So what is a 'muscle knot' and how on earth do I get rid of it?


As fascinating as it is, physiology can be a tough thing to wrap your head around; however, I've discovered that if we understand why we get knots, they become much easier to treat as we can visualize what's going on under the skin. Usually a client's interest piques after we discover a particularly painful knot, sometimes in a muscle they didn't even realize was sore. "So just what IS that super painful little nodule that is so inconveniently giving me my tension headache?"

So in my world, knots are called "myofascial trigger points," but we can shorten that term to TrP for short. There has been a bit of confusion in the medical community as to what exactly causes a TrP, but over the years a general consensus has been developed by researchers which I can help organize here. (If you're mainly interested in getting rid of your TrP, you can scroll to the tips listed after the explanation.)

We all know our nerves make our muscles move, but did you know that calcium plays a big role in that movement as well? Our nerves speak to our muscles through a structure called "motor end plates." This is where the electrical signal from the nerve is converted into a chemical message that your muscle understands.

There are several hypothesis as to what exactly happens at the motor end plate to cause the TrP. These theories get quite complex when we take into account the physiology of our bodies, so let's just keep this simple.

Usually, the electrical signal travels down the nerve and hits the motor end plate which sends a chemical message and as a result, through some very special channels, calcium is released into the muscle. Voila! You are now moving your muscle. When you don't want to move it any longer, the nerve stops sending the message. However, sometimes the muscle fiber is slightly damaged and the muscle has a hard time pumping the calcium back out itself and into the storage system around the fiber from which it was released. It is not a calcium deposit in the traditional sense: it's just a bit of extra calcium causing a very real muscle contraction on a very tiny scale.

Now, suddenly you have this super tight contraction in a muscle fiber that was totally uncalled for. Even though it's a small contraction, it can be very strong. This pulls on either side of the muscle fiber so you get a taut little band on either side of the very painful spot. Holy smokes, you now have a knot. You may notice some weakness in the affected muscle, some restricted range of movement, some tenderness, or outright pain around the TrP. But many of us are very tolerant people, and may not notice the weakness or even (surprisingly) the pain. Until I poke it.

TrPs can be "active" or "inactive." Have you ever felt very achy when you're sick with a cold or flu? Much of this ache can be attributed to inactive (latent) knots that are being woken up or activated by the cold. If they are active they are usually shooting (referring) pain all over the place. If they are in your shoulders, neck, head, or jaw you can get a tension headache. If you have one in your rotator cuff it can make your forearm hurt. There are even knots that can develop in your neck muscles that can make your ear ring, your eye water, or even give you a toothache! If the referral pain touches another knot it can activate it, or if it is chronic enough you can develop MORE knots within the referral pattern of the original knot.

The good news is these referral patterns are not at all random. They follow very specific routes through the body which are so consistent we have developed "Trigger Point Charts." Google it and you'll find a human outline with very colourful blotches on it. Quite pretty, really, if it wasn't so darn painful in real life. The darker areas are the most common referral patterns, the lighter areas a little less common. I have read much debate over why the referral follows these specific routes, but my understanding is that no one knows for certain. I once compared the most common back trigger points with common acupuncture points and discovered not only did most of them line up, but the referral pattern matches almost exactly the muscular indications of the acupuncture point. (Basically, the Chinese doctors have had these knots figured out for at least 2000 years - probably closer to 5000, if you don't include puncturing, but just pressing on the knots.)

So now we have the gist of why we get TrPs. Great. How do I get rid of them?

Well the longer you leave it, the more complicated, frustrating, painful, and expensive it can get. Your best bet is to start treating it immediately. You can either see a massage therapist OR you can start working on them yourself.

1. Make sure it's a knot, i.e., don't treat any little lumps and bumps that are sitting quite close to the surface of the skin. That's probably a harmless little cyst. Leave 'er alone unless it's painful or you have reason to be concerned - then of course you want your doctor to check it out. TrPs are usually tender to the touch, refer pain, or sometimes twitch when pressed, and usually crop up after a bout of physical inactivity followed by a burst of movement. If you're still unsure, you can cross reference your painful spot with a trigger point chart.

2. Heat (10 minutes or less). When a muscle has been very very tight for a long time, the circulation is a little interrupted. That means not only do you have a lack of fresh blood bringing nutrients and oxygen to the injury site, but the lymphatic system (the natural sewage drainage of the body) has a really hard time getting in there and cleaning out the waste products of the living tissue. It sounds weird but it makes sense when you think about it: those little cells are alive and really need their nutrients to repair. When you heat a muscle, not only do you relax the knot a bit, but you flood the area with fresh blood. This is going to greatly reduce your healing time. (Don't have a heating pad? No problem! Dampen a hand towel and microwave for 2 minutes. Shake out excess steam and use your new, cheap-o heating towel. Re-nuke only after it has cooled completely and beware of steam burns. Never fall asleep with a heating pad or leave it on for longer than 10 minutes. Not sure if you can use heat safely? If your doctor has said "No hot showers or baths" then check with them before, and never use a heating pad directly over your heart.)

3. Pressure. TrPs really like pressure. Once you get used to the sensation, most people describe it as a "sweet pain." You can use your hand for reachable knots, a tennis ball on the wall for the hard to get knots between the shoulder blades, or exchange 10 minutes massages with your partner or a friend. If you've had a bad knot for a long time, a professional massage can help get you back to a place where you can perform maintenance at home. The longer you leave it in there, the harder it will be to get it out. The more frequently you push on it, the quicker it will release.

4. Stretching. Give it a little stretch after to help lengthen all those contracted fibers, encourage circulation, and re-train your muscle to move in its proper range. Always stop a stretch before it gets painful, and don't 'bounce' a stretch.

5. Hydration. Wooow do those knots ever refer if you're dehydrated! Tension headaches are particularly notorious for being sensitive to hydration. Drink water through the course of the day, or you may end up eliminating a lot of that water through your urine. (How do you know if you're dehydrated? Very dark yellow urine is a good indicator, unless you are on B vitamin supplements in which case it's normal.)

6. Consistency. Have you heard of "muscle memory"? The more you release a knot, the easier it gets. It doesn't really matter if you're an Olympic athlete or a couch potato, you're going to end up with a few knots here and there. But they don't have to be super painful or difficult to treat, and they certainly don't have to be chronic. Keep at it, they really do heal!

7. Acupuncture. So you've tried everything, and that stubborn knot still refuses to release. Or maybe you just can't take the manual pressure of a massage in your sensitive upper trap muscles ("What is this 'sweet pain' you speak of?") Although it seems counter-intuitive, acupuncture is actually a lot less painful than getting a really bad knot released by hand. (Think of it this way: with a massage, the knot and all the surrounding muscle tissue is compressed, often, over and over. With acupuncture, a thin needle the width of a cat whisker and has a rounded tip is gently inserted between your cells. Your body is mostly water, so the rounded tip of the needle actually avoids puncturing blood vessels and nerves. This is why most acupuncture points don't bleed! If needles freak you out a bit, then you have to consider the alternative - live with the headache, or endure what would be at most a slight pinch, some pressure, and then relief.)

Ok that was a lot, I know. Well done sticking it out until the end! But the next time you get that irritating muscle pain that most of us are so familiar with, you will have a little more know-how, and hopefully a bit more confidence in dealing with it. I hope I have given you at least a little of your power back, because treating this extremely common problem doesn't have to be expensive or time consuming. If you have specific muscle issues and would like a little more info, feel free to come in to the clinic here in Toronto's Liberty Village and we'll do our best to help you achieve your goals in health. Good luck and take care!