Muscle Knots

The concept of muscles knots is fairly universal and I often hear people talk about how ‘knotty’ a muscle feels.

But what is a muscle knot? Well as with many things relating to the human body we don’t really know! The more technical term that’s often used to describe a muscle knot is a ‘trigger point’. These have been defined as “…hyper-irritable spots in skeletal muscle that are associated with a hypersensitive palpable nodule in a taut band…” (1). Put more simply: a tender spot in a muscle.

There is no denying that tender points exist in muscles however, there is plenty of debate about what causes those tender points, how relevant they are to the pain people experience and what should be done about them.

My take on the matter from exploring the science and my experience in treating patients is:

  • The term muscle knot is unhelpful. It implies that things are tangled or matted together and perpetuates the belief that something physical is needed to ‘unknot’ them. Muscle fibres do not tie themselves in knots and things like massage, acupuncture & foam rolling do not cause immediate structural changes in muscle.
  • Even when assessing the same patient expert therapists vary widely in where they identify these tender spots (2). A classic case of if you look hard enough you are bound to find something. Given the variation in findings should we be basing our explanation for people’s pain on such inconsistent findings? I would argue not.
  • Given that pain is a multi-factorial perceptual experience we should always be sceptical of theories that try to place the blame on one body tissue or structure. For every person in pain with tender points in their muscles you could find someone in no pain yet still find plenty of tender points in their muscles. Pain is complex, be wary of overly simple explanations.
  • Tender points in muscles do not need to be stabbed, poked or electrocuted all of which are widely promoted therapies. However, if you find that applying some pressure to the area feels good at the time and helps afterwards then feel free to do that. A foam roller, tennis ball or anything else you choose to use can work. It’s free, easy to do and, provided you use sensible pressure, unlikely to have any adverse effects.
  • The evidence for massage as a therapy to treat pain is limited. However, if you enjoy having a massage, feel better afterwards and can afford it then by all means go ahead. Just don’t take the many claims made by massage therapists (including myself in the past!) at face value.

In summary: tender points in muscles exist in everyone.  These tender points are commonly called muscle knots but there is no evidence that the muscles fibres are actually ‘knotted’. The many therapies claiming to change the muscle tissue in these areas have little evidence to support them. However, there’s no denying that applying pressure over these painful areas can sometimes feel good and help with short-term pain relief. This is easy to do yourself with a foam roller, tennis ball or pretty much anything else you have to hand. Remember it should not feel acutely painful and you should feel better after!