So, what does a muscle knot even mean? You have a ‘tight’ spot in your muscle, what do you call it? I used to call it a knot, or a trigger point, or a band. A trigger point is defined as a small muscle not, or taut band dotted in our body, caused by trauma, overload or postural stress.
I’m here to tell you there’s not actually much evidence for that. That’s not to say that you don’t feel any pain when your physiotherapist pokes or presses a certain spot, but the reason why you think these sore spots occur is not explained by a ‘trigger point’.
The theory of muscle knots being a cause of pain has been around (this time) since before I was born… around the 1980s. I like comparing evidence to my age to point out how ancient it is. 😛
The theory was first developed by a pair of doctors called Travell and Simons (you may have seen their thick trigger point books), and was developed widely by many practitioners despite no research or evidence to back it up. There’s actually no clear cut evidence that muscle knots exist, let alone are a source of pain!
There are many alternative theories as to what causes sore spots through your tissues. Most physiotherapists learn these when completing dry needling courses. Here is the most likely alternative theory:
- Sore spots can be due to issues with sub cutaneous (under the skin) peripheral nerves, either through micro trauma from repeated postures and stresses to the nerves blood supply or macro trauma. Because our neural system requires a lot of fuel to keep it working, if there is a slight disruption in normal flow, sometimes it can cause the nerve to become distressed.
So, more often than not, a ‘knot’ is felt as muscle spasm or increased tone.
What’s interesting, is that the world’s leading experts of trigger points, Travell and Simons who I mentioned earlier, have said that they have trouble finding them in patients! There was a study conducted by a man named Fred Wolfe, who had three groups of patients – (1) Those who had been felt for trigger points and been diagnosed as having them, (2) those diagnosed with Fibromyalgia (therefore had muscle pain but apparently no knots), and (3) a healthy control group – muscle knot and pain free. The examiners (people who looked for muscle knots) were then blinded, and they had no clue who was in what group! What’s interesting is that this study was completed in 1992! What’s that, another study before I was born? Yep.
I’ve also added more research in the references section that support this.
So, in summary, the most logical reason you have ‘sore spots’ isn’t actually a muscle knot. It must be acknowledged that all other theories, including the one I suggested above, also don’t have any robust evidence. So when you do feel a sore spot, just know that this is an area of tissue sensitivity, and not necessarily a muscle source.
Time to get researching!
Soft Tissue Sore Spots of Unkown Origin!
The fibromyalgia and myofascial pain syndromes: a preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease. – Wolfe et al. 1992.
Interexaminer Reliability of the palpation of trigger points in the trunk and lower limb muscles. – Hsieh et all. 2000.
A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance. Myburgh et al. 2008.
Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature. Lucas et al. 2009.
Effectiveness of Dry Needling for Upper-Quarter Myofascial Pain: A Systematic Review and Meta-analysis. Kietrys et al. 2013.