LePelley's Tissue Density Grading Scale Grade 0 (Yellow) = Tissue is flaccid, hangs from attachments and has little to no resistance to gravity. Grade 1 (Green) = Tissue is toned yet easily malleable. Grade 2 (Blue) = Tissue is firm, tender if pressed into; muscles may appear and feel as if they are bound together as one. Grade 3 (Red) = Grade 3 TD is tight, rubbery and is strongly resistant to mobilization. Grade 4 (Brown) = Grade 4 TD is hardened, rigid and immobile. Grade 0 (Yellow) – depicts advanced wrinkling; the hanging tissues found on some chins and underarms and the sagging, drooping tissues often noted on persons who have quickly lost a great deal of weight. It is important to note that grade 0 tissues are often found superficially over an area of elevated TD in the 2 to 3 range. It may feel as if the loose tissues have separated from deeper tissues, which in turn are becoming condensed. The deeper tissues are usually tender with moderate palpation, with easily definable borders. Grade 1 (Green) – TD represents normal, healthy tissue that is pain-free, well hydrated and well perfused. It is easy to palpate, identify and differentiate muscles, bones, ligaments and other connective tissue. Usually warm to the touch with no pitting when palpated. Grade 2 (Blue) – TD indicates elevated tissue density. Upon palpation you will find the tissues tight, sometimes hardened and resistant to mobilization. They do not relax easily and are reported to be uncomfortable, even painful. Clients often describe Grade TD 2 tissue as being tight, sore, achy, heavy, stiff and/or painful. However, grade 2 TD can be latent, without complaint of pain or dysfunction until activated by injury, use or palpation. The borders of the affected areas are easy to determine. Grade 3 (Red) – TD can be found in small strands and bands interspersed with other grades of TD, causing much pain and dysfunction, such as that of Carpal Tunnel Syndrome and Tendonitis. Larger areas are often found in a wide variety of conditions, such as Restless Leg Syndrome, MS, Parkinson's, and Fibromyalgia. Grade 3 TD feels firm and rubbery, and is resistant to mobilization. Grade 4 (Brown) – TD is associated with profound dysfunction, for example, curvatures and contractures such as those experienced by persons who are bedridden or extremely sedentary for long periods of time. Painful knots and lumps, and the “bony overgrowth” found in arthritic conditions are composed of grade 4 TD. It is hardened and often believed to be composed of bone.