In almost every massage session, I am called upon to work out knots in peoples' muscles. The shoulders are the most common culprit when it comes to places in the body that store tension, so most knots tend to be found in that area, but knots can be found all over the body wherever there are muscles. So what exactly are knots, and why do they tend to form in certain places? More importantly, perhaps, what can you do to prevent them from forming?
Muscle knots are the body's way of protecting damaged tissue. If a small tear or strain occurs in the muscle tissue, the surrounding muscles will tense up around it to splint the area, preventing further injury and giving it a chance to heal. The problem with this, however, is that the muscles surrounding the injured site soon become overtired and strained themselves, especially if the area keeps getting moved and the injury is not healing, which leads other muscles around them to tense up. As more muscles keep becoming tired and strained, the body continues to receive messages that the area needs to be protected and more muscle tension is triggered. Gradually, these areas of tension build up into palpable bunches which are commonly referred to as "knots" and more professionally are referred to as "trigger points" or "taught bands."
To remove trigger points, a therapist has to apply what's known as ischemic pressure long enough for the muscles to relax and the trigger point to release. Ischemia means a restriction in blood supply, so ischemic pressure refers to the fact that the pressure will temporarily restrict the blood flow to the affected muscles. Without the blood supply which brings them nutrients and oxygen to continue contracting, the muscles are eventually forced to relax and the trigger point is then released. The area is gently stretched and massaged afterwards to return blood flow so that any waste products the muscles were holding onto can be flushed out and proper healing can occur as oxygen and nutrients flood in.
Having answered the "what" of muscle knots, let's move on to why they form in certain areas of the body. I mentioned that the shoulders are probably the most common area that people find knots. The reason for this is a combination of factors, principle of which are stress and posture. When we are stressed, our bodies tend to tense up naturally as part of the "fight or flight" response. If you've never heard the term "shoulder earrings" it means that you tense up your shoulders and bring them up towards your ears when you are stressed or focusing intensely on something. This natural bodily response can be damaging if it occurs too often, though, because those muscles will become tired and strained from unnaturally holding your shoulders up close to your ears. This results in some trigger points forming.
As to the posture, we live in a world in which everything is just within reach. Literally. We reach forward to eat, to pick up our drinks, to type on our computers, to read a book, to write a letter, to check our phones, and (at least for massage therapists) to work on our clients. All this reaching forward tightens the pectoral muscles, specifically the pectoralis minor. This muscle pulls the shoulders forward – rounded shoulders, anyone? – and constantly stretches out the muscles in the back and lower neck. You might think that being constantly stretched would be a good thing, but stretched does not mean relaxed. Just as if you kept constant tension on a rubber band it would wear out faster than a rubber band that was allowed to relax back to its normal state, so your muscles tire and become strained when they are kept in a constantly stretched position. Combined with this unnatural stretching is the fact that most of us tend to slouch horribly (yes, I'm also guilty as charged, but I'm working on it) when performing many of the above activities, and our upper back and neck muscles simply become exhausted. This is true of any area in the body where unbalanced forces are applied, and that is why trigger points can be found nearly anywhere.
So what can you do to keep these uncomfortable spots from forming in the first place? The best first step is to become aware of your body – how it moves, how it rests, which movements are easy and which are difficult – and really pay attention to unhealthy movements patterns. If you find that you start wearing your shoulders as earrings when you are stressed or find that you stand on one leg all the time and almost never on the other, consciously try to catch yourself doing it and correct the behavior. It may take a while, but eventually your body will self-correct. Another step is to consciously pay attention to your posture. Make sure you are not sitting on your tailbone and are trying to keep your upper back straight and in line with your neck as opposed to slumped forward. In other words, sit so that, if you had a tail, it would not be curled underneath your body and dangling between your legs in the front, but rather so that it has a clear line out the back of the chair. The upper back can be assisted by rolling the shoulders backward in little circles. These small but significant changes will help develop your bodily awareness and encourage your body to physically maintain itself, reducing the possibility that trigger points will form in the first place.