Schrödinger’s Knot

Let me preface this by saying I am not a physics person.  I may be grossly misapplying this principle, I’m OK with that, I’m just trying to infuse some humor into the topic.  I love Big Bang Theory and a friend mentioned this title, which I am using with permission of course.

Clients ask me all the time:  What is a knot?  It could be any number of things, but I really have no idea.  I do know that I feel it and they feel it, and I am going to treat it to see if some symptoms diminish.  There is not a single massage theory book that I can find that defines the term knot.  It is completely a lay term.  What most people mean by knot is this: A specific area that hurts and there is usually some relief when it is pressed on or worked out. There are several theories that exist over what a knot really is.  A lot depends on what particular massage therapist’s background is when they define a knot in their practice.One theory is that individual muscle fibers are in a state of spasm.  When enough muscle fibers are in spasm, people experience a cramp, which completely different from a knot.  This theory is that individual fibers are being irritated by something, possibly overuse, trauma, or fatigue and they are not able to return to a fully relaxed state.   By treating the spasm, the knot is removed.Another theory is that a knot *is* a Trigger Point.  Trigger Points are defined by Dr. Janet Travell as “a hyperirritable locus within a taut band of skeletal muscle, located in the muscular tissue and/or its associated fascia” (Travell and Simmons, Myofascial Pain and Dysfunction, 1:12.) Trigger Points do require a pain referral pattern, which not everyone experiencing a knot has.  There is also some scrutiny of the Trigger Point theory right now and some believe that the use of the term “Tender Point” is more accurate.A third theory of the knot is that there is a collection of waste that may be irritating the Trigger Point (which may or may not exist).  According to Paul Ingraham, a former massage therapist and science writer, “A muscle knot is a patch of surprisingly polluted tissue: a nasty little cesspool of waste metabolites.” ( last theory that I will directly address is the idea of an adhesion.  Adhesions are “when reduced motion at a joint allows cross-links to form among the collagen fibres, further reducing the range of motion.”  (Rattray and Ludwig, Clinical Massage Therapy Understanding, Assessing and Treating Over 70 Conditions, p244.)  Adhesion can also be defined as a “condition in which bodily tissues that are normally separate grow together” or “a fibrous band of scar tissue that binds together normally separate anatomical structures.”  (The Free Dictionary.) Adhesions can also form as part of the scar tissue repair process that can be brought on by the inflammatory process, injury, or overexertion.  If I continued searching, I’m sure I could find even more definitions of adhesion, but I’ll stop there.A therapist that is into the metaphysical types of massage modalities may also say something about your energy being blocked.  That’s not me and there is probably even less research on that topic.There is no consensus in the massage (or medical) community as to what a knot is.  Unfortunately there is a lack of research.  Part of the problem is that live tissue and dead tissue act differently.  There is also the issue with it being a relevant topic to study, which I believe it is.  Without research all we have are a bunch of notions.I even asked a group in Facebook how they define a knot.  One guy took it upon himself to tell me I should go back to school because I don’t know what it is, clearly I need more education.  Hmph. There is a difference between curiosity and ignorance.  Quite possibly I have read too much to fully embrace one idea over the other.  The truth of the matter is that the medical community is still uncertain what a knot is.  Depending on their background they may have different ideas or suggestions, but not one theory has been proven, yet.  If it has, please let me know where I can read this information, I would love to see it.Please forgive me when I answer your question “what is that” with “I’m not really sure, it could be any number of things.”  In my work though, I tend to focus more on how your tissue is responding to what massage technique I am using versus getting caught up in what exactly it is in your muscle.  For all I know it could be a spasm *and* toxic, or and adhesion *and* a trigger point.  Just like the cat could be thought of as both dead and alive.   We just don’t know the answers yet.  For the record, I think I lean toward the spasm/adhesion theories, but just like everyone else it’s a guess based off of experience and the modalities that I use.#25 in the 31 in August Blogging Challenge.