“I have a nasty knot in my (insert body part here)” is one of the most common complaints that we hear from our clients. While we all use this term to describe tension in a specific area, there’s more to the story.
In therapeutic massage, what people call a knot is often a trigger point — but it can also involve something called an adhesion. While they feel similar, the mechanisms are slightly different.
In this post, I’ll discuss trigger points only, but will follow up with another post dedicated to adhesions, and the differences between the two.
What Is a Trigger Point?
To explain it simply, a trigger point is a small patch of muscle that gets "stuck" in a permanent state of contraction, creating a painful knot. This happens due to a breakdown in how your nerves and muscles communicate.
The "Vicious Cycle" of a Trigger Point
Most experts use what’s called the Integrated Hypothesis to explain why these knots form and stay painful:
Nerve Malfunction: Due to injury or strain, the nerve ending releases too much of a chemical signal called acetylcholine. This signal tells the muscle to contract.
The Constant Squeeze: This chemical overload causes a tiny part of the muscle to lock into a tight "knot." This is not a normal cramp; it is a sustained, involuntary contraction.
Energy Crisis: Because the muscle is constantly squeezed, it cuts off its own blood supply (ischemia). Without fresh blood, the muscle runs out of oxygen and energy (ATP).
No Way to Relax: Muscle fibers actually need energy to relax. Since the area is starved of energy, the muscle stays locked in place, continuing the cycle of pain and tension.
Common Symptoms of Trigger Points:
Taut Band: You can often feel a hard, rope-like band in the muscle.
Referred Pain: Pressing the knot often causes pain to "travel" or radiate to a completely different part of your body (e.g., a shoulder knot causing a headache).
Twitch Response: If the knot is snapped or needled (as with dry needling), the muscle may give a quick, involuntary jump or “twitch".
The "Jump Sign": A sudden, involuntary flinch when the sensitive spot is touched
Why Trigger points Form:
Trigger points typically develop from:
Repetitive Stress: Using the same muscles over and over (like typing or manual labor).
Poor Posture: Slumping at a desk for long periods.
Sudden Trauma: A fall, car accident, or sports injury.
Mental Stress: Chronic anxiety often leads to unconscious muscle clenching.
Massage therapy specifically targets the "vicious cycle" of trigger points by using manual techniques to physically break up contracted fibers and restore healthy circulation.
How Massage Therapy Helps:
Ischemic Compression: A therapist applies sustained, direct pressure to the knot for 30 to 90 seconds. This pressure temporarily restricts blood flow; when released, it triggers a surge of fresh, oxygen-rich blood into the area (a process called "reactive hyperemia") to flush out metabolic waste.
Breaking the Spasm: The pressure manually "softens" the hyperirritable muscle fibers, helping the individual muscle cells (sarcomeres) return to their normal resting length and interrupting the involuntary contraction.
Stretching & Lengthening: Following the release, therapists often use stretching or "micro-stripping" (moving skin across the muscle) to realign tissue fibers and prevent the knot from immediately re-forming.
Physical & Neurological Benefits:
Pain Threshold Increase: Studies show that targeted massage increases the local pressure-pain threshold, making the area less sensitive to touch and reducing referred pain that radiates elsewhere.
Improved Mobility: By releasing the "roadblocks" in the muscle, therapy restores full range of motion and flexibility that was restricted by the taut band.
Nervous System Calming: The treatment can stimulate the parasympathetic nervous system, which lowers heart rate and blood pressure, helping the body shift out of a "stressed" state that often contributes to muscle clenching.
What to Expect During and After a Session:
Sensitivity: Treatment can be intense and may cause a "good hurt" or referral sensations (pain traveling to other areas) during the session.
Soreness: It is normal to feel some tenderness for 24 hours post-massage, similar to the feeling after a workout.
Consistency: While one session can provide immediate relief, chronic issues often require 2 to 3 sessions or ongoing management to fully resolve.
When to Book a Session
If you’re experiencing any of the symptoms above, including:
Ongoing tightness
Reduced mobility
Frequent headaches
Recurrent neck, shoulder, or back discomfort
We recommend booking a session sooner than later to treat potential trigger points that may be the cause.
Addressing them early can help restore comfortable movement and prevent compensation patterns which can lead to chronic tension.
If you have any questions about tension that you’re experiencing, from trigger points or otherwise, please feel free to contact us at: info@bewellboston.com
- Jim