What Is a Muscle Knot/Trigger Point?

If you have ever been puzzled or even frustrated by persistent pain, despite clear MRI scans or tests, you are not alone.

Many people experience genuine and troubling pain without visible damage appearing on medical imaging.

Often, the explanation lies in subtle, intricate changes deep within your muscles and connective tissues.

These are called trigger points or commonly referred to as 'muscle knots'.

Understanding Trigger Points: The Basics

A trigger point (street name: muscle knot) is a small, sensitive area within your muscle fibres, often characterised by tightness or contraction that does not easily release on its own.

These points can cause local pain and tenderness but can also send pain signals to other areas of your body.

This referred pain can mimic common conditions like headaches, back pain or nerve-related discomfort like carpal tunnel syndrome. 

Understanding trigger points can mean that orthopaedic surgeries, which can induce even more trauma into a body and mind, can be avoided. Conservative and nurturing soft tissue treatment can release your pain state and also get you moving again. 

On a personal note:

I have now treated far too many clients after multiple surgeries where the surgery has not been effective in reducing their pain, only to find that unfortunately trigger points were present in their tissues.

This is really common when we solely focus on someone’s biology. 

Pain is often experienced as a combination of a perfect storm of physical, biological, emotional, social and psychological stressors. 

In my clinical experience I would even go as far to say that in traumatic cases, on top of all these factors, a person’s spirit has been crushed.

The clients I mentioned above all unsurprisingly had gone through a succession of really challenging life events all causing immense personal stress. 

The types of manual therapies and care I offer are holistic and person centred to meet these factors kindly and empathetically. 

Everyone’s needs are different and I believe deserve to be met with empathy. 

How Trigger Points Develop?

There are several thoughtful explanations for how trigger points come into existence.

Motor End Plate Theory:  

At a microscopic level, muscles contract because nerves signal them using chemicals like acetylcholine. Sometimes this signalling goes awry, causing continuous muscle fibre contraction and creating localised knots.

Energy Crisis and Oxygen Deprivation:  

Continuous muscle contraction reduces blood flow, leading to local oxygen shortages (hypoxia), creating stress and inflammation within muscle fibres. This persistent tension further perpetuates the knot formation.

Muscle Spindle and Nervous System Sensitivity:  

Muscle spindles—tiny sensory nerves in muscles—can become hypersensitive, reinforcing muscle tightness and feeding back tension signals to your nervous system, amplifying pain.

Cinderella Hypothesis (Posture and Habitual Patterns):  

Muscles frequently overworked or under constant strain (due to posture or repetitive movements) become chronically exhausted, developing trigger points as a protective response.

Fascia: A Key Player Connecting the Puzzle

To truly appreciate why your pain persists, it is helpful to understand fascia.

Fascia is the intricate web of connective tissue that envelops your:

• muscles,

• nerves,

• bones

• organs

  
  

Fascia holds your body together through one connective web, allowing smooth coordinated movement.

This connective web is not passive.

It is a dynamic tissue sensitive to hydration, tension and movement patterns.

When muscles develop trigger points:

• They pull unevenly on the surrounding fascia,

• Causing subtle but significant tensions throughout this connective network.

Conversely, when fascia becomes dehydrated or stiff due to:

• Inactivity,

• Repetitive strain,

• Chronic stress,

It can perpetuate trigger points in muscles.

Thus, trigger points and fascia interact continuously.

Each influencing the health & function of the other.

creating a feedback loop that can sustain chronic pain.

Why Does My Pain not Show on a MRI?

MRI scans are excellent at detecting significant structural tissue damage or inflammation but often miss subtle muscular and fascial changes.

Trigger points and fascial dysfunction involve microscopic changes and subtle shifts in chemical balance.

They are real, but often invisible to conventional imaging.

Your pain is genuine, even if scans do not capture its source clearly.

How Small Changes Amplify Pain in Your Body

Your body naturally operates in a delicately balanced state known as homeostasis.

Even small disruptions, such as tiny areas of persistent muscle tension (trigger points) or slight dehydration in your fascial tissues, can significantly impact how nerves communicate pain signals.

Here is how this process unfolds:

• Small muscle knots create persistent, low-level irritation.

• This irritation sends signals through nerves to your spinal cord, sensitising the area.

• The spinal cord becomes more reactive, amplifying future pain signals.

• This process is called central sensitisation.

• Sensitised spinal nerves relay heightened pain signals to your brain.

• Affecting areas involved in emotion, memory, stress response and pain processing.

• Over time your brain & nervous system adapt, making you more sensitive to pain.

• Even minor sensations may feel intense or overwhelming.

How Trigger Points Mimic Common Musculoskeletal Injuries

Due to this complicated nerve and fascial network, trigger points often mimic symptoms of common musculoskeletal conditions.

These include:

• Headaches may originate from trigger points in neck or shoulder muscles.

• Arm and wrist pain resembling nerve compression could be linked to trigger points in shoulder or forearm muscles.

• Lower back or hip pain can come from trigger points hidden deep within gluteal or spinal muscles.

Pain from trigger points can convincingly mimic other, more commonly diagnosed conditions, leading to confusion and sometimes unnecessary treatments or procedures.

The Complexity of Chronic Pain

Chronic pain is not a simple matter of injured tissues alone.

It is influenced profoundly by:

• Your nervous system,

• Emotional well-being,

• Hormonal state,

• Hydration

• Even your perception of pain itself.

Small local changes, such as subtle tension in muscles and fascia, can cause significant chemical shifts in nerves. This can eventually change the way your brain interprets pain.

Your body's balanced state is finely tuned.

Therefore, any minor shifts in hydration, stress, hormones (like cortisol from chronic stress) and muscle tension can cascade into significant feelings of pain and discomfort.

A Holistic Way Forward

Recognising how intricately connected all these factors are, can empower you.

Your body's signals are not lying.

Your pain is not imaginary.

Instead it calls for a gentle and whole person approach to recovery and wellbeing.

Effective strategies often include:

• Massage and Myofascial Therapies:

  Gentle release of muscle knots and fascia can help break the pain cycle, reducing nerve irritation.

  
  

• Movement and Gentle Exercise:

  Activities like stretching, yoga, and light exercise can improve fascial hydration, flexibility and overall muscle health.

  
  

• Hydration and Nutrition:

  Keeping fascia hydrated and nourished through proper water intake and balanced nutrition supports healthy connective tissues.

  
  

• Stress Management and Mindfulness:

  Practices such as mindfulness meditation, breathing exercises, or simply spending time in nature can help reduce stress, lowering cortisol and other stress hormones that amplify pain sensitivity.

  
  

• Understanding and Education:

  Learning about your body's complexity reduces anxiety and confusion, helping calm your nervous system and positively influence your pain experience.

You are Not Alone and Your Pain Is Real.

If your pain remains unexplained by conventional medical tests, please know your discomfort is valid.

Pain science is continually evolving. Subtle imbalances within your body's fascial, muscular and nervous systems profoundly affect your pain experience.

Approaching your pain holistically by caring for your body, mind and emotions, offers a compassionate and effective path forward. This helps restore balance, comfort and quality of life.

Much love

Carmen