Investigation of the Effect of Instrument Assisted Soft Tissue Mobilization Technique in Individuals With Asymptomatic Dynamic Knee Valgus
Condition: Dynamic Knee Valgus; Force Production; Frontal Plan Projection Angle; Instrument-assisted Soft Tissue Mobilization; Postural Stability
Study type: Interventional

Summary: 
      STUDY DESIGN: Randomized controlled study OBJECTIVES: To investigate the contribution of
      instrument assisted soft tissue mobilization (IASTM) applied to gluteus medius (GMed) to
      isokinetic strength, femoral internal rotation (FIR), frontal plan projection angle (FPPA)
      and postural stability (PS) in individuals with asymptomatic dynamic knee valgus (DDV).

      BACKGROUND: In the literature effect of IASTM on force production and performance has been
      examined with exercise, and results of the studies are contradictory. Studies investigating
      the effects of IASTM without exercise and at recommended dose are needed.

      METHODS: 44 participants with DDV (21,39±1,79) were randomized to be control group (CG=22)
      and graston group (GG=22). First day, participants' FIR, FPPA with single leg squat test,
      dynamic and static PS on involved leg evaluations were completed. Second day, eccentric
      strength of GMed was measured by isokinetic test. IASTM application was applied 6 weeks,
      twice a week, 5 minutes, using Graston Technique® instruments. CG has not been attempted.
      Evaluations were repeated at the end of treatment.
    

Detailed description: 
      Introduction Dynamic knee valgus (DDV), one of the lower extremity faulty movement patterns,
      is a biomechanical deviation that occurs in 3 motion plans, involving femoral internal
      rotation (FIR) and contralateral pelvis fall simultaneously with hip adduction.1 Hip flexion,
      adduction and FIR moments occur simultaneously during loading phase of walking, running or
      landing after jumping. Combination of these moments also forms DDV. These moments are
      resisted by intrinsic moments caused by eccentric contractions of hip extensor, abductor and
      external rotator muscles. Strength deficiency of these muscles in weight transfer activities
      causes an increase in hip adduction, and FIR, changes whole lower extremity kinematics.2,3
      The valgus alignment also increases the risk of injury.4 In the review examining relationship
      between hip muscle strength and DDV, it was determined that decrease in gluteus medius (GMed)
      strength in functional activities on single leg was associated with DDV.2 Abduction torque
      produced by hip abductors stabilizes pelvis on relatively fixed femur by controlling pelvis
      in frontal and horizontal planes during stance phase of walking and most of stance and GMed
      produces most of the compression forces in hip.3,5 Therefore, GMed strength is also very
      important for postural stability (PS). In individuals with DDV, strength of hip muscles,
      especially GMed, should be focused on increasing PS during the tests performed on single leg
      and in injury prevention programs.4,6 Anatomical features of women increase the risk of DDV.
      In addition, when gender comparison was made, it was seen that women needed more eccentric
      contraction in the hip abductor muscles during the stance phase of running.7, and strength
      deficiency in proximal hip stabilizers of females could cause a greater decrease in athletic
      performance compared to men.8 Therefore, evaluation of eccentric strength of GMed muscle
      should be evaluated specific to gender.2 Thus, a more precise conclusion can be found in
      terms of abductor muscle strength, DDV and lower extremity alignment.

      Effect of soft tissue mobilization techniques on force production and performance is a
      remarkable topic. Instrument-assisted soft tissue mobilization (IASTM) technique, one of the
      soft tissue mobilization techniques, has also been found to be effective method that affects
      muscle strength, performance and endurance through activation of muscle and nervous
      systems.9-11 However, in studies IASTM technique was applied with an exercise protocol, and
      contribution of IASTM in force generation and performance increase is not understood.

      According to our knowledge, in the literature there is no randomized controlled study
      examining the effect of IASTM applied without exercise. Aim of our study is to investigate
      changes caused by IASTM applied to GMed muscle on eccentric force production of GMed, FIR,
      frontal plane projection angle (FPPA) and PS.
    

Intervention name(s): Graston Technique®
Intervention type(s): Device
Intervention description(s): Graston technique, one of the soft tissue mobilization techniques, has also been found to be effective method that affects muscle strength, performance and endurance through activation of muscle and nervous systems.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized controlled study
Masking: Single (Participant)
Primary purpose: Prevention