Postgraduate Medicine

ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: https://www.tandfonline.com/loi/ipgm20

The current role of Astym therapy in the treatment

of musculoskeletal disorders

E. Carlos Rodriguez-Merchan, Hortensia De La Corte-Rodriguez & Juan M.

Roman-Belmonte

To cite this article: E. Carlos Rodriguez-Merchan, Hortensia De La Corte-Rodriguez & Juan M.

Roman-Belmonte (2019): The current role of Astym therapy in the treatment of musculoskeletal
disorders, Postgraduate Medicine, DOI: 10.1080/00325481.2019.1654836

To link to this article: https://doi.org/10.1080/00325481.2019.1654836

Published online: 28 Aug 2019.

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POSTGRADUATE MEDICINE
https://doi.org/10.1080/00325481.2019.1654836

CLINICAL FEATURE
REVIEW

The current role of Astym therapy in the treatment of musculoskeletal disorders

E. Carlos Rodriguez-Merchana, Hortensia De La Corte-Rodriguezb and Juan M. Roman-Belmontec
a
Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain; bDepartment of Physical Medicine and Rehabilitation, La Paz
University Hospital-IdiPaz, Madrid, Spain; cDepartment of Physical Medicine and Rehabilitation, “Cruz Roja San Jose and Santa Adela” University
Hospital, Madrid, Spain

ABSTRACT ARTICLE HISTORY

Background: In general, chronic problems of soft tissues (muscles, tendons, ligaments) are due to Received 24 December 2018
scarring or degeneration. Astym therapy (Performance Dynamics, Inc. Muncie, Indiana) has been Accepted 8 August 2019
reported to address tendinopathy by stimulating regeneration in soft tissues (muscles, tendons, liga- KEYWORDS
ments) and the resorption of unwanted scar tissue that causes pain and limits mobility. Astym therapy;
Purpose: To analyze the effectiveness of Astym therapy in the treatment of musculoskeletal problems musculoskeletal disorders;
Methods: A narrative review of the literature on the topic was carried out. A Cochrane Library and scar tissue; tendinopathy;
PubMed (MEDLINE) search related to the role of Astym therapy was analyzed. The only language fibrosis
searched was English. Scientific meeting abstracts and other sources of evidence were not considered.
The main criteria for selection were articles that were focused on the role of Astym therapy.
Results: Astym therapy seems to be useful for the treatment of chronic ankle sprains, Achilles tendon
tendinopathy, hamstring tendinopathy, elbow tendinopathy, and the stiff total knee arthroplasty. Astym
therapy also appears to be useful to gain range of motion, muscle strength, and function in patients
with cerebral palsy, and after mastectomy.
Conclusions: Astym therapy seems to activate a regenerative response in degenerative tendinopathy
and eliminate or reduce the scar tissue/fibrosis that causes pain and limitation of mobility. Based on the
positive findings of the emerging published research further study is warranted to confirm the benefits
of Astym therapy on a variety of musculoskeletal disorders.

Introduction topically to locate and treat the underlying dysfunctional soft

tissue through specific protocols for the application of parti-
Astym therapy (Performance Dynamics, Inc. Muncie, Indiana) is
cular pressures and shear forces [5].
a treatment that addresses soft tissue dysfunctions by stimu-
This review analyzes the effectiveness of Astym therapy
lating the regeneration of soft tissues and the resorption of
and its role in the treatment of chronic soft-tissue problems.
inappropriate scar tissue/fibrosis [1–3]. Astym therapy is very
effective, even when other common therapeutic methods fail.
One of the main reasons why Astym therapy is more effective Methods
than other treatments is that it resolves the underlying cause
A narrative review of the literature on the topic was carried out.
of the soft tissue problem, rather than simply relieving the
A Cochrane Library and PubMed (MEDLINE) search related to the
symptoms of the problem temporarily. Astym therapy has no
role of Astym therapy was analyzed. The only language searched
equal in its ability to resolve tendinopathies, scar tissue pro-
was English. Scientific meeting abstracts and other sources of
blems and other soft tissue dysfunctions [1–3].
evidence were not considered. The main criteria for selection
According to Kivlan et al Astym therapy is a manual therapy
were articles that were focused on the role of Astym therapy.
intervention used to stimulate tissue healing, decrease pain,
Figure 1 shows our search strategies (PubMed/Medline and
improve mobility, and improve muscle performance asso-
Cochrane Library). The searches were dated from the estab-
ciated with musculoskeletal pathology [4].
lishment of the search engines (PubMed and Cochrane
According to Davies et al Astym therapy is an approach to
Library) until 24 December 2018.
soft tissue injuries, and is evidenced in animal studies to
promote the healing and regeneration of soft tissues [5]. It
has also been found to reduce pain and increase function in Results
people with soft tissue dysfunction. The aim of Astym therapy
Table 1 summarizes the main data and results of the literature on
is to engage the regenerative mechanisms of the body in
the role of Astym therapy [3–16]. Table 2 summarizes the main
order to resorb scar tissue, stimulate tissue turnover, and
conditions in which Astym therapy is currently used [3–16].
regenerate soft tissues. Handheld instrumentation is applied

CONTACT E. Carlos Rodriguez-Merchan ecrmerchan@hotmail.com Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Paseo de la
Castellana 261, Madrid 28046, Spain
© 2019 Informa UK Limited, trading as Taylor & Francis Group
2 E. C. RODRIGUEZ-MERCHAN ET AL.

PubMed search for “Astym

therapy” (n=17) studies

1 record excluded
17 records reviewed and (not focused on the
screened topic)

0 articles repeated
17 articles assessed for
in Cochrane Cochrane Library search for
eligibility Library: 16 articles “Astym therapy” (n=0)
assessed
eventually

16 studies included

Figure 1. Flow chart of our search strategy regarding the current role of Astym therapy.

Discussion team developed the Astym protocols that stimulate regeneration

and eliminate or reduce problematic scar tissue. Astym therapy
In general, chronic problems of soft tissues (muscles, tendons,
not only works successfully as first-line treatment, but also works
ligaments) are due to scarring or degeneration. Scarring and
after the failure of other therapeutic modalities.
soft tissue degeneration are frequent, causing pain and limita-
In addition to published research, one of the most impor-
tion of mobility. The soft tissues degenerate when inadequate
tant case series is found in the Astym Analyst. It is a database
healing occurs, so that over time, they degrade. Degenerated
in which doctors can include their data freely and indepen-
tissues are weak and prone to injury. Degeneration can have
dently. Its objective is to provide observational data on the
various causes, such as age, overload (heavy use), inadequate
results of Astym therapy in the different diagnoses in which it
movements, a weak musculature that exerts additional pres-
has been utilized [1–3].
sure on other tissues, and some diseases. The majority of
Astym therapy non-invasively activates a regenerative
chronic tendinopathies are fundamentally degenerative in nat-
response in dysfunctional soft tissues. This is achieved
ure [1–5].
through the induction of dysfunctional capillary exudation,
The biggest problems come from the scar tissue that forms
local activation of fibroblasts, phagocytosis mediated by
around joints, muscles, tendons and/or ligaments. The objective
macrophages (microdebridement) and the release of growth
of scar tissue is to reinforce a certain anatomical area, although it
factors that produce an additional recruitment of fibroblasts.
often ends up limiting its mobility and causing pain.
In addition to the action of the humoral mediators and
The possible causes of problems in the scar tissue are
growth factors previously mentioned, Astym therapy elim-
traumatic injuries (ankle sprain, car accident, etc.), surgery,
inates or reduces the fibrosis that causes limitation of mobi-
excessive or intense use of soft tissues (sports, repetitive
lity. The treatment includes personalized exercises and
work, activity that exceeds the physical condition of the indi-
certain actions aimed at the remodeling of collagen. Its
vidual, etc.), and other soft tissue strains. Astym therapy serves
objective is to stimulate the tissues to become stronger
both to regenerate tissues and to eliminate or reduce scar
and more functional, in order to reduce the risk of new
tissue. By eliminating the cause of the problem, the symptoms
injuries [1–16].
will disappear.
Astym therapy was developed to address the underlying
causes of most soft tissue problems which are degeneration
and inappropriate scarring/fibrosis, which eventually cause Conclusions
limited mobility and pain. One of the fundamental facts that The review of the literature suggests that Astym therapy can
led to the development of Astym therapy was the discovery be useful for the treatment of chronic ankle sprains, tendino-
that most tendinopathy is basically of a degenerative nature, pathies (Achilles tendon, hamstring, elbow), and the stiff total
and rarely inflammatory. knee arthroplasty. Astym therapy could also be useful to gain
In general, treatments for tendinopathies have focused on muscle strength, range of motion, and function in patients
reducing inflammation or attempting to break up tissue that that with cerebral palsy, and after mastectomy. Based on the posi-
limits mobility, although normally these treatments are not effec- tive findings of the emerging published research further study
tive. In light of recent evidence indicating that degeneration is is warranted to confirm the benefits of Astym therapy on
the underlying cause of tendinopathies, the Astym research a variety of musculoskeletal disorders
Table 1. Main articles reported in the literature on Astym therapy (AT) – Performance Dynamics, Inc. Muncie, Indiana).

Authors Year Results Comments

Slaven and 2011 These authors reported a patient with chronic ankle pain who was treated with manual therapy After five sessions of therapy consisting of joint mobilization, manipulation and AT, the patient
Mathers [6] including manipulation and AT. As a result of a fall down stairs 6 months previously, the was able to descend stairs and run 40 minutes without pain.
patient sustained a severe ankle sprain. The soft tissue damage was accompanied by bony
disruptions which warranted the patient spending 3 weeks in a walking boot. At the initial
evaluation, the patient reported difficulty with descending stairs reciprocally and not being
able to run more than 4 minutes on the treadmill before the pain escalated to the level that
she had to stop running.
McCormack [9] 2012 This author presented the case of a patient referred to physical therapy with bilateral high After 16 visits, the patient reported that she was approximately 95% improved, was able to run
hamstring tendinopathy (HHT). The patient was a 41-year-old recreational runner that had an 2 · 5 miles without pain, and had no pain with sitting on hard surfaces. This case suggested
insidious onset of right buttock pain 12 months prior to initiating therapy and left buttock that eccentric exercise combined with AT may be an effective treatment for HHT.
pain 9 months prior. Her primary complaints included an inability to run, pain with prolonged
or brisk walking, and pain with sitting on hard surfaces. The patient was treated in physical
therapy two times per week for 16 visits with treatment focused on eccentric hamstring
strengthening and AT. By her eighth visit, the patient was able to walk 2 · 5 miles without pain
and by her 12 visit, she was able to jog 1 mile before the onset of pain.
Kivlan et al [4] 2015 Forty-five subjects (14 males; 31 females) between 18 and 65 years of age were randomized into AT to the involved lower extremity increased maximum force output during an isometric squat
3 treatment groups: 1) Control group – received no treatment; 2) Placebo group – received test immediately following treatment. The results of this study suggested that AT can
a sham AT; 3) AT group- received AT to the lower extremity. A baseline measure of maximal immediately improve muscle performance (maximal force output) for patients presenting
force output (pre-test) during a unilateral isometric squat was performed. The subjects then with muscular weakness caused by a lower extremity musculoskeletal injury.
received the designated treatment intervention. Immediately following the treatment
intervention, maximal force output (post-test) was retested using identical testing procedures
by an investigator who was blinded to the treatment intervention received by the subjects.
The percent change of maximal force output from pre-test to post-test measures was
compared using a one-way analysis of variance. A Tukey’s post-hoc analysis determined the
statistical differences between the groups.The treatment intervention had a significant effect
on the percent change of maximal force output. Tukey’s post hoc analysis demonstrated that
the percent change of maximal force output was significantly greater in the AT group
(15 ± 18% change of Newtons) compared to the placebo and control groups. No significant
difference was noted between the control and placebo groups.
Sevier et al [10] 2015 These authors reported a prospective, two group, parallel, randomized controlled trial. Patients This study suggested that AT was an effective treatment option for patients with LE
with chronic lateral elbow (LE) tendinopathy, commonly known as tennis elbow, often tendinopathy, as an initial treatment, and after an eccentric exercise program has failed. AT
experience prolonged symptoms and frequent relapses. This study had two objectives: (1) to appeared to be a promising, non-invasive treatment option.
compare the efficacy of AT to an evidence-based eccentric exercise program (EE) for patients
with chronic LE tendinopathy, and (2) to quantify outcomes of subjects non-responsive to EE
who were subsequently treated with AT. Age range of 18–65 years old, with clinical
indications of LE tendinopathy greater than 12 weeks, with no recent corticosteriod injection
or disease altering comorbidities. Subjects with chronic LE tendinopathy (107 subjects with
113 affected elbows) were randomly assigned using computer-generated random number
tables to 4 weeks of AT (57 elbows) or EE treatment (56 elbows). Data collected at baseline, 4,
8, 12 weeks, 6 and 12 months. DASH; secondary outcome measures: pain with activity,
maximum grip strength and function. The treating physicians and the rater were blinded;
subjects and treating clinicians could not be blinded due to the nature of the treatments.
Resolution response rates were 78.3% for the AT group and 40.9% for the EE group. AT
subjects showed greater gains in DASH scores and in maximum grip strength than EE subjects.
AT also resolved 20/21 (95.7%) of the EE non-responders, who showed improvements in DASH
scores, pain with activity, and function following AT. Gains continued at 6 and 12 months. No
adverse effects were reported.
POSTGRADUATE MEDICINE

(Continued )
3
 4

Table 1. (Continued).

Authors Year Results Comments

McCormack et al 2016 Sixteen subjects were randomly assigned to either a soft tissue treatment (AT) and eccentric
[8] exercise group or an eccentric exercise-only group. Intervention was completed over a 12-
week period, with outcomes assessed at baseline, 4, 8, 12, 26, and 52 weeks. Outcomes
included the Victorian Institute of Sport Assessment Achilles-Specific Questionnaire (VISA-A),
the numeric pain rating scale (NPRS), and the global rating of change (GROC). Significantly
greater improvements on the VISA-A were noted in the soft tissue treatment (AT) group over
the 12-week intervention period, and these differences were maintained at the 26- and 52-
week follow-ups. Both groups experienced a similar statistically significant improvement in
pain over the short and long term. A significantly greater number of subjects in the soft tissue
treatment (AT) group achieved a successful outcome at 12 weeks.
Chughtai et al 2016 Twenty-three post-TKA patients (29 knees) who had recalcitrant knee stiffness were included in
[11] this study. Pre- and post-AT improvements in ROM and Knee Society scores were compared.
Soft tissue treatment (AT) plus eccentric exercise was more effective than eccentric exercise
only at improving function during both short- and long-term follow-up periods. Soft tissue
treatment (AT) plus eccentric exercise appeared to be a beneficial treatment program that
clinicians should consider incorporating into the management of their patients with
insertional Achilles tendinopathy.
AT may be an effective treatment option for post-TKA patients suffering from persistent knee
stiffness. Further studies are needed to validate this intervention as a part of cost-effective,
E. C. RODRIGUEZ-MERCHAN ET AL.

These authors analyzed knees based on the presence of flexion deficit or contracture. Further standard treatment after TKA.
stratification was made into knees that received AT before and after a 3-month period of
standard rehabilitation. Differences in range of motion from pre- to post-AT were evaluated by
measuring (1) degree of flexion deficit or contracture and (2) total arc of passive motion.
Improvements in subjective functional status were determined by evaluating Knee Society
scores pre- and post-AT. A two-tailed Student t-test was used to compare weighted mean
differences from pre- to post-AT for the above parameters. The mean flexion deficit improved
significantly in all patients after AT. The mean flexion contracture improved significantly in in
91% of patients after AT therapy. Knees with flexion deficits or contractures both improved in
total arc of motion when compared with pretherapy. Overall, patients who underwent
treatment with AT reported significant mean improvements in both Knee Society objective
and functional scores when compared with their pretherapy objective and functional scores.
No harms were reported.
Chughtai et al 2016 The purpose of this study was to evaluate and compare: (1) range of motion and (2) the rate of The group who underwent IMMPT utilizing AT had a significantly higher proportion of patients
[12] repeat MUA in patients who either underwent innovative multimodal physical therapy with optimal range of motion, which implies the potential efficacy of this regimen to
(IMMPT) or standard-of-care physical therapy (standard) following an MUA after a TKA. These improve range of motion. Furthermore, the IMMPT cohort had a significantly lower
authors performed a retrospective database study of patients who underwent an MUA proportion of repeat manipulations as compared with the standard cohort, which implies
following a TKA (N = 57). There were 16 (28%) men and 41 (72%) women who had a mean that an IMMPT approach could potentially reduce the need for a repeat MUA.
age of 59 years (range, 32–81 years). The patients were stratified into those who underwent
IMMPT (n = 22) and those who underwent standard physical therapy (n = 35). The 6-month
ROM and rate of repeat manipulation between the two cohorts was analyzed by using Student
t-test and Chi-square tests. In addition, we performed a Kaplan-Meier analysis of time to
repeat MUA. The IMMPT cohort had a statistically significant higher proportion of TKAs with an
optimal range of motion as compared with the standard cohort. There was statistically
significant lower proportion of patients who underwent a repeat MUA in the IMMPT as
compared with the standard cohort. There was also a significantly lower incidence and longer
time to MUA in the IMMPT cohort as compared with the standard cohort in the Kaplan-Meier
analysis.
McGinn et al [13] 2016 These authors analyzed all non-obese patients who underwent primary TKAs who started an This study showed an IMMPT protocol utilizing AT is able to significantly reduce the rate of
outpatient physical therapy program within six weeks of their surgery (n = 127 knees). There manipulation following a TKA. Furthermore, this IMMPT approach was also able to achieve
were 86 women and 41 men who had a mean age of 67 years (range, 42 to 88 years). This similar range of motion to the standard physical therapy group while reducing the rate of
cohort was stratified into those who underwent an IMMPT regimen at our institution (n = 47) manipulation, which may indicate similar efficacy in restoring ROM.
and those who underwent standard therapy at an outside institution (N = 80). The ROM and
rate of manipulation between the two groups was compared. There were similar proportions
of those who had an optimal range of motion (≥110 degrees flexion and ≤5 degrees
extension) in the IMMPT group as compared to the standard physical therapy cohort (81% vs.
82%). The IMMPT cohort had a significantly lower proportion of patients who underwent MUA
as compared to the standard therapy cohort (2% vs. 13%).

(Continued )
Table 1. (Continued).
Authors Year Results Comments
Bhave et al [14] 2016 This report assessed changes in ROM, pain, function, and patellar tendon length after AT (joint Conservative management of recalcitrant knee joint stiffness after primary TKA can be effective
mobilization use). A 38-year-old male professional skier had a right TKA 3 months before in restoring knee mobility and reducing pain and activity limitation. A multimodal approach
presentation with 2 subsequent manipulations under anesthesia secondary to persistent knee using AT, customized knee bracing, and targeted joint mobilization can be effective in
stiffness. He had patellar baja on radiograph, a reduced arc of ROM, reduced patellar mobility resolving knee joint stiffness.
and muscular extensibility, and pain to palpation along the patellar tendon. He had 12 visits of
physical therapy with the use of AT, patellar mobilization, and tibio-femoral mobilizations with
movement. The patient also used a customized knee device at home for prolonged knee
extension stretching. The patient was treated for 12 visits, along with home use of customized
bracing for knee extension. Significant improvements were seen in pain, function, and ROM.
He returned to work full-time, ambulated prolonged distances, and negotiated stairs pain-free.
He also demonstrated resolution of patellar baja radiographically.
Scheer et al [15] 2016 An eight-year-old female with cerebral palsy was referred to physical therapy for the treatment The results of this case report indicate that physical therapy rehabilitation utilizing an AT
of bilateral hamstring inflexibility and Achilles tendinopathy. Treatment focused on an AT protocol can successfully achieve gains in flexibility and strength and allow for improved
protocol of eccentric exercise, stretching, active and passive range of motion, gait training, and function of bilateral lower extremities in a patient with cerebral palsy. Based on the findings
a home exercise program. The patient underwent a total of 11 physical therapy treatment of this case report, clinicians should consider the use of AT in treating musculoskeletal soft
sessions. At the conclusion of treatment, the patient demonstrated improved resting muscle tissue dysfunction in pediatric patients with cerebral palsy.
tone in bilateral lower extremities with active 90/90 hamstring flexibility measured at 165° and
ankle dorsiflexion active range of motion of 5° without pain at 0° and 90° knee flexion. The
patient exhibited an improved gait pattern with even stride length and diminished genu
recurvatum, decreased pain with standing and walking, discontinued use of ankle-foot
orthoses, and improved activity tolerance and overall function for daily activities.
Davies et al [5] 2016 This study examined the effects of AT on activities of daily living in women who had undergone In this study AT improved active range of motion in the involved quadrant and also improved
a mastectomy following a diagnosis of breast cancer. A quasi-experiment involving 40 women, function in patients following a mastectomy.
following a mastectomy, evaluated five outcome measures pre- and post-AT. All five
measurement scores: Disabilities of the Arm, Shoulder, and Hand Outcome Measure; a clothing
questionnaire on their ability to wear a bra; Patient-Specific Functional Scale; active ROM of
shoulder flexion; and active range of motion of abduction were also measured and all
demonstrated significant changes.
Miller et al [16] 2017 The purpose of this case was to describe using AT in treating spastic diplegic cerebral palsy (CP). AT was effective in treating a child with spastic diplegic CP, resulting in enhanced strength,
A 6-year-old female was treated more than 9 months (36 sessions) for decreased flexibility, flexibility, and gait.
muscle weakness, spasticity, and abnormal gait. Gait performed with articulated ankle-foot
orthoses (75% of the time) or foot orthosis (25%); lack of active dorsiflexion (DF); lack of heel
strike during gait; spasticity in hamstrings, gastrocnemius, hip adductors; hamstring flexibility
(90/90 test position) 50° right and 60° left; gastrocnemius flexibility neutral bilaterally; and
Peabody Developmental Motor Scales, second edition (PDMS-2) age equivalence (in months)
23 locomotion, 25 object manipulation, and 21 stationary tasks. Therapeutic interventions
included AT, stretching, strengthening, neuromuscular reeducation, and gait training. At
6 months, flexibility improved bilaterally to 10° past neutral in gastrocnemius and 0° in
hamstrings. The PDMS-2 age equivalence scores were 27 locomotion, 32 object manipulation,
and 28 stationary tasks. At discharge, patient ambulated full-time with foot orthosis, exhibiting
improved stride length bilaterally with active ankle DF to initiate heel strike. Spasticity was
unchanged.
Chughtai et al [3] 2019 This systematic review evaluated the published literature related to AT on various The authors stated that due to the fact that some of these studies were case reports, larger
musculoskeletal disorders. Specifically, the authors assessed the effectiveness of this studies will be needed in order to confirm the benefits of AT on a variety of musculoskeletal
therapeutic method on disorders related to the: knee, upper extremity, hamstring muscles, disorders.
ankle, and Achilles tendon injuries.
MUA = Manipulation under anesthesia; ROM = Range of motion; TKA = Total knee arthroplasty.
POSTGRADUATE MEDICINE
5
6 E. C. RODRIGUEZ-MERCHAN ET AL.

Table 2. Main conditions in which Astym therapy is currently used.

Diagnosis
Chronic ankle sprain
Achilles tendinopathy
Hamstring tendinopathy
Elbow tendinopathy
Stiff total knee arthroplasty
Muscle strength
Cerebral palsy
After mastectomy
Authors and Year
Slaven and Mathers (2011) [6], Chughtai et al (2019) [3]
McCormack (2012) [9], McCormack et al (2016) [8]; Chughtai et al (2019) [3]
McCormack (2012) [9], Chughtai et al (2019) [3]
Sevier et al (2015) [10], Chughtai et al (2019) [3]
McGinn et al (2016) [13], Chughtai et al (2016) [10], Chughtai et al (2016) [11], Bhave et al (2016) [14], Chughtai et al (2019) [3]
Kivlan et al [4]
Scheer et al (2016) [15], Miller et al (2017) [16]
Davies et al (2016) [5]

Acknowledgments 7. McCormack JR. The management of mid-portion Achilles tendino-

None reported.
Funding
This paper was not funded.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any
organization or entity with a financial interest in or financial conflict with
the subject matter or materials discussed in the manuscript. This includes
employment, consultancies, honoraria, stock ownership or options, expert
testimony, grants or patents received or pending, or royalties.
Peer reviewers on this manuscript have no relevant financial or other
relationships to disclose.
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