More Indications for Instrument/Tool ASTM | Modern Manual Therapy Blog

More Indications for Instrument/Tool ASTM

About 1 year ago, I was treating a patient who had a very bad reaction to an extremely forceful molar extraction.

After 10-20 minutes of using different tools according to the patient, and pulling as hard as he could, the dentist eventually extracted her molar. She had severe ear, TMJ, and facial pain on the left. About 8 visits later, most of her complaints were resolved with the usual postural correction, STM, and TMJ mobilizations.

Sometime later, she had another bad experience with a different dentist causing a severe flareup of her left facial complaints. There was severe tone in her left masseter that I could not release using my normal proximal to distal, slow, layered technique. I tried for about 4 visits with very little change during the visit, and no lasting change between visits.

I normally do not use the EDGE on the facial area, despite being using very little force, it ended up lightly bruising a patient a few years back. She was happy to have relief of her symptoms, but I did not want to cause any facial discoloration. My patient suggested trying the EDGE, and I stated there should be no difference from my hands. I tried anyway....

To my surprise, extremely light application of the dull side second smallest convexity decreased the tone significantly in just 5 minutes. This also made TMJ distractions much easier to perform (plus she wasn't biting me as much - ouch).

I replicated this on many patients since, making sure to control a few things

  • if bilateral tone in the facial area, I would perform hand based release on one side and tool based release on the other
  • the patient was unaware that I switched - attempting to control for expectation
  • if unilateral, I would try hands on techniques one visit, and EDGE based techniques the next, checking for tone differences/ROM, before and after
  • The strokes were using the same slow speed and superficial to deep layering progressing using both my hands and the EDGE
  • no lubrication was used, which made slower stroking with the EDGE easier
In most of these cases, the tone reduced faster and I was able to progress depth easier using the EDGE. Here are the reasons why I think this occurs
  • the body senses contact of another person, skin to skin, and a minor facilitation effect occurs
    • this is the reason why PNF techniques work well for facilitation, as in agonist reversals, etc.
    • in the case of moderate to severe tone, you may be facilitating it just by light touch, thus taking longer to decrease it
  • since the the contact of using an instrument is different (inanimate object vs skin to skin) there is a lack of facilitation, thus decreasing the tone faster with light, slow strokes
I now use the EDGE on almost all TMJ patients to release their masseter and some anterior fibers of the temporalis (the rest is usually behind hair). It works much faster, especially in combination with some light reciprocal inhibition isometric firing of the digastrics. It literally took 5 minutes off of each treatment, allowing me to get to the joint work faster. Thoughts on why this works?


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