Knot Knot who’s there?

I commonly see clients that complain of “knots” in their neck and upper back. When being massaged in the movies and TV you hear the one giving massage that they’re feeling “knots” and tension in their muscles. If you go to a massage therapist we usually talk about knots as well!

Does this mean you actually have fibrous KNOTS of tissue or muscle or toxins or whatever (“I’m Bad Ash”) you can imagine underneath your skin? This is debatable of course but short-answer is no.

The general and agreed-upon (for now) explanation in the medical community is that they’re trigger points. A trigger point is thought to be a small area of contracted muscle. So instead of an entire muscle spasm it is one small part of a muscle that is having a reaction. However, it is theorized that one trigger point in one muscle may refer or cause pain or discomfort to a completely and seemingly unrelated part of the body!

A trigger point can be tricky to identify and distinguish from its different labels as “active,” “referred,” or “latent.”

So when you say you have a muscle knot or a massage therapist says this; it’s correct name is trigger point(TrP) but they also have been called adhesions or myofascial pain receptors if you want to get fancy. Myofascial pain syndrome is caused by trigger points and is treatable!

We don’t know for certain the cause of TrPs but it tends to happen after a muscle injury especially from the strain of repetitive movements. Most common areas are the back, neck, and shoulders. It really boils down to the client’s lifestyle. Many runners and avid bicyclists and cyclers at the gym get trigger points in the glutes, thighs, and leg muscles.

The muscles around a trigger point are usually inflamed or contracted. This can create soreness, reduced range of motion, and pain.

Trigger points can feel like a hard bump or knot when palpated but are hard to diagnose because you can’t see them and really have only been (controversially) proven through ultrasound imaging.

For severe cases, a trained professional can inject saline or corticosteroid straight into the TrP. There is also a procedure called dry needling where it’s similar to acupuncture but instead of lining up with meridians it’s stimulating the TrP to contract and then release which hurts initially then feels better.

One less invasive way to treat TrPs is to perform stretches and ROM exercises while incorporating massage to encourage those muscles to relax. I have experience and training in trigger point therapy massage specifically however scientific studies have proven that a Swedish massage is just as effective for back pain as any other modality. While TrP Therapy helps, it isn’t a cure-all. Trigger points come back especially if you’re continuing the same repetitive motions that caused it or if you injured yourself or simply have the same bad posture at work day after day.

“The bottom line is that the human body is complex and subtle, and oversimplifying – as common sense sometimes impels us to do – can be hazardous to your health.”– Dr. Andrew Weil

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