One of the most frequently asked questions on my massage table is, “What are those knots back there, anyway?”, referring to the clumpy masses of painful muscle tissue, so often found in the neck and shoulder area. It’s a good question; as “knots” are a common source of discomfort, and if left untreated, can cause generalized physical agony.
What the layperson calls a knot is more professionally referred to as a myofascial trigger point (TP). There are varying opinions about these sore-spots’ origins, but overwhelming consensus that there is one sure bet at combating them once they are present: Massage.
First, their origins: Most sources agree that trigger points contain depositions of byproducts from the chemical reactions that take place when a muscle contracts. Sources also agree that these “knots” can exist due to an unreleased muscular contraction, unable to properly relax from its tense state.
Bad posture and over-extended physical activity can result in trigger points caused by unreleased contractions. We rarely realize it, but we regularly put our muscles into unnecessary contraction. For example, sitting at our computers, driving, even running errands, we too often hunch forward without intending to, raising our shoulders toward our ears. Just this simple posture uselessly employs several muscles, flexing our pectorals, levator scapulae and upper trapeziusfibers for extended periods of time.
Leftover byproducts are a key player in forming knots. The muscular contraction process is complex but interesting. In a nutshell, when a nerve impulse is sent to a muscle fiber, asking it to contract, calcium ions are fired into the sarcomeres (small contractile units) of the muscle fibers (cells) from the sarcoplasmic reticulum (SR). Calcium ions bond with proteins that force the muscle into relaxation, holding them away from the contractile proteins, which can then bind and hinge, putting the muscle into contraction.
To release, almost immediately, the SR begins pumping calcium back from the sarcomere, releasing the “relaxation proteins” that were bound to the calcium, allowing the muscle to release, lengthen and rest.
When musles are overused or injured, calcium leakage from the SR, without nerve stimulation, can occur. Calcium ions trigger contraction, and if left unflushed (or un-massaged!), create spasms and chronically tightened, toxic areas, or trigger points. Trigger points can be dense, tense and painful, causing ischemia, or lack of blood flow to the area, and reduced usage of those muscles due to pain. Reduction of local circulation and restricted use causes build-up of more metabolic wastes and restricts oxygen flowing to the muscle. Swelling can occur as well, creating more discomfort while compressing nerves, and so the pain-cycle continues.
The solution? All sources agree, massage releases myofascial trigger points through increasing circulation. Massage flushes stagnant calcium and byproducts, allowing fresh nutrients and oxygen to circulate into muscle tissue. Massage causes the warming of muscle tissue, which can lengthen, relax and decrease pressure of the tissue. Regular massage can substantially improve trigger points over the long term; in fact, some weekly massage clients don’t have many knots to work on. Trigger point massage work can be intense, but brief, and can be self-administered if necessary by applying direct pressure to areas you can reach, briefly, several times a day. Always drink plentiful water after massage work, to assist the muscular system in pumping and flushing out toxins released through physical manipulation. Potassium, calcium and regular hydration all help prevent knots. Be aware of your posture and try not to stay in one position for extended periods of time, taking frequent breaks to walk or stretch.