Aug 15, 2012

Not Knots

I get asked all the time what a muscle knot is. Believe it or not, there is no scientific definition of a knot. It is an everyday term we use to describe that hardened lump of soft tissue we find often in our necks, backs and shoulders, though a knot can occur just about anywhere. My non-massage therapist husband explains it as good as anyone: "a knot is when my muscles are being stupid and they won't relax."
In massage school, you never find out what a knot really is; 'knot' is not a term to be found in the glossaries of any massage textbook, much less Anatomy & Physiology, nor Pathology books. Nonetheless, as a massage practitioner, I can palpate the knots that my clients feel and expect me to rid them of. And it is my professional obligation to record these so-called knots on my chart notes. But there is no medical terminology equivalent to 'knot,' I cannot report finding a "moderate-to-severe knot in the lateral aspect of the right rhomboid major."

Knots exist, yes, but what is a knot if it is not a knot? A knot can actually be a few different things, and it is my job to differentiate and treat the lesion, or abnormal tissue, accordingly. Here is a non-exclusive list of what a knot can actually be:

Knot I - When muscles "are being stupid and they won't relax," is otherwise known as Hypertonic muscles. Hyper (Over) and Tonic (the tone of a muscle) is when a muscle is contracting too much and is staying in a shortened state.

Knot II - The opposite of a Hypertonic muscle is a hypotonic muscle, hypo meaning 'under'. It would seem a contradiction that an underly toned muscle would feel 'tight' and 'knotted', but often it is the hypotonic muscles that cause us the most pain. Hypotonic muscles are overly lengthened, stretching beyond comfort in order to compensate for the hypertonic, or overly-toned muscle that lay opposite of them.

Knot III - Adhesions, as the name implies, are glued bits of soft tissue, specifically the connective tissue called fascia. Adhesions of the fascia can occur within a muscle, between two or more muscles, and even between muscle and viscera. Ideally, all the tissues of our body, despite whatever names and distinctions we've created for them, should slide and glide past each other, like wet spaghetti noodles. But when our bodies become dehydrated or suffer trauma, or have reduced circulation because of lack of movement, the 'spaghetti noodles' of our tissues dry out and get glued, or adhesed together. These adhesions are palpable and lead to reduced range of motion in our joints and less power in our muscles.  

Knot IV - Trigger Points are special knots. They really do feel like tiny, tight knots deep in the muscle belly, and sometimes like a taut band, like a fishing line. Trigger points occur specifically in the muscle tissue, unlike adhesions, which can occur in the connective tissue, but like adhesions, are also caused by dehydration, trauma, and/or lack of mobilization of the tissues. Trigger points are unique in that they send referral pain to other area of the body when palpated.
Each of these 'Knots' is different and should be approached and treated as is appropriate.

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