What is a muscle knot, why does it happen, and what you can do to relieve it
Updated: Jan 4
If you are reading this, chances are you have probably experienced or are currently experiencing the effects of a muscle knot but, what are these odd tight bundles of tissue that make our brains tingle with an odd sensation of tightness and pain?
A muscle knot, also known as a trigger point, is defined as a discrete, focal, hyperirritable spot located in a taut band of skeletal muscle. Essentially it's a singular spot within a tight muscle that is painful specifically to external pressures. So what is it and how do we treat it?
The medical world has tried for decades to understand why these trigger points form. In this article, we will discuss a few of the potential reasons but to understand the reasons a bit better we must first understand how muscles even work, get your physiology hats on!
How do muscles work? Let's take a very brief and simple look. Muscles contract and relax using a combination of nerve activity and chemical signals. Contraction starts with an intention to move which sends nerve signals that initiate a chemical release of a substance called Acetylcholine (ACh). This chemical then triggers a cascade of events that helps calcium bind small muscle fibers together so that they can shorten. Relaxing the muscle is achieved by the utilization of a compound known as ATP (Adenosine Triphosphate) and ATP relies heavily on the presence of Oxygen to release the bonded muscle fibers so that they can elongate to their original position.
Knowing now some of the primary components of how muscles contract and relax, we can understand how a trigger might form. It should be as simple as a segment of muscle that is contracting and not releasing properly right? Maybe.
One of the more popular beliefs as to why knots form is that there is simply too much Acetylcholine (ACh) at the muscular level. This theory would suggest that if there is too much Ach at the muscle level it can make for a more intense or prolonged muscle contraction that might contribute to knots. ACh secretion can be naturally increased through diet typically through protein and caffeine, so something to consider with this theory would be to evaluate the diet. Are you consuming too much protein or caffeine? Maybe an increased amount of water and soluble fiber can help if protein levels are intentionally high. Maybe making a more conscious effort to keep caffeine consumption to moderate amounts would be helpful.
Another treatment option using this theory would be the utilization of Botox injections within the muscle. Botox prevents ACh from being released at the muscle level and in turn blocks its ability to shorten. However, research has shown that Botox injections to trigger points did not have as great of an impact on pain levels as originally hoped. So what now?
Another popular belief as to why knots are present plays on the fault of the muscle to relax, the belief is that there is a poor oxygen supply in the area caused by weak blood vessels or a poor ATP release cycle. We discussed earlier that ATP and oxygen were vital components to the relaxation of a muscle. Carbs and glucose must be broken down in an oxygen-rich environment to release sufficient ATP for cells to thrive. Using this theory perhaps increasing our aerobic activity to boost oxygen levels can help, or perhaps moderating the intake of carbs and sugars?
What else do we know helps with muscle knots? Massage! Our brains are naturally wired to seek pressures and massage when we feel tension or knots, but why? When we place pressure on muscles we create several physical and psychological responses that may help improve the chemical environment of muscle tissue. Massage or myofascial release can help inhibit muscle activity, improve local blood flow, and might even help physically press chemicals out of an area. There is also a psychological response to touch that has very real and physiological effects like the release of oxytocin, dopamine, and serotonin, hormones that induce relaxation. These effects are all temporary but are very beneficial to those in pain.
Other treatment options include the use of massage guns to perform the massage when our hands are too tired. Heat can help improve blood flow and can relax tight muscles. Acupuncture or Dry Needling has also been shown to be helpful to those who do not mind needles. Assisted stretching, yoga, and physical therapy have all been shown to help improve the pain associated with muscle knots.
So how do we get rid of knots/ trigger points for good?
The answer is probably not as clear as we would hope but it is most likely a combination of things. If we can alter our diet to include a balance of protein, fiber, and water with a moderation of caffeine, carbs, and sugars, perhaps our internal chemical environment will be less likely to become irritable. If we can move more and breathe more, taking on a bit of aerobic activity during the week then maybe our body can function more efficiently to process chemical imbalances. Now these changes most likely will not happen overnight and it may not relieve your pain for some time but perhaps some good ol' fashioned massage can help us along the way as we make some of these changes. As a Dr. of Physical Therapy, I help people make the changes needed to resolve their pain for good. If you are interested in learning more, have future blog post requests, or would like to receive physical therapy (live or via telehealth) please fill out the information on our "Contact Us" page, I would be happy and humbled to help however I can. Thanks for reading!
-Dr. Jonathon Martinez, PT, DPT