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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