In a bicep curl, the forearm is raised and the bicep muscle contracts. At the same time, the tricep muscle lengthens. When the weight is lowered, it’s the reverse: the bicep lengthens and the tricep contracts.

A skeletal muscle’s cross section resembles a bundle of wires in a cable. When operating normally, each of those “wires” or muscle fibers expand and contract repeatedly. When fibers are damaged, they lock in contraction.

INJURY

People can tear muscle in so many ways:

physically demanding jobs;
muscle overuse in workouts, exercise, and sports;
overstretching;
accident or abrupt trauma;
giving birth; and,
many more…

Minor damage to a few muscle fibers (Grade 1) will only be uncomfortable for a few days. In the case of a partial or complete tear across the entire muscle or its tendons, surgical repair may be necessary.

TORN FIBERS

When muscle fibers tear, the result is stiffness, pain and inflammation. The body is excellent at “soldering together” the broken ends within a couple of weeks. The end result is a knot, often called a trigger point: a lump where torn ends of fibers have healed.

However, those knotted fibers no longer expand and contract. Muscle strength is proportionally reduced.

A knot is basically made up of a compressed clump of healed muscle fibers. They are so tightly locked together that blood and water cannot penetrate to hydrate and heal the tissue. If that’s not bad enough, damage gradually accumulates around the original damage. I had an athletic client in her 50s whose Biceps femoris (middle hamstring) over time had become damaged its entire length!

As athletes know, when a synergistic muscle compensates but can’t handle the effort, that muscle also gets damaged.

This is why aggressive stretching and strength training can make a problem worse.

Even after the torn fibers have healed, if a nerve is involved, there may be chronic pain. A trigger point is aptly named. Pressing on the knot triggers pain!

PAIN LOCATION ISN’T ALWAYS THE ORIGIN

Knots create tension in the muscle. Because the muscle fibers surrounding the knot are chronically contracted, the muscle may feel hard. Excess muscle tension may tear tendon fibers where they attach to bone.

Here’s an example of a common issue I see in my clinic. Refer to the image below. Fibers in the Biceps brachii (short head) have been injured, forming a knot. The muscle fibers around the knot are chronically contracted. With a large area of damage (you’d feel hard unyielding tissue), the muscle contraction is so strong that it also tears fibers of its tendon at the shoulder attachment (circled). The person feels stinging pain at the shoulder — the knot doesn’t hurt. However, unless the knot is eliminated, that pull on the shoulder (and elbow at the other end), the pain at the torn tendon will not resolve.

Q. How do physical therapists deal with this knotty problem?

EXERCISE IS STANDARD PRACTICE

The goal of traditional rehabilitation is to build more muscle fibers to compensate for the damaged, non-working fibers. Stretching or strength training will NOT eliminate knots and muscle strains.

Damaged tissue needs time to heal. Wait until the injured area heals before exercising that muscle to build new muscle. Exercising too soon is counter-productive because it delays recovery. In some cases, it can make the injury much worse.
Go slow. Start rehab with light weights and gentle stretching. If there is no pain the next day, progressively increase the weight and reps over time. Remember, pain is the body’s signal to ease off.
Senior muscles take longer to recover. Keeping fit is vital in our senior years. When we lose compensating muscle mass, old injuries resurface. It is equally important, though, to reduce the intensity, duration, and frequency of exercise to avoid injuries. Blame aging factors such as diminishing testosterone and estrogen in men and women respectively.

Several senior clients have been injured in exercises directed by a trainer or in a class. I personally pulled muscles trying to keep up in a Pilates class. My husband “blew out his knee” when his trainer encouraged him to do squats. Now in his early 60s, he needs a knee replacement.

A fit client in her early 70s broke her arm. After the fracture healed, she discovered the shoulder she’d immobilized with a sling was frozen. She started physiotherapy. However, in short order she ended up with TWO frozen shoulders. She’d lost muscle mass during two months of inactivity while the fracture healed. The physio exercises were too aggressive and too frequent, and resulted in more injury. Many of my younger clients have experienced this as well.

If there’s no improvement in pain level and range of motion after four sessions, exercise is not working.

BALLS AND ROLLING

Quote from my 16 year old client, a competitive skater: “Pushing on a knot doesn’t get rid of it.”

Normal, healthy muscles fibers stretch when compressed or rolled. The muscle will feel looser. Temporarily. Tension in the muscle will soon return because the knot is still there. Compressing or rolling a knot achieves no lasting results.

A client told me his previous therapist applied a small roller to his surgical scar tissue (Graston Technique.) Again, compression did not break up the tissue. Several sessions later he’d achieved no lasting results. With my technique (see below), in three sessions his deep scar tissue was gone. Permanently.

MASSAGE

Massage has been around for thousands of years, and there are many types.

Be aware that aggressive manipulation of muscle knots will tear more fibers, causing more pain and inflammation. Some therapists believe that destroying the knot will cause muscle fibers to repair properly. Does more damage make sense to you?

Q. If stretching, squeezing, rolling and destroying a knot don’t work, what does?

CUPPING

Cupping involves suction that draws fluid into the damaged tissue. That’s helpful because it separates the fibers, opening space for blood-borne oxygen and specialized cells. Be aware of cupping side effects: interstitial pressure will break delicate blood capillaries, generating bruises and micro blood clots.

BOWEN THERAPY

Bowen Therapy involves gentle cross fiber moves that encourage compressed, locked muscle fibers to separate. Like cupping, Bowen Therapy opens space for oxygenated blood and specialized cells to regenerate muscle fibers. North American Bowen therapists are trained through the American Bowen Academy , Bowen College, and Canadian Bowenwork/Bowetech Group. Massage therapists, osteopaths, naturopaths, physiotherapists, etc. may study Bowen Therapy as part of their continuing education.

Note: although I am unaware of them, there likely are other myofascial release techniques that will similarly loosen knots without pain. (If my clients had found physical therapists with the ability to eliminate the origin of their pain, they would not have needed to “try every therapy under the sun” until they found a Bowen Therapist, namely me.)

MADELINE McBRIDE’s “Find it and Fix it” APPROACH

Four years into my practice as a Bowen Therapist, I realized that regular Bowen moves did not always release severe tissue damage that creates tension and misalignment in the myoskeletal system. I learned to palpate to find the damage, then target it with intense focus using a technique that separates the locked fibers. In a client session I sometimes look at the clock, surprised to discover that I’ve been working on a particular muscle knot, strain or scar for 20 minutes!

Now I teach clients and students in my Iliopsoas Damage Workshop my “Find it and Fix it” approach that resolves stubborn knots, strains, and scar tissue, thus restoring muscle function and skeletal alignment.

Yes, healing knots, strains and scar tissue is possible.

ABOUT THE AUTHOR

Madeline McBride, M.A.Sc., P. Eng., studied civil engineering at Queen’s University and the University of Waterloo. Mechanics and structural design courses underpin her knowledge of biomechanics and tensegrity. Combined with physical therapy training (Bowen Therapy, Applied Myoskeletal Therapy (AMT), Energetic Structural Balance (ESB) and more), she has become a Canadian expert in restoring myoskeletal alignment. Sign up for a workshop or read her blog posts at www.McBridePainClinic.com

Muscle Knots - Trigger Points