Efficacy of Instrument-Assisted Soft Tissue Mobilization as an Adjunct to Therapeutic Exercise in Individuals with Knee Osteoarthritis: A Parallel-Group Randomized Controlled Trial
Improving Pain, Physical Function, and Quality of Life in Patients with Knee Osteoarthritis
Keywords:
Instrument-Assisted Soft Tissue Mobilization, Knee Osteoarthritis, Range of Motion, Therapeutic Exercise, WOMACAbstract
Background: Knee osteoarthritis (OA) is a prominent source of chronic pain and functional deficit, especially after age 40, and is related to soft tissue restrictions, quadriceps weakness, and joint mobility. Therapeutic exercise is still a mainstay of conservative care; however, tight myofascial restrictions can dampen the benefits. The primary goal of this study was to examine the effectiveness of Instrument-Assisted Soft Tissue Mobilization (IASTM) in conjunction with a standardized therapeutic exercise protocol for reducing pain, range of motion, and functional performance in patients with knee OA when compared to therapeutic exercise alone.
Methodology: This was a randomized controlled, blinded, two-arm parallel design trial with a one-year duration from January to December 2025, at Physio Care Center Gujrat and SK Physio OPD Islamabad. The 25 participants who had knee OA (Kellgren-Lawrence grade II-III) were randomly allocated using an envelope method randomization sequence with allocation concealment to two groups of 25 participants. Group A was given a standard therapeutic exercise protocol in addition to the IASTM, and Group B was given the therapeutic exercise protocol only, thrice a week for 1.5 month approximately 6 weeks. Outcome measures assessed at baseline and after the intervention (Week 6) included the Visual Analogue Scale (VAS) for pain, knee range of motion (goniometry), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for functional status. Pair or independent sample t-test analysis of data at the 95% level of significance.
Results: No dropout in the trials; 50 participants finished them. There were significant improvements within each group for all outcome measures (p<0.001). However, Group A significant reduction in VAS score (2.92±1.15 vs 4.12±1.20), greater gain in knee flexion ROM (123.88°±6.92 vs 113.44°±7.48), greater reduction in knee extension deficit (4.12°±2.85 vs 7.16°±3.75), and greater improvement in WOMAC score (33.96±9.13 vs 50.32±8.13) compared to Group B (all p<0.01).
Conclusion: IASTM and therapeutic exercise together are effective at improving pain, knee range of motion, and functional status compared to therapeutic exercise alone in patients with knee osteoarthritis and should be used as a valuable adjunct to therapeutic exercise-based rehabilitation.
References
Chen J, Chen X, Wang T, Li M, Dai H, Shang S, Cheng L, Tang Z, Liu S, Huang C. Global burden of knee osteoarthritis from 1990 to 2021: Trends, inequalities, and projections to 2035. PLoS One. 2025 Jun 11;20(6):e0320115. https://doi.org/10.1371/journal.pone.0320115
Giorgino R, Albano D, Fusco S, Peretti GM, Mangiavini L, Messina C. Knee osteoarthritis: epidemiology, pathogenesis, and mesenchymal stem cells: what else is new? An update. International Journal of Molecular Sciences. 2023 Mar 29;24(7):6405. doi: https://doi.org/10.3390/ijms24076405
Holden MA, Metcalf B, Lawford BJ, Hinman RS, Boyd M, Button K, Collins NJ, Cottrell E, Henrotin Y, Larsen JB, Master H. Recommendations for the delivery of therapeutic exercise for people with knee and/or hip osteoarthritis. An international consensus study from the OARSI Rehabilitation Discussion Group. Osteoarthritis and Cartilage. 2023 Mar 1;31(3):386-96. doi: https://doi.org/10.1016/j.joca.2022.10.009
Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, Callahan L, Copenhaver C, Dodge C, Felson D, Gellar K. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis & Rheumatology. 2020 Feb;72(2):220-33. doi: https://doi.org/10.1002/art.41142
Jafarsalehi B, Boozari S, Torkaman G. Effects of instrument-assisted soft tissue mobilization combined with exercise on knee joint muscle activity during walking in patients with moderate knee osteoarthritis: A randomized controlled clinical trial. Scientific Reports. 2025 Dec 29;15(1):44743. doi: https://doi.org/10.1038/s41598-025-28418-3
Gandotra JB, Ganjave P, Shroff RA. Effect of instrument-assisted soft-tissue mobilisation of iliotibial band with conventional exercise therapy versus conventional exercise therapy alone on clinical performance in patients with knee osteoarthritis: a prospective interventional study. Journal of Clinical and Diagnostic Research. 2025. doi: https://doi.org/10.7860/JCDR/2025/73706.20855
Karimi Soloklo Z, Boozari S, Kahrizi S. Effects of a two-week instrument-assisted soft tissue mobilization and exercise therapy versus sham and exercise on gait kinetics in moderate knee osteoarthritis: a randomized controlled trial. Journal of Manual & Manipulative Therapy. 2026 Jan 2;34(1):16-27. doi: https://doi.org/10.1080/10669817.2025.2481594
Karimi SZ, Boozari S, Kahrizi S. The effect of short-term instrument-assisted soft tissue mobilization on lower limb muscle strength and sit-to-stand kinetics in patients with knee osteoarthritis: a randomized controlled trial. Middle East Journal of Rehabilitation and Health Studies. 2025;12(3). doi: https://doi.org/10.5812/mejrh-159368
Tang S, Sheng L, Xia J, Xu B, Jin P. The effectiveness of instrument-assisted soft tissue mobilization on range of motion: a meta-analysis. BMC Musculoskeletal Disorders. 2024 Apr 23;25(1):319. doi: https://doi.org/10.1186/s12891-024-07452-8
Jafarsalehi B, Boozari S, Torkaman G. Exploring the impact of instrument-assisted soft tissue mobilization on functional measures and quality of life in knee osteoarthritis patients: A randomized controlled trial. Middle East Journal of Rehabilitation and Health Studies. 2025;12(1). doi: https://doi.org/10.5812/mejrh-152345
Huang K, Cai H. The interplay between osteoarthritis and osteoporosis: Mechanisms, implications, and treatment considerations — A narrative review. Experimental Gerontology. 2024 Nov 1;197:112614. doi: https://doi.org/10.1016/j.exger.2024.112614
Liu Y, Wang Y. A comparative study of the efficacy of instrument-assisted soft tissue mobilization and massage techniques in patients with patellofemoral joint pain. Frontiers in Medicine. 2023 Nov 13;10:1305733. doi: https://doi.org/10.3389/fmed.2023.1305733
Goudman L, Pilitsis JG, Billet B, De Vos R, Hanssens K, Billot M, Roulaud M, Rigoard P, Moens M. The level of agreement between the numerical rating scale and visual analogue scale for assessing pain intensity in adults with chronic pain. Anaesthesia. 2024 Feb;79(2):128-38. doi: https://doi.org/10.1111/anae.16151
Jayubo DT, Demegillo P, Ramas AJ, Apolonio NE, Makabenta K, Aznar ME, Legion DM, Manalo EJ, Canono ML, Rosales J, Sudario GK. Reliability of range of motion assessment using universal goniometer and video goniometer application: a comparative study. ASEAN Journal of Rehabilitation Medicine. 2025;35(2):67-75.
Mutiara R, Ardinata D, Fachrina R, Vytra S, Lumongga F. The effect of physiotherapy manual traction techniques on the Western Ontario and McMaster University OA Index (WOMAC) in knee osteoarthritis patients. Jurnal Keperawatan dan Fisioterapi (JKF). 2025 Aug 12;7(2):158-63. doi: https://doi.org/10.35451/jkf.v7i2.2466
Nazari G, Bobos P, Lu S, Reischl S, Sharma S, Le CY, Vader K, Held N, MacDermid JC. Effectiveness of instrument-assisted soft tissue mobilization for the management of upper body, lower body, and spinal conditions. An updated systematic review with meta-analyses. Disability and Rehabilitation. 2023 May 8;45(10):1608-18. doi: https://doi.org/10.1080/09638288.2022.2070288
Tang S, Sheng L, Wei X, Liang M, Xia J, Chen J. The effectiveness of instrument-assisted soft tissue mobilization on pain and function in patients with musculoskeletal disorders: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2025 Mar 14;26(1):257. doi: https://doi.org/10.1186/s12891-025-08492-4
Gercek H, Unuvar BS, Umit Yemisci O, Aytar A. Acute effects of instrument assisted soft tissue mobilization technique on pain and joint position error in individuals with chronic neck pain: a double-blind, randomized controlled trial. Somatosensory & Motor Research. 2023 Jan 2;40(1):25-32. doi: https://doi.org/10.1080/08990220.2022.2157388
Cigdem-Karacay B, Sahbaz T, Gumusay D, Kodak MI, Tuncay F, Ozudogru A, Kocak FA. Short-term results of instrument-assisted soft tissue mobilization in female patients with myofascial pain syndrome: A randomized blinded sham-controlled study. Turkish Journal of Physical Medicine and Rehabilitation. 2025 Nov 10;71(4):496. doi: https://doi.org/10.5606/tftrd.2025.15466
Wadhwa K, Gupta R, Singh S, Kumar M, Singh AK. Impact of instrument-assisted soft-tissue mobilization (IASTM) on the functional status of myofascial structures: scoping literature review. Journal of Iranian Medical Council. 2025 Jun 1;8(3):437-47. doi: https://doi.org/10.18502/jimc.v8i3.18788
Tsokanos A, Livieratou E, Billis E, Tsekoura M, Tatsios P, Tsepis E, Fousekis K. The efficacy of manual therapy in patients with knee osteoarthritis: a systematic review. Medicina. 2021 Jul 7;57(7):696. doi: https://doi.org/10.3390/medicina57070696
Brandl A, Egner C, Schwarze M, Reer R, Schmidt T, Schleip R. Imediate effects of instrument-assisted soft tissue mobilization on hydration content in lumbar myofascial tissues: a quasi-experiment. Journal of Clinical Medicine. 2023 Jan 28;12(3):1009. doi: https://doi.org/10.3390/jcm12031009
Mylonas K, Angelopoulos P, Billis E, Tsepis E, Fousekis K. Combining targeted instrument-assisted soft tissue mobilization applications and neuromuscular exercises can correct forward head posture and improve the functionality of patients with mechanical neck pain: a randomized control study. BMC Musculoskeletal Disorders. 2021 Feb 21;22(1):212. doi: https://doi.org/10.1186/s12891-021-04080-4
Duffy S, Martonick N, Reeves A, Cheatham SW, McGowan C, Baker RT. Clinician reliability of one-handed instrument-assisted soft tissue mobilization forces during a simulated treatment. Journal of Sport Rehabilitation. 2022 Feb 2;31(4):505-10. doi: https://doi.org/10.1123/jsr.2021-0216
Moore MG, Daley AR, Winkelmann Z. An evidence-to-practice review on the efficacy of instrument-assisted soft tissue mobilization. Clinical Practice in Athletic Training. 2020;3(3):2. doi: https://doi.org/10.31622/2020.0003.3.2
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Faiza Kalsoom, Mehreen Ali, Rabbia Irshad, Khakshan Taveel , Zona Mehreen
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
