Lies Massage Therapists Tell: "You've Got So Many Knots!"
"Wow, we've really got to get these worked out!"
I should be kind to my fellow massage therapists. While most of us have extensive training in anatomy and physiology, a lot of what we say and do was modeled for us by other massage types (teachers, therapists, and know-it-alls such as myself). They might not be "lying" so much simply repeating inaccurate information. We've been hearing about "knots" since we first learned about massage—and sure enough, we can feel them in our clients' backs. The clients feel them, too!
This is the part where I start sighing ponderously.
The clients definitely feel... something painful. Something that shifts under the fingers of the therapist. It has a different feel than the rest of the tissue when prodded. The therapist feels a little ball of something, and it feels funny. This is where your therapist should know better and should enlighten you with a bit of X-ray knowledge regarding your anatomy. This is where a little skepticism and questioning would serve both parties well.
Granted, some things can be called "knots"
Trigger points are small and especially painful areas in the muscle/tendon, usually found at areas of high mechanical tension within a muscle, that tend to have the unusual characteristic of referring pain elsewhere. This is definitely a worthy area of research, and anyone who would like relief from persistent pain might get relief from a practitioner familiar with neuromuscular therapy, also known as trigger point therapy. Note that, while trigger point therapy can be a useful bodywork modality, the existence of trigger points as a physiologically detectable phenomenon is in question.
Some massage therapists will say you have an adhesion between the sliding layers of your muscles. This is an interesting, if unverifiable, assertion.
If you'd like to read more about trigger points:
This is my trigger point bible. Just realize that, while poking and prodding can help (in moderation), activity and stretching can be just as useful for working with pain.
So when people say "knot" they mean "trigger point," right?
Oh, if only that were so! I've touched thousands of backs (always with permission), and I've done a lot of Trigger Point Therapy. When people come to me and say "massage therapists always tell me I've got lots of knots," I find tight muscles. Trigger points might be present, but the muscle tone is the main problem. If there are unusual balls of muscle present, I can't find them.
So what on earth are massage therapists feeling in these tight backs? When someone lays their hands on my shoulders and says, "wow, so many knots!", they are invariably pressing upon tendinous tissue, unusual muscles, or areas where muscles overlap. This isn't a problem in my back, it's a problem with their knowledge of anatomy!
The "not knots"
Poke around in your upper back/shoulder region for a bit. If you allow your fingers to move the skin over the underlying structures, you'll find that it's an uneven landscape. There are ridges, lumps, twangy bits, squidgy parts, and the list could go on. Listen, it's really quite beautiful once you give it a chance, but the stuff under the skin isn't nearly so tidy as the outside would make it seem. You might even hit a few areas that downright hurt. Isn't that a knot?
The upper back is complicated, with layer upon layer of thin, sheet-like muscle; narrow ribbons of muscle; feathery, membranous muscle; and all manner of connective tissue. Behold the trapezius: it's not just the squashy bit that sits atop your shoulders. It's kite shaped, extending far out to each side, and far down the spine. It's responsible for more than just letting us shrug our shoulders in despair.
The upshot: there are many places in the back where these structures overlap, and sinking your fingers in and rubbing will invariably result in you thumping over the edge of one. This will probably feel interesting, and might even hurt a little (especially the outer edges of trapezius, which can be quite curmudgeonly). This is not a knot.
There are tendons and tendinous areas of muscle in the back that can be very squirmy under the skin, and that can be quite sensitive: the inferior attachment of levator scapulae, to name a big player, is almost always in a huff about something. It's not an area of trapezius that's "super messed up" and that "needs to be worked out." If you were to successfully "work it out," you would need to hit an emergency room. Not a knot.
Finally, there are some muscles that are just plain weird. Infraspinatus, for instance, starts out with a fan shape, folds into tendon, and wraps around the back of your shoulder. It acts weird, and it feels even weirder. Lumpy. Hurty. Not a knot.
If you'd like some visuals, check out this video:
What to do with this information?
First, forgive your massage therapist. They're just going off of what trusted authorities have passed down, and they probably aren't wrong on purpose. Sure they've got some weird notions about what's going on in the body, but the work they do is still helpful, and they probably have good knowledge in other areas.
Second, lose your complex. Why do I hate this "knot" misconception? Because it's hurtful. It makes people think that there is something wrong with them, and this never goes away. Do you hear me, fellow massagey-types? You're doing harm with this, because people walk around with these mental knots for the rest of their lives. Rather than just the tight muscles that they represent (which can be stretched, or iced, or rested), knots are defects. People have enough body issues without being told that their muscles are defective, "messed up," or "the tightest I've ever felt." Yes, these are the things that come out of my colleagues' mouths.
So, gentle reader, please take what we say with a grain of salt. Enjoy the massage, take mental notes on where you hurt, and try some of the stretches that we recommend. Heck, your massage therapist might even know their stuff, and they might have some straight wisdom to lay down. I just ask that you verify.
Stay tuned for more mythbusting, and be kind to yourself.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.