Everything you didn't know about Muscle Knots


Muscle knots! We are all too familiar with them and yet few of us understand what they really are or their relevance in the pain that we experience. We know that they infiltrate our muscles uninvited and sit there like gate crashers at a party who can't take a hint. The ones we remember have often caused considerable pain and discomfort to areas in their immediate vicinity. But generally speaking, that's the extent of our knowledge.


But if you thought that was all you ever needed to know about knots, you would be very mistaken. For when it comes to musculoskeletal pain, they can work in some surprising and mysterious ways...

Pain from the unexpected


CASE STUDY: A lady came to my treatment room complaining of a deep aching in her wrist. She had already been to see a couple of other therapists who could find nothing mechanically wrong. After also finding no dysfunction in her wrist, I began to explore the possibility that the pain might be being referred from somewhere else. From experience I knew that when a specific muscle in her armpit (called subscapularis) becomes dysfunctional, it can develop knots that will often cause a "tooth-ache" type pain to appear in the wrist. After much explaining and persuading she eventually let me reach into her armpit. Sure enough there was a large knot embedded deep in the muscle. I released it and her wrist pain disappeared.


In this article I will:

  • Explain everything you need to know about muscle knots.

  • How remedial massage therapists diagnose and treat them.

  • Reveal how their symptoms can often be misdiagnosed and be subsequently mistreated.


What is a knot?


Put simply, a knot is a tiny patch of involuntarily contracted muscle that no amount of voluntary brain activity will relax. But what conditions cause a muscle knot to occur? Almost always, knots occur when a muscle has been forced to remain contracted repeatedly over long periods of time. We typically see this in desk workers, who unknowingly overwork and traumatise their postural muscles as they freeze in the same position at their desks for hours at a time.

When a muscle relaxes after being forced to chronically overwork, some of the neurological pathways from the brain that have been telling the muscle to contract fail to switch off. In essence these pathways become stuck or locked and continue to fire and instruct isolated patches of muscle fibres to contract, even though the rest of the muscle is relaxed. Each of these stubbornly contracted patches is what we know as a knot.


A little known prime suspect

The clinical name for a muscle knot is actually a Myofascial Trigger Point and they have an aptitude for causing problems. They can cause pain in their immediate vicinity or far beyond their location (like in the case of the lady with wrist pain). They can be responsible for functional and structural imbalances in the body by either forcing muscles to spasm or inhibiting their ability to relax or contract. This in turn can pull on the tendons and ligaments associated with a given muscle, causing pain to occur in joints. They can even cause confusion by mimicking other common ailments.


Subscapularis (armpit muscle) trigger point pain referral zones

In fact trigger points are responsible for an alarmingly high amount of your aches and pains. Studies in the US suggest that the figure may be as high as 80% of musculoskeletal pain cases. But despite all this, an appallingly high percentage of doctors and other practitioners are still pretty much out of the loop regarding their role in pain or how to treat them. 

How we treat them

Despite 70 years of research (the phrase "trigger point" was first coined in the 1940s), the exact physiological mechanisms of trigger point generation and their symptoms are not fully understood. But what we do know is enough for us to be able to very effectively treat them:

  • They tend to occur in the same locations within a specific muscle (so biceps trigger points tend to occur in the same spots in everyone's biceps).

  • Each specific trigger point within a specific muscle tends to emit very similar symptoms (that's how I knew that subscapularis trigger points often cause wrist pain).

  • It is possible to deactivate or “switch them off” by compressing them in just the right way and relieve whatever symptoms they are causing.

And it is in their predictability that lays the secret to treating them. There are around 620 potential trigger points in the human body and the locations and symptoms of every single one have been thoroughly documented over the years. These trigger point “maps” enable the modern therapist to be able to read the symptoms and predict which trigger points might be causing them.


The great pretender


CASE STUDY: A few years ago a man came to me for a standard deep tissue massage. As we chatted he mentioned that he was highly stressed because of an unresolved toothache that he had been enduring for a couple of months. Dental x-rays of the offending area had revealed nothing untoward and his dentist could not see any infection. He had resigned himself to taking painkillers and hoping it would resolve itself. In fact there is a trigger point in the Masseter muscle (a muscle in the jaw) that can cause a referred pain pattern to the teeth that feels very much like toothache. I asked him if I could investigate his Masseter. Sure enough, there was a large knot right in the centre of the muscle. I worked on the knot for the remainder of the session, but this actually caused the toothache to increase. Highly irritated and dissatisfied, he left. But the next morning he called me to say that overnight the pain had significantly decreased and he thought we might be on to something. Over two more sessions I worked the trigger point shrinking it from a sizeable knot down to nothing, until he was finally pain free. To my knowledge his "mysterious toothache" has not returned.


Muscle knots causing toothache? Consider this small sample of other symptoms that the devious trigger point can mimic:

  1. Appendicitis: there have been well documented cases where it has been discovered after surgery that the appendix was totally fine and the patient’s pain was actually due to an abdominal trigger point.

  2. Lumps in the throat and trouble swallowing.

  3. Nerve pain: including sciatica and carpal tunnel syndrome.

  4. Tinnitus (ringing in the ears), sinusitis and earache.

  5. Incontinence

  6. Erectile dysfunction.




The understanding of myofascial trigger points is as fundamental to the successful treatment of muscular pain as stretching is to yoga. And yet a surprisingly high proportion of the medical and therapist community remain in ignorance of them or their importance. If you have suffered from musculoskeletal pain that seemed to have no origin, then the next time it happens rest assured that a therapist experienced in Trigger Point Therapy will:

  • Have studied trigger point research and understand their locations and symptoms.

  • Be skilled in the diagnosis and treatment of trigger point related myofascial pain syndromes.

  • Be open to the possibility that your pain or dysfunction may have referred origins.


Thank you for reading.