I’m Just Pretending to Know What These “Knots” Are

#1 in the Your Massage Therapist Wants You to Know Series

Photo by Ksenia Makagonova on Unsplash

Ah, the mighty knot. One of the cornerstones of the massage experience. Everyone at some time or another has experienced tension or pain in a particular muscle, and they would describe it as feeling “like a knot or something.” But what is a knot?

Every now, and then a client will ask me what knots are. It was easier when I was a fresh graduate, I had a more limited range of potential theories. After being a licensed massage therapist for almost a decade, I am now full to the brim with theories, and I honestly can’t tell you which one is correct.

It seems weird doesn’t it? For everything we know about the human body, why don’t we know exactly what knots are? You would think it wouldn’t be that difficult to figure out- I mean we do exploratory surgeries for other things, so why not just make a couple incisions and go spelunking? Unfortunately, it’s just not that simple.

Is it the result of a buildup of connective tissue?

Is it an area where the muscle cells, for whatever reason, have decided to contract and won’t let go?

Is it because the muscle fibers are somehow inhibited from sliding past each other as they’re designed to do, causing pain and inflammation?

Is it actually the nervous tissue where the problem lies?

Or are some muscles just kind of chunky and lumpy here and there?

Many authoritative sources claim to know the answer. The most popular of which seems to be the aforementioned idea that the muscle cells contract in a particular area for no apparent reason, although we don’t yet have any evidence this is the case. Don’t let anybody try to fool you- we just don’t 100% know.

What we DO know is that there are lumps we can feel with our hands that correspond to areas of client’s complaints, and when we press on those lumps it can feel intense for the client. Sometimes when we press on them, we can watch the surrounding muscles twitching! And after a moment of applying pressure, the area feels better. So although we can’t say with any certainty what those lumps are, we have a mountain of evidence that massage helps and can even totally alleviate the discomfort.

All of this means that we also can’t say with any certainty what causes them either. Overuse or underuse of the muscles seems to be a factor, as does stress and heightened emotions. We also do know that regular exercise, reasonable recovery times, stretching, foam rolling, and managing stress can also help relieve and prevent the sensations associated with “knots.”

I, myself, woke up this morning acutely aware of a spot about the size of a silver dollar, situated directly between my spine and shoulder blade. When I focus my attention on it, it feels sore and dense, and the feeling radiates out into my upper back. I know I’ll need to work on it for a while. I’ll use cupping, stretching, a lacrosse ball, and see another massage therapist until the discomfort abates. Then I’ll have a long stretch of time where I don’t feel anything in the area at all. If I’m not keeping up on my self care, which I won’t because I’m as distractible and imperfect as anybody, it’ll come back.

The debate about what knots are has raged on for many years now, and we don’t appear any closer to a consensus. Many folks are digging their heels into their position, some of whom are insistent there’s no such thing as a knot and we’re somehow imagining feeling them. For my part, I can’t say that I care what they are. I care that my clients have areas of tenderness, and that for whatever reason pressing on those areas is a satisfying experience for them and leads to them ultimately feeling better. It also doesn’t appear to be doing any damage either. So I’m okay with the mystery. Maybe one day we’ll know for sure, and maybe that will change how we treat them. Until then I’ll just keep giving the people what they want.