Lies Massage Therapists Tell: "You've got so many knots!"

"Wow, we've really got to get these worked out!"


I should be kind to my fellow massage therapists. While most of us have extensive training in anatomy and physiology, a lot of what we say and do was modeled for us by other massage types (teachers, therapists, know-it-alls such as myself). They might not be "lying" so much as they're just wrong. We've been hearing about "knots" since we first learned about massage, and sure enough, we can feel them in our clients' backs! The clients feel them too!

This is the part where I start sighing ponderously.

The clients definitely feel... something painful. Something that shifts under the fingers of the therapist. It has a different feel than the rest of the tissue when prodded. The massage therapist feels a little ball of... something, and it feels funny. This is where your massage therapist should know better, and should enlighten you with a bit of x-ray knowledge regarding the workings of your internal environment. This is where a little skepticism and questioning would serve both parties well.

Granted, some things can be called "knots"...

Trigger points are little, especially painful areas in muscle/tendon, usually found at areas of high mechanical tension within a muscle, which tend to have the unusual characteristic of referring pain elsewhere. This is definitely a worthy area of research, and anyone who would like relief from persistent pain might get relief from a practitioner familiar with Neuromuscular Therapy, also known as Trigger Point Therapy. Note that, while trigger point therapy can be a useful bodywork modality, the existence of trigger points as a physiologically detectable phenomenon is in question.

Some massage therapists will say you have an adhesion between the sliding layers of your muscles. An interesting, if unverifiable, assertion.

If you'd like to read more about trigger points:

The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief
The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief

This is my trigger point bible. Just realize that, while poking and prodding can help (in moderation), activity and stretching can be just as useful for working with pain.


So when people say "knot" they mean "trigger point," right?

Oh, if only that were so! I've touched thousands of backs (always with permission), and I've done a lot of Trigger Point Therapy. When people come to me and say "massage therapists always tell me I've got lots of knots," I find tight muscles. Trigger points might be present, but the muscle tone is the main problem. If there are unusual balls of muscle present, I can't find them.

So what on earth are massage therapists feeling in these tight backs? When someone lays their hands on my shoulders and says, "wow, so many knots!", they are invariably pressing upon tendinous tissue, unusual muscles, or areas where muscles overlap. This isn't a problem in my back, it's a problem with their knowledge of anatomy!

The "not knots."

Poke around in your upper back/shoulder region for a bit. If you allow your fingers to move the skin over the underlying structures, you'll find that it's an uneven landscape. There are ridges, lumps, twangy bits, squidgy parts... Listen, it's really quite beautiful once you give it a chance, but the stuff under the skin isn't nearly so tidy as the outside would make it seem. You might even hit a few areas that downright hurt. Isn't that a knot?

The upper back is complicated, with layer upon layer of thin, sheet-like muscle; narrow ribbons of muscle; feathery, membranous muscle; and all manner of connective tissue. Behold the trapezius: it's not just the squashy bit that sits atop your shoulders. It's kite shaped, extending far out to each side, and far down the spine. It's responsible for more than just letting us shrug our shoulders in despair.

The upshot: there are many places in the back where these structures overlap, and sinking your fingers in and rubbing will invariably result in you thumping over the edge of one. This will probably feel interesting, and might even hurt a little (especially the outer edges of trapezius, which can be quite curmudgeonly). This is not a knot.

There are tendons and tendinous areas of muscle in the back that can be very squirmy under the skin, and that can be quite sensitive: the inferior attachment of levator scapulae, to name a big player, is almost always in a huff about something. It's not an area of trapezius that's "super messed up" and that "needs to be worked out." If you were to successfully "work it out," you would need to hit an emergency room. Not a knot.

Finally, there are some muscles that are just plain weird. Infraspinatus, for instance, starts out with a fan shape, folds into tendon, and wraps around the back of your shoulder. It acts weird, and it feels even weirder. Lumpy. Hurty. Not a knot.

If you'd like some visuals, check out this video:

What to do with this information?

First, forgive your massage therapist. They're just going off of what trusted authorities have passed down, and they probably aren't wrong on purpose. Sure they've got some weird notions about what's going on in the body, but the work they do is still helpful, and they probably have good knowledge in other areas.

Second, lose your complex. Why do I hate this "knot" misconception? Because it's hurtful. It makes people think that there is something wrong with them, and this never goes away. Do you hear me, fellow massagey-types? You're doing harm with this, because people walk around with these mental knots for the rest of their lives. Rather than just the tight muscles that they represent (which can be stretched, or iced, or rested), knots are defects. People have enough body issues without being told that their muscles are defective, "messed up," or "the tightest I've ever felt." Yes, these are the things that come out of my colleagues' mouths.

So, gentle reader, please take what we say with a grain of salt. Enjoy the massage, take mental notes on where you hurt, and try some of the stretches that we recommend. Heck, your massage therapist might even know their stuff, and they might have some straight wisdom to lay down. I just ask that you verify.

Stay tuned for more mythbusting, and be kind to yourself.

Comments 35 comments

kwade tweeling profile image

kwade tweeling 4 years ago from USA

I like your hub. I am especially fond of your message to be kind to one's self. We have enough damage. Let's focus on the healing.

jonsswagger1978 profile image

jonsswagger1978 4 years ago from Birmingham Alabama

Very informative hub my friend. Thumbs up.

joanveronica profile image

joanveronica 4 years ago from Concepcion, Chile

Very good hub! Good content, well presented and informative. I think I need to do more research on my own "not-knots" Voted Up. Useful and interesting

restrelax profile image

restrelax 4 years ago from Los angeles CA

I also agreed your Point joanveronica Therapy people come to me and say "massage therapists always tell me I've got lots of knots.

Heather V. 4 years ago

Good information; an example of why it is very important to never stop learning and educating ourselves as Massage Therapists, beyond just what is called for as CE requirements. However, trying to educate clients about the fact that there are "no knots" in their backs can do more harm than good, because if there is "nothing wrong" other than "normal tension", why would they need to come to us to "fix" them? They will see me, who tells them there is just normal tension in overlapping muscles, stop coming to me when they feel a little better, then see someone else who will tell them they are really "messed up" and that I "don't know what she was talking about." Plus, no matter how much you tell someone they are "normal", they will usually seek out those who tell them something is wrong, because people don't want to be "just like everyone else"; even if it is something BAD, they feel "special" and like they are being proactive when they go see someone to "fix" their "knots" rather than to just work out normal tension. Just my $0.02.

Be Pain Free profile image

Be Pain Free 4 years ago from Florida Author

Hi Heather, I actually agree completely with everything you just said. We need to keep the client coming back if they're to get any benefit from our craft, so it's a delicate balancing act. I would try to convey that there is something awry that needs treatment, but... we can't do to these people what everyone else does. They've been told by their doctor that their low-back pain is "lower facet syndrome" or arthritis, absent any diagnostic imaging. They've been told by their chiro that they have subluxations that are only visible to their scrutiny, or a leg longer than the other (based on a quick tug and eyeball).

We use the "knot" nomenclature because it's useful, it's compact, and it kind of describes what's going on. It's close the the truth, way more compelling, and way less trouble to say. Still, I think we can find something almost as good, and way more honest, especially if we're given the time to actually talk to people. Idealism, I know.

Thanks for the comments, everyone, I hope to hear from more clients and therapists!

Simone Smith profile image

Simone Smith 4 years ago from San Francisco

Yes!!!! I've been looking for this information for YEARS! Every time I get a massage (those treats are few and far between, but STILL), I am told that my trapezius is "messed up" and that "needs to be worked out," but I don't really know what I'm supposed to do with that information, or what "working something out" really entails.

Thanks so much for the explanation. I feel loads better about my "knotty" shoulders now.

Be Pain Free profile image

Be Pain Free 4 years ago from Florida Author

Simone, that's wonderful! Don't let anyone defame your shoulders and traps; they've worked hard for your whole life, and, while they could probably use some stretching (stay tuned!), they're good at what they do.

MsDora profile image

MsDora 4 years ago from The Caribbean

Thanks for these explanations. It is very caring of you to share this information.

Chuck Bluestein profile image

Chuck Bluestein 4 years ago from Morristown, AZ, USA

The most under-rated book is the dictionary. Can a stomach be in knots? If it is, what does it mean? Knots has 7 different definitions with 1 having 3 meanings and 4 and 7 having 2 meanings. So which one would be closest to what the massage therapist is talking about. I always go to Merriam-Webster since some dictionaries online can be wrong.

Definition 1c says: c: a ?tight constriction? or the sense of constriction (my stomach was all in knots)

You said "Trigger points are tiny bundles of contraction." and "When people come to me and say "massage therapists always tell me I've got lots of knots," I find ?tight muscles?."

I have gotten massages of all types including rolfing. They do not say anything to me about my muscles. They just let me feel or experience. The postural intergrationist would always say to make sure to take a hot bath after to help my body get rid of the toxins that were loosened.

Denise Handlon profile image

Denise Handlon 4 years ago from North Carolina

Interesting hub and perspective. I've had a lot of massages and have always heard this. So...I learned something new today-thanks. :) Good luck in the contest.

ripplemaker profile image

ripplemaker 4 years ago from Cebu, Philippines

I just had a massage last night and had lots of those too! hehehe And it always feel better after!

Congratulations on your Hubnuggets nomination. Relax this way as you read and vote:

Be Pain Free profile image

Be Pain Free 4 years ago from Florida Author

Thanks for the comments everyone! Special thanks to ripplemaker for pointing out the little contest that I am currently a part of. Not that I'd want my visitors to go check it out. Via that link, just above this comment.

Goods2Go profile image

Goods2Go 4 years ago from Far left of The South & Extreme west in my best imagination!

Great read! I appreciate your writing style, and your candor. And, a humorous bent, to boot!

Pamela99 profile image

Pamela99 4 years ago from United States

Messages are wonderful and I am glad to understand more about the process. Very interesting hub. Congrats on your nomination.

ktrapp profile image

ktrapp 4 years ago from Illinois

I love your knowledgeable insider information. Now if only I knew what to do about those painful not-knots. I will stayed-tuned as you suggest.

jantamaya profile image

jantamaya 3 years ago from UK

Be Pain Free, thanks for this great hub! It makes me directly feel better. I have also experienced a massage school. :-/ It was a Japanese school in Honolulu, Hawaii. Don't worry, in Hawaii are many things in Japanese hands. There we learned the Swedish massages, like in every other massage school. I only had problems with my teacher. She was desperately trying to find any trigger points on my back. I didn't certainly responded as I should do. There were none or not enough trigger points. I was lost in this game "Run on Trigger Points," and I hated it. I was thinking, this is not a sense of a massage to find some trigger points, allow the client feel bad because of them, and press them until the client "dies." Thanks for your hub, I feel much better now. Voted up.

Diana 3 years ago

Brilliant! Thank you for sharing! I have been reading up on lymph nodes too. My therapist would press upon the nodes under my underarm cos she said they are all blocked up and needs to be unblocked before my shoulder ache would go. anyone can share on this?

Anonymous 3 years ago

As a massage therapist, and a pain sufferer myself..I can assure you this article is phoney. I have had my knots worked on many times, and every time it has ended in relief of pain and tension I have felt for years. I have also worked on many patients, who have felt major relief after I have worked on their knots. This article is misinformed.

Amanda 3 years ago

I too am a massage therapist and think that "knots" is an oversimplified term that came from "knotted muscle" which in fact tight muscles FEEL like knots in a rope. In example: Rock Fish - they aren't made of rocks but they LOOK like rocks.

If we took a step back and realized not everything is literal, especially such a non-medical term as "knot", and educate our clients what they are people wouldn't be thinking that they had muscle tied in their back, or that the origins and insertions are where they need to be working on.

Nic Huette profile image

Nic Huette 3 years ago from Iowa City

Interesting article. I have been doing massage a long time and clients are always asking me if they have knots. I usually just tell them they have some adhesions between layers of muscles, scar tissue, or tight muscles depending on what I feel and know about their medical history (i.e. previous surgery.)

But you're right. Knots is not a very good word to use. Who came up with that one?

Aria Scroggins 2 years ago

I am slightly offended. When I feel a knot in a clients back, I actually mean a knot. I have a lot of clients ask me "is that a knot", and I tell them "no, it's just tight muscles" and of course what I mean by that are muscle fibers that are fused together by sticky fascia and extra proteins. but when I say knot, I mean a big ball of "knotted" up muscle tissue contracted around an injury in the muscle, like a micro-tare or a larger tare. Don't get me wrong, a lot of therapists say, you have knots rather then explain to their client what is really happening in their body. It's not because we are lying, it is just easier to say you have knots then give the person a fat lecture on the anatomy of the body. The clients usually don't care, they just want to feel good.

SD 2 years ago

Healthy Infraspinatuses do not feel lumpy and painful. No healthy tissue comes with an abundance of pain, range of motion restrictions and trigger points. Your evaluation of the situation is very superficial, similar to most massages given in spas or private saunas.

Mariah Fullmer 2 years ago

I think you miss a few points. I don't talk to my clients about trigger points because I want them to think that they're "messed up" and it drives me crazy when clients come to me saying that every therapist has told them that they have the worst back ever. I tell my clients they have knots or trigger points to make them aware that they need to take action to take care of their body if they just think they are perfectly fine what is the point of massage? It becomes a luxury more than a necessity so my purpose in telling my clients that their muscles are not okay is not to make them feel like there is something wrong with them, I make it clear that daily life, stress, and gravity takes a toll on our bodies and we need to make sure that we are doing what we need to, to ensure that we keep healthy. And I do recommend workouts to strengthen muscles, stretches to loosen them, and ice to bring blood. Working out the "knots" is just a simple language to convey to a client that there is a reason for their pain and it won't go away unless they do something about it. And you can say it's just a ridge or whatever or a tendon that I'm going over but I'm always communicating with my clients and asking if they have pain in a specific area before I just hold. And the great thing about massage is even if you're just on some random edge of a muscle it is still beneficial because you are bring blood to the area!!! Muscles lack blood when they're tight and stressed and holding an are brings a surge of blood. So maybe therapist are wrong in they're language but they're not wrong in what they're doing. Mentally and physically massage helps! You as a therapist are putting someone in an environment where they get to feel safe, have positive touch, let go, and have blood sent to their nutrient deprived muscles!! So regardless of knots massage has so many benefits worthy of it's time :)

Daniel 2 years ago

You struck near the truth when you said, "...because people walk around with these mental knots for the rest of their lives." Why don't kids get these tensions? It is mental which is why massage never gets rid of the full problem unless there is an emotional release.

Tyler 2 years ago

I'm going to school as a massage therapist. There is a thing as knots.

But there is a difference between trigger points and knots. There are also tender points.

Knots are just muscles fused together

Trigger points are knots or strips of muscle that have body fluid trapped in muscle and it is due to holding patterns. How you know it is a trigger point is if the pain shoots to your head, leg, neck etc.

A tender point is just tight muscle that needs to be loosened kinda like a trigger point.

Source of info. student massage theapist

I specialize in it.

DB, LMT 2 years ago

THANK YOU!!! You managed to verbalize what frustrates me constantly. It's hard sometimes, however, to educate the client regarding their miseducation from past therapists without sounding like you're disparaging said therapist. I wish I had a penny for every client that referred to their levator scapula as a "knot." Ok I'm done venting:):):)

Etherealenigma profile image

Etherealenigma 2 years ago from Florida

Wow BPF. You sound a bit like me in the fact that you are into myth busting too. I'm glad to see that there are other therapists that can effectively communicate corrections about some of the misinformation out there, especially as a writer. I'm working on something similar to educate more. I definitely have to follow you. Be blessed.

healinghands1668 profile image

healinghands1668 23 months ago from Chicago, IL

Thank you for putting into words what I've been thinking! "Knot" is such a common word for clients to leap to, and I find myself oddly thrown by it. (..."Well, no, Miss Client, that isn't a 'knot,' that's just your upper trapezius. ...Well, yes, I know it feels 'hard', and it is hypertonic...that is, it's tight. Yes, I can pinch it. It is a very thick muscle.") I always end up feeling like I'm rambling and making a fool of myself. ...Even though I know I've got the right information.

Also, ditto the LMT above whose clients call their levator scapula a 'knot'. Really, I need to keep a copy of my Trail Guide to the Body in the room with me so I can point out what levator scapula looks like.

RPM Myotherapy profile image

RPM Myotherapy 23 months ago

It is great to see this put so clearly. It is amazing how many different terms the general public have to label things. Another common one is 'slipped disc' which is technically incorrect because the disc can't slide.

I really enjoyed reading these comments of other frustrated practitioners, thank you for sharing.

I put extra emphasis on the importance of education with either my Myotherapy or Massage clients.

RPM Myotherapy profile image

RPM Myotherapy 23 months ago

It is great to see this put so clearly. It is amazing how many different terms the general public have to label things. Another common one is 'slipped disc' which is technically incorrect because the disc can't slide.

I really enjoyed reading these comments of other frustrated practitioners, thank you for sharing.

I put extra emphasis on the importance of education with either my Myotherapy or Massage clients.

Siobhan 9 months ago

You're so wrong. You shouldn't be able to feel the muscles like that. If you feel the edge of one.. then its tense and should be worked on. and Being a therapist, we learn so much and its so very intense learning all of this and there is just so much to know, our clients do NOT come to us for a school session. THey come to us for basically the exact opposite. So just simply saying this is a tight knot and needs to be worked on has just become the thing to say. Im not going to school them on whats what. Because u know if you say this is this and this is that, then there would be more questions like why is this this and why isn't that this… and its just too much. However, I do agree that there are a LOT of massage therapists who do not know what they are doing all together. So just be aware of the difference between trying to let you enjoy your massage, and ignorance.

Trisha 9 months ago

Long story I hope to make short I have had upper back ad neck problems for 8 years or longer but this pass Oct after a year of pain because everytime I was yelling at event or coughing it was goving me shotting pain all the way down to my feet and hands so had MRI done showed that my c4-c5 disk had no spinal fuild getting through but a hair line my disk was hitting my spinal cord. So I had a spinal fusion done and after 4 weeks they put me into PT. The first week I know my upper back and neck area is tight however its killing becausthey state I have so many knots!! Its extremely painful when they push on these knots and now I am non-stop pain!!! Some of the pain has gone down both arms. Plus not to mention after every treatment I am sleepy so I end up sleeping 17-20 hrs. Please any info will help

Allanc123 5 months ago

Very useful. Thank you.

Thank you 4 weeks ago

Took many words right out of my mouth. It is exhausting explaining to people that a knot isn't really a thing and that their previous therapist was not infact breaking up the scar tissue or adhesions they claim to have been.

Thank you

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