dry needling and successfully passed both a written and practical exam to become a Certified Myofascial Trigger Point Therapist through Myopain Seminars. I highly recommend this course and I find dry needling to be a very effective part of my practice.

Mike’s Thoughts

Great article Ann, thanks.  Dry needling is something I have been exploring and integrating into my practice.  I’d love to hear form others about their experiences as well, so please comment below.  What works?  What technique do you use?  What diagnoses respond best?

Here is a video from Youtube for the extensor pollicis brevis.  This technique is more aggressive in nature, utilizing and “in and out” pattern of needling rather than just different needles.  Different groups teach it differently:

Dry NeedlingAnn is a graduate of Myopain Seminars program, which is great, but I also recommend Dr. Ma’s Integrated Dry Needling approach.  They are both different models.  Myopain is based on the trigger point theories of Janet Travell.   Dr. Ma’s Integrative Dry Needling, Orthopedic Approach™ is a contemporary dry needling therapy developed by Dr Yun-tao Ma and based on the works of Dr Janet Travell, Dr Chan Gunn, clinical evidence, evidence-based research and Dr Ma’s own 40 years of clinical and research experience and neuroscience training.

Click the below links for more information:

References

  • Dommerholt, J. and Gerwin, R., Trigger Point Needling Course Manual, The Janet Travell, MD Seminar Series, 2006
  • Shah JP, Gilliams EA. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther. Oct 2008;12(4):371-384
  • Simons, D.G., Travell, J.G., Simons, L., 1999. Myofascial Pain and Dysfunction: The Trigger Point Manual. Williams & Wilkins, Baltimore.

About the Author

Ann Wendel, PT, ATC, CMTPT holds a B.S. in P.E. Studies with a concentration in Athletic Training from the University of Delaware, and a Masters in Physical Therapy from the University of Maryland, Baltimore. She is a Certified Athletic Trainer (ATC) licensed in Virginia, a Licensed Physical Therapist, and a Certified Myofascial Trigger Point Therapist (CMTPT). Ann received her CMTPT through Myopain Seminars and utilizes Trigger Point Dry Needling as a treatment modality for many pathologies, including lateral epicondylitis.

 

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