Right as Rain Massage

What is a KNOT and how did it get here?​

The word “knot” as it relates to the human body is a misnomer. In order for a knot to be tied, there must be two loose ends. Muscles are attached to bones via tendons. They cannot disconnect, tie themselves into knots and then reconnect to bones. So why do we hear the term “knot” used so often?


My impression of what a “knot” refers to is when someone can palpate a lump in tissue that shouldn’t be there and it feels extremely tender. There is an occasion for this - and where I typically feel this in a client's body is along the shoulder blade. I like to call this a high-traffic area because of the repetitive motion of the scapulae over the ribs in arm movement. This is a key point for the next paragraph. But with that said, not all lumps are knots. Sometimes it's just fat and adipose tissue can be tender.


Scar Tissue isn't Just for Surgery

Increased stress on muscle fibers caused by vigorous exercise or trauma (i.e. whiplash) can produce micro-tears which are repaired with scar tissue. Also, areas of repetitive use (high traffic) are sometimes reinforced by excess fascia that the body lays down over those stressed areas. These are natural functions that serve a good purpose. The problem is two-fold. Sometimes more fascia than necessary is created which leads to the second problem. Excess scar tissue can become adhered to muscle fibers and other fascia causing jumbled tissue. This jumbling can cause nodules (knots), nerve impingement, range of motion restriction and pain. Massage can help to file those areas down through repeated friction treatment. It is kind of like working at a callous with a pumice stone but not as immediate.


Not all Pain is Knots

There are many reasons for pain. Pockets of lactic acid from robust exercise, metabolic waste from normal muscle function and toxic material from poor dietary habits can all create tender points. But more commonly, the reason you have pain in a particular spot is because you have muscles that are tight, irritated, shortened and thirsty for blood (ischemic). These conditions are caused by overuse, overload, repetitive motions, trauma to muscle tissue and repeated length-shortening (i.e. always turning the head to one side). All of these factors can create a breeding ground for trigger points. When these muscles or spots are pressed, you feel pain.


Trigger points are not the same thing as tender points. Trigger points are painful spots in taught muscle bands that keep muscles perpetually tight. They sometimes create palpable nodules and they often refer pain to remote locations. For example, many headaches are actually neuromuscular-induced pain referred from trigger points located in tight neck muscles. More information on trigger points and muscle conditions that foster them can be found in my article, "The Pain-Spasm Wheel: How Stress Transforms Into Pain." More information on fascia, scar tissue and soft-tissue injuries can be found in my article, "Myofascial Massage for the Sports-Minded."


So why is there so much confusion about knots? Because many people make the mistake of thinking that just because they have pain in an area, they must have a “knot.” The real issue is that people are uninformed about what causes pain and exactly how massage takes it away. Articles like this one help people to understand that they don’t have to be victims of circumstance. Healthy habits promote healthy muscles - stretching, exercise, hydration and eating right all contribute. But massage is the most effective way to rid muscles of accumulated scar tissue, trigger points and other factors that cause areas of pain that we frequently call “knots.” When muscles are made more mobile and discomfort is lessened, it is easier for you to do the stretching and exercise which then promotes healthy muscles. Continued massage may prevent knots from forming because extra reinforcement isn't needed when muscles are robust and moving properly.


Emily Hagen CNMT, BCTMB

Board Certified Neuromuscular Therapist

Right as Rain Massage, LLC