The word “knot” as it relates to the human body is a misnomer. In order for a knot to be tied, there must be two loose ends. Muscles are attached to bones via tendons. They cannot disconnect, tie themselves into knots and then reconnect to bones. So why do we hear the term “knot” used so often?
My personal impression of what a “knot” refers to is when someone can palpate a lump of tissue that shouldn’t be there in a muscle that feels extremely aggravated. There is an occasion for this - and where I typically feel this in a client's body is along the shoulder blade. I like to call this a high-traffic area because of the repetitive motion of the scapulae over the ribs in arm movement.
Areas of repetitive use are sometimes reinforced by excess fascia that the body lays down over those stressed areas. This is a natural function that serves a good purpose. The problem is two-fold. Sometimes more fascia than necessary is created which leads to the second problem. Excess scar tissue can become adhered to muscle fibers and other fascia causing jumbled tissue. This jumbling can cause nodules that many people perceive as "knots." Massage can help to smooth those areas down.
Other than this example of accumulated scar tissue, I almost never feel lumps in tissue when someone asks me, “Is that a knot?” So if there isn’t a knot there, what is the client feeling?
There are many reasons for pain. Pockets of lactic acid from robust exercise, metabolic waste from normal muscle function and toxic material from poor dietary habits can all create tender points. But more commonly, the reason you have pain in a particular spot is because you have muscles that are tight, irritated, shortened and thirsty for blood (ischemic). These conditions are caused by overuse, overload, repetitive motions, trauma to muscle tissue and even underuse of muscles. All of these factors can create a breeding ground for trigger points.
Trigger points are not the same thing as tender points. Trigger points are painful spots in taught muscle bands that keep muscles perpetually tight. They sometimes create palpable nodules (although I've never felt one) and they often refer pain to remote locations. For example, many headaches are actually trigger point referrals from trigger points located in tight neck muscles. More information on trigger points and muscle conditions that foster them can be found in my article "The Pain Spasm Wheel - How Stress Transforms Into Pain."
So why is there so much confusion around knots? Because many people make the mistake of thinking that just because they have pain in an area, they must have a “knot.” Perhaps it doesn’t matter what we call it. At the end of the day, why does a poorly-named term matter? The real issue is that people are uninformed about what causes pain and exactly how massage takes it away. Articles like this one help people to understand that they don’t have to be victims of circumstance. Healthy habits promote healthy muscles – but that is a big topic for a separate article. Massage is the most effective way to rid muscles of accumulated scar tissue, trigger points and other factors that cause areas of pain that we frequently call “knots.”
Emily Hagen CNMT, BCTMB
Board Certified Neuromuscular Therapist
Right as Rain Massage, LLC