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315-515-3117 Active Physical Therapy Solutions - 91 Columbus Street - Auburn NY

Knots

Patients often come into the office with the complaint of having “knots in my muscles” that are painful. The reality is that there is no such thing as a “knot in a muscle”. The term “knot” is essentially a lay term to describe a focal area of any particular muscle that has become tight and restricted. Some people use the term “knot” and “trigger point” synonymously. So the question remains, what is a “knot” and why do we get them?

 

While there is still no scientific consensus on why these “knots” develop, we know they tend to appear after the muscle suffers an acute injury or undergoes repetitive motions. These so called “knots” may also occur when the patients physiology is compromised or altered in situations like dehydration, extreme exercise, neurological conditions like Parkinson’s disease and endocrine disorders like thyroid disease, etc. And, they often occur in the postural muscles of the shoulders, back, or neck.

 

Muscles are basically a series of tubes within tubes within tubes and these tubes are made up of a series filaments that will slide past one another causing the muscle to contract. When the sliding filaments become restricted and stop sliding the tubes become adhered to one another.  Because of the restricted motion these areas will experience reduced blood flow, poor oxygenation and will lack other key nutrients such as calcium. Stiff, restricted and knotted muscles tend to allow the accumulation of waste products. These waste products are irritants and will lead to pain when they go untreated. The cumulative effect of these factors may explain why muscle knots don’t usually resolve on their own. Injuries caused by direct trauma such as an automobile accident will damage the sliding filaments, cause swelling and ultimately restrict the fibers or tubes from moving. This area will stiffen and form the “knot”.

 

Sitting for extended periods of time with poor posture such as holding a “head down” posture seen with computer work or excessive text messaging will lead to a similar physiologic response as a forceful trauma. The difference is that the trauma happens in a spit second and the repetitive strain injury happens over a period of time.

Overuse of the muscles from repetitive strenuous exercise, including weightlifting, running, cycling or exercise classes, can produce low-level muscular damage and inflammation resulting in stiff or immobile muscle fibers. Emotional stress can be a form of repetitive strain or muscular overuse. Being anxious or stressed will cause us to unconsciously tense our muscles. This chronic sustained muscle contraction will cause reduced nutrient and oxygen supply leading to low level inflammation and swelling. In the end this type of situation will lead to the restricted motion and stiffness that we refer to as a “knot”.

The first step in the prevention or treatment of ‘knotted muscles” is to hydrate. Simply put the majority of people do not drink enough water. There’s some debate about whether or not the conventional wisdom of “eight glasses of water a day” is overkill, but if you are experiencing frequent muscle knots, it could be a hint to hydrate. This starts by reducing the consumption of beverages that contain alcohol, caffeine and phosphorous and replacing them with water. A simple rule is to drink 66% of your body weight in water per day. In other words, if you weight 150 pounds then you should drink 100 ounces of water per day.

Direct pressure can be used to help relieve or reduce the stiffened area of a muscle. Things such as rolling on a tennis ball to rolling on a foam roller will help reduce the stiffness and improve the circulation. Manual therapy techniques such as Active Release Techniques, Instrument assisted soft tissue techniques, cupping or body tempering can help to treat and reduce these knots.

Using things like heat or ice with not necessarily resolve the knotted area but they will help increase circulation and remove swelling from the muscle fibers and thus improve the chances of restoring movement to the stiffened tissue.

If you are a smoker you are more likely to develop restrictions in your muscles leading to chronic knots. It appears that smoking has been linked to an increase in muscular restrictions and inflammation of the muscular wrapping referred to as fascia.
As we age adding flexibility training and stretching to our daily routine is increasingly important. Aging muscles, tendons and ligaments naturally stiffen especially if you are sedentary. Performing some simple flexibility movements during the day may help prevent or relieve those restrictions.

 

New science is showing a relationship between calcium and nerve response. Since the majority of our food supply is mineral deficient adding a calcium supplement to your diet may reduce the tension in your muscles.

 

Understanding that the stiff or tight area of a muscle is not actually a knot and more about getting the internal structure of the muscle to slide like a piston helps to direct a more effective management.