Sunday, February 24, 2008


People with knotted muscles are often -- almost always -- told to stretch and exercise by well-meaning people, including doctors and physical therapists, who don't entirely understand how muscles work. They are also told to relax, using various techniques. This is usually bad advice.

Or rather, it's mistimed advice. Stretching, exercise, and relaxation are wonderful for preventing knots. It's just that they are useless, or worse than useless, for undoing them.

I'm not talking about stiffness, here. We all know how wonderful it is to stretch out when you're stiff. I'm talking about trigger points. Trigger points don't feel wonderful when they're stretched. They hurt and they feel wrong.

It's commonly thought that we hold our muscles tightened, and so it's just common sense to think that if we let go, then they'll relax. It doesn't actually work that way. Once a muscle fiber is contracted, it actually takes an expenditure of energy to release it.

Consider rigor mortis. For several hours the muscles of a dead body clamp down into a tight contraction. They are not doing this because the dead person is worried about making his mortgage payment. And they will not be helped to relax by stretching -- they can't be stretched, they can only be torn. (Whether exercise would help, I don't think we'll ever be able to say.)

No. What happens is that the dead muscle, having been triggered into contraction, is no longer supplied with the energy required to release it. so it just stays contracted, until the whole system deteriorates and it becomes inert matter.

Now when your muscles are knotted, essentially what's happened is that a few strands have gone into rigor. They're not being supplied with sufficient oxygen to relax, so they're stuck in the "on" position. They will send very clear pain signals if you try to contract them further. They know they're in trouble. Forcibly stretching them will probably tear them. Relaxing your mind will indeed reduce the pain, and releasing the tension on the surrounding fibers may help somewhat, but what really has to happen is for oxygen to get to the locked muscle fibers. Presumably the mind of a dead person is as relaxed as a mind ever gets, but that doesn't release his or her rigor. Only the complete death of the tissue does that. Not the solution we're looking for.

Fortunately, moving oxygen into the locked fibers is usually quite easy. First you find the knot -- it will be hard, like a pea or a bit of gravel in the middle of a band of tight muscle. Pressing on it will hurt. A lot. But it will also feel oddly good. Now you squeeze the thing, between your fingers, if that works, but usually by trapping it against a bone. And you just roll over it, as if it were a tiny sponge and you wanted to get all the fluid out of it. Do that seven or eight times, working in the same direction each time. It should hurt good. Seven, on a scale of one to ten, is what the books say; as much pain as you can relax into, but not more.

Then leave it alone for a couple hours. Don't stretch it, don't exercise it. Let it sit. Then repeat. Keep working it, every couple hours, until it doesn't hurt any more.

That's the simple scenario -- a single trigger point, recently acquired. Unfortunately, by the time people do something about it they usually have numerous interrelated trigger points. And often what hurts is not the trigger point itself, but a nearby joint. It takes some knowledge and some investigation to track trigger points down.

If you ask doctors about joint pain, they will almost invariably say it's arthritis, and that there's nothing you can do about it but take pain-killers. If they say this without manipulating the joint, or any of the muscles that move the joint, you'll know that they're simply -- like most physicians -- pig-ignorant about trigger points and myofascial pain. Sure, it could be arthritis. could be lots of things. The doctor's job is to find out, not to guess.

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