Not a Knot
Have you ever experienced painful muscle aches that just won’t go away? The common term for these irritating and consistent aches is a “knot.” The purpose of this article is to help explain what exactly a “knot” is, how they form, and what massage therapists can do to help relieve them.
First of all, what is a knot? Although many depictions of knots show muscle fibers twisted like a pretzel under the skin, a knot isn’t a literal knot. Knots are known scientifically as myofascial trigger points. Exactly how these points form is still up for discussion, but many studies have shown that they form when a small number of muscle fibers contract and remain contracted, which shortens the muscle. This mini contraction can be caused by repetitive use of a muscle, poor posture, or from a misfiring of nerves.
No matter what the cause may be, due to the contracted fibers, the capillaries around the muscle carrying oxygenated blood are compressed, and that compression causes ischemia, or restricted blood flow. The sensation of muscle pain is caused by the stimulation of tiny receptors called nociceptors, which are specially programed to detect painful stimuli. When the blood flow to an area is restricted, nociceptors are activated causing us to feel the pain and tenderness of a trigger point. Most of the time these points are palpable, meaning they can be felt through the skin, and they are more painful when pressure is applied, or when the muscle is active during movement.
Myofascial trigger points are extremely common, especially for people whose daily lives require specific and consistent muscle patterns. The most common muscle groups where trigger points form are in the shoulder girdle, upper back, or neck. One of the specific muscles is the trapezius muscle, which runs from the occipital bone at the bottom of the skull, laterally to the spine of the scapula, and then down to the lower thoracic vertebrae, or mid back. The trapezius is responsible for stabilizing, rotating, and moving the scapula, or shoulder blade. In other words, we use this large superficial muscle a lot throughout our day to day activity. Even people that are stuck at a desk all day use this muscle while typing, using a mouse, or answering a telephone.
When a trigger point does form in the trapezius muscle, its victim could experience what’s called referred pain. Referred pain is when a trigger point in one spot causes pain in another spot. For example, a trigger point near the shoulder blade could also cause neck pain or even headaches. It is common for tension headaches to be caused by trigger points that are located in the neck or near the shoulder.
So, what can a massage therapist do to help relieve these uncomfortable spots? Since trigger points involve a contraction of a small amount of fibers, the ultimate goal is to get those fibers to release. One technique that is used most often by massage therapists is called trigger point therapy. Trigger point therapy involves putting pressure on the palpable nodule with a finger or similar instrument. Once the spot is located, the therapist will slowly add more pressure, or rock their finger back and forth slightly in order to coax the fibers into a release. While the therapist is treating the point with trigger point therapy, the client may feel the pain intensify, but it should feel almost satisfying, more like a good pain rather than an unbearable one.
Heat has also been known to be beneficial for the treatment of trigger points. When heat is applied to the tissue, blood flow in that specific area increases. Since trigger points cause a restriction of blood flow, heat can sometimes remind the body that there is an issue present and help to return blood flow and release the contracted muscle fibers. Therapists can add heat to their practice with hot stone massage. Hot stones can serve as a heat source, as well as an instrument to assist in releasing the trigger point. With some clients, trigger points will release after one treatment, but others are more stubborn and require multiple treatments, especially if they have been dealing with the issues for a longer period of time, or if it is more of a postural issue.
Trigger points are not ideal, but it’s important to remember that they are extremely common and it is possible to find relief. Massage therapy can be very beneficial for common aches and pains as well as more severe and ongoing issues caused by myofascial trigger points.