What is a Knot and Why Do I Have Them?


A knot is scientifically known as a myofascial trigger point. What does that mean to you who only want to understand what those pesky knots are and why they cause pain and discomfort, limit range of motion, and aggravate the soul causing even more stress? I get asked all the time as I work on a knot, “What is that?” What causes that?” A simple explanation is that a knot is a tight ball of muscle from an overworked muscle. I have been asked if a knot is when two or more muscles become intertwined. A good question because actually fibers within the same muscle can become intertwined as can fibers from separate muscles that share an attachment of the same bone. Try not to think of a knot as a “knot” in the traditional sense though. There is no wrapping into a bow or sailor’s knot of our muscles as the term can easily be misconstrued. Instead think of the knot as a muscle spasm.

To understand what a knot is, it is important to distinguish the normal physiology of muscles. Most of the time, our muscles operate in an on/off manner. That means the muscles that get sore and fatigue easily, the fast twitch fibers (the white meat as opposed to dark meat) that enable us to perform rapid, intense movements of short duration like weight training or throwing a ball are not always at work. They fire or contract during exertion but when the exertion is completed they quit firing. It is when they continue to fire or contract without releasing that a spasm or muscle knot forms. So how does this occur? A fatigable muscle in spasm contains individual sections within the muscle that constrict and pull from both sides. This makes a taut band of muscle essentially forming what is known as a knot.

No really! How does a knot occur? There are direct and indirect causes of knots. One of the most common causes is overwork. Remember, these fast twitch fibers are not meant to be used for long periods of time. The next time you are working out, try doing one more set of 15 reps of what you are lifting and determine if that last set was as easy as the first set. This is why Major League baseball pitchers operate on a consistent pitch count. Because that 120th pitch is not going to be as effective as that 80th pitch! Ask Pedro Martinez! So overworking muscles can cause knots. Trauma, such as can happen in an automobile accident or physical activity or injury, also contributes to knot formation. The stress that we encounter on a daily basis help form the shoulder and neck knots that we all are accustomed to at some point or another. One of my favorite bumper stickers is “Stress is the inability to reach out and strangle someone who desperately needs it” Since we cannot strangle the person who cuts you off on the highway or cuts in front of you in line at the grocery store, we tend to take that “energy” and keep it “balled” inside. So our neck constricts, our shoulders raise and before long if we cannot calm down and realize that Life is just too short to worry about such trivial matters, then those poor muscles that make our shoulders look like earrings remain overworked by contracting and firing too much/too long. Therefore tension knots occur.

So how does massage therapy help in getting rid of our knots and decreasing the associated pain and discomfort? First let’s review what we know about massage. The number one benefit of massage is relaxation. By that I mean, when a person experiences massage, whether Swedish, Deep Tissue, Thai, Shiatsu the list goes on, the primary response to touch is that the parasympathetic nervous system or rather the nervous system that enables us to rest and digest is activated. This means that during your massage session, your body, that is your much more relaxed body, is able to function much more effectively, efficiently, and optimally because it is undergoing a restorative phase. Therefore our circulatory system works optimally and increases circulation which carries blood and nutrients to other systems in our body. Thus these systems operate more efficiently too. Our liver detoxifies and the lymphatic system operates advantageously thus reducing toxins in the body. And what of the toxins that are the chemical makeup of a knot? Because it is thought that a knot can contain excess lactic acid, unusual deposits of protein and other bodily by-products more commonly referred to as “toxins”, massage both directly and indirectly has an effect on the removal of wasteful by-products.
Trigger Point therapy directly aids in the reduction of knots with a massage technique called sustained compression. Translation: the massage therapist locates the knot and applies deep compression with a thumb, fingers, or elbow and holds until the pain and discomfort dissipates (usually 20-30 seconds and is repeated several times). This is done with patient/therapist awareness and focus on breath and thought. Trigger Point therapy can be painful but if done correctly by a legitimate massage therapist can be the difference between chronic pain caused by muscle knots and a freer, more mobile, happier you.

Kip Yates
Massage Therapist

12 thoughts on “What is a Knot and Why Do I Have Them?

  1. Pingback: What You Need To Know Before Your Massage Session | Legitmassage.com

  2. Kip,
    Try to see and respect the idea that knots are formed within weaker muscles and serve as a response to a tonal imbalance and attempt to arrest further extension within that overstretched and weaker muscle group. Elsewhere, whether nearby or distal, there are myofascial groups that have higher tone, tension and strength, thereby overpowering that targeted and knotty myofascial group and need to be stretched and manipulated first before digging into that knot. Otherwise, you are further increasing the stretch imbalance, waking up the weaker muscle group (and guaranteeing a reactive headache if it is in the shoulders or neck as the tone in the chest is highher) and possibly further inflaming the knot while not correcting the primary problem…I’m speaking as a Rolfer™ who has worked as a massage therapist: Perform your firm cross-fiber work opposite the knot of inflammation and use ice on the knot if it is acute or heat if the knot is chronic. Knots or active triggerpoints will soften and calm down with minimal manipulation if you can impart balance to your clients.

    • I agree wholeheartedly with you Sam having had numerous conversations about treating antagonist muscles in such cases. There are more than a few ways to address knots. Ischemic compression works very well as does treating opposite muscles. It depends on how the knot is presenting itself. Is it in hypertonic muscles or weaker muscle? Your input is greatly appreciated.

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  6. There hasn’t been any activity to this thread for awhile, however I’ll try regardless. I have fairly large knots in my shoulder area, and smaller knots in between my shoulder blades on my serratus posterior superior I believe. My girlfriend is actually a massage therapist but hasn’t practiced in a business setting for quite some time. She has tried to use pressure on the knots in both area’s using her fingers and elbows but they won’t seem to break up. Is there any other solution for this? The muscles that line the sides of my spine, which I believe are the thoracis muscles are super tight as well and seemed to be causing a great deal of stress and pain for my spine itself. Receiving massages seems to help temporarily, but the next day it seems that the muscles are locked up just as tight as they were prior to the massage.

    • Thanks for asking Rich, your girlfriend may be providing temporary relief for the knots in your shoulders with the pressure but has she taken a look at the antagonist muscles, i.e the pectorals. In many cases, shoulder knots are a result of tight chest muscles. Are your shoulders rounded to the front? This assessment is important to determine the appropriate treatment. Without releasing the pectoral muscles, the pressure on your shoulders is most likely to remain temporary. As for the super tight thoracic erectors, you may try massage in conjunction with PIR techniques to lengthen the muscles. Another common cause for the pain may be a nerve entrapment, in which case massage therapy in conjunction with Active Release Technique/s may be beneficial. It may take several treatments.before finding lasting relief. I hope this helps.

  7. I was wondering if anyone could give me any advice. I am currently in Afghanistan and have recently developed a knot in my back just to the left of my right shoulder blade. It is very thick and about 5 inches long stretching down my back. I am very active in the gym and have tried ice, heat, tennis ball, pvc foam roller, and stretching. It is not painful when I work out in the gym but does tend to cramp randomly throughout to the day. I have never had anything like this. I go home in just over 2 months and am hoping a massage will completely eliminate this problem. I also feel the same muscle on the left side but its about 3-4 times smaller. Any advice would be appreciated thank you

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