Have you got a hard, tender lump in your shoulder? That’s a muscle knot, right?
You may be surprised by the answer and you may not even believe me!
Muscle knots, also known as myofascial trigger points are described as hard, distinct, palpable nodules that are found in taut bands of skeletal muscle.
These myofascial trigger points are divided into 2 types, active and latent.
Active trigger points:
These are muscle knots that are painful without pressing them.
Latent trigger points:
These are muscle knots that are painful only by pressing them.
What is the history of muscle knots?
Treatments to muscle and fascia and using pressure points has been used since ancient times and there are also many acupuncture points that are considered trigger points and acupuncture has been around for thousands of years. The first thinking of what these muscle knots were came from Froriep (1943) and were described as calluses of connective tissue. The Gowers et al (1904) called them “fibrositis” thinking they were related to inflammation of the connective tissue but this was found to be incorrect. Nowadays, the syndrome is called “myofascial pain.” This basically means pain in muscle and fascia (Shah et al 2015).
Trigger points or muscle knots can be associated with muscle dysfunction, muscle weakness, and a limited range of motion (Travell & Simons 1999). For a long time the presence of muscle knots was in itself considered the core problem and treating them was considered to be getting to the root cause. However, this was not the case. Next, they were thought to be a reaction to an underlying issue. For example, a lumbar disc bulge causing lower back pain may cause the muscles around the area to ‘knot up’. Gerwin (1997) believes up to 95% of mechanical musculoskeletal pain may be trigger point related.
Next came the debate:
Can the feeling of ‘muscle knots’ tell us anything, and more importantly, what are we actually feeling?
Up to this very day, nobody has been able to visualise knots or find them. Even the experts have been unable to do this, which makes us sceptical of their true existence as a structural phenomenon. From my own experience, at Hawkes Physiotherapy, I can tell you that I have been on training courses where we all palpate and feel other practitioners. Commonly, you will hear people saying, “Whoa! How tight are you?” and “Wow, that’s solid, that knot is!” only to then ask, “Does it hurt” or “Do you have any problems or injuries?”
The answer was usually, “I’m fine why?”
On the flip side, I have had patients in agony who are super tender to touch but their muscles are ‘knot’ free and soft as butter!
Even research supports my findings, in a study by Dieterich et al (2020) they used shear wave elastography to measure muscle stiffness and found no differences in muscle stiffness in people with and without chronic neck pain. Even more interestingly, the individuals with neck pain actually felt the sensation of increased neck stiffness but physically it was absent.
So if muscle knots don’t exist then what am I feeling?
Now, I’m not saying that you are imagining this lump, but if you felt Arnold Schwarzenegger’s relaxed Bicep then it would be soft and smooth and flat. Then ask him to flex it and boom! A rock hard lump appears. Is this a knot or is it just s tense muscle?
Remember, muscle is not flat nor smooth and there are layers of other muscles and structures below. Not to mention, bone is not flat as it too has many lumps and bumps.
So why does a muscle relax after pressing the trigger point?
Basically, there is something called the stretch reflex. This is when a muscle is stretched there is an automatic reflex causing the muscle to relax. What is well known now, is that pressure elicits this reflex relaxation of muscle. This is why muscles relax after massage, trigger point pressure, foam rolling and even acupuncture. The muscle spindle, which regulates resting muscle tone, reacts to pressure as in the same way that it does to stretch. Now if you think of the different parts of the body, some parts are going to be great for causing pressure and some are going to be rubbish for this. It all depends on what is under them to be squashed against.
So in summary.
We all have trigger points, but they may not mean much.
Muscle stiffness and tension is more of a sensation than a physical reality.
Trigger points can be a sign of an underlying injury or problem.
Muscles can be more or less tense and this is individual.
Muscle knots are partly the natural contours of the muscle and what is below them, which is more noticeable when tense.
Muscle tension and pain will reduce with pressure applied to the known trigger point areas of the body.
Physio, sports massage and acupuncture all help the muscle spasm and pain but you may need to assess more thoroughly to work out why the muscle seems to have knotted up.
So there you go. Things are not always as they seem!
The content in this blog article is provided for general information purposes only and is not meant to replace a physiotherapy or medical consultation.