4/25/2018 0 Comments
It's not knots
Muscle knots. Sigh.
First let's say this and get it out of the way: There is no such thing as a muscle knot.
There is no such thing as a muscle knot.
The idea that certain fibers in a muscle can become "knotted" or "stuck" and that we, manual therapist, can, with our bare hands, unstick them or rub out the knot, is not supported by any study or model of anatomy that I've seen. There is no correlating pathology in the medical community that means "muscle knot".
So what are people talking about when they say "knot"? It's usually either a lumpy or bumpy muscle they've run across and can't identify it. There are a few common areas people have "knots" that just end up being a tendon or edge of a muscle that can feel bumpy. You've got lots of bumpy muscles and tendons in your body, but when these are correlated with the areas of pain or tightness you're experiencing, this can lead your brain to want to identify a physical object that must be what's causing all this. Pain is not so simple unfortunately.
Some therapists use the word "knot" to mean "trigger point". Trigger Point Theory says you have areas of hyper contracted fibers inside bigger muscles, and that these can refer pain to other areas. There is a lot of anecdotal evidence in the patterns, but the actual methodology has mixed scientific reports, the biggest issue being that even people who touch bodies for a living have about a 50/50 chance of correctly palpating areas of anatomy (https://www.ncbi.nlm.nih.gov/pubmed/19158550), which would make it very difficult to correctly palpate a small area of contraction. There's studies and reports about wishful-thinking palpating and examining and how that works in our brains, but maybe that's a different blog post. Here's a great article that gets into Trigger Point Theory: https://www.painscience.com/articles/trigger-point-doubts.php
What do I hear when a client tells me they have a muscle knot? Either hey have had a massage in the past where the therapist used that language and they took it and labeled themselves with it, or they feel something bump where there is pain, and that's what word society uses for that phenomenon. It's very easy and understandable, when a person in authority gives you words to describe what is going on with your body, and giving something a name makes it much easier for our brain to process and think up solutions for.
I don't use the word knot. I think it's a fine metaphor for tightness and pain, but I don't find it helpful and feel it could be harmful to pathologize something completely normal. What's more helpful, telling you you have a disease that only I can help get rid of, or that what you're feeling is a totally normal pain pattern your brain has learned, and massage (along with lots of movement based therapies) can help rewire that pattern into something that doesn't cause pain?
I would much rather my clients feel in control of their pain, of their bodies, and learn to love their bodies instead of come to be because their body is "messed up" and they need me to "fix" them. There are plenty of therapists with that mindset. But not in my treatment room. There you are an amazing body with unlimited potential to love and feel the way you want to. I'm just your guide to that.
You hear it almost every massage place you go. After the massage they hand you a cup or bottle of water and say "make sure to drink lots of water today!"
I'm not going to say that those therapists are wrong or are doing anything harmful, but it's something that really irks me. The phrase alone implies that if you don't drink water after the massage, you will suffer consequences. What consequences do they suppose you might suffer?
Here is the common rhetoric I hear from therapists. Soreness, aches, maybe even bruises, all caused by a build up of lactic acid or toxins that I just massaged out of your muscles. Now you must drink lots of water to flush those toxins, otherwise you'll feel terrible the next day.
So. Lots of things wrong with that thinking. 1st massage does not push lactic acid or toxins from your body. Massage is not a detoxifying process. Massage is NOT a detoxifying process.
Lactic acid is removed very quickly from your muscles and reprocessed for cellular repair within 15 mins or a workout, (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC137458/), within hours after extreme workouts (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769631/). So it's not a toxin and it's not what causes muscle soreness. And we've known this for decades. Drop this myth.
So does massage release other toxins? What toxins do we suppose are hiding in our muscles and just waiting for a nice relaxing massage to release and flush from our system? Our body is constantly working (very effectively!) to filter and flush any toxin that comes in our body from the outside world. Through our liver, kidneys, lymph nodes, and blood enzymes, our bodies have developed amazing ways to deal with almost any normal "toxin" we will encounter in our daily life.
So why do you feel sore after a massage? Usually the unfortunate culprit is the massage. When we work too deep too quickly, or deeper than your body wants that day, the muscles can get injured. Extreme soreness is never wanted, and in my opinion can further exacerbate the issue you came in for. Some mild soreness may be beneficial in the long run, especially with chronic "tight" feeling or range-of-motion issues you've had for a long time. Getting something to start moving may be better even if it comes with some slight soreness. I don't have studies for this yet, and this opinion could change with our scientific understanding of massage.
I don't tell you to drink a lot of water after a massage. Because I don't want you to hear "or something bad could happen" or "because I need to flush the toxins", because that's just not what science shows us. I have water available freely in my office, and you are more than welcome to bring your own bottle and refill before moving on with your day.
More than anything I ask you to start being more mindful about your body and what your body is telling you, including thirst. Start building that trust in how your body works, this can help lead you to solutions for tight-feeling muscles, painful sore spots, or low range-of-motion. Tune in to that amazing body and let it do what it's meant to.
4/13/2018 1 Comment
What is "Mindful" massage? What makes it different?
I pay attention to YOUR body and how you tell me it feels, how it moves, what is YOUR normal? I don't measure you against some ideal muscle tension, posture, or pain. I use my 5+ years of experience to lead to to techniques that might help, but more importantly I listen to the patterns your brains has created, impacted by years, and work with you to rewrite those so you can feel in your body and in control, and hopefully in less pain.
Have you experienced a massage like that? If not, I'd love to see if I'm the therapist to help you. If not, I am well connected in the community and can give you referrals.
Lindsay Juarez, LMT
Lets nerd out about massage and pain science!