Journal of Sport Rehabilitation, 2022, 31, 505-510

https://doi.org/10.1123/jsr.2021-0216
TECHNICAL REPORT

Clinician Reliability of One-Handed Instrument-Assisted Soft Tissue

Mobilization Forces During a Simulated Treatment
Shaun Duffy, Nickolai Martonick, Ashley Reeves, Scott W. Cheatham, Craig McGowan,
and Russell T. Baker

Clinicians utilize instrument-assisted soft tissue mobilization (IASTM) to identify and treat myofascial dysfunction or pathology.
Currently, little is known regarding the ability of clinicians to provide similar IASTM forces across treatment sessions. The authors’
purpose was to quantify clinician reliability of force application during a simulated IASTM treatment scenario. Five licensed athletic
trainers with previous IASTM training (mean credential experience = 5.2 [4.3] y; median = 5 y) performed 15 one-handed
unidirectional sweeping strokes with each of the 3 instruments on 2 consecutive days for a total of 90 data points each. The
IASTM stroke application was analyzed for peak normal forces (Fpeak) and mean normal forces (Fmean) by stroke across 2 sessions. The
authors’ findings indicate IASTM trained clinicians demonstrated sufficient Fpeak and Fmean reliability across a treatment range during a
one-handed IASTM treatment. Future research should examine if IASTM applied at different force ranges influences patient outcomes.

Keywords: manual therapy, massage, IASTM

Instrument-assisted soft tissue mobilization (IASTM) is an (eg, weight, beveling, surface, number of treatment edges, etc),
intervention used to provide localized treatment with hand-held training options (eg, training required for instrument purchase,
instruments.1,2 Clinicians apply longitudinal or perpendicular forces instruments marketed to health care professionals or patients, etc),
along myofascial lines or to specific soft tissue structures to manipu- and the approach to instrument application (eg, instrument motion,
late soft tissue.1–4 The use of IASTM has been reported to promote speed of stroke, stroke force, patient positioning, etc). For example,
healing,4,5 improve patient outcomes,1,5 and increase range of the Graston Technique® offers multiple training programs, has
motion.3 Clinicians have also indicated a preference for utilizing specific protocols (eg, examination, warm-up, IASTM treatment,
instruments rather than their hands when applying soft tissue mobi- stretching, strengthening, ice) guiding IASTM application, and is
lization.5,6 This preference may be related to perceptions that instru- designed to be applied by trained medical professionals.11,12 Other
ments enhance soft tissue anomaly detection5,6 or allow application IASTM companies, however, may not promote specific IASTM
of more targeted forces5–8 to increase fibroblast recruitment, stimulate protocols or require any training prior to instrument purchase or
collagen repair, and promote connective tissue remodeling.9–11 utilization. Potential differences in IASTM training, instrument
Numerous companies, such as Técnica Gávilan®, Graston application or treatment protocols, and clinician preferences or
Technique®, Edge Mobility System™, and Fascial Abrasion Tech- treatment goals in IASTM application may result in inconsistent
nique™, market instruments, or IASTM training programs for clin- IASTM application in clinical practice and research.5,6,11
icians. While some similarities exist across instruments and IASTM Potential variations (eg, the amount of force used during
training across the companies, variations also exist across instruments IASTM application, etc) may also exist within and between
clinicians irrespective of training and little is known regarding
the optimal IASTM treatment application (eg, stroke type, stroke
force utilized, stroke speed, treatment length, patient positioning,
© 2022 The Authors. Published by Human Kinetics, Inc. This is an Open Access etc) to maximize treatment effectiveness.5,6,13 Some researchers
article distributed under the terms of the Creative Commons Attribution-NonCom- have described the directionality of the IASTM treatment but not
mercial-NoDerivatives 4.0 International License, CC BY-NC-ND 4.0, which the actual force application.1,14,15 Others have reported an esti-
permits the copy and redistribution in any medium or format, provided it is not mated force (∼208 g or 2.04 N) based on the weight of the tool
used for commercial purposes, no modifications are made, appropriate credit is used.13 Research with instrumented tools is limited; however,
given, and a link to the license is provided. See http://creativecommons.org/licenses/ available data provide a wide range of treatment forces for peak
by-nc-nd/4.0. This license does not cover any third-party material that may appear force (495.58–924.88 g and 4.68–9.07 N) and mean force (268.19–
with permission in the article. For commercial use, permission should be requested
455.81 g and 2.63–4.47 N) during IASTM application by a single
from Human Kinetics, Inc., through the Copyright Clearance Center (http://www.
copyright.com).
clinician.16 Forces may also vary across target tissue, treatment
sessions, or instruments. Researchers17 recently reported that
Duffy, Martonick, and Baker are with the WWAMI Medical Education Program, trained IASTM clinicians produced an average peak force of
University of Idaho, Moscow, ID, USA. Martonick, Reeves, and Baker are with the
6.7 N (683.21 g) and average mean force of 4.5 N (458.87 g)
Department of Movement Sciences, University of Idaho, Moscow, ID, USA.
Cheatham is with the Division of Kinesiology, California State University Dom-
during a simulated treatment of calf tightness using a force plate.
inguez Hills, Carson, CA, USA. McGowan is with the Department of Integrative However, wide ranges in average peak force (265.13–1427.60 g
Anatomical Sciences and Keck School of Medicine, University of Southern and 2.6–14.0 N) and average mean force (163.15–1019.73 and
California, Los Angeles, CA, USA. Baker ([email protected]) is corresponding 1.6–10.0 N) were also found across clinicians, and the reliability of
author. these forces was not established across instruments or treatment
505
Unauthenticated | Downloaded 01/26/24 04:03 AM UTC
506 Duffy et al

sessions.17 Variations in the amount, duration, or reliability of the the testing protocol on each day. Following the familiarization periods,
applied forces within or between clinicians or across instruments the same standardized treatment scenario was provided to participants
might help explain inconsistent outcomes in the IASTM literature.11 before each treatment session. Participants were asked to reproduce
Failure to establish clinician ability to replicate similar forces their clinical practice for the standardized treatment scenario with each
across treatment sessions limits our ability to examine IASTM instrument using one-handed unidirectional sweeping strokes.
effectiveness in clinical and laboratory settings. In addition, pro- Participants were instructed to lift the instrument off the
viding insight into the ability of trained IASTM clinicians to simulant between strokes to allow researchers to identify individual
produce similar forces across treatment sessions can help inform strokes during the testing protocol. Clinicians performed 5 one-
future research studies. Therefore, the purpose of this study was to handed, sweeping strokes on the skin simulant with each instru-
investigate the reliability of the average forces and the average peak ment in a randomized order. The testing protocol was repeated 3
forces applied by clinicians during a simulated IASTM treatment. times for a total of 15 strokes per instrument on each testing day; a
total of 45 treatment strokes were completed each day. Across the 2
sessions, a total of 90 treatment strokes were recorded (30 treatment
Methods strokes per instrument).

Study Design Data Analysis

The University of Idaho Institutional Review Board approved the Descriptive statistics and coefficients of variation (CVs) were cal-
study. The investigation was conducted as a randomized crossover culated in Excel 16.3 (Microsoft®, 2019, Redmond, WA) for Fpeak
study in a university biomechanics laboratory and utilized 3 different and Fmean (Table 1). Average peak forces (Fpeak) were calculated as
IASTM instruments: (1) Técnica Gavilán® (Técnica Gavilán, Tracy, the sum of maximum vertical forces for each stroke divided by the
CA) Ala, mass: 196 g; (2) Fascial Abrasion Technique™ (Fit Institute, number of trials. Average mean forces (Fmean) were defined as the
Niagara Falls, ON) FAT Stick, mass: 293 g; and (3) RockBlades® average of the vertical forces produced across the entire length of a
(RockTape, Durham, NC) Mullet, mass: 178 g. The average force single stroke and divided by the number of trials. Coefficients of
(ie, the average force perpendicular to the treatment plane from the variation (CV = [SD/mean] × 100) were calculated across both days
beginning to end of a single stroke; Fmean) and the average peak force for individual instruments and for the total strokes across all instru-
(ie, the peak force plate reading during a single stroke; Fpeak) were ments for Fpeak and Fmean; CVs ≤ 30% were considered low and
recorded (in Newtons) for each IASTM stroke applied during the indicative of data homogeneity.18 Box and whisker plots were
treatment scenario. Informed consent was provided by participants created to compare Fmean and Fpeak between days.
prior to study participation. Bland–Altman (BA) plots (Figure 1) were created for each
clinician to determine agreement between the peak and mean forces
Participants applied on days 1 and 2. The BA plots were created with R (version
3.6.2; The R Foundation for Statistical Computing Platform, 2019,
A convenience sample of 5 licensed athletic trainers who were a https://www.r-project.org/about.html) and the BlandAltmanLeh
subset of a previous study17 was utilized for this study. Participants (version 0.3.1) package. The BA plots were created with data points
were included if they had previously completed at least one from all instruments and are presented with mean differences, 95%
professional IASTM training course (Técnica Gávilan® = 5 and limits of agreement, and the precision of those limits (eg, 95%
RockBlades® = 1). Credentialed experience among participants confidence intervals). We also calculated these values using the BA
ranged from 1 to 12 years (mean = 5.2 [4.3] y; median = 5 y), analysis for each instrument (Table 1).
while current use of IASTM in clinical practice also varied (never =
1, rarely = 2, and frequently = 2).
Results
Instrumentation Participants produced average Fpeak ranging from 2.9 to 7.9 N
Forces were applied to a skin simulant (Complex Tissue Model; (∼296–806 g) and average Fmean from 1.9 to 5.6 N (∼194−571 g;
Simulab Corporation©, Seattle, WA) of a 1-in thickness designed to Table 1; Figures 2 and 3). The highest Fmean (6.9 N) occurred with
replicate skin, subcutaneous fat, fascia, and preperitoneal fat. The skin the RB instrument (clinician E), while the lowest Fmean (1.7 N)
simulant was attached to a force plate (HE6×6; AMTI©, Watertown, occurred with the TG instrument (clinician B).The highest Fpeak
MA). Raw data were obtained with the force plate set to record at (8.8 N) occurred with the RB instrument (clinician E), while the
500 Hz and recorded with NetForce software (version 3.5.3; AMTI, lowest Fpeak (2.6 N) occurred with the FAT and TG instruments
Watertown, MA); the force plate was zeroed between each instrument (clinician A and clinician B, respectively). The SDs were all <2 N
and participant. Force plate data were exported into MATLAB for average Fpeak and 1.2 N for average Fmean. The CVs for Fpeak
(version 2019b; MathWorks, Natick, MS) and were filtered with a and Fmean were lowest for all participants when the TG instrument
10-Hz low-pass Butterworth filter. The plotted data were used to was utilized; average CVs across all instruments and participants
visually determine the start and finish of each instrument stroke. ranged from 17 to 37 for average Fpeak and 16 to 32 for average
Fmean (Table 1). Box plots indicated the Fpeak and Fmean values
Procedures tended to overlap from days 1 to 2 suggesting similar force
application across days (Figures 2 and 3). The BA analyses suggest
Data were collected at 2 time points on 2 consecutive days in a participants demonstrated agreement for force application across
university biomechanics lab; participants reported for the second days. When examining forces across all clinicians and instruments,
session approximately 24 hours after the first session. Participants 97% of the data points were within the limits of agreement
completed a familiarization protocol (ie, practiced 5 one-handed (Figure 1). The limits of agreement were widest for Fpeak of
strokes with each instrument on the skin simulant) before beginning clinician D and narrowest for Fmean of clinician B. The highest
JSR Vol. 31, No. 4, 2022
Unauthenticated | Downloaded 01/26/24 04:03 AM UTC
 IASTM Reliability 507

Table 1 Peak Force Equals the Peak Force From Each Stroke From All Instruments Across Both Days and Mean
Force Equals the Average Force From Each Stroke From All Instruments Across Both Days
Peak forces, N Mean forces, N
Mean CV Mean Lower Upper Mean CV Mean Lower Upper
Clinician Instrument force (SD) % diff. limit ± CI limit ± CI force (SD) % diff. limit ± CI limit ± CI
A RockBlade 5.4 (1.0) 19 −1.2 −3.4 ± 1.0 0.9 ± 1.0 3.9 (0.8) 20 −0.9 −2.8 ± 0.9 0.8 ± 0.9
FAT 2.6 (0.9) 33 −0.2 −1.7 ± 0.8 1.4 ± 0.8 2.4 (0.8) 34 −0.2 −2.1 ± 0.9 1.6 ± 0.9
Gavilan 4.3 (0.7) 17 −1.2 −2.2 ± 0.5 −0.2 ± 0.5 3.2 (0.6) 19 −1.01 −1.7 ± 0.4 −0.3 ± 0.4
Total 4.1 (1.5) 37 −0.4 −3.3 ± 0.7 2.4 ± 0.7 3.0 (0.9) 31 −1 −2.5 ± 0.4 0.4 ± 0.4
B RockBlade 2.9 (0.6) 19 −0.7 −1.7 ± 0.5 0.3 ± 0.5 1.9 (0.4) 21 −0.5 −1.1 ± 0.3 0.2 ± 0.3
FAT 3.1 (0.6) 18 −0.8 −1.6 ± 0.4 0.1 ± 0.4 1.9 (0.3) 18 −0.4 −1.1 ± 0.3 0.2 ± 0.3
Gavilan 2.6 (0.3) 11 −0.2 −0.8 ± 0.2 0.4 ± 0.2 1.7 (0.2) 11 −0.2 −0.8 ± 0.2 0.3 ± 0.2
Total 2.9 (0.5) 19 −0.6 −1.5 ± 0.2 0.3 ± 0.2 1.9 (0.3) 18 −0.4 −1.0 ± 0.2 0.3 ± 0.2
C RockBlade 8.1 (1.4) 17 0.2 −2.3 ± 1.2 2.5 ± 1.2 5.0 (1.0) 19 0.1 −1.8 ± 0.9 1.9 ± 0.9
FAT 7.0 (1.4) 20 1 −2.8 ± 1.3 3.7 ± 1.3 4.1 (0.8) 19 0.5 −1.0 ± 0.8 2.0 ± 0.8
Gavilan 5.7 (0.8) 15 0.8 −0.7 ± 0.8 2.4 ± 0.8 3.3 (0.4) 13 0.1 −0.7 ± 0.5 1.0 ± 0.5
Total 7.0 (1.6) 23 0.7 −1.6 ± 0.6 3.0 ± 0.6 4.2 (1.0) 24 0.2 −1.2 ± 0.4 1.7 ± 0.4
D RockBlade 4.2 (1.1) 27 −1.6 −3.6 ± 0.9 0.4 ± 0.9 4.0 (0.8) 31 −1.1 −2.4 ± 0.6 0.1 ± 0.6
FAT 7.2 (1.6) 22 2.1 0.8 ± 0.7 3.5 ± 0.7 4.2 (1.0) 24 1.3 0.2 ± 0.6 2.5 ± 0.6
Gavilan 6.6 (1.0) 15 −0.7 −2.1 ± 0.6 0.7 ± 0.6 3.8 (0.7) 19 −0.5 −1.5 ± 0.5 0.5 ± 0.5
Total 5.9 (1.8) 30 −0.1 −3.6 ± 0.9 3.5 ± 0.9 3.5 (1.1) 32 −0.1 −2.5 ± 0.5 2.3 ± 0.6
E RockBlade 8.8 (1.5) 17 0.9 −1.0 ± 1.0 3.0 ± 1.0 6.9 (0.9) 17 0.4 −0.9 ± 0.7 1.7 ± 0.7
FAT 8.1 (0.8) 10 −0.4 −1.8 ± 0.7 1.0 ± 0.7 5.9 (0.7) 12 −0.2 −1.2 ± 0.5 0.8 ± 0.5
Gavilan 6.9 (0.7) 10 0.1 −1.6 ± 0.8 1.8 ± 0.8 5.0 (0.6) 12 0.1 −1.5 ± 0.8 1.7 ± 0.8
Total 7.9 (1.3) 17 0.2 −2.3 ± 0.6 2.3 ± 0.6 5.6 (0.9) 16 0.1 −1.3 ± 0.4 1.5 ± 0.4
Abbreviations: CI, confidence interval; CV, coefficient of variation; FAT, Fascial Abrasion Technique™. Note: The CVs were calculated as (SD/avg.) × 100. Values from
the Bland–Altman analysis (mean differences, limits of agreement, and 95% CIs for the limits) are also presented.

value for mean differences was displayed by clinician D (2.1 N) for that instruments can be applied during exercise. Our findings are
Fpeak with the FAT instrument; however, mean differences of 1 N interesting because all participants in this study completed TG
or less for the total strokes from all instruments were found for all training and produced lower force levels and less variation with the
participants. TG instrument. However, it is also possible that this is the result of
other factors, such as the type of instrument utilized, instrument
Discussion weight, instrument beveling, and feedback, different levels of
We investigated the reliability of the Fmean and Fpeak applied by experience with different instruments, or different levels of resis-
clinicians during a simulated IASTM treatment. The CVs, box and tance (eg, different instrument surfaces) between instruments and
whisker plots, and BA plots provide insight into the consistency of the skin simulant. The lack of formal training in another IASTM
force application during IASTM. The summary of evidence indi- technique (eg, Fascial Abrasion Technique™, etc) or the type of
cates clinicians who have at least completed some formal IASTM stroke being utilized may also influence these results.
training (ie, Técnica Gávilan®) are likely providing consistent forces Prior reports have indicated that clinicians may not consider or
within a therapeutic range from treatment session to treatment be able to calculate the amount of force being applied during
session (eg, Fmean SD was ∼1 N or less across all instruments IASTM.5,6 Clinicians may also not accurately predict the amount
and clinicians) whether they do (ie, Técnica Gávilan® Ala) or do not of force being produced during IASTM,17 and optimal force appli-
(Fascial Abrasion Technique™ FAT Stick or RockBlades® Mullet) cation for IASTM has not been established across pathologies or
have training using that specific instrument. Our participants had the treatment locations.11 Our results, however, inform the efforts in this
lowest SD and CVs when using the TG instrument, and typically area by providing evidence that IASTM trained clinicians still
produced lower Fpeak and Fmean values when utilizing the TG provide consistent Fpeak and Fmean within a therapeutic range across
instrument compared with the RB and FAT instruments (Table 1). treatment sessions despite these limitations. Our Fpeak (2.9–7.9 N;
Researchers5,6 have recently tried to gain insight into IASTM ∼296–806 g) and Fmean (1.9–5.6 N; ∼194–571 g) across all parti-
utilization by surveying clinicians. The majority (∼80%) of re- cipants were also similar to reports by Vardiman et al16 (4.68–
spondents in one survey5 indicated they either do not know how to 9.07 N, 495.58–924.88 g and 2.63–4.47 N, 268.19–455.81 g for
or do not try to quantify force during IASTM; it has also been Fpeak and Fmean, respectively). Thus, it is likely that IASTM trained
reported that clinicians may willfully deviate from recommenda- clinicians are treating within these ranges when applying IASTM to
tions taught in IASTM training courses.5,6 Our results provide the posterior leg, and future research should examine difference in
some insight into these phenomena. The TG training program outcomes when IASTM is applied at the lower or higher ends of
includes recommendations that lower force loads are needed and these ranges to determine differences in therapeutic effects.
JSR Vol. 31, No. 4, 2022
Unauthenticated | Downloaded 01/26/24 04:03 AM UTC
Figure 1 — Bland–Altman plots for peak forces (in Newtons) and mean forces (in Newtons). Peak force equals the peak force from each stroke. Mean
force equals the average force from each stroke. Each data point indicates the proximity to zero of a given difference (calculated as the first measurement
minus the second) plotted against the average value of the 2 measurements. Rows are labeled by clinician.

508 JSR Vol. 31, No. 4, 2022

Unauthenticated | Downloaded 01/26/24 04:03 AM UTC
 IASTM Reliability 509

Conclusion
Our findings indicate IASTM trained clinicians demonstrated
sufficient Fpeak and Fmean reliability with applied forces within a
narrow treatment range during a one-handed IASTM treatment.
Our participants produced forces that were similar to but not quite
as high as prior reported forces in human trials; however, the forces
utilized were substantially higher than those used in animal models.
Further research is needed to determine if the variation in forces
within clinical sessions affects clinical outcomes, as well as how
variations in force ranges (eg, 2–4 N vs 6–8 N) between clinicians
influence patient outcomes.

References
Figure 2 — Box and whisker plots for Fpeak across all instruments for
each clinician. 1. Baker RT, Nasypany A, Seegmiller JG, Baker JG. Instrument-as-
sisted soft tissue mobilization treatment for tissue extensibility dys-
function. Int J Athl Ther Train. 2013;18(5):16–21. doi:10.1123/ijatt.
18.5.16
2. Fousekis K, Eid K, Tafa E, et al. Can the application of the Ergon®
IASTM treatment on remote parts of the superficial back myofascial
line be equally effective with the local application for the improve-
ment of the hamstrings’ flexibility? A randomized control study. J
Phys Ther Sci. 2019;31(7):508–511. PubMed ID: 31417211 doi:10.
1589/jpts.31.508
3. Gunn LJ, Stewart JC, Morgan B, et al. Instrument-assisted soft
tissue mobilization and proprioceptive neuromuscular facilitation
techniques improve hamstring flexibility better than static stretch-
ing alone: a randomized clinical trial. J Man Manip Ther. 2018;
27(1):15–23. PubMed ID: 30692839 doi:10.1080/10669817.2018.
1475693
4. Loghmani MT, Warden SJ. Instrument-assisted cross fiber massage
increases tissue perfusion and alters microvascular morphology in the
vicinity of healing knee ligaments. BMC Complement Altern Med.
2013;13(1):240. doi:10.1186/1472-6882-13-240
Figure 3 — Box and whisker plots for Fmean across all instruments for 5. Cheatham SW, Baker RT, Larkins LW, Baker JG, Casanova M.
each clinician. Instrument assisted soft-tissue mobilization: a survey of practice
patterns among allied health professionals. J Athl Train. 2021;
56(10):1100–1111. doi:10.4085/1062-6050-0047.20
6. Baker R, Start A, Larkins L, Burton D, May J. Exploring the prepara-
Our study is not without limitations. Our sample was relatively tion, perceptions, and clinical profile of athletic trainers who use
instrument-assisted soft tissue mobilization. Athl Train Sports Health
small and only included clinicians with similar professional
Care. 2018;10(4):169–180. doi:10.3928/19425864-20180201-02
IASTM training course backgrounds, and only a limited number
7. Hammer W. The effect of mechanical load on degenerated soft tissue.
of instruments and treatment strokes were utilized. For example,
J Bodyw Mov Ther. 2008;12(3):246–256. PubMed ID: 19083680
utilization of a different instrument (eg, FAT-Tool Pro Large,
doi:10.1016/j.jbmt.2008.03.007
Técnica Gavilán® Garra, RockBlades® Mallet, etc) or a different 8. McMurray J, Landis S, Lininger K, Baker R, Nasypany A, Seegmiller
treatment stroke taught in an IASTM course could influence force J. A comparison and review of indirect myofascial release therapy,
production and reliability. The results may also be influenced by instrument-assisted soft tissue mobilization, and active release tech-
having the clinicians treat a simulated tissue that lacked myofascial niques to inform clinical decision making. Int J Athl Ther Train.
adhesions. Furthermore, our study protocol (eg, standardized treat- 2015;20(5):29–34. doi:10.1123/ijatt.2015-0009
ment table height, skin simulant, unidirectional stroke, patient 9. Melham TJ, Sevier TL, Malnofski MJ, Wilson JK, Helfst RH.
positioning) may not fully replicate patient care, the forces utilized Chronic ankle pain and fibrosis successfully treated with a new
across a complete IASTM intervention session, or the reliability of noninvasive augmented soft tissue mobilization technique
those forces across a more diverse clinician group who have (ASTM): a case report. Med Sci Sports Exerc. 1998;30(6):801–
completed other forms of IASTM training. Future research is 804. doi:10.1097/00005768-199806000-00004
needed to elucidate how different IASTM instruments, trainings, 10. Davidson CJ, Ganion LR, Gehlsen GM, Verhoestra B, Roepke JE,
or clinical experience may affect force reliability. Future research is Sevier TL. Rat tendon morphologic and functional changes resulting
needed to determine if and how clinician-applied forces change from soft tissue mobilization. Med Sci Sports Exerc. 1997;29(3):313–
based on treatment goals, the instrument being used, and the tissue 319. PubMed ID: 9139169 doi:10.1097/00005768-199703000-
being treated. 00005

JSR Vol. 31, No. 4, 2022

Unauthenticated | Downloaded 01/26/24 04:03 AM UTC
510 Duffy et al

11. Cheatham SW, Lee M, Cain M, Baker R. The efficacy of 15. Laudner K, Compton BD, McLoda TA, Walters CM. Acute effects of
instrument assisted soft tissue mobilization: a systematic review. instrument assisted soft tissue mobilization for improving posterior
J Can Chiropr Assoc. 2016;60(3):200–211. PubMed ID: shoulder range of motion in collegiate baseball players. Int J Sports
27713575 Phys Ther. 2014;9(1):1–7. PubMed ID: 24567849 doi:10.1016/j.
12. Graston Resources: Frequently Asked Questions. Graston Technique jbmt.2015.04.010
Website. 2016. https://grastontechnique.com/Clinicians/Resources/. 16. Vardiman J, Siedlik J, Herda T, et al. Instrument-assisted soft tissue
Accessed April 1, 2021. mobilization: effects on the properties of human plantar flexors. Int J
13. Cheatham S, Kreiswirth E, Baker R. Does a light pressure instrument Sports Med. 2015;36(3):197–203. PubMed ID: 25347141 doi:10.
assisted soft tissue mobilization technique modulate tactile discrimi- 1055/s-0034-1384543
nation and perceived pain in healthy individuals with DOMS? J Can 17. Martonick NJP, Reeves AJ, Whitlock JA, et al. Instrument-assisted
Chiropr Assoc. 2019;63(19):18–25. soft tissue mobilization forces applied by trained clinicians during a
14. Markovic G. Acute effects of instrument assisted soft tissue mobili- simulated treatment. J Sport Rehabil. 2022;31(1):120–124. doi:10.
zation vs. foam rolling on knee and hip range of motion in soccer 1123/jsr.2020-0247
players. J Bodyw Mov Ther. 2015;19(4):690–696. PubMed ID: 18. Favero LP, Belfiore P. Data Science for Business and Decision
26592226 doi:10.1016/j.jbmt.2015.04.010 Making. San Diego, CA: Academic Press; 2018:60–61.

JSR Vol. 31, No. 4, 2022

Unauthenticated | Downloaded 01/26/24 04:03 AM UTC