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A Knotty Question


One of the most common questions I get from clients is, what is a knot?  Most people have them, whether you can feel them all the time or only when you go for a massage.


The technical term for a knot is a ‘trigger point’ or adhesion and when a massage therapist works on a knot, this is known as trigger point therapy. 


What is a knot?

A knot is a tender spot in a muscle and is often painful when pressure is applied.  It can be crunchy or clicky and you can sometimes hear the noise when it is being worked on.

It is thought that they are a taut mass of skeletal muscle fibres, sometimes in the form of a ball.  One theory is that they impinge on the nerves around, causing pain.  Another that they are so compact that blood is prevented from getting into the area, and so the body is unable to heal the knot through its usual means of oxygen and nutrients.

They cause tiny spasms in the surrounding muscle that often you cannot feel but can become very sensitive.

There are two types of knot:

1.    Passive Trigger Points.  These hurt only at their precise location.

2.    Active Trigger Points.  These refer pain outwards in the body.


What causes knots?

A number of factors can lead to knots forming.  Poor posture is a big culprit, due to the strain it places on muscles. This is why many people with desk jobs can suffer with them.  Lack of moving around also contributes.  If you are into sports, that can also lead to muscle tension and tightness through working the muscles, and soft tissue injuries can result in knots.  The last major cause is stress, as we carry tension in our bodies.


I have knots! Do I need to worry?

No, knots are benign and while they can cause pain and limited range of motion, they are not dangerous.


Where are knots located?

They are located in the muscles and fascia (web of connective tissue under the skin holding all organs and muscles in place). They can occur anywhere in the body.  The most common places are the trapezius muscles (between the neck and shoulders), the quadratus lumborum muscles (lower back), hamstrings, calf strings and the iliotibial band (known as the IT band along the outside of the legs). Naeblys/Shutterstock


What is Referred Pain?

Some knots send or ‘refer’ pain to different areas of the body, which is why clearing a knot in say the scapula area can relieve pain in the arm! The pain can manifest in various ways.  It can be a headache, or feeling of pressure, a shooting pain or nerve pain.


What is Trigger Point Therapy?

This is a soft tissue technique where a massage therapist locates and loosens trigger points. It is one of the main tools used by a therapist to relieve pain.  The most basic way is to apply pressure, either manually using fingertips or elbows, or using a massage tool.  As a knot is being worked on, it may be painful or uncomfortable, but as it is loosened and dissipated this should reduce. The pressure works by cutting off circulation to the tissue.  This increases a chemical called nitric oxide, which signals to your body to open up microcapillaries. The increased blood flow then helps to heal the knot.


What are the benefits of Trigger Point Therapy?

The main benefits are an immediate relief in the knot if it is painful as it loosens, and reduced referred pain which you should feel within 24 hours.  If the knot was causing restricted range of motion that should also improve.  Knots can sometimes be eliminated in one session, but this is rare, and most people find that regular massages are needed to keep on top of knots fully.


After a massage session, always drink plenty of water.  Toxins build up in muscle tissue and a massage releases them so they need flushing out!


Everything You Need to Know About Trigger Point Massage Therapy, Surreal Holistic Therapy (accessed 31/01/2024)

What Are Trigger Points and How Can MT Help? Inverarity, L(2022) cited in

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