ASTYM – Flashcard
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Evidence based rehabilitation process designed to effectively treat chronic tendon disorders, scar tissue, and fibrosis, regeneration therapy
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Basic definition of ASTYM
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What is the goal of ASTYM?
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to stimulate the body's healing response resulting in: -the reabsorption and remodeling of scar tissue -the regeneration of degenerative tendons *helps guide scar tissue to be laid down
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Examples of diagnosis that respond well to ASTYM
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-post surgical scarring -post traumatic scarring -CTS -rotator cuff tendonopathy -plantar fasciopathy -hamstring strains -SI/low back pain *just a couple examples, more in powerpoint but anything to do with muscles and tendons responds well
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tendinosis versus tendinitis
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tendinosis - more chronic tendinitis - acute, inflammatory process
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indications for ATSYM (4)
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-scarring or fibrosis that is excessive or dysfunction -chronic tendinosis/ degenerative tendinopathy -soft tissue with limited mobility or compromised contractility -nerve desensitization
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Precautions/ CIs (1-6, 13 total)
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1. hemophilia or clotting disorders (Drs approval) 2. easy bruiser (blood thinners) 3. auto-immune dysfunctions ex. RA, lupus 4. Fibromyalgia 5. Cancer - not over active metastatic sites 6. Diabetes - be gentle, monitor response, may need longer recovery time
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Precautions/CIs (7-13, 13 total)
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7. obesity - may not be able to access fibrosis 8. surgical hardware 9. growth plates 10. acupuncture points and pregnancy 11. vascular concerns - work around variscosities, spider veins, stripped or harvested veins 12. RSD/CRPS - not tolerated well in acute phase 13. lymphadema - used along with lymph drainage techniques (??)
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NSAIDS and ASTYM
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can still be effective but should be off by conclusion of treatments
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Cortisone and ASTYM
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inflammatory response will be suppressed but there is still a mechanical breakdown of adhesions, fibroblast stim, neuromotor stim, and secretion of humoral factors in the area
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Coumadin/heparin and ATSYM
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may be used if INR is 2.0
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quinolone aintobiotics and ASTYM
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-possible side effects include shoulder, hand, and achilles ruptures which can affect how aggressively you load the tendons -recommended 3 months off antibiotic before heavy eccentrics
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Is ASTYM the same thing as IASTM
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NO. Teddy hates IASTM. ASTYM is a specific process to stimulate regeneration and healing in dysfunctional tissue (cellular level response)
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Differences between ASTYM and IASTM: What does IASTM do?
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-mechanically breaks down tissue, may break down both healthy and unhealthy tissue -variable application -not supported by evidence -spot treatment -not designed to regenerate tissue IASTM = friction massage with or without tools
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Differences between ASTYM and IASTM: What does ASTYM do?
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-scientifically developed to regenerate tissue and resorb scar/fibrosis from release of growth factor from blood -does not damage healthy tissue -supported by evidence -substantially better outcomes -specific protocols and consistent results
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How does ASTYM work?
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1.abnormal tissue has fragile capillaries and the instruments locate and catch abnormal tissue 2. provides the appropriate dose of "shear" force which leads to leakage of abnormal capillaries 3. blood components are released with essential growth factors
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What is released when the capillaries leak?
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growth factors are released from serum into surrounding tissue
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what is the most significant growth factor?
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Platelet derived growth factor
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What is the result of growth factors being released?
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fibroblast activation (increased healing)
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How does ASTYM help with phagocytosis?
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-leaky capillaries activates macrophage mediated phagocytosis -increases macrophage activity and recruitment of fibroblasts
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Mechanical stimulation of fibroblasts results in....?
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-deformation of fibroblast cell membrane activated in the nucleus -results in collagen synthesis
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Overall picture of ASTYM and healing
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ASTYM > capillary leakage > growth factors released and phagocytosis occurs > fibroblast activation > collagen synthesis occurs *all about stimulating the healing process
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How often should patients be treated with ASTYM?
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2x a week, must have 1-2 days in between visits to allow healing to occur
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How do proper exercises and activities help with ASTYM?
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They help guide the alignment of tissues, ASTYM is in addition to treatment...not a treatment by itself
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Why does ASTYM not damage healthy tissue?
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*ASTYM better controls the pressure and stress to the tissue -scar tissue has abnormal capillaries that are fragile and easily disrupted when shear forces are applied (how you get cellular contents and humoral products to leak out) BUT...normal capillaries will tolerate the shear forces and stress of ASTYM without damage
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What are the patient's responsibilities? (3)
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1. should be as active as possible 2. perform HEP stretches 4x daily 3. hydrate to help with healing and decreased discomfort
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ASTYM tools (3)
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1. evaluator - used for long stroke 2. localizer - used for long and short strokes 3. Isolator - smaller areas
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What angle should your strokes be?
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60-80 degrees and parallel to tissue fibers
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Rate of strokes?
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6-8 inches per second with pressure firm enough to feel fibrosis
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the more tension on tissue, the more _____________ the treatment
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superficial, if not getting deep enough will need to slack tissue
