Musicians' Health Collective

Musicians' Health Collective: Supporting the health of musicians

What is a Muscle Knot?

Last week I mentioned the importance of getting bodywork to target muscle knots- I imagine that few people see muscle them as literal knots, but what are they exactly and how do they exist?

There are a few words to know first- trigger points and fascial adhesions.  I mentioned trigger points last week, but "a skeletal muscle tissue trigger point is a hyperirritable focal area of muscle hypertonicity (tightness) located within a taut band of skeletal muscle tissue." (Joseph Muscolino)  These areas of tightness often cause pain and discomfort, especially in those overused musician areas of the upper back.  The word trigger point came to use in the 1940's because of a Doctor Janet Travell (yes, an awesome woman pain doctor in the first half of the twentieth century!) and her research into myofascia, trigger points, and pain.

This is Dr. Janet Travell, who was also a white house physician!  Image from her website.

This is Dr. Janet Travell, who was also a white house physician!  Image from her website.

It is not something subjective, not something of which the patient complains. It is an objective physical sign in that it is disclosed by physical examination of the patient. Then, the trigger point is identified as a localized area, a spot of deep tenderness in a firm band of muscle that can be readily felt. Usually the palpable band parallels the muscle fibers; occasionally it feels like a button, or a nodule. At the spot of maximum tenderness (the trigger point), if the band is snapped briskly (transversely), and is thus mechanically stimulated, it contracts; this we have called a ‘local twitch response.’ The examiner can feel and see the line of contraction of the band, and can judge which muscle harbors it.
— Janet Travell, Basic Principles of Myofascial Pain, 1984
Remember this image from last year's fascia post? Fascia is everywhere in the body and is the "body's aqueous knitting fabric" (Jill Miller)!

Remember this image from last year's fascia post? Fascia is everywhere in the body and is the "body's aqueous knitting fabric" (Jill Miller)!

In some of Janet Travell's other writing, she talks about how the trigger point affects muscle strength and reflexivity, joint mobility, and radiates pain to surrounding areas.  (She was also a general badass and way ahead of her time in many other ways!)   There is a fair amount of disagreement about what causes trigger points, though we can all agree overuse, misuse, and abuse are contributing causes.  Carry a large purse on one side of your upper back and chances are, your trapezius will tighten up and eventually form a trigger point that could radiate into your forearm and neck, like the picture below. 

Images like this are usually referring to trigger points, or areas of myofascia that radiate sensation and pain to surrounding areas.

Images like this are usually referring to trigger points, or areas of myofascia that radiate sensation and pain to surrounding areas.

Now what's a fascial adhesion and is there a difference between that and a trigger point?  Andrew Biel writes that a consistently shortened or lengthened muscle will cause change within the muscle and the fascia, which may grow "dense and fibrous.  The excess connective tissue can result in fascial adhesions that affix one muscle to another, limiting range of motion."  (Trail Guide to Movement, 12)  Remember that fascia is everywhere in the body, like the white stuff in a citrus fruit giving structure to the juice within.  Your fascia can be dehydrated (think gross grapefruit!) or overgrown from a trauma or from overuse/underuse.  Adhesions address fascia, according to some folks, and also address scar tissue and an abundance of collagen from healing.  For example, if you had tendonitis in your forearm when you were younger, you may have some scar tissue lingering in that location- it might not be extremely painful but it might be hindering your ability to use your forearm and hand.  Trigger points are generally thought of as more muscular/myofascial in origin, though to be frank, your body's network of muscles and fascia is continuous!  There is a fair amount of disagreement in the manual therapy world about what causes what, and how things cause pain, and why they arise in the body, so this is just a general survey.

How can you help both your trigger points and your adhesions?  Well, go get some bodywork and talk to your bodyworker about what they find and what tissues they find acting abnormally.  Consider getting on the self-massage train and start excavating these issues yourself, and look into different types of bodywork.  Cranio-sacral vs. rolfing vs. deep tissue vs. graston technique.  Get curious!

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