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Re: Ask Well, “Muscle Knots,” by Gretchen Reynolds Tuesday, July 14, 2015 Science Section

Updated: Jul 19, 2020

Ms. Reynolds, in her quest to understand what she has coined “muscle knots," tells a story that is inaccurate and requires clarification.

First, reporting that scientists from a single publication found “no scientific basis” for muscle soreness from muscle knots, because the knots rarely show up on scans, Ms. Reynolds is dismissing the reality of what many experience as debilitating pain that is localized at these specific trigger points. Stating that pain is instead neural – involving the brain and nerve endings as a distinguishing feature – reveals a poor understanding of the nature of pain. Pain is always neural. Something is irritated and pain receptors are triggered sending a signal to the spinal cord and brain. The irritation may occur for any number of reasons and may present in many different ways. As clinicians it is our job to determine and address what the underlying factors are precipitating the pain.

Also important, Ms. Reynolds overlooks the long history of myofascial trigger points being distinguished from normal tissue using diagnostic ultrasound.

Second, faulty biomechanics and muscle overuse are not the same as slouching, as Ms. Reynolds states. Faulty biomechanics is a descriptive term to describe inefficiency of movement involving poor alignment, poor motor control and difficulty recruiting optimal muscles for a movement to occur. Slouching is rather a possible result of faulty biomechanics and muscle overuse, among other possible causes.

Finally physical therapists do not “pummel” myofascial trigger points as Ms. Reynolds states. The use of the word pummel conjures up crude images of striking a muscle repeatedly and mindlessly as if it were a punching bag. Instead physical therapists use a variety of techniques, that are specific in identifying and addressing the restrictions involved in trigger points. These techniques include myofascial release, functional mobilization, trigger point release, Strain Counter Strain and more. When these methods work, and they do work, it is due to a number of possible mechanisms. One explanation is that in stimulating mechano receptors with some type of manual treatment, pain receptors are inhibited. In addition, trigger points are sometimes the result of positional faults that involve joints and bones. These positional faults can be resolved using other manual techniques including joint mobilization, manipulation and muscle energy techniques.

It is unfortunate that Ms. Reynolds article was imprecise on several levels. What is important, however, is that readers realize that when they have pain that feels like “muscle knots” the pain is real and that there are ways to resolve the pain which include manual therapy and postural re-education to correct faulty biomechanics.

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