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EVIDENCE-TO-RACTICE REVIEW 

 

4 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020 

 
 

An Evidence-to-Practice Review on the Efficacy of Instrument Assisted 
Soft Tissue Mobilization  
Matthew G. Moore, SCAT, ATC; Aneika R Daley, SCAT, ATC; and Zachary Winkelmann, PhD, SCAT, ATC 
University of South Carolina, Columbia, SC 
  

 
ABSTRACT 

Instrument assisted soft tissue mobilization (IASTM) is the use 
of specially designed instruments that provide a mobilizing 
effect to soft tissue to help with decreasing pain and 
improving range of motion. Over the years, there has been 
an increase in the use of IASTM as well as an increase in 
research for its effects on soft-tissue injuries, range of motion 
(ROM), and pain management; however, the results have not 
been supported as a whole. Evidence for the positive 
outcomes from the use of IASTM, in conjunction with 
therapeutic exercise or other interventions, has been lacking 
in many studies. As a result, clinicians question its 
effectiveness. The purpose of this evidence-to-practice 
review was to summarize the results of the systematic review 
and apply it to clinical practice. The authors of the guiding 
systematic review aimed to investigate the current state of 
available literature on the topic of IASTM, specifically using 
studies that compared IASTM pre & post-treatment and 
compared the IASTM group to other intervention or control 
groups. Seven total studies were included in the final review, 
and of those, five focused on IASTM treatment for 
musculoskeletal pain and two focused on IASTM treatment for 
joint ROM. Each study varied in methodology, interventions, 
treatment times, and outcome measures. Therefore, the 
systematic review was unable to make a direct comparison 
between all studies and results were deemed inconclusive. In 
conclusion, using IASTM as a stand-alone treatment is not 
recommended in any case. However, in the event the 
treatment is not contraindicated and the clinician is inclined to 
use the treatment for physiological improvement, then 
implementation and use of IASTM is not unreasonable and 
could potentially benefit the patient when used in conjunction 
with therapeutic exercise or other form of treatment.  
 
Key Phrases 
Therapeutic devices, rehabilitation, clinician-rated outcomes 

Correspondence 
Dr. Zachary Winkelmann, University of South Carolina 
1300 Wheat Street, Columbia, SC 29208.  
E-mail: winkelz@mailbox.sc.edu  
Twitter: @zachwinkelmann 
 
Full Citation 
Moore MG, Daley AR, Winkelmann ZK. An evidence-to-
practice review on the efficacy of instrument assisted soft 
tissue mobilization. Clin Pract Athl Train. 2020;3(3):4-11. 
https://doi.org/10.31622/2020.0003.3.2.  
Submitted: April 20, 2020 Accepted: September 1, 2020 

ORIGINAL REFERENCE AND SUMMARY 

Cheatham SW, Lee M, Cain M, Baker R. The 
efficacy of instrument assisted soft tissue 
mobilization: a systematic review. Journal of the 
Canadian Chiropractic Association. 
2016;60(3):200-211.  

SUMMARY 
 
CLINICAL PROBLEM AND QUESTION 
 

Soft tissue injuries are common among the 

general and athletic populations and these injuries 
can lead to acute and chronic loss of function, 
adhesions, and pain.2-4 Instrument assisted soft 
tissue mobilization (IASTM) is the use of specially 
designed instruments that provide a mobilizing 
effect to soft tissue to help with decreasing pain 
and improving range of motion (ROM).2-4 Over 
the years, IASTM has become a popular treatment 
for soft tissue injuries involving myofascial 
restrictions and in increasing pain thresholds.5 This 
therapy has been utilized over a variety of 
different treatment areas, almost all of which 
involving a musculoskeletal injury or pathology.2-4 

During the healing process of an injury or 
pathology, the human body will respond with an 
initial inflammatory response, followed by a 
proliferation phase, and then finally maturation of 
the new tissue. During these last two phases, 
IASTM is traditionally utilized as an 
intervention/modality in order to aid the 
realignment of tissue, collagen elasticity, and 
increase perfusion of tissues to promote 
healing.2 Studies have been conducted to 
investigate the effect of IASTM on patient ROM 
and pain.2,4,5 Results of these studies lack 

mailto:winkelz@mailbox.sc.edu
https://doi.org/10.31622/2020.0003.3.2


An Evidence-to-Practice Review on the Efficacy of Instrument Assisted Soft Tissue Mobilization 
 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020 
 

definitive findings in almost all cases, and in turn, 
many clinicians have been using IASTM without 
truly understanding the outcomes of the technique. 
Therefore, the purpose of this review was to assess 
the clinical effectiveness and efficacy of IASTM as 
a treatment protocol.  

SUMMARY OF LITERATURE  

The authors conducted a systematic search for 
studies/clinical trials using IASTM through the 
databases of PubMed, PEDro, Science Direct, the 
EBSCOhost collection, and hand searching known 
journals. Studies that were included in the review 
had to meet the following criteria: 1) peer 
reviewed, English language publications, 2) 
controlled clinical trials that compared pre- and 
post-test measurements for an intervention data 
extraction and synthesis program using IASTM, 3) 
investigations that compared an intervention 
program using IASTM, and 4) investigations that 
compared two intervention programs using IASTM. 
The search identified 261 articles, plus two others 
identified through other sources, for initial review. 
After duplicates were removed and records were 
screened, 47 full-text articles were reviewed for 
inclusion. After review, seven articles were 
included in the qualitative synthesis.  

SUMMARY OF INTERVENTIONS  
 
Of the articles synthesized (Table 1), six articles 
examined the Graston Technique® and one 
examined the Fascial Abrasion Technique®. Five 
studies investigated the effects of IASTM on the 
patients’ pain from a musculoskeletal pathology, 
while two studies examined the effect of IASTM 
on the ROM in healthy individuals. For the five 
studies that focused on IASTM treatment for 
patients with pathology, the interventions in each 
study differed so it was difficult to determine 
which resulted in a better outcome. Two studies 
focused on comparing IASTM with a control group, 
one to treat patients classified with lateral 
epicondylitis6 and the other to treat the upper 

back.7 One study compared IASTM with soft-tissue 
massage to treat patients with carpal tunnel 
syndrome8 and one study compared two different 
intervention programs that included IASTM, 
strengthening exercises, stretching, and 
chiropractic manipulative therapy to treat 
patients with patellofemoral pain syndrome.9 The 
final study compared three intervention programs 
including IASTM, dynamic strengthening, or 
proprioception exercises to treat patients with 
chronic ankle instability.10 All studies that used 
Graston Technique® had a timeframe for 
interventions ranging from 2-6 weeks. Only one 
study followed the recommended Graston 
Technique® protocol with other studies modifying 
it or not including all components of intervention in 
their reported methods.  

The two studies that focused on IASTM treatment 
for joint ROM measured the effects of the 
treatment on ROM of the shoulder and knee in 
healthy subjects. The study focusing on the 
shoulder measured the difference in glenohumeral 
ROM after a single session of Graston Technique® 
treatment with an experimental and non-
intervention control group.11 The other study 
compared the effects of one session of IASTM 
following the Fascial Abrasion Technique® and 
one session of foam rolling.11 The Graston 
Technique® protocol was not followed in the first 
study and no specific IASTM protocol was used in 
second study. From these two studies we can see 
that IASTM was able to increase ROM over control 
group, so IASTM could possibly be a tool used for 
increasing ROM, however, further research is 
needed to validate this.  

SUMMARY OF OUTCOMES  
 
The five studies that focused on IASTM as 
treatment for musculoskeletal pathologies 
included a combination of patient-reported and 
clinical-rated outcome measures (Table 1). The 
most common patient-reported outcome used was 
the Visual Analog Scale for pain. All studies 



An Evidence-to-Practice Review on the Efficacy of Instrument Assisted Soft Tissue Mobilization 
 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020 
 

measured outcomes pre-intervention and 
immediately post-intervention. Three studies 
reported a second follow-up, which ranged 
between 2-3 months post-treatment. The two 
studies using IASTM as treatment for joint ROM 
both used joint ROM, measured with a digital 
inclinometer, as the primary outcome measure. 
There were no patient-reported outcome 
measures used in those studies, but they both 
measured pre-intervention and immediately post-
intervention outcomes. The study that followed the 
Fascial Abrasion Technique® was the only method 
to conduct a 24-hr post-intervention follow-up 
assessment.  

FINDINGS AND CLINICAL IMPLICATIONS  

Each study varied in methodology, interventions, 
treatment times, and outcome measures (Table 1) 
and therefore, the systematic review was unable 
to make a direct comparison between all studies 
and results were deemed inconclusive. Out of the 
7 articles included in the systematic review, 
Graston Technique® was the most common form of 
IASTM used, only one study did not use Graston 
Technique®. However, the recommended 
treatment protocol was only followed by one of 
the six studies, while others had their own 
variation, which may have been a contributing 
factor to the inconsistent results across the studies. 
The studies examined in the review, along with 
their methods and outcomes, can be seen in Table 
1. The differences in the protocols followed by 
each study also deemed the results insignificant in 
determining the effectiveness of Graston 
Technique® because the specified Graston 
Technique® protocol was not followed. Due to the 
variability in the study protocols (which includes 
methodology, interventions, and outcome 
measures), it was difficult to determine the best 
treatment protocol. Clinicians conducting future 
research should consider what technique they are 
utilizing and differentiate if the technique chosen 
followed the manufactures’ specific treatment 

protocols, or if just the tools or general treatment 
method was used. 

From this systematic review, evidence does not 
support the efficacy of IASTM for treating certain 
musculoskeletal pathologies and is weak in 
supporting effectiveness of IASTM for increasing 
lower extremity joint ROM as a standalone 
treatment. Though IASTM is a form of myofascial 
therapy, there is a lack of evidence to support its 
use or validation. As a result of this, there still lies 
a gap between the current research and clinical 
practice. However, IASTM may have a degree of 
clinical utility due to each study individually 
identified improvements for their outcome 
measures. Clinicians should be tentative in the use 
of IASTM since it has not been validated; however 
it may still be used clinically paired with another 
treatment to help improve patient-reported 
outcomes, barring any contraindications. Future 
research should focus on testing specific IASTM 
protocols, with uniformity in methodology, 
interventions, and outcome measures, to validate 
its use. 

 
CLINICAL BOTTOM LINE 
 
The guiding systematic review suggests that 
IASTM lacks the efficacy to positively support its 
use in myofascial treatment. While IASTM was 
found to not have good efficacy, depending on 
the patient, it may help improve outcomes of acute 
joint ROM (Table 1).11 In order to implement 
IASTM clinically to have the best possible results, 
it is recommended that the clinician follow the 
specific IASTM treatment protocols provided by 
the manufacturer and to ensure the patient does 
not have any contraindications for the treatment. 
If a clinician were to implement IASTM into a 
treatment, it is always important to consider the 
patient population that is undergoing the 
treatment as well as the patient presentation. In 
the case of working with patients that are minors, 
parent/guardian education and consent should 



An Evidence-to-Practice Review on the Efficacy of Instrument Assisted Soft Tissue Mobilization 
 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020 
 

always be considered, especially if the treatment 
results in adverse effects such as visible bruising, 
ecchymosis, petechiae, or inflammation. When 
treating the geriatric patient population, it is 
important to consider their current health status 
and the ability of their bodies to withstand and 
recover from this type of treatment. In order to 
maintain consistent quality and standard of IASTM 
treatment, it is recommended that clinicians 
utilizing IASTM receives training in the application 
and administration of the treatment, and 
specialized training should be at the discretion of 
the clinician or the clinician’s employer. To 
conclude, IASTM has not been shown to have 
adequate efficacy, and using IASTM as a stand-
alone treatment is not recommended. Based upon 
the results of current literature, IASTM was not an 
effective intervention for certain musculoskeletal 
pathologies and further research is necessary to 
better understand the clinical effect of this 
intervention. 

REFERENCES 

1. Cheatham SW, Lee M, Cain M, Baker R. The 
efficacy of instrument assisted soft tissue 
mobilization: a systematic review. J Can 
Chiropr Assoc. 2016; 60(3):200-211.  

2. Kim J, Sung DJ, Lee J. Therapeutic 
effectiveness of instrument-assisted soft tissue 
mobilization for soft tissue injury: mechanisms 
and practical application. J Exerc Rehabil. 
2017; 13(1):12-22. 
https://doi.org/10.12965/jer.1732824.41
2.   

3. Stow R. Instrument-Assisted Soft Tissue 
Mobilization. Int J Athl Ther Train. 2011; 
16(3):5-8. 
https://doi.org/10.1123/ijatt.16.3.5.   

4. Ikeda N, Otsuka S, Kawanishi Y, Kawakami Y. 
Effects of Instrument-assisted Soft Tissue 
Mobilization on Musculoskeletal Properties. 
Med Sci Sports Exerc. 2019; 51(10):2166-
2172. 

https://doi.org/10.1249/MSS.0000000000
002035.  

5. Gulick DT. Instrument-assisted soft tissue 
mobilization increases myofascial trigger 
point pain threshold. J Body Mov Ther. 2018; 
22(2):341-345. 
https://doi.org/10.1016/j.jbmt.2017.10.01
2.   

6. Blanchette MA, Normand MC. Augmented 
Soft Tissue Mobilization vs Natural History in 
the Treatment of Lateral Epicondylitis: A Pilot 
Study. J Manipulative Physiol Ther. 2011; 
34(2):123-130. 
https://doi.org/10.1016/j.jmpt.2010.12.00
1.  

7. Gulick DT. Influence of instrument assisted soft 
tissue treatment techniques on myofascial 
trigger points. J Bodyw Mov Ther. 2014; 
18(4):602-607. 
https://doi.org/10.1016/j.jbmt.2014.02.00
4.   

8. Burke J, Buchberger DJ, Carey-Loghmani MT, 
Dougherty PE, Greco DS, Dishman JD. A pilot 
study comparing two manual therapy 
interventions for carpal tunnel syndrome. J 
Manipulative Physiol Ther. 2007; 30(1):50-61. 
https://doi.org/10.1016/j.jmpt.2006.11.01
4.  

9. Brantingham JW, Globe GA, Jensen ML, et al. 
A feasibility study comparing two chiropractic 
protocols in the treatment of patellofemoral 
pain syndrome. J Manipulative Physiol Ther. 
2009; 32(7):536-548. 
https://doi.org/10.1016/j.jmpt.2009.08.00
5.  

10. Schaefer JL, Sandrey MA. Effects of a 4-
Week Dynamic-Balance-Training Program 
Supplemented With Graston Instrument-
Assisted Soft-Tissue Mobilization for Chronic 
Ankle Instability. J Sport Rehabil. 2012; 
21(4):313-326. 
https://doi.org/10.1123/jsr.21.4.313.  

11. Laudner K, Compton BD, McLoda TA, Walters 
CM. Acute effects of instrument assisted soft 
tissue mobilization for improving posterior 

https://doi.org/10.12965/jer.1732824.412
https://doi.org/10.12965/jer.1732824.412
https://doi.org/10.1123/ijatt.16.3.5
https://doi.org/10.1249/MSS.0000000000002035
https://doi.org/10.1249/MSS.0000000000002035
https://doi.org/10.1016/j.jbmt.2017.10.012
https://doi.org/10.1016/j.jbmt.2017.10.012
https://doi.org/10.1016/j.jmpt.2010.12.001
https://doi.org/10.1016/j.jmpt.2010.12.001
https://doi.org/10.1016/j.jbmt.2014.02.004
https://doi.org/10.1016/j.jbmt.2014.02.004
https://doi.org/10.1016/j.jmpt.2006.11.014
https://doi.org/10.1016/j.jmpt.2006.11.014
https://doi.org/10.1016/j.jmpt.2009.08.005
https://doi.org/10.1016/j.jmpt.2009.08.005
https://doi.org/10.1123/jsr.21.4.313


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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020 
 

shoulder range of motion in collegiate 
baseball players. Int J Sports Phys Ther. 2014; 
9(1):1-7. 

12. Markovic G. Acute effects of instrument 
assisted soft tissue mobilization vs. foam 
rolling on knee and hip range of motion in 
soccer players. J Bodyw Mov Ther. 2015; 
19(4):690-696. 
https://doi.org/10.1016/j.jbmt.2015.04.01
0.  

  

https://doi.org/10.1016/j.jbmt.2015.04.010
https://doi.org/10.1016/j.jbmt.2015.04.010


EVIDENCE-TO-RACTICE REVIEW 

 

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Table 1. Summary of Studies1 

Study Pathology Intervention Outcome 
Measures 

Graston 
Technique® 

Used 

Graston 
Technique® 

Protocol 
Followed 

Results 

Blanchette 
and 
Normand6 

Lateral Epicondylitis 

• IASTM: Twice a week for 5 
weeks 

• Control: Education, computer 
ergonomics, stretching exercise, 
ice, and anti-inflammatory 
medication 

• VAS 
• Pain rated 

evaluation 
• Grip strength 

Yes No 

• Post intervention and 3-
month follow-up: both 
groups showed 
improvement in all 
outcome measures 

Burke et al8 Carpal Tunnel 
Syndrome 

• IASTM:2x/week for 4 weeks, 
1x/week for 2 weeks 

• Control: Soft tissue mobilization, 
2x/week for 4 weeks, 
1x/week for 2weeks 

• VAS Yes Yes 

• Post intervention and 3-
month follow-up: Both 
groups showed 
improvements in all 
outcome measures 

Gulick7 Myofascial Trigger 
points in upper back 

• 2 Phases of IASTM: 5 min, 6 
treatments (2x/week for 3 
weeks) 

• Control: no treatment 
 

• Pressure 
sensitivity with 
algometer 

Yes No 

• Post intervention: both 
groups showed 
improvements in 
outcome measures 

• No secondary follow-up 
reported 



An Evidence-to-Practice Review on the Efficacy of Instrument Assisted Soft Tissue Mobilization 
 

 

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Laudner et 
al11 
 

Posterior shoulder 
muscle 

• IASTM: 1 treatment, treatment 
time of 40 seconds 

• Control: No Treatment 

• Glenohumeral 
horizontal 
adduction, and 
internal 
rotation of 
motion 

Yes No 

• Post intervention: IASTM 
group showed greater 
acute improvements in 
ROM compared to the 
control group 

• No secondary follow-up 
reported 

Markovic12 
 

Quadriceps and 
Hamstrings 

• IASTM: One treatment, 2 
minutes each region 

• Control: Foam Rolling, one 
session 2x/I minute 

• Passive 
straight leg 
raise test 

• Supine passive 
knee flexion 
test 

No (Fascial 
Abrasion 

Technique® 
used) 

N/A 

• Post intervention: both 
groups showed 
improvement in joint 
ROM 

• 24-hour follow-up: 
IASTM group -> the 
most joint ROM 

Schaefer and 
Sandrey10 

Chronic Ankle 
Instability 

• IASTM: 2x/week, max of 8 min 
• Control: 4-week balance 

program (single-limb hops to 
stabilization, hop to 
stabilization and reach, 
unanticipated hop to 
stabilization, single-limb stance 
activities) 

• VAS 
• Foot and ankle 

ability 
measure 

• 4-way ankle 
ROM 

• Star Excursion 
Balance Test 

Yes No 

• Post-intervention: all 
groups showed 
improvement in all 
outcome measures 

• No long-term follow-up 
reported 



An Evidence-to-Practice Review on the Efficacy of Instrument Assisted Soft Tissue Mobilization 
 

 

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All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020 
 

 

Brantingham 
et al9 

Patellofemoral Pain 
Syndrome 

• Chiropractic manipulative 
therapy, exercise 

• Group 1: IASTM to knee joints 
only 

• Group 2: IASTM to 
lumbosacral, hip, knee, ankle, 
and foot 

• Both groups received treatment 
1-3x/week for 2-6 weeks, 
total of 6 treatments 

• VAS 
• Anterior knee 

pain scale 
• Patient 

satisfaction 
scale 

Yes No 

• Post-intervention and 2-
month follow-up: both 
groups showed 
improvement in all 
outcome measures 

VAS = Visual Analog Scale; IASTM = Instrument Assisted Soft Tissue Mobilization  


