S.A.S.T.M. - Sound Assisted Soft Tissue Mobilization

Sound-assisted soft-tissue mobilization (SASTM) instruments and technique appear to be next generation in soft-tissue rehabilitation. Instruments effectively break down fascial restrictions and scar tissue. The ergonomic design of these instruments provides the clinician with the ability to locate restrictions through sound waves like a stethoscope and allows the clinician to treat the affected area with the appropriate amount of pressure, due to square surface concept.

The introduction of controlled microtrauma to affected soft tissue structure causes the stimulation of a local inflammatory response. Microtrauma initiates reabsorption of inappropriate fibrosis or excessive scar tissue and facilitates a cascade of healing activities resulting in remodeling of affected soft tissue structures. Adhesions within the soft tissue which may have developed as a result of surgery, immobilization, repeated strain or other mechanisms, are broken down allowing full functional restoration to occur.

The tools were developed by David Graston. Graston is the creative force behind three of the contemporary instrument-assisted soft-tissue techniques currently on the market: augmented soft-tissue mobilization, (ASTYM), fashioned by Thomas L Sevier, MD, after a long collaboration with Graston; The Graston Technique; and SASTM. Graston and André Hall developed much of the methodology and technique used to identify and treat soft-tissue lesions. Essentially, each set of instruments is an amalgamation of the other, and all are derivatives of Graston's expertise and experience.

SASTM differs from its predecessors in three significant ways: instrument construct, instrument configuration, and instrument application. As a customized "structural ceramic," this material is known for its unmatched tensile strength, malleability and reverberation. Instrument configuration and application have changed, too. The rigidity of steel now yields to the flexibility of polymer. Convex and concave instruments designed to sweep around and treat amid anatomical prominences are replaced with blunt treatment edges specific to lesion size. Treatment edges decrease in size, as fibrotic lesions are isolated, treated and released. Pressure once disbursed along the entire instrument surface now is focused on and transmitted directly to the isolated lesion. This allows the practitioner to be extremely specific in fibrotic mapping, manipulation, mobilization and remodeling of fibrotic tissues.

Grounded in the gua sha technique (pronounced gwa shar) in Chinese medicine a long cross-fiber form of instruments are used. Graston suffered a ligament injury of his knee in an water skiing accident. After reconstructive surgery and a long rehabilitation program, he was able to regain strength, but not range of motion. The therapist showed him how to perform cross-friction massage on the surgical scar (with his thumbs), which he found beneficial.

Graston became "obsessed" with restoring motion to his knee and performed the cross-fiber massage continuously. Shortly thereafter, he was diagnosed with and surgercised for carpal tunnel syndrome. Thus began the construct and evolution of instrument and technique.

Steeped in need and fashioned from wood, Graston's first instrument design was a roller that restored a modicum of motion to the surgical site, but did not allow deep penetration into the soft tissues. Wood transitioned to aluminum, an affordable medium that provided penetrative abilities not found in the wood. However, bony prominences were still difficult to navigate around with the aluminum.

Through trial and error, instrument form followed function and the next generation of instruments was cast, first in aluminum and later in steel. Says Graston: "The steel instruments are great, they resonate beautifully, but the very material that allowed for reverberation increasingly became the origin of a grip problem. The cream used as a barrier between the instrument and the patient causes the steel to become slippery.

Another byproduct of the instrument size and configuration is the unnecessary bruising of healthy tissue. SASTM treatment instruments are navigated by the shaft and held by "ridges" which prevent slippage while transferring vibrations from the treatment surface up the shaft and into the fingers. Instruments are designed around surface area; they are lesion specific and limit the intrinsic damage to surrounding healthy tissue.

Dr. John Toth, DC, of River Park South Chiropractic Center has been utilizing the SASTM technique for several years and is a registered provider in the SASTM network. For more information regarding this specific soft tissue therapy or for consultation to determine if it could be effective in the treatment of your condition, please call (204) 253-6995.