What is a Muscle Knot?

The Anatomy of A Muscle Knot

This is probably the #1 question I am asked as a massage therapist, so I’ll attempt an “everyman’s guide” to the troublesome muscle knot.

Myofascial Trigger Points

Myofascial Trigger Points

Muscle “knots” are myofascial trigger points to the medical world. Let’s break that jargon down:
Myo= muscle
Fascia= connective tissue (this is what surrounds everything in our bodies, muscles, organs, nerves, blood vessels, etc., both holding them together and helping them slide over each other)
Trigger Point= really irritable spots in the muscles, associated with tight bands of muscle fibers

What is a Muscle Knot?

“Knots” are areas where connective tissue has somehow adhered in the muscle causing decreased range of motion and a painful, tight lump. You may picture something out of a sailor’s handbook:

Midshipman's Hitch

Land ho!

When in reality, a “muscle knot”, or Myofascial Trigger Point, looks more like this:

Muscle Adhesion

That’s the one.

But connective tissue adhesion is not necessarily the problem here. To understand where the pain in a muscle knot comes from, you need to understand sarcomeres.

Sarcomeres

Sarcomeres are the smallest functioning part of the muscle.  It’s the job of the sarcomere to help a muscle contract. Muscles are made up of many smaller muscle cells, or fibres, all of them bundled up by thousands of sarcomeres.

Sarcomere

Sarcomere

You can imagine a sarcomere as chains of proteins that overlap, sort of like the tines of two forks interlaced. When you contract a muscle, the sarcomeres overlap and grab on to each other like velcro. When you relax the muscle, the sarcomeres “let go” of each other.

Where Do Muscle Knots Come From?

The problem is that sometimes the sarcomeres in one part of a muscle start to pull apart, but don’t “let go” like the rest. For whatever reason (fatigue, trauma, pain) they stick to each other and stay that way.

When you overstretch or sustain some injury (even a very small one, like a bad sleeping position), your sarcomeres do their job and contract the muscle to protect the structures around it, for instance, your joints. This is really helpful in most cases, the problem arises when your muscle gets swept into a “pain-spasm-pain” cycle.

Pain Spasm Pain Cycle

Nice, right?

Let’s say you were rear-ended in your car. Likely your neck muscles tightened up (the sarcomeres contracted) during the impact to protect the more easily injured joints in your vertebral column. The impact caused some small degree of pain in the moment, but you’re basically fine. However, the sarcomeres in your neck muscles (many of which also attach to and affect your shoulders) are contracted so tightly and for so long after the initial accident, that as time goes by they begin to cut off their own blood supply. Tiny tears and swelling within the contracted area create scar tissue (made up of fascia) and impinge the nerves and blood vessels. This causes a buildup of metabolic waste in the area, aggravating the local nerve endings and causing pain. Some of your neck muscles, feeling the pain, think the spine is again in danger and contract even more. Rinse and repeat.

If this goes on long enough (it doesn’t take too long) not only is your range of motion decreased, but you’ve got some angry trigger points.

So How Do You Get Rid of Them?

Address myofascial trigger points before they become a chronic problem! I cannot emphasize this enough. It’s much easier (and less expensive) to treat trigger point pain in the early stages than it is after it’s been around for several years.

In both acute (close to the time you notice it) and chronic (you’ve had it for a while) cases, massage therapy is a very effective form of treatment for myofascial trigger points. If your trigger points are causing a great deal of pain and you’ve been dealing with it for a while, ask your doctor for her treatment recommendations. It may be possible to get a prescription for massage or physical therapy treatment that your insurance will cover.

Deep Tissue Massage

Aaaahhhh…

There are several effective massage techniques that can address knots in the muscles, one of which being Deep Tissue Massage. It’s important to find a skilled Deep Tissue Massage therapist to treat your myofascial trigger point pain, because Deep Tissue does NOT just mean “lots of pressure.” In fact, using too much pressure can aggravate the area and feed directly into the “pain-spasm-pain” cycle, causing further damage. A skilled therapist will work slowly into the tissue, relaxing it and enabling the body to release natural painkillers and endorphins. Properly performed Deep Tissue massage will break up the fibrous, “stuck” connective tissue, which helps fresh, nutrient-filled blood and oxygen circulate into the stagnant tissue. When the muscles relax and receive the nutrients they need to function properly, the sarcomeres release, tissue is re-built, and strength and flexibility are restored.

Your healthcare provider (massage therapist, physical therapist, chiropractor) may also use heat, ice, targeted exercises or electrical stimulation to address chronic myofascial trigger points.

How Can You Avoid Them in the Future?

If you think you’re getting more than your fair share of muscle knots, talk to your doctor about your diet. Calcium and Potassium are what your body releases when it wants your muscles to relax after contracting, so in addition to remaining hydrated, increasing your Calcium and Potassium can help if your body is deficient.

Keep in mind that, in our culture, most of us are relatively sedentary with short bursts of activity. A lot of us spend 8 hours every day hunched over a desk, which trains our muscles to behave abnormally. When we come home and want to rearrange the living room it’s more difficult to prevent injury. You can avoid injury in this case by becoming more aware of the way you hold your body. Take frequent breaks to stretch, walk around, and evaluate your posture at work and throughout the day.