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  • Akosua Knowles

"Like a piano tuner." A few words on intraosseous lesions

Updated: May 10, 2023

The other day, I was tapping my finger down a client’s spine, as I sometimes do, listening to the sound each bone made. One vertebra made a higher pitched sound than its neighbours. My client could hear the difference too. I explained that by tapping the bone, we can listen for variations in pitch within the bone or in comparison to its neighbours. A higher pitch indicates a more dense structure. He said I reminded him of a piano tuner! Piano tuners are fascinating. I was flattered. The osteopathic term for a density within a bone is an intraosseous lesion. Intraosseous, meaning ‘within bone,’ and lesion, meaning different from the tissue's normal physiology.

Structurally, our bodies are beautifully mapped arrangements of densities and tensions, which combined form a balanced system. This follows the principles of tensegrity, something which perhaps I will delve into further at another time. In health, our structure is adaptive. We can both receive force and push it back, like a spring. Sometimes however, a force acts upon us that is either too great, ill-timed, or too frequent for our tissues to be able to adapt, resulting in injury.

Bones, although relatively dense in comparison to the rest of our bodies, are largely composed of fluid. Living bones therefore have flex, and motion occurs even within them. How a bone reacts to a force depends on the amplitude, direction, and frequency of the force, as well as the health of the bone and the body it lives in. A fracture results when a bone is unable absorb, deflect, and/or disperse a force, and the force is able to pass through it. But what happens in the case where a force is not quite great enough to cause a fracture? If enough force remains absorbed within the bone, local tissue damage occurs. As tissues repair, they remodel according to the forces that act upon them. In this case, because the injuring force remains in the bone, the tissue remodels in a more dense organization than its original state. The once flexible tissue becomes inflexible. Due to the principles of tensegrity, this new area of hypomobility must result in a corresponding area of hypermobility. Hypermobile tissues are overworked, and may feel strained and unstable.

Let’s take, for example, an intraosseous lesion of the tibia. Its Saturday morning, we’re walking to the kitchen and whoops- whack our shin into the coffee table (it came out of nowhere!). We wince. Perhaps we notice bruising. In a week or two the bruise has healed and our shin (tibia) feels better, but we likely do not notice that this area of the bone has becomes more dense and inflexible. What we may notice a few weeks or months later is an achey knee, or an unstable ankle, or perhaps shin splints. What we’re feeling are the areas of hypermobility that came about in response to the new point of density at our tibia.

The good news is, intraosseous lesions can be identified and treated with relatively straightforward manual techniques. One method of identification is listening to the resonance of a bone when it's tapped. You can try this on yourself. Tap down the length of your shin (tibia), listening for the sounds that are created. If an area creates a higher pitch, you may have found an intraosseous lesion. To treat an intraosseous lesion, we use our hands to create precise force vectors in order to completely surround the density with pressure. This helps the body ‘melt’ the density, returning the structure closer to health and homeostasis. I can’t say intraosseous lesions are always easy to treat, and one must be able to find them in the first place to know to treat them, but it is oh-so-satisfying when, after successful treatment, we tap the bone again and the pitch created beautifully matches that of its neighbours. I have glimpsed the joys of a piano tuner’s work.

With thanks to my instructors at the Canadian College of Osteopathy, for teaching me so many wonderful things.

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