IASTM: An Interview with Dr. Vizniak

IASTM Question Answer with Dr. Nik
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In this interview, Dr. Vizniak shares his knowledge and answers some basic and common questions about Instrument Assisted Soft Tissue Mobilization (IASTM) in a way that can benefit both patients and practitioners.

Q:

A lot of massage therapists have come to me because they’ve been overusing their hands trying to help other people heal. I think even physical therapists sometimes get into trouble.

A:

You’re absolutely right. Based on a study back in 2016, physical therapists who do hands-on techniques actually miss work 3-4 times a year due to thumb pain. That thumb pain is significant for anyone. Massage therapists in the US, their typical average life span in practice is only five to seven years, and that’s because you’re wearing out these small joints in the hand. It’s a repetitive strain injury for practitioners.

When it comes to treating the patient, it allows you to be a lot more specific in your treatment of the tissue. A lot of patients will tell you they want deep treatment, and that means a lot of loading on the joints for the practitioner. Really, what they mean is they want specific treatment. Instruments allow you to do that where your hands cannot approach that type of specificity of contact on a patient.

Q:

I noticed that some of the instruments are shaped differently. Can you talk about how that works?

A:

When I first started getting into this, I didn’t even realize what it would mean. Is this even going to work? Is this going to make that much of a difference? It is a game changer. We have the largest collection I’m aware of in the world, over $50,000 worth of instruments from all kinds of different companies. Some of them are over $1,000 an instrument. We sampled all of these, and we developed our own instruments. They’re designed to emulate the shapes of your own hand to facilitate treatment.

Our ProSTM Tristar, one point is literally the shape of my own thumb. Now, instead of me loading in with my thumb, and can load in with this instrument and save myself that repetitive strain injury. Another edge is exactly like a knuckle, and it has a groove edge that is ideal for up and down the spinal laminar groove. When we do our courses and you see the real anatomy, you realize how limited your hands are in comparison to the tools, and what a difference these tools can make in a patient’s outcome.

Q:

How does it actually work? Sometimes, I feel like my physical therapist is flossing my tissues, for lack of a better word.

A:

Yeah, absolutely. It’s not a bad word to use. There’s a bunch of different ways you can look at this. It works by, number one, stimulating your nervous system. What else happens? You also get a reflex hyperemia. This means you get more blood flow in the area, and that is directly related to healing.

We also have a YouTube video, and it’s probably one of the most popular videos on IASTM. If you just go into YouTube and type in ‘Vizniak, What is IASTM’ you should find that video. We show a computer graphic of what it theoretically does, we show a cadaver dissection and we also show it applied on an actual patient. So, through that, you can see some of those applications, and what it actually does. These instruments make a night-and-day difference for the practitioners and the patients.

Q:

As I understand it, you’re clearing up soft tissue scarring?

A:

There’s a big controversy and debate around that. The older information talked about breaking up adhesions and increasing soft tissue flexibility. One of the things you do see in a number of studies is increased range of motion following treatment. Whether that’s due to neurologic stimulation, increased blood flow, or actually physically linking the tissue? Any of those mechanisms are plausible, but the research is still out on what mechanism is actually creating those results.

For most patients, the first treatment ends up being a little more difficult for them to handle as you’re working through the tissue. The second treatment, you can load in a little bit more. By the third treatment, you’re able to work much more deeply and start seeing real results. If you want to understand how well these things actually work, I am a doctor who now treats mostly other therapists. What are they asking for? They’re asking for a detailed assessment, but they’re also asking for IASTM techniques so they can learn themselves to apply them, and to see how quickly they make their body better.

Q:

I was surprised that it doesn’t hurt, at least the experience that I’ve had. I’m not a big believer that painful treatments are useful, I think sometimes they just create more pain. It was not unpleasant, and what surprised me was how much better I felt. I see my physical therapist on an as-needed basis. I do a lot of work on my own to take care of myself. How do people gauge how many treatments they need? Do they need more in the beginning? How does that work?

A:

It all depends on the individual. You need at least one treatment, and then a follow-up treatment to see how you’re going to respond. Everybody responds a little bit differently, and it’s the same for any kind of treatment. They have to be individualized for the patient. Part of this almost exploratory for some people. Some people, you use it at the start, and they feel great. They’re read to go for the second treatment. Some people, you do the first treatment, and they feel like they got hit by a bus, because the treatment had such a profound effect on their body.

So, at least two treatments are required. Also, because the dosing is so much stronger, you may need to give them more time to heal between treatment. If someone is healthy and muscular, say a CrossFit athlete, the treatments will be quite a bit more intense than a geriatric patient. For all of the seminars we teach, you always want to start light and gradually increase to determine what the patient can tolerate.

Q:

It sounds like if you are going to try IASTM, it’s good to give it more than one session so you can adjust the dosage, and not immediately write it off if you do feel it didn’t work well.

A:

Like anything else, you should also sample different practitioners. A lot of the therapies that are showing up on YouTube are very superficial and lack technique, which is great if your goal is just to abrade the skin. My goal is to get deeper into the tissue, start separating the muscles and get deep to problem areas. Like I said, I treat a lot of therapists and doctors. The reason they come to me is because we can actually get results, and show them the results they can get through the techniques that a lot of practitioners are short on.

I posted a video on Instagram for some neck work. A lot of people with whiplash have an issue with longus colli, which is a deep muscle in the back of the neck. A lot of people believe you can’t palpate that or reach it. You can, but you have to have a trained professional with the knowledge to do so. A trained professional using IASTM can actually slightly move the esophagus and reach that muscle, which can provide results when other things have not worked. Obviously, that’s not something you’d want to try at home.

Q:

I’m glad that you talked about the relationship between the patient and the physical therapist, and communicating during therapy about how they are feeling. I think a lot of people make the assumption that their therapist knows best. They don’t feel comfortable if something feels like it’s a little too much, asking the therapist to lighten up a little bit. They don’t realize that open communication is good.

A:

You are absolutely right. If you are looking at outcomes, all the outcomes are better with open communication, and a patient-centered approach. There is no healthcare without the patient being the center of that process. So anything they are feeling is absolutely valid for them to share. We need to respect and work within that limit. If a practitioner is being honest, not every treatment is wonderful. If it doesn’t work, we find alternate ways to treat a patient. Again, you’ve got to work within the limits of the patient.

Q:

In terms of how it helps, as I understand it it reduces scarring and allows the tissues to move more freely?

A:

Absolutely, that’s what it really does. You make your tissues more fluid. One thing we’ll do is treat one side of a patient’s neck, and then have them bend their neck. They have a direct comparison. They always say the untreated side feels stuck and less fluid compared to the treated side. You apply this principle to every part of the body. So you show them results that actually last.

Q:

I have found it to be useful as a maintenance program.

A:

Yep, absolutely. Especially as we get into more scar tissue formation, especially as we start to get older. Let’s be realistic, none of us are getting any younger. One of the major symptoms of aging is a loss of flexibility. These instruments are a great way for you to maintain flexibility and overall range of motion to keep yourself physiologically younger.

Q:

How long do these treatments typically last?

A:

It depends on the practitioner. If you were in to see a massage therapist, you’d have a standard 45 minutes to one hour visit, with a mix of hands and instruments. A lot of chiropractic visits, it depends on what someone has come to see me for, it could be much shorter, because we use instruments that are working smarter, not harder. It depends 100% on the practitioner.

Q:

That is so interesting. I was just thinking that a lot of professional sports players are probably interested in this.

A:

Absolutely. As you get into more and more elite function, I do seminars for professional sports teams, as well. These guys, all the trainers and therapists, they want the most cutting edge ways to get their players better, faster. This has got to be there for every professional sports team, and most of them are already using different methods of instrument assisted techniques.

Q:

What I like the best about it is it’s effective for the patient, but it also spares the hands of the practitioner. I think that’s just brilliant. It just makes sense that you don’t want to be injuring your hands helping someone else.

A:

Exactly. How can you help somebody if you’re injured yourself? I dislocated a shoulder about four years ago, and that six months in practice definitely required a lot of modification in techniques. You want to avoid injury at all costs. Practitioners are at the highest risk of repetitive strain injuries. They are doing hard work on joints that are not designed to be weight-bearing joints. So it’s a win-win for everybody. Patients get better faster, practitioners stay healthy so they are able to help more people.

Q:

One thing you said earlier, about pulling rather than pushing? Please talk about that.

A:

Absolutely. If you look at anyone who has a repetitive strain injury, what causes that? Repetitive motions. Literally, if I’m a massage therapist, all day I’m pushing through the tissues. It’s actually easier for you if you pull sometimes. Change the actions around. When we do our classes, we look at the thumbs of different practitioners. After about five years in practice, if somebody likes to use one thumb all the time, it’s shorter, it’s wider and it aches.

Q:

I did a very interesting segment on the thumb with a doctor who is an expert on this, and you have to be so careful with your thumb.

A:

This is what allows you to do so much in life, and this is what you’re trying to save.

Q:

Yes. Well, thank you for this education in IASTM. I’m so excited about this. I’m assuming if practitioners who are interested in enlarging their skill set, they could come study with you or find a way to learn about IASTM.

A:

What we have is online seminars that people can take. We have in person seminars about four times a year, as well. There’s lots of opportunity for people to find information on this. What we do differently, though, is we aren’t proprietary. We let participants try all of these instruments, and make an informed decision. A lot of companies only let you try their instruments. No. We know our instruments are good.

People can also find us online at ProHealthSys.com. They can also search Vizniak, because it’s a distinctive last name, it’s easier to find. They can also find us through our textbooks, as well, on everything from anatomy to advanced orthopaedic assessments.

Q:

I do the same thing when I’m doing ergonomic assessments. I used to have an ergonomic playpen, where I’d bring in all the tools that I felt were the best. The best keyboard, the best headset, the best sit-stand risers, the chairs that I like. I would bring in all those things and let people try them. You can’t tell when things are shrink-wrapped how they’re going to feel in your hands.

A:

That’s exactly it. Anatomical variation has to be out there. A certain doctor might claim to be an expert, when they’ve only see one instrument. You have to look at what’s out there, and then make an informed decision, not put the blinders of bias on. Some people say that this instrument must be the best, because it’s been around for so many years.

The proSTM Certified Practitioner Kit includes everything you need to start integrating IASTM into your practice:

  • 3 online courses
  • IASTM Certification
  • proSTM™ instruments
  • full color IASTM introduction booklet

proSTM Certified Practitioner Kit

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