A lot of people ask me about muscle knots or come to see me specifically complaining about knots or trigger points, so I am writing this blog post for those people, and also anyone else who happens to be searching for answers regarding these questions. There are a lot of words and phrases that get used in the massage and also in the fitness world pertaining to muscles and the various things they do, some of which are outdated, misleading or even plain wrong. I will start with 'knots'. When we think of muscle knots we tend to imagine a tangled mass of fibres caught up in the belly of a muscle, restricting movement and causing pain. That's not strictly true, and the word 'knot' is really more of a metaphor used to describe the sensation of the dysfunction rather than actual description of the dysfunction itself. In other words, it is not a medical term.
So what are they? muscle knots are more often than not simply tight muscles. They may feel lumpy or stringy, but muscles are by nature lumpy in places, and stringy in places. The main thing to focus on here, is 'are they causing me pain?' If the answer is yes, then you are dealing with a dysfunction of some kind. These can take the form of hypertonicity (a muscle that has become too tense from over work, under work or injury), a tear, spasm or rupture. So basically, a muscle 'knot' is just a way of describing how a muscle that is not functioning correctly feels on palpation.
Moving on to trigger points, these are slightly different in that they do refer to a specific kind of muscular dysfunction. To understand the theory behind trigger points it is helpful to have a little knowledge about the anatomy of the striated muscles in which they are thought to occur. Striated muscle refers to pretty much all the muscle in the body, exceptions being cardiac muscle (the heart) and the smooth muscle that makes up our intestines. Striated muscle, so called because of its construction that consists of many tiny bands, is a fibrous tissue with all of the fibres going in the same direction, like a packet of spaghetti. Each band of muscle contains many tiny fibres called sarcomeres. Each sarcomere is an independent unit of muscle, and can contract and expand independently. At any one time, all of the striated muscles in your body are full of relaxed and contracted sarcomeres, and this is called your muscle 'tone'. The sarcomeres continually swap between relaxation and contraction, in order that no one sarcomere gets overburdened. But of course, when you are using a muscle for something that requires all of the sarcomeres, weight lifting for example, the entire muscle contracts (shortens).
Here is a very simplified sketch to hopefully help you to visualise that structure, yes I did use pencil crayons because I am 4:
Trigger points are thought to be caused by a single tiny band of striated muscle becoming stuck in a contracted position. I use words like 'thought' and 'theory' when talking about trigger points simply because there is not hard evidence I am aware of that would be excepted in the medical profession that these things are absolutely the case. That said, there has been a fair amount of research into trigger points and the effects of trigger point therapy including dry needling. I am not a medical professional so any opinion I offer here is merely my own uneducated speculation, however it is my suspicion that the response to therapy varies from individual to individual as do all massage techniques, due to the make up of that persons nervous system, unique anatomy and even their mental disposition. That all may or may not be the case, however there is some good evidence for trigger point work being effective in some people and I have found it to be effective in my own practice some of the time. Perhaps part of the challenge with this sort of treatment is that it relies on the therapist actually being able to palpate the trigger point, which may be deep in the belly of a muscle or contained within an muscle that is inferior to many other structures. It is also possible that the trigger point is simply too small to be felt by the therapist, therefore the practice must be guided by feedback from the client. An issue with this approach may be that the client is unsure about the source of the pain, there may be other sensations that are confusing them if there is a lot of generalised tenderness, and pain referral patterns may also be throwing them off from the location of the source if the pain.
There is currently no evidence to show exactly how or why trigger points form in the muscle, but they are generally thought to be the result of muscle overuse, stress or trauma.
This has been a very simplified explanation of trigger points and muscle function, but I hope it has been of some use to you if you have been told you have trigger points and left feeling baffled. I may do another blog post about the two kinds of trigger points at some point, but I think I will leave it there for now.
Have a great day,