muscle pain

No Such Thing As A Knot!

So your massage therapist told you that you have "knots," or maybe "the most knots I've ever felt!" What is a knot, and what can you do to get rid of them? Well, I've got good news: There is no medical phenomenon known as a "muscle knot." Your muscles don't get knotted up or clumped together when you get stressed, and there are no balls of messed up tissue within your muscle.

So... what is your massage therapist talking about? As I say in the video (0:55), they're probably just talking about tight postural muscles, usually in trapezius, rhomboids, and the spinal erectors. These are naturally very lumpy muscles—in high-tension situations, they can feel quite bumpy, especially where they overlap. If you don't know your anatomy (your massage therapist should, by the way), it could be easy to mistake this for a problem.

Another likely "not-knot" are the many bits of your anatomy that are difficult to identify (4:24), such as the tendon of levator scapulae, the inferolateral border of trapezius, and the many ridges and folds of perfectly healthy muscle. If you've been told that you have knots in your upper back, it's very likely that your massage therapist was just unaware of what they were feeling under their hands.

It's possible that your massage therapist was talking about myofascial trigger points (3:00), a phenomenon with mixed scientific evidence. Here's the theory: You've got taut bands in your muscles that tend to have isolated areas of contraction within them. These can refer pain elsewhere, following predictable patterns. While the referral of pain from one area to another seems to be reliable (if poorly understood), the palpability of trigger points is in question. See this study for an example: , and this article by Paul Ingraham for a comprehensive write-up:

If your massage therapist told you that you have knots, it's likely that they're just using the language and interaction style modeled for them by teachers and colleagues. Those people were mistaken too. Please feel free to let those knots go. If you've got muscle tension that's giving you trouble, that can and will change over time, especially if you make some changes.

To the massage therapists in the crowd, I'd love to hear your thoughts. If you used to tell clients about their knots (I know I did), what made you change your mind? Have you found other language that's more useful, and that creates less stigma? Let's talk about it!

What does your massage therapist mean by "knots"? 
0:55 1. Tight posture muscles.
3:00 2. Trigger points
4:24 3. Mistaken anatomical identity
4:57 What should you do about your "knots"?
The "not-knots":
5:27 The superior angle of the scapula
7:00 Inferolateral trapezius
7:53 Aponeurosis medial to the spine of the scapula
8:30 Infraspinatus
8:58 The "back mouse"

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