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What Are Muscle Knots? And Why Are They There? Podcast 17 Transcript with Dr. Nick Sanders PT, DPT.

area function guarding increase injury knots muscle muscle tone nerve pain pattern protect release scenario sympathetic tone tight tightness tissue tone Sep 11, 2021

What Are Muscle Knots? And Why Are They There? Podcast 17 Transcript with Dr. Nick Sanders PT, DPT.  

Sat, 9/11 1:34PM • 18:32



muscle, injury, knots, area, protect, nerve, tone, increase, pattern, tight, tightness, function, sympathetic tone, guarding, pain, tissue, release, scenario, muscle tone, position



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Hey guys, today I want to talk a little bit about why muscles get tight. And it's a really interesting thing. I mean, we all have muscle knots, and we know they're painful and annoying. And some of us even name them. I know. Some of those names are a little vulgar. But why do they happen? You know, where do they come from? And then what can we do to get rid of them? And so let's talk a little bit about why those muscle knots might be there. And then maybe some strategies to to get those things to go away, depending on on the reason, obviously. So there are a couple reasons the muscles might be tight. And, you know, I do think that genetically, some people are just tighter than others, right? Whether it's a connective tissue thing or a genetic thing. I mean, you see people that are super hyper mobile, they can bend all over the place your contortionist, if you will, that certainly exists. So I do think there's a scenario where genetically you're just tighter or looser than somebody else. And maybe there's tendencies tend to be a little higher. So that's an option. And ultimately, there's not much we can do about that one. But what even what's even interesting in that scenario is you may find somebody that ligamentous Lee is very hyper mobile, your your dancers, your Yogi's, your your people that can bend all over the place. But they still end up with muscle knots, right as that muscle is trying to do things and protect loose joints and do some other things. So I really don't think that the genetics is that big of a culprit. It's a piece, it's a part of the puzzle. It's something to think about. But I really don't think that it's the main reason most of us are experiencing muscle knots and Titans. So the next question is, you know, why does that muscle just all of a sudden, one day decide to be mad and pissed off at you? And where does that where does that actually come from? And, you know, most of the time, I don't think the muscle just decided one day to be annoying, right? It's not? It's not some little little kid that's trying to pick on you. Right? It's, it's just, where does it come from. And I think there's a couple of scenarios that that we want to look at. And the first is, you know, trying to protect something. If the brain feels it needs to protect an area, it's going to tighten the muscle in that area to create a brace or splint of sorts. And it's just a nice protective mechanism. And I think that's one of the knots that we see the most often. And so, you know, what ends up happening is, you feel that knot, and you just try to smash the heck out of it, where it's at. And it just gets more sore, right, you kind of get that, I don't know, kind of short term pain relief of kind of that feeling of the pressure. But the pain never actually goes away, doesn't doesn't work, so to speak. And, and so, you know, you hear people say all the time, while foam rolling doesn't work. And doing this kind of tissue work doesn't work because of that scenario. And that's not the case, in my opinion, you just use the wrong technique at the wrong time. If that muscles tight, because it's protecting something, then you know, working on that muscle is only going to go so far. You need to figure out what it's trying to protect. And getting to that next layer of assessment is really the goal. You know, yeah, the muscles tighten cool. Why is it tight, and if we can figure out why it's tight, then then we're getting somewhere. And so some of the possible reasons, you may find the muscle that's tight. One of the ones I think is common is protecting a nerve. So if something happens, nerves, the nerves or the powerline the body, right, they control everything, they're sending electrical signals to the muscle, they're relaying sensory and pain information back to the brain. They're literally the the power lines to the house, right? Like if they don't work, nothing's gonna work. So your brain is going to protect those power lines at all costs. It's a it's a high priority safety mechanism, right, protecting the nerve is a high priority thing. So if there's tension on that nerve, whether it's irritation locally around the nerve sheath, where it's going through the muscles, where it's going through different grooves, where it's irritation, where it's coming out on the spine, any of those situations, your brain is going to tighten that muscle around the nerve to protect right muscles protect nerves. And so you can try to stretch that muscle and work on that muscle all you want. But if you don't take the pressure off of that nerve, it's irritating that nerve, you're just not going to get there. And so in that level of assessment we need to do we need to figure out where along that nerve pathway, that irritation, that compression or wherever that might be is coming from, because if we can address that, then that muscle tone is just going to go away. Right and so nerve protection is one of the key reasons that I think we see muscle tone, and probably one of the ones I see the most often in clinic, especially things that just don't go away on their own right, like little naggy tightness is they just disappear so they don't end up in my office. But that nerve tension ones, they're the ones where you know you putting the hypervolt right on the spot isn't working and we got to go a little further with our assessment and decision making and where we want to go so nerve tension is definitely one of those protecting the nerves. Definitely one of those reasons, I think we see muscle knots.



Another reason that we may find muscle knots, I think are just postural and repetitive motion type things. So because you're in a position, often, your brain wants to be good at it. And so you've kind of made this decision that I need to do this a lot, and you're gonna adapt to be able to do it a lot. And so if you're going to sit with a forward head all the time, the traps are going to get tight to increase that tone and protect that area. And it's going to put connective tissue down and some of those other things to try to make that area stiffer to make that act of sitting easier to do. And so I think when we do something, often, we start to see telling related to that pattern that we're that we're using all the time. And so in that scenario, you know, the scenario is kind of similar to what we just talked about, with the nerf protection, you can release that knot. But if you don't fix or alter that sustained position, or at least create the ability to move the other direction, well, it's gonna come back, right. I mean, if you use that pattern all the time, you can release it, but it's definitely coming back. So again, second layer to assessment, what's causing them also not if it's a positional, repetitive motion, a postural type of a thing, we got to figure out where, where that is happening, and what we can do to undo that. And for some things, like seated postures, I think, you know, something as simple as moving early in the morning, and maybe some intermittent breaks throughout the day, may be enough to unglue some of that, I mean, honestly, as long as you're asking the body to move the other direction, as well, it's gonna have, it's gonna want you to have the ability to do that. If all you ask your your body to do is sit, well, it's gonna get good at sitting, right, and so the outside of your hips, the calves, the hamstrings, the back, those areas are going to get tight, because that's what you're doing the most stuff, that's what you're going to get good at. But if you also ask him to do extension, and range of motion in the other direction, well, now those adaptations aren't gonna occur as quickly. And hopefully, we can reverse and unglue some of that stuff, if assuming we haven't had actual bony adaptation and some of the things that make him along with long term positional things. So in the short term release, those are those are pretty easy things to unglue. And in addition to releasing the knot, you got to work on those partial things. And I personally believe that in that situation, there is still a high value to being able to release that not using the hypervolt, using cops needles foam rolling, wherever you want to do, there still have value to release that because it's going to enable you to get into those new positions, right? If you're so locked into one posture, that forward seated posture, and that tone is very high in that position. Well, it's really hard to even get it to go the other way, and you can try to exercise it. But if that pattern is already engaged, if you're already in that, let's just use forward head forward shoulder position, if you're already in that position, and you ask it to go backwards. Yeah, sometimes it works. And sometimes it doesn't, right, it depends how locked in that pattern is. So a lot of times we can use a manual therapy technique or a self self Elise style technique, whether it's a lacrosse ball, or one of the hyper rice, vibration things or cops or whatever you have at home, we can use those to kind of temporarily offset that cycle. And then once that cycle is temporarily offset, now we can go ahead and train that new position in exercising that new position. So that we create adaptation, we create enough stress in the other direction so that we get adaptation in the other direction, that now that pattern doesn't hold and we can move in now of those seated postures. To be able to do some of the other things we want in ultimately, I really think that's the key is to be able to use multiple positions, not just one all the time. And if we can use release, you know, techniques to do that then been fantastic, right, it just creates an opportunity for change. And that's really what we're looking for is that new input to allow us to create some change. So I do I do think that's an important and important thing. And again, one of the the second kind of idea of sustained postures or repetitive motions doing the same thing all the time. I think that's another reason where we can get muscle knots. In addition to just protecting the nerves as a third one, I would I would kind of just lump in protecting injuries. We mentioned protecting neural tension, but any kind of injury. ankle sprains, you tweak a muscle, you put some tension in an area where you're not used to putting tension or or force or stretch that you're not used to. And you may get some recoil tightness as a means of just protecting that injury. And you see that splinting that guarding that almost crampy cramping like feeling you tweak a knee or an elbow or whatever, you may see some guarding along that pathway. So tissue trauma may create some splinting around that area, which kind of leads me into my last one that I want to talk about, which is sympathetic nervous system tone.



So our nervous system is divided into audit your autonomic nervous system divided into two things. Your parasympathetic is You're sympathetics. And autonomic just means it's happening in the background think automatic, right? It's just running. sympathetic, of course, is your fight and flight parasympathetic is your rest and digest. So when you have an injury, or you have a pain in an area, it's going to activate some of that fight or flight mode, that's sympathetic activation. And now we're going to see an increase in toning guarding in that area. And so I think locally, part of that protective mechanism may be an autonomic nervous system function of increased sympathetic activity in that area. Now, the consequences of increased sympathetic activity in that area, we're going to get increased muscle tone, which becomes a protective brace splint or whatever you want to say around that joint becomes a mechanical protection barrier, like a brace. But the downside to that, right, it's all our body's gonna do short term protective goals, the long term downside protective effect of that is when I squeeze that muscle tight enough, I blocked some of the vessels, right on like squeeze in the garden hoses. And now I can't get blood into the area, which is where my immune system is going to function to get nutrients and oxygen and all those things, I need to fix the injury, I'm not going to get to get those in as well. And some of the veins and the vascular, the venous structures, as well as the lymphatic structure that didn't clear some of that waste product out from the injury, they're going to be compressed as well and may not function as well. So the problem with that increasing with axon that guarding long term is that it may block some of the ability to oxygenate and supply nutrients to an area. And so part of what we need to do is create at least enough relaxation around that area to be able to supply oxygen and nutrients to that areas of the tissue can heal, we get inflammation out. Now, this is theoretical, this is just kind of me rambling. But I do think that's part of when we're trying to make sure we get an area to heal, we need that to happen. It's also I think we need movement after an injury, right? So often we you know, let's say we roll our ankle, we just want to protect it, you know, as much as we can. But the problem with not moving is that we lose that pump, we lose that vascular pump of squeezing those, those pipes, if you will, squeezing those hoses, if you will, that's going to help us move that fluid in and out that fluid exchange of bringing healing tissue into the area as well as clearing waste out. And so yes, we need to protect the area, but it's a relative protection, right, I need to protect it enough that the injury is not going to progress. But I can't, you know, due to fear or whatever, I can't protect it so much that I hamper the healing process, I hamper the ability to get blood flow and nutrients in and out of that area. So I think it's it's kind of a catch 22 of protecting, versus making sure that we're able to keep the tissue moving enough that it can heal. And I think that plays the fear of that injury is also part of this whole equation, right? Because, you know, fight or flight mode is an anxiety type of thing, right, we're getting into fight mode. So if that injury is significant enough that, you know, I start to get nervous about it, I'm worried it's never gonna go away, I'm worried how it's gonna affect my job, my ability to participate with my family, and my kids are doing activity that I that I like doing, if that fear starts to set in that, oh, what if I'm never able to do these things again? Well, now all of a sudden, that sympathetic, that fight or flight mode is now even higher. And with that, being even higher, we get more tone, we get more guarding, and locally in that area, I think but also throughout the body.



So it becomes a very interesting dilemma of the emotional components of that pain, and making sure that we understand, you know what the injury actually is, we don't get too far down those rabbit holes that where we snowball and go, Oh my god, I rolled my ankle, now I'm not gonna be able to go work now I'm not gonna be able to collect a paycheck. Now I'm not going to be, you know, do my mortgage, and now this, you know, I'm gonna be homeless. And it's just funny how quick those things go down those rabbit holes sometimes. But as soon as you start doing that, that's going to increase that sympathetic activation, which is going to increase the fight or flight mode, increase the tone, increase the guarding, reduce the blood supply of the area. Hey, it's a it's an interesting little cycle there. And again, this is just kind of me talking and in theory, but I think there's I think there's definitely there's definitely evidence of increased sympathetic activation around pain and injured areas, and the emotional thing increasing sympathetic tone, I think it just kind of theoretically makes some sense and at least worth consideration when we when we talk about injuries and we talked about trying to get out of pain and get rid of those muscle knots. So from an injury, we can increase sympathetic tone. But when we say things like stress increases my pain. Well, now we got to think about that as well, right? Because if stress increases sympathetic activity, and I'm always in the sympathetic fight or flight mode, well now sudden I got an increased tone, increased tone, decrease oxygenation, tissue tightness, tissue pain, all those things that come along with with decreased blood flow and changes in the blood chemistry. And so we can have this overall state of sympathetic activation, that may, in fact, increase some of the tone, which may decrease blood flow increased decreased nutrients to the tissue, increase some of the guarding, I think you're starting to get the idea. And so not only do we need to reduce that tone, and we can use manual therapy techniques, of course, I love those things. But we also need to figure out how to reduce that sympathetic state. So maybe that's just understanding of what the injury is. And in trying to kind of work our way through that. Maybe we need to do things that reduce sympathetic tone, deep breathing activities, yoga, meditation, you know, you see people talking about all kinds of different things as far as breathing drills and ice baths, and you know, different things that just try to help us get in and out of these different autonomic states. And I think there's some validity to that, and something that we definitely need to spend some time on thinking about how do we affect sympathetic tone locally where that injury may have occurred, because that's gonna increase tone and night tightness, but also throughout the body, and looking at different strategies that kind of calm the system overall, both emotionally and as well as you know, looking at breathing patterns in the vagus nerve. And just some other ways to try to reduce overall tension and tone that may help things feel better, in addition to just looking at a singular knot and smashing that guy, that singular knot. So a lot of rambling there, I hope that helps you understand a little bit about kind of our thought process, my thought process, and what we do at fit for function, when we say, hey, if somebody's got a muscle, not where's that thing coming from? And certainly, we know that treating the local area is effective, and it can be very effective in certain scenarios. But we also need to look at the depth of those layers of the assessment and figure out okay, are we trying to protect the nerve? Is there a sustained postural position that we need to make adjustments to or train the opposite patterns? Is there a injury that we're trying to protect? Or is there something going on with the sympathetic nervous system locally or as a whole that we need to address, and then once we're able to figure out that layer of assessment, well, now all of a sudden, we can, we can change our plan of attack into getting past just treating that local area, but also making decisions based on those other findings of where we need to go with some of the other things we're doing to help get rid of that muscle knot. And hopefully get that pain out of there. So as you can probably imagine, working out that puzzle is a fun game, but it can also be challenging. And you know, when you've been dealing with different patterns for a long time, or different stressors for a long time, it can be hard to deal with, and, and it requires some real real adjustment, real change sometimes. So not always the easiest thing, right? Certainly a lot easier decision was to just say, Oh, you got an author here, let's push on it and smash it. And we'll do those things. But we also need to figure out why is that not there and take that that layer of assessment one level deeper, to see if we can get us from A to B. So there's my quick not so quick understanding of muscle knots, muscle tone, muscle tension, and hopefully helping you make some decisions on maybe thinking about why that knot might be there versus just treating a local area. So thanks, guys for listening. We'll see on the next episode if you need anything or have any questions we do offer free phone consults at fit for function comm so if you have a specific issue that you want to talk about, we'd be happy to talk with you there. Give us a call, shoot us a text visit fit and we'll go from there. Appreciate it and we'll talk to you on the next one.



Written by Dr. Nicholas Sanders PT, DPT, CSCS, CIDN.  Dr. Sanders is the founder and owner of PHYT For Function where we provide a convenient and simple solution for people to continue to do the activities they love without muscle, joint, or nerve pain.  He is a national instructor for Integrative Dry Needling and Co-Creator of a Neuro-Inflammatory Manual Therapy course. 

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