The Basis of TDR Massage

By Linda LePelley, RN, NMT
June 7, 2016

The Basis of TDR Massage

By Linda LePelley, RN, NMT
June 7, 2016

Around 2004-2005, I was excited to learn that Robert Schleip was organizing the International Fascia Research Conference and he was asking for relevant papers. He encouraged me to write up my theory regarding tissue density (TD) and its relationship to pain and dysfunction. An associate's degree in nursing had not prepared me to write an acceptable scientific paper, I didn't know what a PDF was, let alone how to send one. Looking back on what I submitted is a little embarrassing. Mr. Schleip very kindly told me that my idea was,"Fascia-nating" and that I should find someone with experience who might want to help me develop and present it.

Juggling my supervisory nursing job, massage clinic, and increasingly severe health issues left me little time and energy to find the help I needed to compose what I had been finding in my clinical experiences into a professional paper. My attempts to find a mentor were unsuccessful and, at times, discouraging. The only reason I did not give up on sharing my experiences, observations, and ideas was my firm conviction that everyone has the right to know about and become aware of the pain that can be associated with elevated tissue density (ETD), as well as the fact that it can be restored to a mobile, pain-free density.

To even begin a conversation about pain, the terms used must be concise. To be understood when talking about what one "feels" requires that emotions or ideas have been clearly differentiated from tactile sensation. (I realized this after having a frustrating conversation with another therapist in which I was talking about what I was feeling with my hands, and they took it to mean that I was "feeling" with my imagination or some sort of energetic sense). Even the word "sensation" can be taken as a subjective, intangible feeling, rather than an objective, palpable reality. So, I want to be clear, while many aspects of pain do affect those experiencing it in subjective, emotional, and impalpable ways, for the purpose of this discussion, I am referring to a detectable and measurable actuality. I am claiming that where one person can palpate areas of ETD on a client at the exact location of that client's pain, another person can come alongside and also palpate and measure the same ETD with their own hands.

Current research substantiates my clinical observations. Pavan, Stecco, Stern & Stecco (2014) state: "Chronic densification alters the gliding action between adjacent fibrous layers. This affects collagen fiber deposition, even at a site distant from the first site of densification. Indeed, the fascia is always subjected to remodeling pressures responding to the local mechanical state. If spatial deposition of fibers is altered with respect to physiological conditions, the rebuilding will be pathological."

This seems to support my idea that when layers of ETD move, or attempt to move, rather than being able to slide and glide freely, nerves within them get pulled and tugged, depending on the degree of TD present and the directions of movement. If a layer of microscopic nerve endings are firmly cemented within two or more layers of tissue, and then those two layers are forced to glide across each other, without the associated nerves being able to smoothly slide or stretch, they will be pinched, yanked, and possibly scissored or shredded. A good example of this is in the case of headaches. A person might go quite a while with ETD forming at the back of the neck and shoulders, and over the skull and scalp with no problems – until the day comes that they develop an increase in tension (either from a reflexive reaction triggered by emotional stress, or from a strain produced by musculoskeletal movement), resulting in tightness and tugging in the head, neck, and shoulders. Tense muscles pulling against hardened tissue layers result in nerves getting stretched and pulled beyond the abnormally developed boundaries they are caught up in (See "Adventitious Tissue Structures," Massage Today, June, 2013), and a headache ensues.

Pavan et al. (2014), listing several causes of alterations in connective tissue, describes one of which is aging, and states,"...increasing age creates stiffer, stronger, and more stable connective tissues, although they are much less flexible." I have noticed this by means of palpation, however, I have also found that through properly applied tissue density restoration (TDR) massage, the density can be restored to a more mobile, comfortable density. I am not claiming that TDR massage is the only massage method to relieve pain. Any massage method that results in a reduction of ETD will and does provide pain relief and improves mobility.

It is my belief that every sensation means something, whether or not we happen to understand it. In an otherwise healthy individual, pain is the method by which our bodies let us know that there is a problem somewhere. Rather than assuming that the brain is misfiring, or that a person is having some kind of emotional or psychological manifestation that is irrelevant, we need to pay close attention and investigate the affected tissues closely with our hands.

Clients often come in saying that they have pain, but nothing showed up on their diagnostic tests. Their doctor has told them everything appears to be fine, often leaving them to feel that he thinks they were either making it up, drug seeking, or delusional. Even worse, they either get told or already believe that they are just old, the pain is to be expected, and they need to learn to live with it. I tell them that if I can feel with my hands, so can they, and so can anybody. More importantly, if it can be felt, it can very likely be restored and relieved, regardless of age. I show them how to palpate the painful area and feel the ETD, which verifies that something is going on that is affecting the nerves at that site – right where they are experiencing it, and it is real. One client was ecstatic to report that she had gone home and shown her husband that there was a physical manifestation at the location of her long-time area of complaint. Once he felt it with his hands and realized that there was a substantive reason for the discomfort she had been experiencing, he became a partner in helping restore the tissues and bringing about the relief of his wife's pain.

Reference:

  1. Pavan, P.G., Stecco, A. Stern, R., & Stecco, C. (2014) Painful Connections: Densification versus Fibrosis of Fascia. Current Pain and Headache Reports, 18(8). doi 10.1007/s11916-014-0441-4.