Graston vs ASTYM vs Gua Sha vs Massage

[PTAwesome]

In my limited opportunities to do observation work as I attempt to enter PTA school, I've had the luck to see different PTAs use Graston, ASTYM, and manual massage work on their patients. I'd like to know what the major differences between Graston and ASTYM are and I'd also like to know how they compare with Gua Sha and manual massage work as well. Any input, experience, or resources are welcome. Thank you!

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[PTMattI]

Graston and IASTM is easier on the hands, but can be more uncomfortable for the patient. For anyone still doing cross friction massage for tendonopathy, check this out: http://ptpodcast.com/pt-inquest-episode-75-how-a-tendon-is-like-a-doughnut/

 

[MWill002]

More generally, these techniques are called instrument assisted soft tissue mobilization techniques (IASTM). There are many adaptions of IASTM, e.g. Graston Technique, ASTYM, ASTM, STM, ISTM, FAKTR, FAKTR PM, SASTM, FAT etc

They all have their own little variations, however, differences are very small, because they are overlapping each other. E.g. they use movements while stroking, they vary tissue tension during stroking etc. However, all these techniques use many different protocols which can be defined as different subtechniques, e.g. peripheral nerve releaseing, breaking up adhesions, muscle spindle resetting etc. Bottom line is, that look for IASTM, you'll get more results while looking literature.

Copied text from mikept's post's in physiobob forum:
Studies mostly so beneficial effects. One showed no effect. Methodology between studies differs, different instrument assisted techniques were used, results aren't 100% comparable.

• 2 minute treatment and significantly improved ROM, even better than foam rolling (FAT technique):Acute effects of instrument assisted soft tissue mobilization vs. foam rolling on knee and hip range of motion in soccer players. - PubMed - NCBI
• significantly increased ROM (IASTM): Acute effects of instrument assisted soft tissue mobilization for improving posterior shoulder range of motion in collegiate baseball players. - PubMed - NCBI
• increases temperature (graston technique): Comparison of blood flow changes with soft tissue mobilization and massage therapy. - PubMed - NCBI
• decreases pain (gua sha): Randomized controlled pilot study: pain intensity and pressure pain thresholds in patients with neck and low back pain before and after traditional... - PubMed - NCBI
• fourfold increase of microcirculation (gua sha): The effect of Gua Sha treatment on the microcirculation of surface tissue: a pilot study in healthy subjects. - PubMed - NCBI
• some found no effect (graston technique on calf muscles):http://www.ncbi.nlm.nih.gov/pubmed/25347141
• increases tissue perfusion and alters microvascular morphology in the vicinity of healing knee ligaments: http://www.ncbi.nlm.nih.gov/pubmed/24073942
• accelerated ligament healing: http://www.ncbi.nlm.nih.gov/pubmed/19574659

Nowadays, this field includes even more techniques like fascial manipulation, Gua Sha, Cross Friction etc. New IASTM tools are adapted for using many techniques, it's not only one technique.

How to compare these techniques with massage, gua sha?
They are very different, IASTM has very concentrated mechanical pressure and works differently than massage. Gua sha's goal is also different, however, some if it may be similar. It's really hard to compare these techniques, because IASTM-like techniques include so many sub-techniques.

I use many different manual techniques in my practice, also many IASTM techniques. I would say that IASTM has it's unrerplaceable place in therapy, for example thight plantar fascia, releasing peripheral nerves, mobilizing immobile tissue. It's like with every technique, no technique is universal and you always need many techniques to treat patients. IASTM can't be the only technique in your arsenal, still I would say, it is very useful if it is in your arsenal.

Sorry, my answer isn't the best. IASTM is a practical technique, you'll get better picture if you try these techniques, specially if you try these techniques with different conditions. Few IASTM tool manufacturers have manuals, which include many of these techniques, buy their tool and you'll get more clear picture of IASTM.

 

[MWill002]

I googled a bit, this tool comes with manual which includes many techniques:
http://www.physioneers.com/adhesiontool

Google for similar tools, maybe you'll find more which come with a manual.

 

[jesspt]

In my limited opportunities to do observation work as I attempt to enter PTA school, I've had the luck to see different PTAs use Graston, ASTYM, and manual massage work on their patients. I'd like to know what the major differences between Graston and ASTYM are and I'd also like to know how they compare with Gua Sha and manual massage work as well. Any input, experience, or resources are welcome. Thank you!

There are no studies that I know of which compare ASTYM vs Graston. So, the primary known difference is one set of tools is made of metal, one of plastic. And I'm only being a little sarcastic with that answer.

 

[SportsMD]

I am the Medical Director of the Astym Program, and I am happy to provide some background on these different approaches that may be helpful.

Astym therapy was scientifically developed to engage the regenerative mechanisms of the body. It has multiple randomized clinical trials demonstrating its safety and efficacy, and is highly effective across a wide range of soft tissue injury and disorders.

The IASTMs (Instrument Assisted Soft Tissue Mobilization) are largely unsupported by research, and are based upon the mechanical breaking apart of tissue.

For a full summary of the research and backgrounds on both Astym therapy and IASTM, refer to this Research Overview.

Astym therapy resulted from a massive research project undertaken by a multidisciplinary research team who developed a completely new approach in the treatment of soft tissue dysfunction. Astym certification includes full-time clinical support (including case consultation and education on particular health care conditions), on-going education for advanced and expanded Astym applications for particular patient groups and specific conditions, research updates, clinical review videos, condition specific checklists, indications and contraindications, continuing education in areas the support and complement Astym therapy (functional exercise, anatomy, therapeutic loading strategies, etc.), physician information (primary care, podiatrists, sports medicine, surgeons) patient information, and numerous other clinical resources.

While only clinicians that have attained licensure are eligible for certification in Astym therapy, students are encouraged to explore the evidence base and the potential benefits of Astym therapy. Resources for student projects and in-services are available upon request at [email protected]. In addition, experienced clinicians are available to explain the research and science behind Astym therapy, and answer any questions students may have.

In my limited opportunities to do observation work as I attempt to enter PTA school, I've had the luck to see different PTAs use Graston, ASTYM, and manual massage work on their patients. I'd like to know what the major differences between Graston and ASTYM are and I'd also like to know how they compare with Gua Sha and manual massage work as well. Any input, experience, or resources are welcome. Thank you!

 

[Fiveoboy11]

"Research on astym therapy began from a multi-disciplinary research team theorizing about a potential physical treatment method with the ability to regenerate and remodel soft tissues."

Might want to change that to:
"Research on astym began from a multi-disciplinary research team theorizing about a potential treatment method with the ability to regenerate and remodel soft tissues."

The words physical and therapy in the first sentence, nice, I see what you did there. Indirectly use the good name of my profession and makebelieve astym is some kind of separate and distinct therapy. Oxygen therapy, opioid therapy, physical therapy, astym therapy. They're all therapies, right? Wrong. Of all those physical is the only real and legitimate therapy, the others are passive and do not correspond to a profession.

Also, I would bet astym is most provided by PT's, yet this post makes no mention of who actually does it. I honestly would debate whether any IASTM (astym is a iastm imo) is within the scope of a physician. The argument maybe being, among those that disagree with me, that astym is a distinct and separate intervention, but it isn't. It's mainly done by PT's in conjunction with other components of a POC. Or since physicians can do what they do, they can do anything especially any "therapy." Wrong, physicans are not trained in manual therapy or soft tissue mobilization in order for astym to make sense IMO. Physical therapists and other conservative NMSK providers have been doing soft tissue mobilization for > 100 years.

On a side note I'm not sure what justification astym has for outrageous fees to take classes plus maintenance fees to be "certified" in this "therapy."

Graston is superior IMO. No maintenance fees. No misuse of terms. They admit it's a iastm. They call it what it is, a texhnique. http://www.grastontechnique.com/research

 

[MWill002]

I agree with Fiveoboy11.

 

[SportsMD]

Astym therapy is primarily provided by physical and occupational therapists. That is another difference between IASTMs and Astym therapy; IASTMs are primarily provided by chiropractic physicians, however, the Astym program does not license physicians; Astym therapy was always meant to be a therapeutic intervention.

The use of the term “Astym therapy” helps the referring MDs understand that this is therapeutic intervention, and they must refer their patients to a certified therapist. The term “Astym treatment” can also be used. Astym therapy is often the subject of discussion/presentation at physician meetings (mostly MD and Podiatric meetings), and using the term “Astym therapy” reminds them that they must refer a patient to a therapist for this treatment.

Although Astym treatment was scientifically developed to contain an entire treatment approach for specific conditions, there can be synergies with other treatments, and that is part of the Advanced Training offered by the Astym Program.

 

[PTAwesome]

I really appreciate all of the information and resources presented in this thread and I am fascinated by the discussion going on in this thread right now. It's a lot to take in, but I'm grateful to have somewhere great to start.

 

[Fiveoboy11]

Astym therapy is primarily provided by physical and occupational therapists. That is another difference between IASTMs and Astym therapy; IASTMs are primarily provided by chiropractic physicians, however, the Astym program does not license physicians; Astym therapy was always meant to be a therapeutic intervention.

The use of the term “Astym therapy” helps the referring MDs understand that this is therapeutic intervention, and they must refer their patients to a certified therapist. The term “Astym treatment” can also be used. Astym therapy is often the subject of discussion/presentation at physician meetings (mostly MD and Podiatric meetings), and using the term “Astym therapy” reminds them that they must refer a patient to a therapist for this treatment.

Although Astym treatment was scientifically developed to contain an entire treatment approach for specific conditions, there can be synergies with other treatments, and that is part of the Advanced Training offered by the Astym Program.

That's a really nonsensical and robotic response. I hope many here can see that the ASTYM way of thinking in terms of its status and relationship with physicians and PT's is flawed.

 

[DPTSolid]

Sportsmd, your stance is that of someone trying to differentiate their product.
Unfortunately for you, astym is not distinguishable from iastm and does indeed fall under that umbrella. They are tool meditated manual therapies. Any difference in technique is inherent to the practitioner and their training.
Sportsmd regularly maintains a presence on forums such as these to lobby for his product, but his efforts are largely for marketing purposes.
Id be interested in knowing about any credible differences in atsym compared to iastm. I've not witnessed anyone try to make this argument other than someone financially incentivized to do so. Astym is separate from other iastm systems primarily due to their business model. Unlike most other tool mediated therapies, astym requires a recurring subscription fee be paid in order to continue using their brand. Similar to crossfit. Once trained, you can continue to deliver treatment, but if you want to continue using the name and the tools you have to pay the licensing fee.
Any attempt to differentiate their treatment approach is an attempt to justify this licensing requirement, in my opinion.

Its a bit like saying "thrust technique is superior to manual therapy, and research clearly shows this." HVT is a component of manual therapy. Instead of trying to differentiate, i believe astym should accept its role as one path in a variety of tool mediated approaches.

Additionally, i would propose that any evidence-supported effects attributed specifically to astym would be generizable to the larger field of IASTM, particularly when using a similarly shaped tool and a similar treatment technique.

I believe astym classes teach good tool technique. But when it comes to paying a licensing fee, there is nothing exclusive or proprietary to astym that can't also be attained by non-astym means. And in my practice, i intend to employ the most useful technique while using the most cost effective tool i can put in my hands.