The following is a guest post from a good friend and awesome clinician, Joseph Paul Coviello. Check it out and let me know what you think!
Ahh, good ol’ tendinopathy.
You know, that delightful nagging pain that you keep ignoring until you can’t turn a doorknob?
Luckily, within the last two decades some intelligent people figured out that this is not just an inflammatory irritation, but actually a degeneration of the tendon itself. Findings like these are wonderful for us researchers and clinicians alike so we can re-direct our creative minds toward interventions that will better treat this type of pathology.
Enter Thomas L. Sevier and W. Stegink-Jansen. These ingenious folk did a little researching for us comparing ASTYM vs. eccentric exercise for lateral epicondylitis. As soon as I see an article advocating for the use of manual therapy (yay!) vs. me counting exercises repetitions (boo) (sorry, I mean lets make people better using the best evidence), I read the whole thing through and through.
Back to business… There is some encouraging literature out there advocating for the use of eccentric exercise for lateral epicondylitis, but the protocols are varied and an optimal program has yet to be established. Eccentric exercise seems to have a reorganizational effect on the collagen fibers of the tendon which may be why it is so effective. Wait, doesn’t ASTYM do something like that to?
Indeed my friends.
ASTYM claims to be a novel, systematic, treatment approach that is separate from the instrument assisted soft tissue mobilization category despite utilizing an instrument to elicit a response from soft tissues. The aim of ASTYM treatment is to apply a mechanical shear load to a specific dysfunctional tissue with the effect of stimulating fibroblast and fibronectin production, two chemicals thought to be essential to normal collagen organization.
In this 4 week trial, 1 group of subjects received a therapeutic exercise program consisting of 6 upper extremity exercises performed 2 times per week for 2 pain free sets of 15 reps (focus on the eccentric). The other group received an ASTYM protocol 2x per week that included the ASTYM treatment in conjunction with the same program of stretching and eccentric exercise as the therapeutic exercise group. 40.9% of the eccentric exercise group had a resolution of symptoms at the end of 4 weeks while 78.3% of the ASTYM group saw a complete resolution. I think we can call that a success. They even took the recalcitrant subjects from the eccentric exercise group and gave them the ASTYM treatment after the initial trial. As expected, they had wonderfully successful results. I’ll leave out the specific outcome measures as a little cliff hanger so you can all have the joy of reading this article.
In regards to using similar treatments to address tendinopathy, a controlled laboratory study on mice looked into the effects of instrument assisted cross friction massage (IACFM) on rat subjects. In the report, the researchers induced a controlled MCL injury and then provided IAFCM treatment to the healing ligament. The findings were that the treatment may have induced positive effects on collagen formation and organization. While this was a ligamentous structure as opposed to a tendon, some of these effects could potentially carry over to other collagenous structures.
Moral of the story, ASTYM may help you get better results with your patient’s suffering from lateral epicondylitis. For those of you saying, “but Paulie I don’t want to spend the money on this ASTYM tool,” well truthfully it’s a beautifully sculpted piece of plastic used as part of a systematic approach. Becoming an ASTYM provider would obviously be the optimal situation, but unless they’ve blessed this tool with water from the depths of the dead sea, I think you can use your clinical judgement and find something similar that will do the job.
Lets make people better,
Joseph Paul Coviello, DPT
I would like to thank Dr. Thomas Sevier for speaking with us regarding his product and informing us about the evidence backing this treatment approach. Be sure to check them out at ASTYM.com for more information.
About the Author:
Joseph Paul Coviello, is a recent graduate of the Ithaca College Doctor of Physical Therapy Program. Paul competed as a D-III football player during his undergraduate career, but realized after that his true athletic passion was in bodybuilding and the strength sports. Despite his personal love for sports, Paul enjoys treating people from all walks of life, stating with his persistent half-serious tone, “Let’s make PEOPLE better!” Paul’s clinical and research based interests revolve around manual and manipulative therapy as well as biomechanics. Currently Paul is involved a few research projects regarding the use of IASTM, cervical mobilization, and lower extremity biomechanics. Stay tuned to share the love of PT with this young clinician and researcher.