The effects of an Instrument-Assisted Soft Tissue Mobilization (IASTM) protocol to improve shoulder range of motion for post-operative rotator cuff repair and debridement: a case report
Abstract Background and Purpose: It has been suggested that the use of Instrument-Assisted Soft Tissue Mobilization (IASTM) can be utilized to remove scar tissue, improve blood flow, promote tissue healing, and increase range of motion (ROM). Improvements in ROM from the administration of IASTM were stated to be from the results of removing tissue adhesions and increasing muscle extensibility. However, there is a lack of literature examining the effects of IASTM on patients with a post-surgical status. The purpose of this case report is to evaluate the effects of IASTM on shoulder ROM in a patient with a post-operative rotator cuff repair and debridement. Case Description: IASTM was initiated on the 14th therapy session for a duration of eight weeks due continuously limited ROM, pain, diminished strength, and decreased left shoulder function. A protocol involving a warm up, IASTM, manual therapy, stretching, strengthening, and cryotherapy were initiated in that order to combat the deficits. Manual muscle testing (MMT), ROM measured by goniometry, Numeric Pain Rating Scale (NPRS), and the Upper Extremity Functional Index (UEFI) were collected prior to the IASTM protocol, on the 14th, 17th, 20th, and 23rd treatment session to asses for improvements in shoulder function. Outcomes: The patient reported and demonstrated improvements in all objective measures at the end of an eight week treatment. NPRS improved from 3/10 to 0/10. Shoulder flexion (flex) MMT from 3-/5 to 4-/5, shoulder abduction (abd) from 3-/5 to 4-/5, shoulder internal rotation (IR) from 3+/5 to 4+/5, shoulder external rotation (ER) from 3-/5 to 4-/5, and shoulder extension (ext) of 4+/5 to 5/5. Active shoulder flex increased from 109 degrees to 135 degrees, shoulder abd from 60 degrees to 102 degrees, IR from 38 degrees to 75 degrees, and ER from 20 degrees to 44 degrees. The UEFI raised a total of 13 points from 57/80 to 70/80 at the end of the protocol. Discussion: The IASTM protocol as an intervention to increase shoulder mobility has already been demonstrated in other studies. However, the literature lacked evidence to support the use of IASTM for patients with a post-surgical status. The protocol implemented with IASTM may provide beneficial gains for pain, strength, shoulder active range of motion (AROM), and functional use of the shoulder for patients that are restricted in those areas as a result of a post-operative status.
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