FAQ - What is a Muscle Knot?

This is undoubtedly one of the most commonly questions asked during a massage, alongside with 'What does a muscle knot feel like?' and 'What does massage actually do?' These questions are not always easy to answer, and with many possible answers being thrown around the internet finding an easy way to explain what a 'knot' is and how your massage techniques are beneficial is difficult.

Up until this point I have done my best to keep it simple, primarily to not feel like I'm throwing medical terms at holiday makers who were ultimately looking to relax. From my experience they are commonly used areas that are used statically or in a small range, resulting in the individual fibres becoming almost 'sticky' and struggling to glide over one another in full range. This links in well with the term 'adhesion' that is frequently used interchangeably with 'knot', as the effect a small drop of adhesive would have provides good imagery. Using whichever term you prefer, they are typically common in the levator scapulae, trapezius, rhomboid and quadratus lumborum muscles from desk work (or other jobs that often use similar posture, including drivers, waitresses and massage therapists themselves). 

Generally I find that it is not only one point in the muscle that is 'knotted', with increased tension along the length of the muscle presenting in almost all cases. Additionally where muscles overlap, adhesions can start to form not only between the individual muscle fibres, but the fascia surrounding whole muscles. As a number of muscles work in different directions to perform a single movement, you can almost think of it as increased friction between the muscles leading to increased difficulty and discomfort.

Many sources refer to 'knots' as 'myofascial trigger points' that occur in typical patterns in individual muscles. There is variable methodology and theories that practitioners use to diagnose, with a number of classifications (e.g. active, potential, latent or key). Trigger point maps indicate roughly 620 possible trigger points across the body, which on observation support areas that I work through on a daily basis. These areas are frequently described as predisposed to trigger points, which I think works well with the typical pattern most desk workers seem to follow. Other than postural or ergonomic causes; trauma, overuse, strain, imbalanced mechanics, poor nutrition, stress and cold temperatures can also exacerbate trigger points. 

Knots, trigger points, adhesions or whatever else you may refer to them as are also commonly described as small areas of tension, whereby the muscle has been used and ineffectively relaxed afterwards. I see this commonly amongst skiiers, as it is one of the rare forms of exercise where few warm up or stretch and most cool downs are very much sedentary with an apres-ski pint. There are definite ways to avoid or lessen the effect of knots and prevent damage:

Number 1) Have a long 'warm up' run as your first run of the day. A nice meandering blue at a relaxed pace is perfect. An actual warm up or stretch is often ineffective due to the time taken to then begin skiing and the limitations presented by your equipment.

Number 2) Use heat to help vasodilate your blood vessels; increasing blood flow to the area and promoting recovery. Hot tubs and baths work well for this, relaxing you both physically and mentally. However be cautious that with an injury you want to reduce blood flow to the area for the first 48 hours, meaning that the hot tub won't do you any good. If you are in doubt contact a healthcare professional.

Number 3) Take the time to stretch. Yes, I know it's a faff, but the benefits are beautiful. The quadriceps, gluteals and calves commonly tighten up in skiiers and are possible to slip into your daily routine. For example, stretch your quadriceps whilst waiting for the kettle to boil, your gluteals just before you go to sleep or you calves when you're brushing your teeth. The longer you hold the stretch, the more time you are giving your muscles to stretch along all the areas of tension, rather than just the one it reaches first. So try to hold the stretch for a minimum of 15-30 seconds.

If it's too late and the above aren't helping to lessen the effect; see a trained therapist. This can be a remedial or sports massage therapist, acupuncturist or whoever else works for you. Although they can be expensive, the benefits are often quick and effective. However if you are commonly obtaining areas of tension or knots it's almost certainly worthwhile booking in with a physiotherapist (or osteopath or chiropractor if you prefer) to try and identify the cause and work on techniques you can use to prevent them, rather than managing the symptoms when they appear.