Muscle Tightness and Muscle Knots

Let’s talk about that bulge

The Rundown

It’s common practice in physiotherapy circles to identify phenomena referred to as “tight muscles” or “muscle knots”…particularly when patients mention soreness or the feeling of muscular pain.  These trigger points can often lead to extensive (and expensive) treatment recommendations. How valid are the diagnoses and what should you actually do about these nagging problems?

Trust me, I’m a doctor.

Let’s not beat around the bush here. It surprises most people to learn that muscle knots/tightness have never been shown to exist.¹ Keep in mind, these knots are portrayed as something different than true hypertonia (a condition that causes abnormally high muscle tone). If you have actual hypertonia, you require oral medications, injections into the muscle, or surgery as treatment methods…not massage, foam rolling, or scraping techniques.

The reason therapists believe muscles have knots is due to an effect called palpatory pareidolia. Palpation being the process of using your hands to feel the body, in our case to identify possible health issues. According to Ingraham: “Pareidolia is a type of illusion or broken perception in which a vague or obscure stimulus — i.e. subtle textures under your skin — is perceived as if it was actually clear and distinct.” (think the same effect that causes us to see shapes in clouds)

This misunderstanding causes a host of misdiagnoses that are often seen as:

• fascial restrictions and releases
• vertebral subluxations
• various asymmetries
• cerebrospinal fluid circulation
• and, of course, muscle tightness and knots

You tell a clinician that you feel tight, sore, or have a pain spot…they will invariably find something, whether it’s there or not. This has been shown ad nauseam in the research. Researchers have tested physiotherapists by lying to them about experienced sensations…and every time the physiotherapist finds “something” upon palpation.

When evaluated under controlled circumstances, therapists fail to replicate findings from other therapists when looking for tightness and knots.^2,3 In fact, even the physiotherapists that invented the concept of palpation to identify muscle knots are unable to find them reliably when tested.⁴

Like Gumby

Luckily, it doesn’t matter if they could find tight muscles (which they can’t)…they wouldn’t be able to do anything about it anyway. Humans aren’t strong enough to release or deform deep fascia…not with our hands or any of the various tools on the market.^5-7,10

Which is a very good thing for you because your physiotherapist could significantly injure you if this was possible. You’d also deform your butt sitting too long, your face during sleep, or your hand from a manly handshake.

And although current evidence does not support the use of instrument-assisted soft tissue mobilization to improve pain, function, or range of motion, I don’t doubt that massage feels good.^8,11 Touch does. It just has ZERO to do with loosening tight tissues.

The most likely benefits of massage come from the fact that it is both relaxing and may lower neural inhibition.¹¹ The mind is a powerful thing, and it is guided by our perceptions and expectations.

Wrap it up

This is not to deny the existence of the clinical phenomena of pain spots, knots, or tight muscles themselves, for which scientifically plausible explanations exist. Potential culprits for trigger points include issues with the axons of peripheral nerves, central nervous system over-stimulation, subjective experience with subsequent sensitization to danger signaling, or plain old confirmation bias.

Many physiotherapists simply have a high prevalence of over-treating, over-complicating, and over-diagnosing. They aren’t necessarily doing it intentionally and there are certainly a ton of great physiotherapists out there. But I want you to be aware of such a widespread problem. It can save you time, money, and mental anguish.

Even a single treatment session has been suggested to be just as effective as many sessions over extended periods of time to reduce pain and improve function.⁹ Realistically, a lot of this is likely in your mind…that’s how a large part of the pain experience works. That’s why education and reassurance should be first line treatments…yet are often missing from the equation entirely. Much to your detriment, it may be prolonging your pain experience.

People with pain need advice that it’s safe to continue progressing movements within their ability and reassurance that things will improve over time. The saying “motion is lotion” is true. Assuming severe injury isn’t in play, if you have pain or the feeling of muscle tightness, stay active as you are able. And realize the most important factor for healing of sports related injuries is simply giving it enough time with a positive outlook.

Your body is an amazing thing. Fuel it well, keep moving, and it will likely heal up just fine given enough time.

Hopefully this article can give you that reassurance you need to continue pushing forward. You’ve got this.
 
-Dr. Allan

Citations

1. PMID: 25477053
2. PMID: 28098584
3. PMID: 19158550
4. PMID: 1404132
5. PMID: 18723456
6. PMID: 24697346
7. PMID: 29332733
8. PMID: 30797743
9. PMID: 37805175
10. PMID: 31256353
11. doi/10.1177/0021886396322003