Dr. Donald Littlewood
The Truth About Muscle Knots
Updated: Jun 17, 2022
We’ve all been there before: your shoulders are sore and you poke around in there only to find a big ol’ hard spot chilling in the middle of the muscle. You press on it and pain washes over the entire area.
That, my friend, is a trigger point, more commonly known as a muscle knot.
Trigger points are common, but what exactly are they? Well, you have come to the right place. In this blog, we are going to talk about what trigger points are, why they form, and what you can do about them.
Anatomy of a trigger point
Trigger points are small, palpable nodules in very sensitive, taut areas in a muscle. They can be broken down into two forms: active & passive.
Active trigger points cause spontaneous pain at rest and that pain is increased when there is stretching or contraction involved. There is also often a decrease in range of motion.
Latent trigger points do not have this spontaneous pain but it still can cause pain when palpated and restricts range of motion.
There are some overarching characteristics that all trigger points have in common:
Focal point of tenderness of the muscle that reproduces the pain you’re feeling
Presence of a taut band of musculature
Restricted range of motion
Pseudo-weakness is often involved
These buggers play a role in tension headaches, low back pain, neck pain, jaw pain, forearm & hand pain, postural pain & pelvic/urogenital pain.
So why/how do we get these?
I want to start this off by saying, everyone gets a trigger point at some point in their life. I don’t actually have a stat to back that up, but I yet to encounter someone who has not had one of these pesky little suckers wreaking havoc on their day. I am fully convinced that 100% of people will have a trigger point in their upper trapezius muscle at some point in their life.
The going idea is that these arise out of chronic micro-trauma in the area. In my practice, I see a lot of trigger points in the upper back, neck and head/jaw.
In order to fully explain this, I’m going to get a touch science-y on you. It’ll be short. I promise.
The first thing that happens is chronic physical stress. This can come from a build-up of the psychological stress we all have throughout our lives, or it can come from chronic physical stress meaning repetitive use or overuse. This chronic stress makes the nerve endings more sensitive and causes dysfunction where the nerve makes contact with the muscle fibre.
The intersection of the oversensitive nerve ending, the dysfunction of the motor end plate, and a local twitch response in the muscle fibre is thought to be the cause of these trigger points and they act as a sustained contraction in the muscle. Most trigger points start our as a latent one and then develop into an active trigger point with time.
Trigger points also refer pain elsewhere and often the referral doesn’t make much sense. For example, the infraspinatus, which is one of your rotator cuff muscles in the back of the shoulder, refers down the back of the arm into the elbow.
So you have trigger points, what now?
Okay, so you might not have active ones RIGHT NOW, but I would be willing to bet some cash that you’ve had one in the past, and that you’ll have more in the future.
Sorry ‘bout it!
Along with these trigger points often comes joint restrictions and always comes with a decrease in range of motion. And that’s where I come in.
Now obviously I treat the muscle… that’s a given. But how?
This is a go-to for me. Essentially I find, and apply pressure to the trigger points and take you through a range of motion. Is it comfortable? No. Does it feel good? Yes.
I like to call it the good pain.
Trigger points respond to tactile pressure. This will release the trigger points and slowly melt them away. The release of the trigger point also releases lactic acid (because the muscle is contracted) so I tell my patients to drink lots of water after treatment to flush it all out.
This is essentially magic.
There are traditional acupuncture points, and then there are functional acupuncture points, and I use both. That being said, around ~70% of the traditional acupuncture points are found where common trigger points lie.
The Ancient Chinese were onto something!
Inserting acupuncture needles directly into the trigger point, or at nearby spots, can cause the trigger points to literally melt away.
I also usually add some electrical stimulation to the area. The electricity activates the muscles to fire in a more appropriate & efficient manner and really speeds up the healing process.
Adjustments are the pop & crack people often associate with chiropractors.
Trigger points are often associated with joint immobility in the area. Remember when I said that trigger points cause a lack of range of motion in the muscle? When that happens, you are obviously not moving the area in its full range and when you don’t move it, you lose it, so your joints stop producing as much lubrication and stop moving the way they should.
Adjustments are aimed at getting the joints that aren’t moving, moving again. It is a quick, small, specific movement that provides patients with a lot of relief.
Stretching is SUPER important with trigger point work. You want to make sure you are properly stretching the muscles with the trigger points in them before you start to strengthen.
This is because if you overwork an already sore and painful muscle, it is just going to get more sore, and more painful.
So stretch first, and then strengthen.
Want to know what stretches to do? Leave a comment or send me a message, and I would be happy to point you in the right direction.
Before I go, I want to take a second to talk about my absolute favourite supplement. Magnesium. This little mineral is wildly important in our body. Involved in 300+ processes, magnesium is crucial for down-regulating the nervous system, relaxing muscle tissue, and energy production.
Remember how I said that trigger points act as a sustained contraction in the muscle? Well in order for that muscle to relax, magnesium has to come into the muscle to take the place of calcium so that the muscle can relax and go back to its relaxed state. Magnesium also plays a really important role in desensitizing the overactive nerve fibres that are present in a trigger point.
At some point, you will have trigger points, if you haven’t already; I have one in my right trap as I type this. Getting your muscle aches looked at and taken care of by a healthcare provider will not only help them in the moment, but will help in the future too.
Dr. Donald Littlewood