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What is a Knot?

As a massage therapist, I am asked this question constantly, especially when people are first getting into the swing of massage. Often during people's first massage, they will ask me if I found any knots. When I tell them yes, there is often a look of defeat, like my client is getting a bad diagnosis. But this is not the case! Knots are completely normal, and we all have them to some degree. Some knots are very big and painful. Some knots are small and you may not even notice them, until they get bigger.


There are also different types of knots. The more commonly known knot variation is a trigger point. A trigger point is a discreet, hyper-irritable spot located in a taught muscle fiber. It will produce pain locally and/or refer pain elsewhere. The trigger point is locked in a state of muscular contraction. Without the ability to relax, the muscle stays in this contracted position. This prevents blood from moving through the muscle, so the byproducts of muscular contraction (lactic acid) accumulate in that area. This can create an aching pain that worsens over time. Sometimes we do not feel the tension as a trigger point is developing. This is called a latent trigger point. Research has shown that trigger point treatments through massage can prevent latent trigger points from turning into active trigger points (Ge HY).


An example of Trigger Points. The X marks the trigger point. The red indicates the pain referral pattern. The dark red indicates the primary referral pattern, and the spotty red indicates the less common, pain referral pattern, that develops as the trigger point gets worse.


The other type of knot is adhesion. Whereas a trigger point takes place in the muscle itself, an adhesion is when one muscle sticks to another. Our muscles are coated in a fibrous webbing called fascia. It creates sacks around our muscles that keeps them separate and distinct. These fascial cases, or epimysiums, are designed to slide against one another to allow for a healthy range of motion. Movement through your full range of motion and stretching helps keep these epimysiums separate. Spending a long time in any one position will cause the epimysium of one muscle to get stuck to another. These adhesions can then limit range of motion and create a sense of tightness because the muscles are no longer smoothly gliding against each other. The muscles involved will become tied together.


There are many similarities shared by adhesions and trigger points: they can both become tender and painful to the touch and they can both refer pain elsewhere. The difference between these types of knots is subtle. Whereas a trigger point occurs in a muscle fiber or muscle cell itself, the adhesion occurs on the outside of the muscle. This differentiation is most important for how we treat these types of knots. A trigger point is best treated through compression with massage. Adhesions can be addressed in massage, but for long-term healing, adhesions are best treated through stretching and active use of a full range of motion.


Both types of knots are completely normal! Regular massage treatments can help release or lessen the intensity of knots. Regular treatment is crucial for addressing knots because we are constantly reforming them. By releasing them with massage we prevent them from compounding by continuing to get tighter and tighter. Some knots can go away forever, and some will be on and off issues that we deal with continuously. Knots are normal and we all experience them.


Sources:

Ge HY, Arendt-Nielsen L. Latent myofascial trigger points. Curr Pain Headache Rep. 2011 Oct;15(5):386-92. doi: 10.1007/s11916-011-0210-6. PMID: 21559783.

https://triggerpoints101.blogspot.com/2019/01/levator-scapula-trigger-points.html



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