Tissue Density (TD), as it pertains to therapeutic massage, is a description of the compactness and consistency of a body's soft tissues. The firmness of the tissues can be assessed and graded (See "The Tissue Density Grading Scale: A Communication Tool," Massage Today, March, 2014). One of my theories, based on 20 years of clinical massage experience, is that an elevation in tissue density increases in direct association with musculoskeletal pain and dysfunction. This means that we (the persons experiencing pain as well as the therapist addressing it) are able to physically, through our sense of touch, feel the affected areas – even areas that are "invisible" to X-ray and other imaging methods.

Normal, healthy tissue does not hurt, and is not uncomfortable when pressed into. While every noxious sensation has elevated tissue denisty associated with it, not every area of tissue density hurts. It can take years of development for tissue density to become painful and affect function. While it would be beneficial for all tissue density graded at G2 or above on the Tissue Density Grading Scale (TDGS) to be restored to G1, it is most practical (and appreciated) to focus on and treat the areas that hurt the most, and impair function, first.

Being adept at TD palpation means you are able:

• To provide tangible evidence that the client's complaint is an actual, physical reality.
• To locate the specific problem areas with your fingers, determine their size and shape, and grade their density throughout the assessment, treatment, and discharge processes.
• To communicate the condition of the target tissues to the client, and to other members of the health care team.
• To determine and compare the effectiveness of specific treatment modalities.
• To definitively establish that therapeutic massage is an effective treatment for pain and dysfunction based on the objective, palpable state of the tissues, rather than just the subjective claims of pain relief, that might easily be attributed to other treatments or circumstances.

In the beginning, your best practice model is going to be yourself. It takes some therapists a while to accept that all pain is palpable via the tissue density. By exploring the tissue density and areas of pain in your own body, one is more able to recognize the feel of it. Because most active massage therapists have pain issues with their own hands and wrists, these are ideal places to start exploring the relationship between sensations and tissue density. Painful knees provide larger and more easily defined areas.

The warmer your target area is, the easier you will find it to differentiate tissue density from its surroundings. Cold tissues are firm. Once warmed, the more normal tissues will soften, leaving the tissue density more palpable.

Pick any spot that hurts, place your fingers over the area, and drag them across, seeking the specific location of pain. When you are directly upon it, carefully feel to determine its borders. Use as much pressure as you need to palpate the affected area without increasing the pain level. Once you have located and measured an area of tissue density, have another person palpate the same area, and compare your findings. An important approach to TD palpation is that the more you practice it, the more expert you become.

It is this ability, for two or more persons to uniformly feel, measure, and grade the actual condition of the affected tissues that makes it possible to firmly and undeniably establish the effectiveness of massage therapy.