Q&A Time! Is IASTM Safe with Post Op Patients? | Modern Manual Therapy Blog

Q&A Time! Is IASTM Safe with Post Op Patients?

A reader asked me about whether or not it was appropriate to use IASTM with TKA patients. Here are my indications and contraindications.


Indications:

  • "weakness"
    • weakness is in quotes because often, it is a recruitment issue
    • Recently saw a patient s/p DIP amputation from a trauma, he was getting stretched every visit despite having full motion in every single joint in that UE (POPTs)
    • he also was doing the same exercises every visit for 8 weeks, still being stuck at 45# of grip strength
    • after IASTM to the anterior and posterior radial bony contours for 10 minutes, grip strength improved to over 70# - case write-up next week
  • aberrant movement
    • limited motion
    • pain during motion
    • motor control issues
    • working on the tissues surrounding the area that is not moving will often improves the previous three dysfunctions
One of the first things I tell students is the patterns of dysfunction I have found over the years. Regardless of your theories, school of thought, mechanisms, working on tissues in these patterns (one of the topics of my seminars) improves quality of motion despite the condition.

So, how does this relate to any post op condition? It does not matter whether it is TKA, THA, s/p rotator cuff repair, work on the tissue patterns and motion improves. STM and IASTM have less contraindications than joint mobilization because you perform the techniques without moving the joint or placing it in compromising positions if there are post op contraindications to certain motions. 

I often see TKAs for about 10-12 visits at most, just performing light IASTM to the upper and lower leg anteriorly and posteriorly. For HEP, I give them general heel slides if acute, then progressing to mini lunges and squats. Sometimes they are given step ups and bridges. That's it for the most part. They never exercise or push themselves like the inpatient PT does cranking on them, causing pain, fear avoidance, and then most likely decreasing the chance of successful PT in the long term. They regain their motion exercising in the pain free range. IASTM seems to help with recruitment and they can perform their exercises faster. 

This goes for any post op condition, the hard part (repair, etc) is done. Just assess movement, and get them moving better. As long as the tissues are intact, that itself is an indication.


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5 comments:

  1. This is spot on! Why crank on a patient on put them in pain, when gent STM will do the job. Thanks for sharing.

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  2. Another interesting post...although I have a question re: one of your statements:


    "They never exercise or push themselves like the inpatient PT does cranking on them, causing pain, fear avoidance, and then most likely decreasing the chance of successful PT in the long term."


    Being an acute/inpatient PT, I work w/ pts s/p TKA daily. In the acute setting, if their knees are not ranged into flexion, I feel that they will develop significantly limited knee ROM. The first few days post-op tend to be when I can really improve their ROM before they are discharged to SAR/home w/ PT/outpt PT.


    I understand where you are saying that using IASTM can be beneficial in improving ROM s/ "cranking on them," but if the ROM is not aggressively performed in the acute setting, does it not just limit the pt further by the time they are seen in outpt?


    Maybe I am just misreading the point of the statement but curious as to your thoughts further on this.


    On another note...Keep up w/ the great posts!

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  3. I've referenced before that the single best predictor for long term outcomes TKA is fear avoidance. It's fine if you crank on someone and they can tolerate it, for the patients who hate it, guard, you'll just sensitize their CNS, lowering their pain threshold and making them less compliant. If research shows that CPROM machines do not improve outcomes, why should you crank on them? You're better off ranging the more sensitive patients in mid range, the motion will come as long as they keep moving themselves. I just finished a TKA who only had 20-65 starting, and hated the PT "cranking" him to 90 daily. He came as soon as he was d/c-ed and he was done in 8 visits. Just used the program I described above.

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  4. That makes sense to me. I wish I could just tell this to the ortho surgeons!

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  5. Well, they wouldn't listen anyway, do what we should always do... what is best for the patients regardless of what the referral source thinks we should be doing.

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