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Lies Massage Therapists Tell: "You've Got So Many Knots!"

I am a massage therapist in Florida, and I'm currently working on a Master's degree in general psychology.

"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:

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.

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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.


sharon on June 27, 2019:

A knot is a rope tied and twisted. It is just a saying. I tell my clients it is a collection of fluids crystalized remnants of LA that the body did not metabolize. dead cells etc.... Then they just OK get rid of it. Then I tell them from now on I will just refer to these bumps as "KNOTS" they like that much better..... I have a necklace charm that I LOVE it says

"I Make knotty people cry"

Ingz on May 25, 2019:

So, I've got Marfan Syndrome... crocked back in many ways.

One time my neck was stuck and I asked a friend to massage the knot at the small of my back. He told me I had a knot about the size of a baseball. I don't usually walk around with a baseball sized knot in my back, it was there until it wasn't.

Every time I go to the beach I pay 10€ to a chinese woman for a massage where not a single word is spoken because of a language barrier. I always know when they find a knot because I can feel it. They even once refused to massage my largest knot and instead gave me some kind of a patch because I guess they didn't trust themselves to work on it. I don't walk around with all these knots in my back all the time, they come and go.

My hip surgeon also told me he could feel a knot over my sacroilliac joint before my hip surgery.

If I understand this correctly, it's saying that my knots don't exist?

The funny bone also isn't a bone. I'm guessing "the funny nerve" didn't sound as good.

Fanny on April 28, 2019:

I have a lot of trigger points, if the PT uses dry needling, this "Knot" produces REL response. I have myofascial syndrome so, please, be careful, if you really have trigger points dont go for a massage, it will harm you.

Sabrina on April 24, 2019:

I, too, say "knot" a lot because I don't read more to be able to be detailed when clients have questions. All I do is cling to "knot" and "Your very tense" but I am not detailed when it comes to being asked questions and I am interested in learning more. I can't believe I'm not the only one whose been misguided. So this must be a common thing.

Matt on March 11, 2018:

NYC LMT 25yrs.

It's a knot dude.

When someone is trying to relax giving them an anatomy/chemistry lesson on lactic acid, muscle striation, fascia wrinkling, etc isn't what they want to hear. They want to hear, "You have a knot, I'm attempting to work it out". Just like a headache. There are thousands of reasons we get a headache and it isn't really called a headache scientifically but for easy "semantics" we describe it as such.

bb82 on January 20, 2018:

What about a doctor (orthopedic surgeon) saying you have "knots" in the muscles of the back or legs. From my point of view they feel like a Charlie horse or cramped muscle. I don't know what the massage therapist feels but she said she hates doing my back because as soon as I stand it all "reknots up."

Bibi14930 on September 10, 2017:

I'm a therapist and I can't tell U how many times I hear these thai masseuses say 'Ur very tight' 'so many knots' And all the customers start thinking they r so unique or special. I just wanna tell all these customers that they say the same thing To everyone. Plus, this article really got it right. I mostly don't find knots just very hard tensed muscles. Once in a while u do feel someone who has a big nasty ball but not often.

Chari on September 03, 2017:

Great video

dude on September 02, 2017:

Muscle knots are very real

Paul on June 22, 2017:

You said what not to massage but how do I get rid of the muscle tightness causing the pain

Courtney on June 14, 2017:

I love this!! How massage therapists speak to their clients is key to relief and recovery from muscle tension. I have been told "this or that is sooo tight/knotted up" and it only ever made me feel worse about my body and reinforced the pain.

Joel Horwitz on May 28, 2017:

Thank You. I'm a Therapist and honest person who hasn't yet gone past the realization that whatever the bumps in the scapula are, most people have them, and they feel better after a session.

I tell clients they are clusters of muscle, often from stress and/or labor, that slow-down the blood flow and that feel better when massaged. I tell them massage increases blood circulation, which is always healthy. I tell them for some people the relief last days, some weeks, and some longer. I tell them if they feel better after a session, they should come back when they hurt again. Although this might contribute to me getting fewer regular clients, I feel true to myself. Possibly, I'll reach a point where I will feel comfortable saying: "I think you should come back every.....," but I'll take it as it comes.


Sarah on May 24, 2017:

Thank you, I have so many clients who come in saying they have all these "knots" i'm ill search but all I can find is tight muscle bands and trigger points. I often hit the trigger point at the top of the scapula, which can be painful, and my clients will ask me to "work it out" and if I say I can't then they move on to someone else because they believe these are things we should easily be able to remove.

patricia whitham on January 07, 2017:

Thank you for your video! I've always thought knots was not a good term to use with my guests. You've enlightene me!

I find that many of my clients have the same little bumps or nodules in the same areas, and it's just part of their structure, it's really nothing that can be worked out.

Luka. on October 26, 2016:

Hi I am a big fan of busting myths in this industry, yes there are many miss conceptions. My fav is drink plenty of water to flush out the toxins. I have no proof of this being a myth yet I suspect it as I can find NOTHING in peer reviewed literature. Hell I used to say it myself and one day thought what are the toxins. Re your article People may have irregularities in their tissue and common sensitive tissues are often mis construed as defective. Yer a competent practitioner should perfor a bilateral comparison when possible. This can refute or demonstrate some relevance to the claim of a pathology. Additionally not undertaking basic techniques to differentiate between tissues superficial and deep to each other is a further concern for misunderstanding causal factors in dysfunction or pain. I often suggest that knots are often a generalized term people utilize to cover hypertonic / fibrous scar tissues and trigger points. But the best method to rectify these issues is to move (sensibly). I've been in the sports injury and remedial industry for 27 yrs

Thank you on September 21, 2016:

Took many words right out of my mouth. It is exhausting explaining to people that a knot isn't really a thing and that their previous therapist was not infact breaking up the scar tissue or adhesions they claim to have been.

Thank you

Allanc123 on April 26, 2016:

Very useful. Thank you.

Trisha on January 23, 2016:

Long story I hope to make short I have had upper back ad neck problems for 8 years or longer but this pass Oct after a year of pain because everytime I was yelling at event or coughing it was goving me shotting pain all the way down to my feet and hands so had MRI done showed that my c4-c5 disk had no spinal fuild getting through but a hair line my disk was hitting my spinal cord. So I had a spinal fusion done and after 4 weeks they put me into PT. The first week I know my upper back and neck area is tight however its killing becausthey state I have so many knots!! Its extremely painful when they push on these knots and now I am non-stop pain!!! Some of the pain has gone down both arms. Plus not to mention after every treatment I am sleepy so I end up sleeping 17-20 hrs. Please any info will help

Siobhan on January 16, 2016:

You're so wrong. You shouldn't be able to feel the muscles like that. If you feel the edge of one.. then its tense and should be worked on. and Being a therapist, we learn so much and its so very intense learning all of this and there is just so much to know, our clients do NOT come to us for a school session. THey come to us for basically the exact opposite. So just simply saying this is a tight knot and needs to be worked on has just become the thing to say. Im not going to school them on whats what. Because u know if you say this is this and this is that, then there would be more questions like why is this this and why isn't that this… and its just too much. However, I do agree that there are a LOT of massage therapists who do not know what they are doing all together. So just be aware of the difference between trying to let you enjoy your massage, and ignorance.

RPM Myotherapy on December 01, 2014:

It is great to see this put so clearly. It is amazing how many different terms the general public have to label things. Another common one is 'slipped disc' which is technically incorrect because the disc can't slide.

I really enjoyed reading these comments of other frustrated practitioners, thank you for sharing.

I put extra emphasis on the importance of education with either my Myotherapy or Massage clients.

RPM Myotherapy on December 01, 2014:

It is great to see this put so clearly. It is amazing how many different terms the general public have to label things. Another common one is 'slipped disc' which is technically incorrect because the disc can't slide.

I really enjoyed reading these comments of other frustrated practitioners, thank you for sharing.

I put extra emphasis on the importance of education with either my Myotherapy or Massage clients.

healinghands1668 from Chicago, IL on November 28, 2014:

Thank you for putting into words what I've been thinking! "Knot" is such a common word for clients to leap to, and I find myself oddly thrown by it. (..."Well, no, Miss Client, that isn't a 'knot,' that's just your upper trapezius. ...Well, yes, I know it feels 'hard', and it is hypertonic...that is, it's tight. Yes, I can pinch it. It is a very thick muscle.") I always end up feeling like I'm rambling and making a fool of myself. ...Even though I know I've got the right information.

Also, ditto the LMT above whose clients call their levator scapula a 'knot'. Really, I need to keep a copy of my Trail Guide to the Body in the room with me so I can point out what levator scapula looks like.

Sandra M Urquhart from Fort Lauderdale on August 20, 2014:

Wow BPF. You sound a bit like me in the fact that you are into myth busting too. I'm glad to see that there are other therapists that can effectively communicate corrections about some of the misinformation out there, especially as a writer. I'm working on something similar to educate more. I definitely have to follow you. Be blessed.

DB, LMT on June 27, 2014:

THANK YOU!!! You managed to verbalize what frustrates me constantly. It's hard sometimes, however, to educate the client regarding their miseducation from past therapists without sounding like you're disparaging said therapist. I wish I had a penny for every client that referred to their levator scapula as a "knot." Ok I'm done venting:):):)

Tyler on June 11, 2014:

I'm going to school as a massage therapist. There is a thing as knots.

But there is a difference between trigger points and knots. There are also tender points.

Knots are just muscles fused together

Trigger points are knots or strips of muscle that have body fluid trapped in muscle and it is due to holding patterns. How you know it is a trigger point is if the pain shoots to your head, leg, neck etc.

A tender point is just tight muscle that needs to be loosened kinda like a trigger point.

Source of info. student massage theapist

I specialize in it.

Daniel on May 05, 2014:

You struck near the truth when you said, "...because people walk around with these mental knots for the rest of their lives." Why don't kids get these tensions? It is mental which is why massage never gets rid of the full problem unless there is an emotional release.

Mariah Fullmer on March 31, 2014:

I think you miss a few points. I don't talk to my clients about trigger points because I want them to think that they're "messed up" and it drives me crazy when clients come to me saying that every therapist has told them that they have the worst back ever. I tell my clients they have knots or trigger points to make them aware that they need to take action to take care of their body if they just think they are perfectly fine what is the point of massage? It becomes a luxury more than a necessity so my purpose in telling my clients that their muscles are not okay is not to make them feel like there is something wrong with them, I make it clear that daily life, stress, and gravity takes a toll on our bodies and we need to make sure that we are doing what we need to, to ensure that we keep healthy. And I do recommend workouts to strengthen muscles, stretches to loosen them, and ice to bring blood. Working out the "knots" is just a simple language to convey to a client that there is a reason for their pain and it won't go away unless they do something about it. And you can say it's just a ridge or whatever or a tendon that I'm going over but I'm always communicating with my clients and asking if they have pain in a specific area before I just hold. And the great thing about massage is even if you're just on some random edge of a muscle it is still beneficial because you are bring blood to the area!!! Muscles lack blood when they're tight and stressed and holding an are brings a surge of blood. So maybe therapist are wrong in they're language but they're not wrong in what they're doing. Mentally and physically massage helps! You as a therapist are putting someone in an environment where they get to feel safe, have positive touch, let go, and have blood sent to their nutrient deprived muscles!! So regardless of knots massage has so many benefits worthy of it's time :)

SD on March 01, 2014:

Healthy Infraspinatuses do not feel lumpy and painful. No healthy tissue comes with an abundance of pain, range of motion restrictions and trigger points. Your evaluation of the situation is very superficial, similar to most massages given in spas or private saunas.

Aria Scroggins on November 19, 2013:

I am slightly offended. When I feel a knot in a clients back, I actually mean a knot. I have a lot of clients ask me "is that a knot", and I tell them "no, it's just tight muscles" and of course what I mean by that are muscle fibers that are fused together by sticky fascia and extra proteins. but when I say knot, I mean a big ball of "knotted" up muscle tissue contracted around an injury in the muscle, like a micro-tare or a larger tare. Don't get me wrong, a lot of therapists say, you have knots rather then explain to their client what is really happening in their body. It's not because we are lying, it is just easier to say you have knots then give the person a fat lecture on the anatomy of the body. The clients usually don't care, they just want to feel good.

Nicholas Huette from Iowa City on May 24, 2013:

Interesting article. I have been doing massage a long time and clients are always asking me if they have knots. I usually just tell them they have some adhesions between layers of muscles, scar tissue, or tight muscles depending on what I feel and know about their medical history (i.e. previous surgery.)

But you're right. Knots is not a very good word to use. Who came up with that one?

Amanda on May 16, 2013:

I too am a massage therapist and think that "knots" is an oversimplified term that came from "knotted muscle" which in fact tight muscles FEEL like knots in a rope. In example: Rock Fish - they aren't made of rocks but they LOOK like rocks.

If we took a step back and realized not everything is literal, especially such a non-medical term as "knot", and educate our clients what they are people wouldn't be thinking that they had muscle tied in their back, or that the origins and insertions are where they need to be working on.

Anonymous on March 17, 2013:

As a massage therapist, and a pain sufferer myself..I can assure you this article is phoney. I have had my knots worked on many times, and every time it has ended in relief of pain and tension I have felt for years. I have also worked on many patients, who have felt major relief after I have worked on their knots. This article is misinformed.

Diana on February 26, 2013:

Brilliant! Thank you for sharing! I have been reading up on lymph nodes too. My therapist would press upon the nodes under my underarm cos she said they are all blocked up and needs to be unblocked before my shoulder ache would go. anyone can share on this?

MJC from UK on December 05, 2012:

Be Pain Free, thanks for this great hub! It makes me directly feel better. I have also experienced a massage school. :-/ It was a Japanese school in Honolulu, Hawaii. Don't worry, in Hawaii are many things in Japanese hands. There we learned the Swedish massages, like in every other massage school. I only had problems with my teacher. She was desperately trying to find any trigger points on my back. I didn't certainly responded as I should do. There were none or not enough trigger points. I was lost in this game "Run on Trigger Points," and I hated it. I was thinking, this is not a sense of a massage to find some trigger points, allow the client feel bad because of them, and press them until the client "dies." Thanks for your hub, I feel much better now. Voted up.

Kristin Trapp from Illinois on April 24, 2012:

I love your knowledgeable insider information. Now if only I knew what to do about those painful not-knots. I will stayed-tuned as you suggest.

Pamela Oglesby from Sunny Florida on April 23, 2012:

Messages are wonderful and I am glad to understand more about the process. Very interesting hub. Congrats on your nomination.

Lisa Dewey from Far left of The South & Extreme west in my best imagination! on April 23, 2012:

Great read! I appreciate your writing style, and your candor. And, a humorous bent, to boot!

Be Pain Free (author) from Florida on April 22, 2012:

Thanks for the comments everyone! Special thanks to ripplemaker for pointing out the little contest that I am currently a part of. Not that I'd want my visitors to go check it out. Via that link, just above this comment.

Michelle Simtoco from Cebu, Philippines on April 22, 2012:

I just had a massage last night and had lots of those too! hehehe And it always feel better after!

Congratulations on your Hubnuggets nomination. Relax this way as you read and vote:

Denise Handlon from North Carolina on April 21, 2012:

Interesting hub and perspective. I've had a lot of massages and have always heard this. So...I learned something new today-thanks. :) Good luck in the contest.

Chuck Bluestein from Morristown, AZ, USA on April 20, 2012:

The most under-rated book is the dictionary. Can a stomach be in knots? If it is, what does it mean? Knots has 7 different definitions with 1 having 3 meanings and 4 and 7 having 2 meanings. So which one would be closest to what the massage therapist is talking about. I always go to Merriam-Webster since some dictionaries online can be wrong.

Definition 1c says: c: a ?tight constriction? or the sense of constriction (my stomach was all in knots)

You said "Trigger points are tiny bundles of contraction." and "When people come to me and say "massage therapists always tell me I've got lots of knots," I find ?tight muscles?."

I have gotten massages of all types including rolfing. They do not say anything to me about my muscles. They just let me feel or experience. The postural intergrationist would always say to make sure to take a hot bath after to help my body get rid of the toxins that were loosened.

Dora Weithers from The Caribbean on April 20, 2012:

Thanks for these explanations. It is very caring of you to share this information.

Be Pain Free (author) from Florida on April 19, 2012:

Simone, that's wonderful! Don't let anyone defame your shoulders and traps; they've worked hard for your whole life, and, while they could probably use some stretching (stay tuned!), they're good at what they do.

Simone Haruko Smith from San Francisco on April 19, 2012:

Yes!!!! I've been looking for this information for YEARS! Every time I get a massage (those treats are few and far between, but STILL), I am told that my trapezius is "messed up" and that "needs to be worked out," but I don't really know what I'm supposed to do with that information, or what "working something out" really entails.

Thanks so much for the explanation. I feel loads better about my "knotty" shoulders now.

Be Pain Free (author) from Florida on April 17, 2012:

Hi Heather, I actually agree completely with everything you just said. We need to keep the client coming back if they're to get any benefit from our craft, so it's a delicate balancing act. I would try to convey that there is something awry that needs treatment, but... we can't do to these people what everyone else does. They've been told by their doctor that their low-back pain is "lower facet syndrome" or arthritis, absent any diagnostic imaging. They've been told by their chiro that they have subluxations that are only visible to their scrutiny, or a leg longer than the other (based on a quick tug and eyeball).

We use the "knot" nomenclature because it's useful, it's compact, and it kind of describes what's going on. It's close the the truth, way more compelling, and way less trouble to say. Still, I think we can find something almost as good, and way more honest, especially if we're given the time to actually talk to people. Idealism, I know.

Thanks for the comments, everyone, I hope to hear from more clients and therapists!

Heather V. on April 17, 2012:

Good information; an example of why it is very important to never stop learning and educating ourselves as Massage Therapists, beyond just what is called for as CE requirements. However, trying to educate clients about the fact that there are "no knots" in their backs can do more harm than good, because if there is "nothing wrong" other than "normal tension", why would they need to come to us to "fix" them? They will see me, who tells them there is just normal tension in overlapping muscles, stop coming to me when they feel a little better, then see someone else who will tell them they are really "messed up" and that I "don't know what she was talking about." Plus, no matter how much you tell someone they are "normal", they will usually seek out those who tell them something is wrong, because people don't want to be "just like everyone else"; even if it is something BAD, they feel "special" and like they are being proactive when they go see someone to "fix" their "knots" rather than to just work out normal tension. Just my $0.02.

restrelax from Los angeles CA on April 16, 2012:

I also agreed your Point joanveronica Therapy people come to me and say "massage therapists always tell me I've got lots of knots.

Joan Veronica Robertson from Concepcion, Chile on April 09, 2012:

Very good hub! Good content, well presented and informative. I think I need to do more research on my own "not-knots" Voted Up. Useful and interesting

jonsswagger1978 from Birmingham Alabama on April 08, 2012:

Very informative hub my friend. Thumbs up.

kwade tweeling from USA on April 08, 2012:

I like your hub. I am especially fond of your message to be kind to one's self. We have enough damage. Let's focus on the healing.

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