Seven principles of tissue density recovery
Restoring tissue density is a massage technique based on the theory of Linda LePelli, which states that pain in the structures of the musculoskeletal system is directly related to an increase in tissue density. By restoring normal tissue density, you will thereby relieve your client of pain. In addition, by carefully assessing and comparing the density of different tissues of the client, it is possible to accurately diagnose various problems with the musculoskeletal system before, during and after therapy.
To get started, let us turn our attention to the tissue density rating scale developed by Linda.
Level 0 = sluggish fabric, “hanging”, does not resist the force of gravity. This tissue density indicates that a person has recently lost a significant percentage of body weight or the presence of deep wrinkles. In addition, with age, in many people, the skin and other tissues of the chin acquire just such a density. You may have the feeling that the superficial tissues seem to have separated from the deep ones, and they, in turn, often respond with pain upon palpation, and their borders are very easy to determine.
Level 1 = tissues are supple, but retain tone: this is the most natural, healthy state of tissue. The skin and other tissues are well hydrated, easily palpated, muscles, bones, tendons and ligaments are well felt. Such tissues are usually warm and do not respond to pain on palpation.
Level 2 = the tissue is dense, its palpation, especially rather deep, always causes pain, when probing several adjacent muscles, it may seem as if they are “merging” together. The second level is increased tissue density.
Level 3 = tissues are tense, on palpation they are almost like rubber and respond very poorly to mobilization.
Level 4 = fabrics are very hard, rigid and motionless.
So, having a general idea of what “tissue density” is in the understanding of Linda LePelli (we will discuss narrower issues on Thursday), let’s look at the basic principles of her author’s approach to massage.
Work first with the area that hurts the most. It is getting rid of pronounced pain that cares for the client, and after it mobility disorders will also go away – after the first session you and your client will notice changes for the better. Moreover, sometimes intense pain in one area does not adequately assess the severity of symptoms in others – another reason to get rid of it as soon as possible.
Before you work through the fabrics, warm them up – heat makes the fabrics more supple. Stekko S. (2015) states: “It has been shown that when the temperature rises to more than 40 degrees C [104 degrees F], the three-dimensional superstructure of the chains of hyaluronic acid through inter- and intramolecular water bridges (Van der Waal forces and hydrophobic forces) gradually collapses. This reduces the viscosity of HA with loose connective tissue, usually located inside and under the deep fascia and muscles (p. 64, Fig. 3.3). ”
Reducing the viscosity of HA leads to softening of tissues. The author also notes that this effect, which occurs when the temperature rises, is temporary and suggests that the overstrain of some muscles and other tissues, which is observed in many people in the morning, is due to the fact that at night we lie almost motionless, the temperature of the tissues rises, and the viscosity of the HA increases. She summarizes the following: “If the viscosity change is insignificant, only a minimal temperature increase is enough to restore the normal functionality of the fascia.”
The area you work with must constantly move! During movement, friction occurs, and during friction, the temperature rises and the blood supply to the tissues improves. Poor blood circulation and a decrease in the flow of fluid to the tissues lead to a loss of their elasticity, they shrink and become harder.
Work with an area comparable to the coverage of your two palms. To evenly warm up and mobilize tissues, thereby relieving pain from the client as soon as possible, you should focus your attention specifically on areas of increased tissue density. If you spray your strengths while working with a larger area, you simply will not be able to raise its temperature to the required values.
Work with one target area for at least 45 minutes. Based on my clinical experience, continuous work and warming up tissues at such a time interval at the first session leads to a significant decrease in tissue density, relieve pain and improve mobility. Often massage therapists who practice my technique, but do not know all its aspects, argue that such manipulations have only a temporary effect, but the thing is that they simply do not devote enough time to working with tissues.
Before a session of restoring tissue density, the client should drink plenty of water throughout the day – as we have already noted, adequate hydration of the whole organism is necessary to restore normal tissue density.