'knots in the muscles'

  THE TRIGGER POINTS





image from google

You might be thinking about how knots can even be growing inside your muscles. Is this possible for a muscle to develop knots inside? Well, Yes! These things are for real. You do sometimes have knots in your muscles usually called as the MYOFASCIAL TRIGGER POINTS, in medical terms.

Recently I have been doing a research as a partial fulfillment for my BPT course, and I found some really good results and learnt a lot of new concepts. My research was based on the management of trigger points, a comparative study between two treatment protocols. So, here I decided to share with you my experience throughout the research and also I’ll try to explain you in brief what these points actually are.

TRIGGER POINTS (Tying up of the muscles).


Trigger points (muscle knots) are the small hyperirritable nodules often found in a tight band of muscle fibers. These knots are sometimes palpable as a considerably big round knot found deep inside the muscle and sometimes they are just tender points that hurt when we apply a deep pressure over them. These knots are developed due to micro trauma inside the muscle, repetitive injury to the muscle and overuse. Almost all of us these days are working on screens which makes us to attain certain position which are harmful for our body. Trigger points are a result of such postures that we are living in for prolonged hours.
Here, i have tried to explain you about the structure of the muscle fibers before and after the formation of trigger points.
image form google



The muscle becomes tight and stiff, forming areas which are hyperirritable and tender. These areas are deficient of metabolites. They lack oxygen and become ischemic. The influence of these points affect the surrounding muscle fibers as well. And the adjacent muscle fibers become stretched due to formation of knots between these two stretched fibers. The affected muscle is shortened in length, due to the inflammation of one point in the entire muscle length.
Myofascial Pain Syndrome due to trigger points
David G. Simons, M.D.


These trigger points can be of two types:
1.     Active:
These are the points which are “pain expressive”, which means, these causes pain, muscle tightness, spasm and referred pain (pain reaching to other areas as well). This simply means that you need not go on a hunt to search where the trigger points actually are inside your body, they make their presence noticeable on their own by the symptoms.
2.     Latent:
These points does not express pain. They are the hidden ones. They scream only when you irritate them by compressing deeply.
The micro trauma causes release of free calcium ions and increased metabolism in the affected region, causing several metabolic changes.
Myofascial Pain Syndrome due to trigger points
David G. Simons, M.D.

I randomly selected 30 patients, both male and female of age ranging between 18-60 years fulfilling the inclusion criteria. I chose the upper trapezius muscle fibers (the muscle at the back and sides of your neck and above shoulders) for study. This is found to be the “knottiest” muscle by earlier studies and is more prone to development of nodules.

The inclusion criteria being:

-         Presence of at least 1 knot on any side.

-         Presence of palpable knot or tender point.

-         Presence of both active and latent trigger points.

-         Presence of tight muscle band.

    I excluded the patients with any injury, surgery, tumors or lesion to the area.

Identifying the trigger points (Are you knotted up)?


So, how can you identify, if you are a victim of these knots. The simple symptom check can make it easier for you to find them inside your muscles.

-         You experience pain around the muscle, which after some time reaches other areas.

-         Your muscle is tight and it is difficult for you to perform that particular movement.

-         When pressure is applied to that point, you experience a ‘jump sign’. That means you suddenly jump off the couch due to sudden pain.

-         The pain is often aching, bumping and burning.

-         You observe a spherical ball like structure in the muscle when you press deeply.

   I chose three major critera to identify the trigger point presence in patients. The visual analogue scale (VAS), which helped me determine the severity of pain in the patient. The Range of Motion using universal Goniometer, a device which helped me to measure the values of neck movements and Neck Disability Index scoring (NDI), which told me about the affected functions of daily life activities of the patient.

Trigger point management (Getting rid of muscle knots).




I chose two treatment protocols for my patients:

1.     Phonophoresis :
Phonophoresis is a method used to relieve pain, with the help of topical agents. These topical agents are medicines which are applied to the skin topically and are absorbed inside the muscles with the help of ultrasound therapy. I used diclofenac gel (volini©) which is an NSAID (non-steroidal anti-inflammatory drug), used to relieve local inflammation and pain.

2.     Ultrasound therapy:
This is a physiotherapeutic intervention used to enhance the healing the tissues deep inside, by increasing the local blood supply which is already deficient in the area of trigger point.

3.     Stretching:
This is a form of flexibility exercise which is used to increase the range of motion by increasing the muscle flexibility and improves the movement of the particular affected area.

4.     Hot fomentation:
There is always a dilemma between ice and heat when it comes to trigger point. Both are effective in relieving symptoms, you can’t really prove which one is better. I decided to choose hot fomentation to provide sedative heating effect along with reduced stiffness in the muscle. Moist heat is better to use in case of muscle stiffness.

5.     Interferential current:
IFT, is used to reduce localized pain in the muscle. These low frequency currents are produced deep inside the muscle by combining two medium frequency currents. And these are found to be effective in pain relief.

There are many more treatment methods which are used to treat myofascial trigger points. These are a few which I chose for my patients.
Trigger points have become common now, it was not difficult for me to find patients suffering from these muscle knots. I found out, that a major cause behind formation of these knots inside the muscle is ‘posture’. Long hours of mobile use, computer use, and desk work etcetera makes you more prone to the muscle knots.
Along with these treatment methods, try to improve your working habits and posture. So that you can eliminate the further risk and exacerbations.

What I found, was that the method of phonophoresis was more effective as compared to ultrasound therapy, the nodules were dissolving slowly. You will have to be patient for the nodules to disappear as it takes quite a long duration for them to vanish.

“It doesn’t matter how slow you go, as long as you do not stop”.

 As the knots reduces, the range of motion improves. The stretching was helping more to increase the range to the normal values. Hot fomentation reduces stiffness considerably and helps in increasing the elasticity of muscle a bit so that it’s easy for the muscle to stretch, whether actively or passively. So, everything is kind of inter-related. One effects the results of the other and the protocol as a whole works effectively for the condition.

“Your body’s ability to heal is greater than anyone has permitted you to believe”.

If you can relate with this article and feel like you too might have these, consult your physiotherapist now. If you leave these knots unnoticed, the condition might worsen and cause several musculoskeletal difficulties and restrict your daily activities.

 Myofascial trigger points are often one of the most common reasons behind pain in your body. Once the treatment is done, and the knot is disappeared, the muscle is reverted back to its original length. And the symptoms therefore, are eventually reduced.

I am still in a process of learning and i am trying to discover more about myofascial trigger points. until I come up with more findings, i hope this information helps you identify your problem.

Take care,

Jasrah Javed 

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