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Massage Today
June, 2013, Vol. 13, Issue 06

Adventitious Tissue Structures of Elevated Tissue Density

By Linda LePelley, RN, NMT

A 12-year-old boy was brought into my clinic complaining of pain in his right heel, which impaired his ability to participate in sports, even to walk normally. His doctor, having x-rayed it, diagnosed a bone spur, explaining that the pain may or may not resolve on its own and it could be surgically removed if it continued to bother him.

The boy's mother had heard I'd helped a friend with a similar problem so she wanted to see if I could help her son with the pain until something could be done about the bone spur. A hard nodule the size of a pea was palpable on his right heel.

A mechanic came in complaining of right-sided upper back pain, with trouble raising his right arm. I found a large mass of dense tissue, approximately 9 cm long, 4-5 cm wide, with an approximate depth from 1 cm at the outer borders, to 3 cm deep at its center. Its presence, at the medial border of the scapula, involved all of the musculature at that region, and prevented full range of motion. Palpation indicated it was ensconced all the way through to the bones of the ribs.

A 65-year-old woman presented with severe low back pain. She stated that she had never had any problems with her back until several days earlier. She had driven for 6 hours to visit her daughter, stopping only for fuel and then going directly to bed once she had reached her destination. The following morning she awoke to find herself barely able to walk without grimacing and crying out in extreme pain. Upon palpation, I found a large, rubbery, firm area the approximate size and shape of a 5 x 3 cm oblong pancake, 2 cm deep, engulfing her right sciatic nerve and the tissues around it.

A friend showed me her left wrist where, over the period of just a few months, a knot had formed on the radius, proximal to the scaphoid bone. Her doctor had told her it was arthritis, and her sister told her that she had suffered the same thing on her wrist, and had it surgically removed – suggesting my friend should do the same. My friend was no longer able to wear her watch, due to tightness and irritation. The knot felt just as if it was solid bone.

What these seemingly unrelated conditions have in common with each other is that they all involve the formation of a new tissue structure. I refer to these tissue structures as "Adventitious" because they are extraneous and they do not belong where they occur. And while they are likely the result of a body's attempt to maintain homeostasis; their development often results in pain and dysfunction. In my previous article, "Tissue Density's Relationship to Pain and Dysfunction", from the April 2012 issue, I wrote as follows: "My thoughts regarding the etiology of elevated TD involve the lipid-rich components of our extracellular fluids, which I believe are attracted to the bio-polymeric nature of our cartilaginous tissues. This attraction, combined with a variety of dynamic factors, including body heat, compressive force, overuse, injury, hypo-hydration, torsion, sheer force, tensile force, inertia, chemical environment and fluid viscosity may cause the extracellular fluid to accumulate, thicken and eventually precipitate into gelatinous plaque. Over time, I believe that these plaques harden and become mineralized, turning into the rubbery nodules or bone-like overgrowth of arthritic joints, as well as contributing to many other conditions. The plaque may be as thin as a sheet of a single layer of fascia cells or it can form a large area of many tissue layers sandwiched together, such as those found over arthritic hip joints and the thick, tender pads which so often develop at the medial aspect of knees." (I suspect that the main component of this conglomeration is cholesterol.)

Elevated Tissue Density (TD) is, in my opinion, the first sign of adventitious tissue structure formation. It seems to continue to increase in size and hardness over time. I wouldn't characterize it as "growth," but as an accumulation. Tissue Density Restoration (TDR) massage is an effective way to prevent and reverse this condition. In most of the examples above, the structures were stable, easy to isolate, and not too difficult to resolve.

In the case of the mother who spent several hours driving, the problem was a little more complex. An adventitious tissue structure had formed and become dense at her sciatic nerve area. Because it had not impeded movement or caused her pain, she was unaware of its existence. Over time, it continued to accumulate and condense, holding the nerve firmly in place until, that is, it shifted. When my client spent several hours driving, with her right leg extended to the gas pedal, enough heat was created in the affected area to slightly melt the outer layer of the adventitious structure. She then went to bed, sleeping in a side-lying position. During the night, her tissues resumed their normal temperature and the structure re-hardened, but now it was in a slightly different position. While the structure maintained its solid grip on the nerve, it had shifted, pulling the sciatic nerve painfully out of place.

Adventitious tissue structures can form sharp points, such as the bone spur on the young man's heel; large, immobile, lumpy barriers to free movement, as found in the mechanic's back; unstable, shifting bodies such as the one experienced by the traveling mother; and some so smooth and solid one would easily believe that it was simply a large, bony prominence. Fortunately, these affected tissues can often be restored to normal density and function through the proper application of TDR massage, as happened with each of the examples listed above.

A client who has rheumatoid arthritis complained of pain in her right ankle, stating that she had erosion in an ankle bone, as explained to her by her physician, and evidenced by x-ray. She brought her x-ray in. It occurred to me that perhaps the eroded area might actually be an adventitious tissue structure, formed over the bone, which had then melted in one spot (due to the heat of RA inflammation), leaving the appearance of erosion. I applied TDR massage, relieving her pain. Our hope was to then have the ankle x-rayed again for comparison; however the health care provider was not interested in exploring the matter. Whatever the actual etiology may have been, almost a year later, the client has not suffered pain in that ankle since.

I surmise that the reason elevated TD and these adventitious tissue formations have been overlooked, is due to the fact that they are largely invisible to diagnostic imaging. They are, however, palpable and once located, treatable through the proper application of massage. Massage therapists have the ability to resolve a great deal of human suffering, literally, within their grasp.

Click here for previous articles by Linda LePelley, RN, NMT.


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