Hi everyone, I’m Ian Harvey, massage
therapist, and today I’d like to talk about knots. If you’re here, you’ve probably been told by your
massage therapist that you have muscle knots. Or, you’re a massage therapist who’s
wondering with this whole “knot phenomenon” is really about. First we’re going to talk about what
a not is and what it isn’t and then we’re going to get a client on the table
and we’ll talk about structures that might feel like knots but they’re not. If
you’d like to skip ahead click on the time codes down in the description. First,
and, i just want to get this out of the way there is no such thing as “knots.” There
is no corresponding medical term that we could mean when we say “knots.” Knots are
just an idea that massage therapists throw around and that clients receive, and then
kind of carry around with them for the rest of their lives if we’re not careful.
When your massage therapist told you that you have muscle knots, they meant one of three things. The first
possibility is that you have tight postural muscles. They were working on
your shoulders, or on your upper back, and they said, “wow you’ve got so many
knots up here.” What they really meant was, “I feel muscle
tightness.” And what they should have said was, “Wow you’ve got type postural muscles… just like everyone else.” In fact, because that’s true why even say
anything? I don’t know. To me, it seems like some
massage therapists like to make a big deal out of muscle tightness so that they can get people to come back,
or so that they can make it seem worthwhile that this person is receiving
the massage that they’re receiving. Or it’s their opinion that that client has
extra tight muscles. Well, I believe that they should keep
that opinion to themselves. If you have tight postural muscles, you’ve earned
those over years of hard work, of standing, of living your life, and this
isn’t something that we need to be pathologizing and acting as if, “Oh, this is a problem!” If you have tight postural muscles and
you don’t have pain, then there’s nothing wrong with you. If you do have pain, then
this could be contributing. This tightness, this tug-of-war between all
these muscles. So what your massage therapist should be
putting across is that, “Hey, you’ve got some tightness up here,
but that’s something that can be changed.” One, through massage. It’s possible
through a series of massages that we can get these muscles to calm down. And,
primarily, through your actions. By you changing your habits, such as how our
economic is your workstation, are you moving in lots of interesting ways, are
you staying active, or are you just doing one task all the time? And there might be
some stretches and strengthening things that you could be doing to mellow all
this out. So the message I want to get across: If
you’ve got tight muscles, then that can change, and it’s likely to change if you
make a few alterations to how you’re living your life. The second thing that
massage therapists might mean by muscle knots is trigger points. Trigger point
theory is that certain areas of your body can refer pain elsewhere and that
seems to be well borne out by anecdotal evidence and somewhat by research. But
another part of trigger point theory is that there are these little bundles of
tightness within larger muscles that massage therapists can feel with their
fingers. This is not borne out by research. If
there are little pebble-like bits of muscle that we can palpate, if you bring
four other massage therapists in the room they’ll either feel that little nodule
somewhere else, or they won’t feel it at all. In fact, people have done these
studies, and if you’d like to check those out you can click down in the
description. So massage therapists if you feel these nodules then use that
information for yourself, but don’t go giving that to your client. That information isn’t
necessarily useful for them, and that will stay permanently in their head. They’ll think, “Oh I’ve got trigger points.”
Whereas, that is something that can change. If they’ve got this referred
sensation, if they got this tightness in their
muscles, that can change. So, if you must tell them about these
things, please frame it in that light. The third thing that they might mean is
that they have found a piece of your anatomy that they can’t quite identify.
They feel something that is lumpy, and so they think, “Oh, that must be a knot in
another muscle.” And I get this a lot when someone is rubbing my shoulders. They’ll come across the uppermost part of
my scapula, my shoulder blade, and they’ll say. “Ian you’ve got this huge knot right here but no,
what they’re palpating is the tendon of a muscle that runs up through here.
And, yeah, it’s a big tendon, it’s a twangy tendon but that’s supposed to be there. So, massage clients, if you’ve been told
that you have “knots,” maybe don’t take it to heart. Think about, hey, you might have thai postural muscles,
but that just means that it’s time to stretch more, it’s time to move a bit more.
Maybe get some more massages, and possibly from people who aren’t giving
you a complex. And massage therapists, if you’ve stuck around through this little
bit of tough love, then I’d like to show you some areas of
the body that are easily mistaken for knots in other muscles, but they’re not.
Alright, I’ve got my friend Maria here with me today. When massage therapists
find a knot, they tend to find them in one of the few places. First of all, it’s right here, it’s at
this superior angle of the scapula. They’ll bump over this superior angle,
they’ll feel something bump under their fingers and they’ll think that, “Oh, this is trapezius.” But no, this is the
superior angle of the scapula, and the tendon of levator scapulae, so if you feel a
lumpy bumpy here, don’t try to get rid of it. Now, some
people will say, I worked on this bump a lot and it does go away. What you’re experiencing when a feature
like this “goes away” is, one, you have reduced the tone in the area. So the tone
of levator scapulae has temporarily dropped, the tone in trapezius has
temporarily dropped. And two, you have increased vasodilation and probably
increased inflammation just a bit, so the tissue feels a little bit more pliable,
and so you might feel like have made some headway in getting rid of that knot.
But really, what is likely to have happened is that you have overworked this area,
bringing a lot of blood supply to it, but tomorrow it’s going to feel like it got
hit by a truck. So find that superior angle, and realize
that that doesn’t need to go away. You can feel free to do a lot of nice
work around and near it, just don’t overwork it. It can be quite
sensitive, especially when it’s directly targeted. The second most likely suspect,
the second “not knot,” is the place where trapezius intersects with the scapula. So that’s right here. I’m just medial to
the spine of the scapula on this medial border here. So what I’m feeling is a lump. I’m able to bump over this bit of tissue
here, and that’s not a knot. That’s the edge of this kite of muscle. It’s the edge of trapezius. And while
this can be a great place to work, if you can trap this under your
fingers and apply a little bit of pressure, it can feel great and it can be
useful for people who are having upper back pain, this isn’t something that we need to get
rid of. This isn’t a knot that needs to be worked out. And I find a lot of people
working right by the spine of the scapula here, just medial to it, because
this tends to be an area of a lot of pain for some people, it’ll be very
sensitive. Well you’re on a bit of tendon, actually there’s some aponeurosis
right here, so this broad sheet of tendon, that is under a lot of mechanical
tension. So we don’t need to work on this innocent bystander here that’s being
pulled on by the rest of this muscle. We need to work on this muscle, so that
it reduces its tone a bit, and this is in a less high-tension environment. Some
other suspects are infraspinatus here. It’s a very lumpy bumpy muscle, and it
doesn’t need to be smoothed out. In fact it can’t be, this is part of its structure. It’s a
very three-dimensional muscle and any attempt to iron it all the way out, or to
sink in and work out those knots, is just going to increase inflammation, and
possibly cause pain the next day. The next is right here, right at the superior
most portion of the sacrum. Sometimes you feel these little nodules,
and those are not knots. Those are not things that you can work out. These are little bits of connective
tissue and adipose tissue that have formed a little bubble, a little nodule,
and any attempt to get rid of this nodule is just going to create
inflammation, and possibly create more pain. When I find one of these, I don’t try to work directly with it, I work with all the structures that are
going to be yanking on this thoracolumbar fascia, such as all of these rotators,
and steam rolling out of these low back and thoracic muscles. Finally, I’d like to point out that a lot
of muscles have interesting funky textures. Like masseter here, it actually has two heads, they’re
overlapping, and they’re both very fibrous and full of these interesting
bands of tissue. So any attempts to get rid of
knots in the masseter here is just going to create some pain and create some
inflammation. So my main takeaway here is to learn
what these muscles feel like. Learn their structure, even if you don’t do it
using a textbook, do it using your hands. Feel how this trapezius folds over on
itself. Those aren’t knots that you need to get rid
of, that’s just it’s natural
three-dimensional structure. Feel these bands that are part of the deltoids.
Again, that isn’t something that needs to be smoothed. Alright guys, let me know
what you think in the comments. If you’ve been using the word “knots,” I don’t mean this to be a personal
attack on you. It’s just a word that we use because
people have used it when they’ve been working on us, people have used it in classrooms, our
teachers use the word “knots,” and it’s really a useless word. The reason that i dislike it as much as
I do is because clients tend to hear the word “knot,” and then take that word home
with them. It’s the reason why this video is going
to get hits. Because people are going to be searching online for, “what is a muscle
knot?” or, “how to get rid of muscle knots.” It’s because they’re afraid. They’re worried
about this problem that they think that they have now. So, don’t give people a new
problem, a problem that they don’t really have. It doesn’t need a new name, it just needs to be called tight muscle,
or whatever it is that you’re actually feeling. And if you do find tight muscle,
consider whether it actually helps your client to tell them about it. And if you
do, make sure to frame it in such a way that it sounds like something that can change. Tight muscle is something that
can be stretched, it can be moved, it can be affected by activity and new habits. And
yeah, by massage. Knots, however, are something that clients can carry around with them
for the rest of their lives. So, let me know what you think in the
comments, consider subscribing if you enjoyed this, and I will see you next
time!