ONE LITTLE KNOT. ONE BIG $5,000 PROBLEM.
Well-documented clinical research has concluded 70-85% of all pain is believed to come from little tiny knots in the muscle (clinically known as trigger points). The good news is pain caused by muscle knots can be easy to fix. The bad news is that our instinct is to run to the doctor, or reach for medication, every time something hurts. Unfortunately, not many doctors understand that muscle knots can be the root cause of pain. The Centers for Medicare & Medicaid Services reports U.S. health care spending reached 2.9 trillion in 2013. But what does that humongous number mean to the average person?
Fourteen years ago I had excruciating back pain. After two months of continuously worsening pain I went to a doctor ($200 visit). She prescribed eight visits to a physical therapist ($150 visit/$1200 total). I was still in pain. I went back to the doctor and was prescribed pain medication and muscle relaxers ($200 visit, $30 prescriptions). Nothing was working. The doctor then scheduled an MRI, X-ray and ultrasound to rule out a tumor ($2,200). Tumor ruled-out, I was then diagnosed with “arthritis” and given another pain killer prescription ($30). I refused to accept the diagnosis and decided to see a medical massage therapist who specialized in injury ($350). Something started working. Went back eight more times ($800). Pain gone! Total cost: 1.5 years of chronic, almost unbearable pain and $5000 ($2,000 out of pocket, $3,000 covered by insurance).
The total cost had I known about muscle knots and pain mapping: one book ($25) and one week of time – maybe less. That’s just one story. I have more. Lots more. Since I founded Tiger Tail USA in 2006 I have personally met over 100,000 people, heard hundreds of stories similar to my own, and have helped almost a million people solve their own pain battles. My mission is to change the way people think about pain. Instead of grabbing a pain pill, I want you to think about your muscles. Use this book to find and fix the muscle knot that’s causing your pain. If 70-85% of all pain is caused by muscle knots, then your odds of finding some are pretty darn good. Finding your muscle knots and stopping your pain can be life changing. Empowering people with the ability to unlock pain and make their muscles happy is my greatest joy. I hope this book allows you to live a happy and healthy life.
MUSCLE KNOTS. QUESTIONS ANSWERED.
Travell and Simons, the pioneers of trigger point research, define a trigger point (muscle knot) as a hyper irritable spot in the muscle.1 A muscle knot can be the size of a pin head, small pea, or macaroni noodle – even a small pickle. Muscle knots can typically be felt, and are typically located, in the belly of the muscle. The muscle will feel tender when the knot is touched or palpated.
Muscle knots consist of contracted muscle fibers (known as sarcomeres), and can be the source of an amazing amount of pain because these little fibers have contracted so tightly, they’ve forgotten how to relax. When muscles hold their contraction, they cut off blood and oxygen to the area, which allows waste products to accumulate in that area.
Think of what happens when you fall asleep on your arm. The pain gets so bad that it finally wakes you up. Once you’re awake, you can hardly wait for the blood and oxygen to get back into your arm so the pain will go away. A knot in the muscle is much like your arm falling asleep.
The little muscle fibers in your knot have contracted so tightly, the muscles have fallen asleep on a microlevel. When you start rubbing the muscle knot, you get the muscle fibers to relax, allowing the blood and oxygen to circulate freely to that muscle area. As soon as the blood and oxygen can get through, the pain can go away.
The result of a knot in the muscle is sometimes reported as pain (ranging from dull to severe), reduced range of motion, flexibility, power, and sometimes weakness.
A muscle knot can be actively painful, or you might not even know it exists until you put pressure on it. But make no mistake, when you press on one with just the right amount of pressure, it can make you laugh and cry at the same time because it can “hurt so good”. Press too hard and it can make you cry for mercy.
The amazing thing about muscle knots is that they “refer” pain – meaning, the pain you feel is often not in the location of your trigger point until you press on it. This means that the bottom of your foot might hurt, but the trigger point is in your calf.
If you gently rub the muscle knot you may feel tenderness in both the muscle and the muscle knot. Sometimes, the referred pain symptoms are able to be reproduced when pressure is applied to the muscle knot.
Although the first trigger point was documented more than 165 years ago, Janet G. Travell, M.D. (1901–1997) and David G. Simons, M.D. (1922–2010) are considered the founding mother and father of trigger point research. Through this research, it is believed that approximately 70-85% of ALL pain is related to trigger points either directly or indirectly.
There are 696 muscles in the body that move bone, support the organs, and produce heat. BUT, different muscles have different functions. Some muscles help other muscles move or help keep the body upright to maintain good posture. Sometimes these muscles are overworked, or in the case of athletes – over trained, or the muscles become injured causing unhappy muscles.
Pain caused by muscle knots may be the largest cause of pain and muscle dysfunction in the world. Experts estimate that nearly 1/3 of adults suffer from some type of chronic pain. This means that muscle knots could be the biggest cause of loss of productivity in the workplace, in school, in professional and amateur sports, and everyday life. Pain costs the USA between $60 and $100 billion annually in healthcare expenses, lost income and lost productivity.2
Travell and Simons quote studies in their Volume 1 Trigger Point Manual that suggest 93% of pain sufferers coming into a pain clinic had muscle knots that were related to their problem, and that muscle knots were considered the primary cause of the pain in 74% of those same patients. Travell and Simons also cite a second study where muscle knots were the sole cause of pain in 85% of the pain sufferers.3 It seems extremely important that we all learn as much as we can about muscle knots.
A muscle knot looks like what it feels like — a little knot in the muscle fibers. When a muscle contracts, the contraction is actually happening in a microscopic unit called a sarcomere. To make your muscle contract, even for the smallest movement, thousands of sarcomeres have to contract first. A muscle knot builds when sarcomeres are unable to release a contraction. The resulting knot is what causes referred pain. That’s why the bottom of your foot can hurt if you have a muscle knot in your calf.
Figure 1 represents several muscle knots within several muscle fibers.
Letter A represents a muscle fiber in its relaxed state. It is not working (neither contracting nor stretching).
Letter B illustrates a knot in the muscle fiber where many micro sarcomeres have contracted into a muscle knot. It is this muscle knot that feels pretty darn painful when massaged, that many refer as a “good pain”.
Letter C illustrates the part of the muscle that extends from the knot to where your muscle attaches on the body (like on a bone). When the muscle is stretched like this, the muscle fibers lengthen unnaturally, and ultimately cause pain to seemingly uninvolved areas of the body (referred pain).
Fascia is best described as a continuous web of connective tissue that encompasses the entire body from head to toe. Fascia connects structures of body together including muscles, organs, arteries, and veins. Tight fascia can cause restrictions in most of the systems of the human body.
Restricted fascia can lead to pain, reduced range-of-motion, and the development of muscle knots. Fascial lines can be defined as patterns of fascia that are located throughout the body based on the connections of fascia. Thomas Myers (Myers, 2009) noted these fascial trains or “lines of pull” affect the body in both structure and function.4 Muscle knots are located in the muscles whereas fascial points are located in the fascia.
Fascia and other forms of connective tissue are made up of several different types of fibers and materials that give it different characteristics and strength capabilities. One of these substances is a “gel-like” substance of proteoglycans and hyaluronic acid or as we like to call it, Sticky Acid H. The purpose of Sticky Acid H is to allow the fascia, muscles, and other connective tissues to glide over each other with minimal friction.
Fascia and muscles may become restricted and “stuck” on each other when an individual overworks muscles or sustains an injury or trauma. Sticky Acid H can create myofascial restrictions because it can become less pliable and more stiff, which prevents muscles and fascia from sliding freely. It is important to warm up this gel-like substance to help make it become slippery and liquefy into a lubrication instead of a restrictive irritant.
When Sticky Acid H is warmed up as a result of exercise, soft-tissue work, working with Tiger Tail muscle massage tools, or even a hot shower, the fascia, muscles, and other soft-tissues are able to move more freely. This heating affect can help increase range-of-motion, functional movement, and reduce pain.
Muscle tension is created as a result of a contraction of the muscle. Shortening of the muscle belly, or a concentric contraction, causes tension in the muscle creating force to move bones. Most people think of muscle tension that causes pain and discomfort. But muscle tension can be a result of anxiety, stress, or overworked muscles. Prolonged muscle tension can cause muscle knots throughout the body leading to referred pain.
There are a number of reasons why muscle knots form. They can be the result of overtraining or overworking a muscle. If you keep your muscle in a shortened position without stretching it for a long period of time, a muscle knot can form. For example, sitting at a desk can put the abdominal muscles in a shortened position.
Other factors that can cause muscle knots are called perpetuating factors. These include stress, vitamin and mineral deficiencies, ergonomic factors, dietary factors, and structural abnormalities of the human body. It is best to seek professional guidance in these types of situations.
A primary (or parent) muscle knot usually develops as the result of over training or overuse of the main muscle. A secondary (or child) muscle knot is one that develops in a helper or opposing muscle to the main muscle. For example, when you push something away by using the chest muscles, you may feel a pain in the back. This may be a secondary muscle knot that formed.
An active muscle knot has the characteristics of a primary muscle knot. An active muscle knot will be painful when palpated, causing either local or referred pain dependent upon the pain pattern. A latent muscle knot is an inactive or dormant trigger point. The latent muscle knot is tender upon touch, but does not cause local or referred pain like an active muscle knot.
Muscle knots will typically create local or referred pain. This pain can be characterized as dull and achy type of pain in the muscles, fascia, and joints. Referred pain is a type of pain that is felt in a different area than where the source of the pain is located. Referred pain is common with most muscle knots. For example, if you press on a muscle knot on the side of your hip you may feel pain down the side of the leg. Or, the muscle knot may be located on your abdomen, however the referred pain is felt in the lower back.
The type of muscle knot will define the symptoms. Most muscle knots will be active muscle knots. Symptoms may include local or referred pain or complaints of dull, achy feelings in the joints, muscles, and fascia. Depending on the muscle knot, the pain may be subtle and with time may increase in intensity. Other symptoms may include increased weakness of the muscle and/or decreased range of motion and flexibility. It is important to remember that muscle knots may be the source of pain, but it is recommended to consult with your health care practitioner if symptoms worsen or the pain is severe.
There is no set timeline in how fast the pain will go away if the pain is caused by a muscle knot. The time for a muscle knot to go away will depend on how long the muscle knot has been active and what the perpetuating factors are. Often times, a muscle knot can be treated and eliminated with just one treatment of compression and massage to the area for 10-15 seconds. Some muscle knots may take several treatment sessions to go away. Some factors to consider are how long the pain has been present, what caused the trigger point, what treatment is being sought to reduce the muscle knots, correction of any perpetuating factors, and compliance with self-care and stretching programs.
All muscles have memory. This means each time a muscle performs a certain movement this movement is “recorded”.
Sometimes the muscle “forgets” it no longer needs to contract, which is why chronic pain is often attributed to muscle knots. In some cases, muscle knots are responsible for years of pain because the muscle “forgot” how to relax. Muscle knot self-help works by changing muscle memory, increasing circulation, and releasing the bunched up muscle fibers which have become a “dam” in the muscle. Muscle knot self-help can change the muscle memory by lengthening the muscle tissue and fascia.
By interrupting the muscle knot with massage and manipulation, the muscles are lengthened. This can help “remind” the muscle that it no longer needs to be in a contracted state, which helps restore proper muscle contraction and promote new muscle memory. This is why someone with chronic pain that has lasted for years can find relief with trigger point therapy. In some cases years of pain were erased with just several sessions.
Many individuals will experience post workout soreness due to increased loads or trying a new exercise. This is referred to as DOMS or delayed onset muscle soreness. DOMS will develop within 12-24 hours after working out. It is the result of the muscle repairing itself with most discomfort present up to 72 hours after working out. It is important to differentiate DOMS from acute muscle soreness. Acute muscle soreness will present itself immediately following exercise. If the acute muscle soreness or pain persists or it is present on one side only, then medical advice should be considered.
Vitamins and minerals are necessary for the body to function properly and are important for healthy muscles and fascia. Note that this information is for educational purposes only. If you think you may be deficient or have questions, you should consult a trained medical professional. Do not self-medicate.
Calcium: Calcium is necessary for proper nervous system functioning, muscle contraction, and building of bones and teeth.
Magnesium: Magnesium is used to release energy from carbohydrates stored in muscle, regulate body temperature, help control blood pressure, build bones, and assist in producing proteins.
Potassium: Potassium is used in electrolyte and fluid balance in the body, helps with muscle contraction, nervous system functions, and release of energy from the macronutrients.
Vitamins: Vitamins can be categorized as either fat-soluble or water-soluble. Fat-soluble vitamins include A, E, D, and K. These vitamins are stored in the liver and fatty tissue. Water-soluble vitamins include Vitamin C and the B-complex vitamins. Water-soluble vitamins are not stored in the body.
Vitamin D: Vitamin D plays a role in the absorption of calcium. The sun is an excellent source of Vitamin D as well as supplements. A recent study from the University of Michigan suggests muscle weakness, muscle pain and skeletal pain is linked to low levels of Vitamin D.
B-Complex Vitamins: The B-complex includes Thiamin, Riboflavin, Vitamin B6, Folic Acid, Pantothenic Acid, Biotin, and Vitamin B12. The B-complex vitamins play a role in metabolism of carbohydrates, fats, and proteins. In addition, they assist with nervous system function and formation of red blood cells.
Vitamin C: Vitamin C assists in the formation of collagen that gives structure to bones, cartilage, and muscle. It is also important for the absorption of Iron.
If self-help treatment on a muscle knot does not help within a short period of time, we always recommend talking to your doctor or specialist. These trained professionals evaluate your health and medical history, review the structural and functional aspects of the body, use special tests to determine strength and range-of-motion, and discuss possible perpetuating factors.
A myofascial trigger point therapist is a specially trained therapist that has had additional training in trigger point, myofascial pain, and treatment of muscle knots. To locate a myofascial trigger point therapist, go to www.myofascialtherapy.org and click on “Find A Therapist”. There may be local practitioners such as massage therapists or manual therapists that have had additional training in myofascial trigger point therapy. It is important to do research when looking for someone who specializes in this form of treatment. Asking questions such as do they have training and where did they receive their training should be asked prior to scheduling an appointment. Not all massage therapists have the proper training to work with those who suffer from pain due to muscle knots.
Internet suggested keyword search terms: Neuromuscular specialist, trigger point therapist, soft tissue specialist, massage therapist, Active Release Therapist (ART). Make sure to include your city location.
- Simons, D.G., & Travell, J.D. (1993). Travell & Simons’ Myofascial Pain and Dysfunction, The Trigger Point Manual. The Lower Extremities. Philadelphia, PA: Lippincott Williams and Wilkins.
- National Institutes of Health, NIH guide: new directions in pain research: 1. Bethesda, MD: National Institutes of Health. 1998 Sept. 4.
- Simons, D.G., Travell, J.D., Simons, L.S. (1999). Travell & Simons’ Myofascial Pain and Dysfunction, The Trigger Point Manual. Volume 1: Upper Half of Body, 2nd edition. Philadelphia, PA: Lippincott Williams and Wilkins.
- Myers, T.W. (2009). Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. (2nd Ed). Elsevier Publishing.
Typically muscle knots are found when rubbing or palpating a sore area of the body. Pain will be felt or experienced when a muscle knot is located and pressed on. There are many factors that contribute to fixing a muscle knot. Some can be fixed by applying pressure directly on the muscle knot until it goes away (this is muscle compression).
The benefits of muscle compression are numerous. First, muscle compression warms up the muscles and the fascia tissues. When using muscle compression with tools or self-massage start out with light pressure to warm up the muscles and fascia tissues. When the tissues are warmed up additional pressure can be used. Muscle compression is beneficial to restoring normal muscle function, increasing range-of-motion, increasing blood flow, and improving nutrition to the muscles and other tissues.
Look for tools designed for self-massage; these will help save your hands, fingers and wrists from fatigue and injury. Some specialists may recommend using tennis balls, golf balls, lacrosse balls, or broom sticks. Unfortunately for muscle knots, these items were all designed specifically for tennis, golf, lacrosse and sweeping. They were not designed for massage. The Tiger Tail family of tools was created specifically to help you perform self- massage from head to toe, all on your own, without the assistance from someone else.
Tiger Tail® foam roller family
- The Long One™, 22˝ Tiger Tail Portable Foam Roller
- The Classic™, 18˝ Tiger Tail Portable Foam Roller
- The Roadster™, 11.5˝ Tiger Tail Travel Foam Roller
- The Big One™, 15˝ x 5.5˝ Foam Roller
Knot Buster® family:
- The Knotty Tiger® Knot Buster®
- The Tiger Ball® 2.6 Massage-on-a-Rope®
- The Tiger Ball® 5.0
- The Tiger Ball® 1.7
- The Strappy Tiger™ Foam Roller Accessory (for any big roller)
- The Curve Ball™ Stationary Foam Roller
Happy Muscles™ pain relief treatments:
- Pain Relief Balm
- Pain Relief Serum
Turn sore muscles into happy muscles by helping relieve muscle knots, aches, cramping, spasms and stiffness.
- Apply about 10 pounds of pressure over muscles (+/- depending upon your needs) with your TIGER TAIL products of choice.
- Relaxing your muscles during this process will help you massage the “belly” of the muscle.
- You are the judge of how much pressure to apply. Strive for a “good hurt”- from 5-7 on a scale of 1-10.
With “Hurts So Good Pain” it’s not unusual for people to laugh and/or get really serious when applying this type of pressure on a muscle knot. This is usually where we see the best success.
- Always follow muscle paths. Massage each muscle group 10-20 seconds. With each pass, gently press deeper into the muscle. Avoid massaging directly over bones.
- Tender muscle knots can reduce range of motion while causing aches, discomfort and muscle fatigue. Knots come in various sizes, like a pin head, pea, noodle or small pickle.
- Minor discomfort or tenderness may be experienced when passing over muscle knots. To minimize knots, apply 10 seconds of firm, constant, focused strokes, for three sets.
- Recurring or stubborn muscle knots often need additional attention. Using Tiger Tail products 2-3 times a day may help speed healing. Over the course of time, muscle knots should get smaller or disappear.