ASTYM legitamacy?

[DesertPT]

So I was reading about this ASTYM therapy, a name brand for some special "protocols" preformed with some special tools. This is a paragraph from the company's website:

"Astym® treatment is a therapy that regenerates healthy soft tissues (muscles, tendons, etc.), and eliminates or reduces unwanted scar tissue that may be causing pain or movement restrictions. Astym® treatment is highly effective and even works when other approaches routinely fail. One of the main reasons Astym® treatment is so much more effective than other treatments is that it was scientifically developed to resolve the underlying cause of soft tissue problems, rather than just trying to temporarily relieve symptoms. It is one of the most researched and effective therapy treatments available. Astym® treatment is unmatched in its ability to resolve tendinopathies, scar tissue problems, and other soft tissue dysfunctions. Doctors regularly prescribe Astym® treatment specifically for their patients, and elite athletes and knowledgeable patients seek out Astym® treatment for superior results."

To be honest, this just screams bogus to me. Any thoughts? Trying to see if this is a legitimate thing or if it's just one more quackery to add on top of "craniosacral therapy" and myofascial release....

---

Members don't see this ad.

 

[Moon08]

There is another form of this technique called "GRASTON". The main difference between the 2 in my opinion is the tools that are used. Graston has the patten on metal therefore use metal tools. As an avid runner/surfer/cycler I can vouch for the graston technique. It got me back up and competing as nothing else was working for my soft tissue injury at the time.

ASTYM supposedly claims that it treats injuries on a cellular level. ASTYM also has some verifiable research to back its claim. I have not heard any personal testimonies from anyone who has undergone the procedure but it seems to have some merit. If GRASTON didn't work then I would have tried ASTYM next.

Check out some of the literature on it, its pretty interesting.

 

[DPTErudition]

I don't think ASTYM is any better or worse than any other instrument assisted soft tissue mobilizations. In my experience it's more about technique and knowing when to use IASTM. Graston isn't worth the money, but there's something called adhesion breakers that are similar for much cheaper.

 

[DesertPT]

I guess the part that seemed bogus to me was this claim that rubbing these things across the soft tissues of the body actually causes cells to rapidly reabsorb scar tissue and regenerate connective tissue. I don't think fibroblasts or other cells are all of a sudden going to pull some magical superfood out off thin air and regenerate tendons and ligaments any faster than they would naturally. It's not the concept of soft tissue mobilization that I have a problem with. Anybody who has had a massage knows you can mobilize soft tissues.

 

[SportsMD]

I am the medical director of the Astym program, and I have been involved with medical/rehabilitation research throughout my career. Astym treatment was researched and developed over a period of years by a team including medical doctors, therapists, scientists and other medical professionals. Research on Astym treatment began with a multi-disciplinary research team theorizing about a potential physical treatment method that could have the ability to regenerate and remodel soft tissues. These theories were built upon emerging evidence regarding the degenerative nature of tendinopathy, and the investigations into how cellular mediators and growth factors may enhance healing. Hypothesizing that an external, non-invasive intervention could impact cellular activity, basic science studies were conducted on Astym treatment to elucidate physiologically relevant mechanisms, and to develop specific treatment protocols aimed at stimulating the regeneration of soft tissues and the resorption of inappropriate scar tissue/fibrosis. In vivo studies revealed that the Astym protocols improved tendon repair, increased limb function, and normalized movement patterns in rats. Further, Astym treatment resulted in a significant increase in both fibroblast activation and fibroblast number, as well as the production of fibronectin, which together with interstitial collagens interact to form an important component of the extracellular matrix. Following the basic science investigations, clinical investigation and study was performed to optimize protocols and results, and to confirm effectiveness. Recently, a large, randomized clinical trial on tendinopathy of the lateral elbow documenting the effectiveness of Astym treatment was presented at the American Society for Surgery of the Hand, and has been submitted to MSSE for publication. In addition to controlled clinical trials, the real world effectiveness of Astym treatment can be seen in outcomes submitted by independent clinicians from across the country in a variety of clinical settings. If you would like to review these outcome reports, see a listing of published research, or read a series of patient stories about their success with Astym treatment, you can go to www.astym.com.

Astym treatment is very different than the IASTM approaches (Graston, etc.). IASTM is often described as tooled cross friction massage. Generally speaking, IASTM is largely unresearched and varies widely in application and results, but its main focus is always the direct, mechanical breaking up of tissue. IASTM also has a significant side effect profile. While in certain situations IASTM can have some effectiveness, it is often unpredictable depending on the practitioner or the patient. The primary practitioners of IASTM are chiropractors, athletic trainers and massage therapists, however, there are some therapists who provide it too. The references to IASTM are usually contained in the chiropractic publications or magazines.

Astym’s methods, goals, application and indications are quite different than the IASTMs. Being focused on regeneration rather than on the mechanical breaking apart of tissue, Astym therapy is safer, more effective and treats a much broader range of conditions.

There is very little research on IASTM, and what is available is almost exclusively in chiropractic publications. The limited research on IASTM does not support its effectiveness. The chiropractic publications refer to IASTM as Cyriax or cross friction massage with tools. In a pilot study where the same clinician used IASTM Graston tools to deliver treatment to one group and then performed the same treatment on another group with only the clinician’s hands, it was found that using tools did not improve clinical results, suggesting that manual therapy with IASTM tools is no more effective than manual therapy with hands alone. In a larger study where IASTM was added to a dynamic balance training program for chronic ankle instability, it was shown that the addition of IASTM did not improve treatment results of subjects, suggesting that IASTM/Graston has no positive effect when added to a rehabilitation program. In another study of 30 subjects with lateral elbow tendinopathy, IASTM was compared to no treatment, and it was found that IASTM results were comparable to no treatment being provided.

 

[Moon08]

I am the medical director of the Astym program, and I have been involved with medical/rehabilitation research throughout my career. Astym treatment was researched and developed over a period of years by a team including medical doctors, therapists, scientists and other medical professionals. Research on Astym treatment began with a multi-disciplinary research team theorizing about a potential physical treatment method that could have the ability to regenerate and remodel soft tissues. These theories were built upon emerging evidence regarding the degenerative nature of tendinopathy, and the investigations into how cellular mediators and growth factors may enhance healing. Hypothesizing that an external, non-invasive intervention could impact cellular activity, basic science studies were conducted on Astym treatment to elucidate physiologically relevant mechanisms, and to develop specific treatment protocols aimed at stimulating the regeneration of soft tissues and the resorption of inappropriate scar tissue/fibrosis. In vivo studies revealed that the Astym protocols improved tendon repair, increased limb function, and normalized movement patterns in rats. Further, Astym treatment resulted in a significant increase in both fibroblast activation and fibroblast number, as well as the production of fibronectin, which together with interstitial collagens interact to form an important component of the extracellular matrix. Following the basic science investigations, clinical investigation and study was performed to optimize protocols and results, and to confirm effectiveness. Recently, a large, randomized clinical trial on tendinopathy of the lateral elbow documenting the effectiveness of Astym treatment was presented at the American Society for Surgery of the Hand, and has been submitted to MSSE for publication. In addition to controlled clinical trials, the real world effectiveness of Astym treatment can be seen in outcomes submitted by independent clinicians from across the country in a variety of clinical settings. If you would like to review these outcome reports, see a listing of published research, or read a series of patient stories about their success with Astym treatment, you can go to www.astym.com.

Astym treatment is very different than the IASTM approaches (Graston, etc.). IASTM is often described as tooled cross friction massage. Generally speaking, IASTM is largely unresearched and varies widely in application and results, but its main focus is always the direct, mechanical breaking up of tissue. IASTM also has a significant side effect profile. While in certain situations IASTM can have some effectiveness, it is often unpredictable depending on the practitioner or the patient. The primary practitioners of IASTM are chiropractors, athletic trainers and massage therapists, however, there are some therapists who provide it too. The references to IASTM are usually contained in the chiropractic publications or magazines.

Astym’s methods, goals, application and indications are quite different than the IASTMs. Being focused on regeneration rather than on the mechanical breaking apart of tissue, Astym therapy is safer, more effective and treats a much broader range of conditions.

There is very little research on IASTM, and what is available is almost exclusively in chiropractic publications. The limited research on IASTM does not support its effectiveness. The chiropractic publications refer to IASTM as Cyriax or cross friction massage with tools. In a pilot study where the same clinician used IASTM Graston tools to deliver treatment to one group and then performed the same treatment on another group with only the clinician’s hands, it was found that using tools did not improve clinical results, suggesting that manual therapy with IASTM tools is no more effective than manual therapy with hands alone. In a larger study where IASTM was added to a dynamic balance training program for chronic ankle instability, it was shown that the addition of IASTM did not improve treatment results of subjects, suggesting that IASTM/Graston has no positive effect when added to a rehabilitation program. In another study of 30 subjects with lateral elbow tendinopathy, IASTM was compared to no treatment, and it was found that IASTM results were comparable to no treatment being provided.

Have you found that it works compared to other treatment modalities? In what cases have you seen that its most useful?

 

[DPTErudition]

http://www.astym.com/video/default.asp

Please educate me on what specific properties/techniques of Astym make it any different than any other IASTM approach. IASTM as a whole is supposed to help break up scar tissue adhesions and help with the realignment/proliferation of collagen fibers to help rebuild tissue.

Also, by definition, astym falls under the IASTM umbrella.


Also, the research on the astym website is not very strong and didn't include very many specifics.

http://astym.com/Medical/Research

 

[SportsMD]

Astym treatment works well on conditions where degeneration of soft tissues or scar tissue is a component. The standard diagnoses routinely addressed by Astym treatment are all types tendinopathies, with the exception of the flouroquinolone drug induced tendinopathy (which is problematic for many reasons), post-surgical or post-traumatic scar that may be impeding movement or causing pain, and other soft tissue dysfunction from scar or degeneration. A larger listing of diagnoses can be found at astym.com. Astym therapy has been compared to evidence-based eccentric exercise, and deep transverse friction massage/exercise/stretching and was found to be superior in the resolution of tendinopathy, and also found to be effective in the treatment of tendinopathy recalcitrant to those treatments. This is significant in that study findings for successful treatment of recalcitrant tendinopathy are rare (except surgery of course, and that is even a matter of some debate). One study of the regenerative injections techniques performed by physicians (PRP, ABI) showed they have success in the treatment of recalcitrant tendinopathy. If you read any of the patient accounts on the website, you will often see that they had different treatment interventions that failed before finally receiving relief with Astym treatment. I personally believe Astym therapy is more effective because it is stimulating regeneration of tissues, where other treatments may make dysfunctional tissue more mobile, have an analgesic effect, or make supporting tissues stronger. Those other elements can be helpful, but there are limitations and a significant degree of ineffectiveness to deal with.

Recently, Astym protocols were developed for women who have survived breast cancer. The surgery and radiation often leave soft tissues so contracted and dysfunctional, breast cancer survivors can have a significant degree disability. That research is continuing, but the first round of findings were published in Rehabilitation Oncology.

Current research projects include:

• Mid-substance Achilles tendinopathy, multi-center RCT
• Insertional Achilles tendinopathy, RCT
• Outcomes comparison of rehab with and without Astym treatment
• Arthrofibrosis of knee, case series
• Three year case series regarding effect on scar tissue
• Performance enhancement effects of Astym treatment, RCT
• DeQuervain’s tenosynovitis, RCT
• Effect of Astym treatment on muscle performance, RCT
• Shin Spints, case series or pilot RCT
• Neural desensitization from Astym treatment, case series
• Carpal tunnel, RCT
• Plantar fasciopathy, RCT
• Critically appraised topic distinguishing Astym treatment from IASTM
• Normalization of Y-Balance test after Astym treatment

I am having difficulty understanding the comment that Astym by definition is an IASTM (instrument assisted soft tissue mobilization), in that it Astym does not use instruments to perform soft tissue mobilization, but rather utilizes instruments to initiate regenerative responses that were studied on a physiological level. If anyone is truly interested in learning more details about this topic, they can contact the Astym program office ([email protected]), and we can keep a list of names, and if there is sufficient interest, we can hold a webcast going over things in more detail.

 

[DesertPT]

If you read any of the patient accounts on the website, you will often see that they had different treatment interventions that failed before finally receiving relief with __________ treatment.

You could fill in that blank with reflexology, chiropractic adjustment, Asea, magnet therapy, craniosacral therapy, krill oil, or just about anything else. Everyone's own website says this. Anecdotal evidence is, unfortunately, unhelpful.

I'm interested in what Astym does on a molecular level to actually stimulate fibroblast proliferation and protein output. Their are very few things that naturally cause this to occur, and I would like to see some biology behind why pushing on the general area of the body where these cells live would cause them to function beyond the way they do normally.

I'm having a hard time envisioning why it would be significantly more effective than any other manual therapy, or even just a good massage. I understand the "it treats the source of the problem not just the symptoms" buzz-phrase, but that doesn't actually mean anything. I'm not criticizing your approach or your product, but I would be interested in the presentation of actual mechanisms behind the effectiveness of this treatment.

I tend to believe that if something actually worked as miraculously as commercials and websites say is does, everyone would do it. We consume like 5 million metric boatloads of Advil every year in this country because, well, it works. 95% of the time your headache goes away when you take it.

 

[Azimuthal]

I'm just wondering if the name "Astym" actually stands for something...

 

[DPTErudition]

knj27 - I hope he answers the question this time. I don't really feel like he answered mine.

I just realized he didn't actually answer my question because he copied and pasted from the astym website's faq about IASTM.

 

[DesertPT]

I read that is stands for "a stimulation", as in "a stimulation" of the body's natural healing properties, or something like that. Maybe they came up with then after they decided they weren't focused on mobilizing?