Here is the email:
"My question is how do you use the edge tool when you are dealing with scar tissue say for a post op ankle fracture that has been immobilized and you are first getting to see them 8 to 9 weeks post op. I understand you promoting lighter pressure using the edge tool and working to change tone. But what about the situation where there is scar tissue restricting motion. Can you comment on using IASTM for these type of situations."
This is a good question in light of how I am teaching soft tissue manipulation. It all comes back down to the simplified classification system about rapid and slow responders. You are either going to make rapid changes in ROM, function, pain, strength, DTRs, etc.. or slow changes. Anyone who has been immobilized for 6-8 weeks normally falls into the slow responder category.
Slow responder review
- multidirectional loss of motion
- does not respond well to repeated end range loading, often painful
- use mid range motions, but moving often for HEP
- requires true tissue deformation - which is why it cannot be done (without damage) rapidly
- your goal is to facilitate threat free movement
IASTM is still useful, but may be daunting for someone who just had a boot or cast removed. I still use the EDGE very lightly, despite the need for soft tissue changes, this is not something you are going to change rapidly. The best you can hope to do is create a more comfortable and less threatening environment for movement by using IASTM around all adjacent areas if there is an incision. I stopped doing "scar massage" years ago, as it is often very hypersensitive even years after surgery. Getting the first layer of skin moving on the superficial fascia with light skin mobilization works very well. I also use RockTape "finger" patterns for edema control which works very well.
I use the EDGE very lightly, 1-2 minutes in broad patterns anteriorly, posteriorly, medially and laterally around the area. If they are unable to tolerated this, I use a mirror box and treat the contralateral side, placing the involved side in the box. Treat the contralateral side with both IASTM and joint mobilizations. For HEP, I instruct them on the use of light skin mobilization circumferentially, often with an EDGE Mobility Band. I then have them move with the band passively and joint actively in all directions lightly to mid range for a few minutes several times/day as tolerated.
Using variations on the above method, adding neurodynamics, mobilizations with movements, or anything else that promotes pain free movement will help recovery speed along. I last saw a patient with a fractured fibula a few months ago, and I'll write-up his case for Wednesday's Blog. Hope this helps! Just because someone has a significant multidirectional loss of motion, doesn't give you the right to go to town on their tissues with either a hand or a tool!