What Is IASTM?
Instrument-assisted soft tissue mobilization (IASTM) is a manual therapy technique used by physical therapists to apply controlled pressure to muscles, tendons, fascia, and other soft tissues using specialized handheld instruments.
Instead of using only their hands, physical therapists use tools designed to help assess and treat soft tissue.
IASTM may be used as part of a broader physical therapy program to address pain, mobility limitations, muscle tightness, or difficulty moving.
The technique is sometimes associated with tools made from stainless steel, plastic, or other materials. Different systems may have their own terminology, instrument shapes, and treatment approaches, but the general concept is similar: a clinician uses an instrument to apply mechanical pressure and movement to targeted soft tissues.
Importantly, IASTM is not intended to be a standalone cure for an injury.
It is typically used as an adjunct to active rehabilitation, including therapeutic exercise, strengthening, mobility training, and movement retraining.
What Does IASTM Stand For?
IASTM stands for:
Instrument-Assisted Soft Tissue Mobilization
Each part of the name describes the technique:
- Instrument: A handheld therapeutic tool
- Assisted: The instrument assists the therapist's hands
- Soft Tissue: Treatment can target muscles, tendons, fascia, and other soft tissues
- Mobilization: The therapist uses controlled movement and pressure to influence the targeted tissue
You may also hear IASTM referred to as:
- Instrument-assisted soft tissue therapy
- Instrument-assisted manual therapy
- Soft tissue mobilization
- Graston technique
- Scraping
- Myofascial instrument therapy
"Graston" is a specific branded approach to instrument-assisted soft tissue treatment, while IASTM is the broader category.
How Does IASTM Work?
The exact biological mechanism behind IASTM is still being investigated.
During treatment, the therapist moves the instrument over the skin and underlying tissues using controlled pressure.
This creates mechanical stimulation of the tissues and sensory receptors.
IASTM may influence:
- Pain perception
- Local tissue sensitivity
- Range of motion
- Muscle tone
- Short-term mobility
- Patient tolerance to movement
One proposed mechanism is that mechanical stimulation can influence the nervous system's response to the treated area
However, claims that IASTM simply "breaks up scar tissue" or physically "scrapes away adhesions" should be treated cautiously.
The human body is more complex than the idea of physically breaking apart scar tissue with a tool.
Current research suggests that the effects of manual therapy may involve a combination of mechanical, neurological, and contextual mechanisms rather than a single structural change.
What Does IASTM Feel Like?
IASTM can feel different depending on the technique, area being treated, and amount of pressure used.
Patients may experience:
- Pressure
- Stretching
- A scraping or gliding sensation
- Mild tenderness
- Warmth
- Temporary sensitivity
IASTM should not be excessively painful.
A therapist can adjust the amount of pressure based on the patient's tolerance and treatment goals
Some patients may develop temporary redness or discoloration after treatment. Bruising can also occur, particularly when greater pressure is used.
However, more bruising does not mean a better treatment.
The goal should be an appropriate therapeutic response, not creating tissue damage.
What Are the Potential Benefits of IASTM?
Research has investigated IASTM for several outcomes, particularly range of motion, pain, and muscle function.
1. Improving Range of Motion
One of the more consistent findings in IASTM research is that it can produce short-term improvements in range of motion.
A systematic review and meta-analysis published in the Journal of Athletic Training found that IASTM may improve range of motion and reduce pain in some populations. However, the authors noted that study quality and treatment protocols varied
Another systematic review found that IASTM can improve range of motion, particularly when applied before activity, although evidence regarding long-term improvements is less clear.
This is an important distinction.
IASTM may help someone move more freely during a treatment session, but that does not necessarily mean the underlying injury has been permanently corrected.
2. Reducing Pain
IASTM has also been studied for pain.
A systematic review and meta-analysis found that IASTM can produce improvements in pain compared with control conditions in some populations. However, the researchers noted substantial variation in study designs and limitations in the available evidence.
Pain is influenced by many factors, including tissue sensitivity, nervous system activity, movement, stress, sleep, and previous experiences.
Therefore, a reduction in pain after IASTM does not necessarily mean that the therapist has physically "broken up" damaged tissue.
Instead, the treatment may influence how the body perceives and responds to movement.
3. Supporting Movement Before Exercise
One practical use of IASTM is helping a patient move more comfortably before performing therapeutic exercise.
For example, if someone has limited ankle mobility, a therapist might use manual therapy followed by mobility exercises and strengthening.
The manual treatment can potentially create a short-term change in movement, while exercise helps the patient develop and maintain that movement.
This is why IASTM is often most useful when it is combined with active rehabilitation.
4. Addressing Soft Tissue Sensitivity
Some patients may have areas of muscle or soft tissue that feel particularly sensitive during movement or palpation.
IASTM can provide a controlled sensory stimulus to those areas.
This may help some patients tolerate movement or exercise more comfortably.
Again, the goal is not simply to "fix the tissue" during the manual therapy portion of the appointment.
The goal is to create an opportunity for better movement and progression.
What Does the Research Say About IASTM?
The research on IASTM is promising but mixed.
A 2019 systematic review and meta-analysis examined IASTM for musculoskeletal disorders and found improvements in pain and function in some studies. However, the authors noted substantial heterogeneity between studies and limitations in the quality of available evidence.
A separate systematic review examining IASTM and range of motion found evidence that IASTM can improve short-term flexibility and range of motion, but there was less evidence demonstrating long-term benefits.
A 2024 systematic review examining IASTM for lower-extremity musculoskeletal conditions found potential benefits for pain, range of motion, and function, but again highlighted differences in treatment protocols and study quality.
Overall, the evidence supports IASTM as a potentially useful adjunct, particularly for short-term changes in pain and mobility, but it does not support presenting IASTM as a cure for soft tissue injuries.
Does IASTM Break Up Scar Tissue?
This is one of the most common questions about IASTM.
The simple answer is:
Not in the literal way it is sometimes described.
You may hear claims that the instrument "breaks up scar tissue," "breaks adhesions," or "breaks down fascia."
Those descriptions are oversimplified.
Scar tissue is biologically integrated into the surrounding tissue, and there is limited evidence that a therapist can mechanically scrape away scar tissue through normal IASTM treatment.
The effects of manual therapy are likely more complicated and can involve mechanical stimulation, changes in sensory input, pain modulation, and changes in movement tolerance.
IASTM may still be useful for someone with a scar or soft tissue restriction, but it should be combined with appropriate rehabilitation rather than marketed as a way to physically remove scar tissue.
Can IASTM Increase Flexibility?
IASTM may temporarily improve flexibility or range of motion.
For example, a person may have limited hamstring flexibility. Following IASTM, they may demonstrate greater range of motion.
Research supports short-term improvements in range of motion following IASTM in some populations.
However, maintaining long-term mobility requires more than passive treatment.
A comprehensive approach may include:
- Active mobility exercises
- Strength training
- Neuromuscular control
- Progressive loading
- Functional movement
In other words:
IASTM may help create movement. Exercise helps teach the body how to use that movement.
Can IASTM Help Athletes?
IASTM is commonly used in sports physical therapy and athletic settings.
Athletes may receive IASTM as part of treatment for:
- Muscle soreness
- Limited mobility
- Tendon-related pain
- Overuse injuries
- Sports-related soft tissue problems
- Movement restrictions
For an athlete, the most important outcome is not simply feeling looser after treatment.
The goal is to improve the athlete's ability to:
- Produce force
- Absorb force
- Change direction
- Run
- Jump
- Lift
- Perform sport-specific movements
IASTM may be one tool used to help achieve those goals.
IASTM vs. Massage
IASTM and massage both involve manual treatment of soft tissues, but they are not identical.
Massage generally uses the therapist's hands to apply pressure and movement to muscles and other soft tissues.
IASTM uses a handheld instrument to assist the therapist in applying pressure and gliding techniques
Neither technique is automatically better.
The appropriate treatment depends on the patient, the therapist's clinical reasoning, and the goals of rehabilitation
IASTM vs. Foam Rolling
Foam rolling is a form of self-administered soft tissue intervention.
IASTM is performed by a trained clinician using a specialized instrument.
Both approaches may temporarily influence range of motion and how an area feels during movement.
The major difference is that IASTM allows the clinician to assess the tissue and modify the technique based on the patient's response.
Foam rolling, meanwhile, gives the patient a tool they can use independently.
In a comprehensive rehabilitation program, either may be appropriate depending on the patient's goals.
Is IASTM Painful?
IASTM does not need to be painful to be effective.
Some patients experience mild discomfort or tenderness during treatment, but excessive pain is not the goal.
Older approaches to instrument-assisted therapy sometimes emphasized aggressive treatment and bruising.
Current evidence does not establish that more aggressive treatment produces better outcomes.
A physical therapist should use an appropriate amount of pressure based on:
- The patient's condition
- Treatment goals
- Irritability of the tissue
- Patient tolerance
- The stage of rehabilitation
How Long Does IASTM Take?
Treatment duration varies.
A physical therapist may use IASTM for several minutes as part of a larger treatment session.
The amount of time spent on manual therapy depends on the patient's presentation and goals.
IASTM does not necessarily need to occupy the entire appointment.
In many cases, the most valuable part of the session may be what happens after the manual treatment.
For example:
IASTM → mobility exercise → strengthening → functional movement
This approach uses the short-term effects of manual therapy as an opportunity to perform active rehabilitation.
Is IASTM Safe?
IASTM is generally considered a low-risk manual therapy technique when performed appropriately.
However, it may not be appropriate for every patient.
A physical therapist should consider factors such as:
- Skin integrity
- Acute injury
- Bleeding disorders
- Medications that affect bleeding
- Vascular conditions
- Recent surgery
- Infection
- Fracture
- Patient tolerance
Patients should always communicate relevant medical history and medications to their physical therapist before treatment
Is IASTM Evidence-Based?
IASTM has evidence supporting some short-term outcomes, but the research is not strong enough to support every claim made about the technique.
The strongest evidence appears to involve outcomes such as short-term range of motion and, in some populations, pain.
The evidence is less convincing for claims that IASTM permanently changes fascia, breaks up scar tissue, or directly remodels tissue through mechanical scraping.
Evidence-based physical therapy means using IASTM when it makes sense for the individual patient and combining it with interventions that address the underlying functional limitations.
The Bottom Line
IASTM is a manual therapy technique that uses specialized instruments to apply controlled pressure to soft tissues.
Research suggests IASTM may help with:
- Short-term range of motion
- Flexibility
- Pain
- Movement tolerance
- Certain musculoskeletal conditions
However, the evidence is mixed and treatment protocols vary.
IASTM should not be viewed as a magic tool that "breaks up scar tissue" or permanently fixes an injury.
Instead, it can be a useful to an active rehabilitation program.
The most effective approach may look something like:
Manual therapy → improved movement → active exercise → progressive loading → improved function
The goal is not simply to make the tissue feel different for a few minutes.
The goal is to help the patient better and build the strength and capacity needed for long-term results.
IASTM at Core Performance Physical Therapy
At Core Performance Physical Therapy, IASTM may be incorporated into an individualized treatment plan when appropriate.
Our physical therapists can combine manual therapy with therapeutic exercise, strength training, mobility work, neuromuscular training, and functional rehabilitation.
Rather than relying on passive treatment alone, the goal is to use manual therapy strategically to help patients progress toward better movement and function.
Whether you're dealing with an injury, returning to sport, experiencing persistent pain, or simply having difficulty moving the way you want, a physical therapy evaluation can help identify the factors contributing to your symptoms and determine which treatment strategies may be appropriate.
Frequently Asked Questions About IASTM
What does IASTM stand for?
IASTM stands for instrument-assisted soft tissue mobilization.
What is IASTM used for?
IASTM may be used to address pain, soft tissue sensitivity, mobility limitations, and other musculoskeletal impairments as part of a larger physical therapy program.
Does IASTM break up scar tissue?
There is not strong evidence that IASTM literally breaks up scar tissue. Its effects are likely more complex and may involve mechanical stimulation, sensory input, pain modulation, and changes in movement tolerance.
Does IASTM hurt?
IASTM may create pressure, tenderness, or a scraping sensation, but excessive pain is not necessary for treatment to be effective.
Can IASTM improve flexibility?
Research suggests that IASTM can produce short-term improvements in range of motion and flexibility in some populations. Long-term mobility improvements require continued active rehabilitation.
How is IASTM different from massage?
IASTM uses specialized instruments to assist the therapist in applying pressure to soft tissues, while massage primarily uses the therapist's hands.
Is IASTM the same as Graston?
Graston is a specific branded approach to instrument-assisted soft tissue treatment. IASTM is the broader category of instrument-assisted soft tissue techniques.
Can athletes benefit from IASTM?
IASTM may be incorporated into sports rehabilitation to address mobility limitations, pain, and soft tissue sensitivity. It is generally most useful when combined with exercise and sport-specific rehabilitation.
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