Muscles, Knots & Trigger Points

Muscles, Knots & Trigger Points

Muscles, Knots & Trigger Points and How they Effect Health and Performance

Author: Troy Dopson, Physiotherapist
The Body Group (

I would like to talk about the relationship between healthy muscles, trigger points and knots. From my experience the relationship between the health of a muscle and its performance is a very important issue to address.

“Healthy muscle” is high metabolic rate tissue that is responsible for our movement by contracting (or pulling) across joints. Generally the younger we are the healthier our muscles. They are soft and loose at rest and very hard and tense under maximum activation. They are capable of a big range of active tension and are very responsive to what our brains tell them to do. They also respond efficiently to stretching and compress easily when relaxed.

“Knot” is not a scientific term but effectively describes hardening in muscles. I think the description has come more from examples around the shoulder blades where it is very clear to feel the ‘hard’ against the soft. But in other areas muscles may just be uniformly hard or noticeably harder than its counterpart on the other side or compared to how it was in the past. It is hardened even at rest and under a constant passive tension. Its range between maximum and minimum tensions is narrowed and is relatively unresponsive. Sometimes your trainer may think that you just don’t get a movement concept but it could be that the muscle no longer fires efficiently. Stretching it is also inefficient and it does not compress well making that area “stiff”.

“Trigger points” were first described by Travell and Simon. They are sensitive and potentially painful points in muscle. They don’t so much block movement like knots do but they can make them painful. Trigger points form in healthy muscle when a muscle is constantly “on” with little to no movement. These circumstances constrict the blood supply energy available to the muscle and it reaches a crisis point – a trigger point. As an example, this happens with prolonged slouched sitting. If there is not much inflammation (e.g. from exercise) the trigger points may gradually progress to hardening and stiffening of the muscles. In response to injury, muscles go into “protective spasm” and trigger points suddenly form. All of this is painful. As the trigger points convert to hardening, pain is replaced with stiffness. Knotted muscle can be broken down into trigger points. Typically, then a second step is required by applying pressure to the trigger points to neutralize them into healthy muscle. For this reason I recommend tissue work after exercise, particularly the next day at maximum soreness.

The whole thing is somewhat complicated by inflammation. Both exercise and direct tissue work create inflammation whose effects are felt after some delay. Inflammation has aspects that help the process of improvement and healing, and “protective” aspects like spasm and swelling which are counterproductive to this process. So what we want is to maximise these good aspects like increased blood flow and metabolic rate and minimize the spasm. This should feel more like just soreness rather than pain.

Generally the inflammation of tissue work is more controlled than that of exercise. I do not recommend heavy tissue work before exerise or during the sore period for this reason. Exercising muscle already inflammed by tissue work increases the chances of it reacting with spasm and increasing pain. However working on a muscle after exercise will decrease spasm and enhance recovery. For working on ones self, different tools can be used. Foam rollers are good for covering a large area quickly but not so good for penetrating deep into hard muscle which is better done with smallish hard balls or deeper yet with a specialised tool called “the jacknobber”.

Direct tissue work can be used to reduce pain and tightness. What is less well appreciated is that areas that are stiff and blocked with little feeling of stiffness there will be hardened tissue that may be intensive and tissue work can be used to soften these and facilitate stretching and movement. Of course, if the pain is serious or of concern then see a doctor who can rule out serious causes and indicate whether tissue work would be appropriate.