Massage: The Mechanics of Knots Part 2

pexels-photo-96081.jpegWhat is an overactive muscle and why is it like that?

An overactive muscle just won’t turn off. It stays contracted and feels “tight.” A common cause of an overactive or hypertonic ( too much tone) muscle is the nervous system over recruits that muscle due to ingrained faulty motor patterns that have set in over the years. A motor pattern is a sequence of muscle movements such as your stride when you walk, or lowering into a squat. These “unhelpful” motor patterns often come from weaknesses in posture, too much sitting and the like. For example, you sit at work so the gluteal muscles are not working, the core is not working and so you learn to only use your back and hip flexor muscles to hold you upright. Why is this a “faulty pattern”? Well, you are not as strong or stable lacking glute and core strength. In this common scenario the hip flexors become overactive causing hip and low back pain.

How does massage help?

Physically applying pressure to a muscle can quiet an overactive or “tight” muscle into relaxing. There are actually mechanoreceptors (a sense organ or cell that responds to mechanical stimuli such as touch) located in muscle and joint tissue. Examples of these mechanoreceptors are muscle spindle cells and golgi tendon organs that sense stretch and tension. The sensory information of pressure from massage sends a signal from these mechanoreceptors through the nervous system to your brain to inhibit the muscle contraction. There is a law of neurology called the Arndt-Schulz Law, which states weak stimuli activate physiologic processes and very strong stimuli inhibit them. Therefore, gentler massage work can be done to stimulate and activate a muscle where as deeper techniques can be done to inhibit a muscle.

The appropriate technique and amount of pressure can send opposite neurological signals in order to counterbalance an unhealthy pattern of tension and help the body normalize into healthier muscle tone and range of motion.

Relate this back to the example of sitting too much at work. Too much sitting causes a lack of glute strength and tight hip flexors so a therapist would use deep work to inhibit the hip flexors and more stimulating techniques to activate the gluteal muscles. All with the intent to not just physically work through tight knots (stuck connective tissue) but to help the nervous system balance muscle tone in the body. 


Quick Tip: How to get the most from your stretching

Most of us don’t stretch enough. So here’s a quick tip to get more out of it.


  1. Using 10-15% of your strength, contact your muscle and hold for 10 seconds.
  2. Then relax and ease into the stretch a little bit further. Hold.
  3. At the new bit of length you’ve just eased into, repeat the contraction (10-15% strength) and ease in just a tiny bit further.
  4. Repeat one last time at the new depth. Hold in your core for support as you ease out of the stretch.

Example Hamstring Stretch:

  • While standing, place your heel on a step or chair. Ensure the height is not too challenging for your current flexibility.
  • Press your heel down for 10 seconds.
  • Keep your back straight and lean forward towards your toes. If it’s just an inch that’s ok.

Remember: Keep the stretch relatively comfortable. Don’t push too far or your muscle will lock up on you and you’ve gained nothing.

This technique can be done on most any area. Try the pecs too. Happy stretching!

How massage works: The mechanics of knots

How does massage work? Is it really just breaking up knots? 

Yes, simplistically speaking, when looking at bones and muscles as a system of levers and pulleys. Massage mechanically un-tangles stuck tissues (fascia, muscle, tendon) and can help relieve compression on a “pinched” nerve or mobilize a tight joint capsule. It becomes more complex when you look at how that in turn affects the nervous system and the cascade of responses in the body that follow. But first, what is a knot?

back muscle-pexels

What is a knot anyway?

Massage and physical therapists often refer to a knot as an “adhesion.” When injury occurs the body repairs the injured tissue with building blocks such as collagen, elastin and fibronectin. (Whether the damage happens over time from the wear and tear of angrily sitting in your car two hours every day or quickly from spraining your ankle.) These building blocks are pretty sticky and fibrous so they often get a bit stuck together. Adhesiveness is the property of sticking together, hence, a “knot” is called an adhesion.

If you were wondering, yes there is a difference in the density, texture etc. of an adhesion based on how long it took to form and other factors. A tight muscle may not always be tight from a knot; but we’ll get to that later.

The soft tissues in the body are composed of proteins and fluids that are more like gels (technically they are colloids), which means they are viscous and elastic. This makes tendon, muscle and fascia malleable and influenced by mechanical force (examples include tension, torsion and compression).

Since the soft tissues in the body respond to mechanical force, massage therapists apply tension, compression and such to “unstick” adhesions. The skill is to effectively pinpoint the affected area and use appropriate methods so as not to cause too much pain and more damage. By teasing and coaxing away the stuck layers from each other the body can repair itself in a more organized fashion. The goal is to get movement between muscle, facia and other tissues so the layers slide easily on top of one another avoiding more adhesions. Fluid content in a muscle also determines the density and pliability of that muscle. Manipulating and stretching tissues also affects the veins and capillaries which helps circulate blood in and out of the area. When a therapist applies traction to a joint it encourages the flow of synovial fluid. Sticking with our analogy….keeping you like a well oiled machine.

As I mentioned, muscle is not always tight because of a “knot.” Those tense, ropey cords of muscle can actually be due to an overactive or hypertonic muscle. 

But what exactly is an overactive muscle? How and why does that happen? It’s all in the mind so to speak. This is when the nervous system gets involved. In fact, there are actually receptors at the cellular level in muscles and veins that communicate with the nervous system. Let’s save that for Part 2. 


Mosby’s Fundamentals of Therapeutic Massage Sixth Edition by Sandy Fritz

Cortisol decreases and serotonin and dopamine increase following massage therapy. Conducted by Touch Research Institutes, University of Miami School of Medicine, Miami, Florida. 

A preliminary study of the effects of a single session of Swedish massage on hypothalamic-pituitary-adrenal and immune function in normal individuals. conducted by Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center.


My favorite calf stretch

Improve balance, posture, reduce knee pain and more just by stretching your calves.

WHY: The calf stretch is easy to incorporate throughout your day and will give you huge benefit. Tight calves are so important to address because they affect your walking gait as well as squat position. Calves (made up of the Soleus muscle and Gastrocnemius muscle) and hamstrings share connective tissue and have close attachment sites at the knee so you will probably feel the stretch run up through the hamstrings as well. More bang for your buck.

HOW: This stretch can be done with a half dome foam roller, rolled up towel, yoga mat or the foot of a squat rack to give you a few ideas. Post heel on roller/towel etc. and step through to deepen the stretch. Experiment with stepping through, as I did in the image, or placing your feet side by side.

Make sure to stand tall in order to get the most out of the stretch. This walk through is helpful in that you are keeping your hips level. You may notice it even requires a bit of balance so you need to fire your abdominals.

DO: Stretch calves daily and even multiple times a day. (Come on it’s an easy one)
Hold for a minimum of 30 secs per side. Keep a timer or count slowly to 30 because guaranteed you will do it for 7 secs and think it feels like 30 (or is that just me).

What does my neck hurt?

Many gym clients ask about neck tension. They felt they got in a good workout the other day, and are not sure why but they wake up with a stiff neck. They didn’t notice anything feel off during the workout. Sound familiar to you?

So what happened?

It’s a combination of weak and tight neck muscles (tight muscles are always weaker) and elevated shoulders (overly active traps and levator scapulae muscles for the most part).

Elevated Shoulders and lack of independent movement

It’s become pretty common knowledge that our modern chair-bound life has created a lot of physical problems for us. We do move less and we actually move in fewer ways. For example, how often during your work week do you overhead carry reams of paper up the stairs, climb a wall, bear crawl across the floor, do a back bend to grab a pen? We have gotten so tight and weak that we can not do many independent movements. Our shoulder stabilizers are not strong, our lats and external rotators may not be functioning properly and we are so used to hunching our shoulders up to our ears with daily stress. The neck and shoulders now move in unison instead of producing independent movement. For example, picking up a cup of coffee. Did your shoulder come up to your ear along with it?

xray purse

If you pay attention you’ll start to notice that you elevate your shoulders, over recruiting your upper traps for a lot of movements. They don’t need to come along for the ride.

Hold your head up

Then you add in weak neck flexors. Due to years of doing a bazillion crunches while holding the head (improper ab training), most of us are recovering from over developed trunk flexors (rectus abdominis) and weaker neck flexors to hold our heads. From this imbalanced training, the trunk flexors have gotten stronger and the neck flexors, which should work together, have been left behind. Our head can not function self-supported and we must actually hold it up with our hands during exercise.

v up anatomy

Look at the body you can see the connection and that functionally these muscles should work together .


When the head is supported it promotes an imblance of strength between the trunk and neck.

To stabilize the neck, you must maintain proper tongue position. Your mouth should remain closed with your tongue resting naturally at the roof of your mouth, behind your teeth. Say the letter “N”…..”nnnnnnnnnnn” that is where your tongue should rest. About the same position as when you swallow.

tounge position

The tongue should comfortably rest behind the teeth at the roof of the mouth.

Why do this? Why does this matter?

1.When your mouth is open your body compensates to open up the airway for you to breathe by moving the head forward (you’ve probably heard that forward head posture is something to avoid. And…it doesn’t look so good.)

2. This helps stabilize your neck. Deep neck flexor muscles are not properly activated to support the weight of your head unless your tongue and jaw are in proper position.

Studies have shown that a low-load program of craniocervical flexion exercise focusing especially on motor control of the deep neck flexors has been shown through clinical trials to reduce neck pain and headache.

So, in conclusion…

Pay attention to your neck and shoulders. Are you elevating your shoulders and over recruiting your traps? 

Keep proper tongue position when doing ab work with your head unsupported, and stop once your neck gets tired so that you can balance your neck and trunk.

Sharp pain in the top of your shoulder?

Shoulder impingement typically causes pain as you try to raise your arm overhead. The pain you are feeling is due to pinching of the supraspinatus tendon underneath the acromion process of the scapula. The scapula is pulled too far forward by over developed internal rotators of the shoulder. Posture, overuse and repetitive movements overhead are all contributing factors. Targeted tissue work to “unstick” tight fibers in the indicated muscle groups along with strengthening external rotation is effective. Strengthening is always important to regain balance. Plus, a stronger muscle responds better to treatment according to biomechanics specialists Dr. Ivo Waerlop and Dr. Shawn Allen.

Supraspinatus Impingement

Image adapted from Visible Body.

How massage can help you increase your “studliness”

1. Massage can help you rebuild muscle more quickly.

A new study published in Science Translational Medicine found that a massage session can reduce inflammation, which can help your muscles recover after a hard workout. Vigorous exercise causes tiny tears in muscle fibers, leading to an immune reaction — inflammation — as the body gets to work repairing the injured cells.

“What massage seems to do is … it reduces the inflammatory response as a function of the damage you incurred while you’re exercising,” explained one of the study’s authors Simon Melov, a molecular biologist at the Buck Institute for Research on Aging.

2. Massage can help muscle adapt to increased demands of exercise.

Massage also seems to help cells recover by boosting amounts of another protein called PGC-1alpha, which spurs production of new mitochondria — tiny organelles inside cells that are crucial for muscle energy generation and adaptation to endurance exercise.

“The bottom line is that there appears to be a suppression of pathways in inflammation and an increase in mitochondrial biogenesis,” helping the muscle adapt to the demands of increased exercise, said the senior author, Dr. Mark A. Tarnopolsky.

3. Massage aids in avoiding abdominal fat storage.

Cortisol directly effects fat storage and weight gain in stressed individuals. Prolonged stress can lead to enhanced lipogenesis (fat creation), visceral obesity (deep abdominal obesity), breakdown of tissues, and suppression of the immune system according to Christine A. Maglione-Garves, Len Kravitz, Ph.D., and Suzanne Schneider, Ph.D. from the University of New Mexico. In reducing cortisol, massage is a powerful tool for keeping your body healthy and avoiding fat storage due to the stress response. It is certainly not a replacement for proper nutrition and exercise but will help you be successful with a great health plan in place.

4. Massage boosts recovery of muscle tissue.  

In another recent study, researchers put 11 young, healthy men through a strenuous workout and took muscle biopsies of both legs—before and after exercise, and after 10 minutes of Swedish-style massage. The brief massage affected two specific genes in the muscle cells. The first gene decreases inflammation caused by exercise, similar to the relief anti-inflammatory medications. The second gene turned up production of mitochondria in the muscles, which are the energy producers of cells. Mitochondria use oxygen and other nutrients to generate energy needed by the cells. As muscle cells become adapted to endurance exercise, the number of mitochondria increases. Massage seems to help this process along. Ice baths and anti-inflammatory medications can reduce inflammation, however, studies show these methods tend to block muscle repair and growth; whereas massage, appears to not only make you feel better, but also reduces muscle recovery time.

5. Get better sleep. 

Sleep is of utmost importance for recovery. Fluctuations in several types of brain waves either stimulate sleep or tell you to wake up. Massage increases delta waves — those linked with deep sleep — according to a study at the Touch Research Institute. That’s why it’s common for clients to drift off on the massage table. Massage is especially beneficial in treating sleeping problems that stem from stress, migraine headache, pain, and muscle and joint stiffness.

6. Massage decreases pain.

Touch Research Institute (TRI) at the University of Miami School of Medicine has found massage may boost immunity and seems to help soothe pain from arthritis. Massage creates chemical changes that reduce pain and stress throughout the body. One way it does this is by reducing a brain chemical called substance P that is related to pain. In a TRI study, individuals with a form of muscle pain called fibromyalgia showed less substance P in their saliva, and they reported reduced pain, after a month of twice-weekly massages.

7. Massage may boost immunity.

Several studies have measured the stress hormone called cortisol in subjects before and after massage sessions, and found dramatic decreases. Cortisol, produced when stressed, kills cells important for immunity, so when massage reduces your stress levels and by lowering cortisol in your body, it may help you avoid getting a cold or another illness while under stress.

8. Massage reduces blood pressure.

Massage reduces hypertension, suggests a good deal of research. High blood pressure patients demonstrate lower diastolic blood pressure (measures the pressure in the arteries between beats), anxiety, and stress hormones. This may be because it stimulates pressure receptors that prompt action from the Vagus nerve, which regulates blood pressure, as well as other functions.

Reduce Stress and Expense

Experts estimate that upwards of ninety percent of disease is stress related. And perhaps nothing ages us faster, internally and externally, than high stress. Although we can never truly avoid stress, massage can help manage stress while helping you make faster gains in your fitness regimen.

Just like a good exercise program, regularly scheduled massages can play a huge part in how healthy you’ll be and how youthful you’ll remain with each passing year. Remember, just because massage feels like a pampering treat doesn’t mean it is any less therapeutic and you can save money by using tax-free funds. If you have a Flexible Spending Account (FSA) or Healthcare Savings Account (HSA), massage therapy can be a qualified medical expense, as long as a physician recommends it with a written prescription. Consider massage appointments a necessary component of your health and wellness plan.

In my practice, I see many chronic conditions from the wear and tear of bad body mechanics. The trinity of resistance training, mobility work and massage is a powerful combination to bring people back to health.

Pull your weight

A female gym member asked how I learned to do dead hang pull ups. She has trouble getting through the first 1/3 of the pull. This makes sense because most people have trouble with shoulder stability and the rotator cuff muscles.

For me, and I think many starting out, it’s about learning how to recruit your full body to stay stable. At first we think we are supposed to just pull with our arms. Just like it says in the name right?

To strengthen shoulder stability, start out by just hanging from the bar while protracting and retracting your scapulae (basically shrug your shoulders and pinch them back together). This should help with initiating the pull.

Also work on strengthening the lats for the pull: Bent over rows, ring rows

And practice using the glutes and abs to keep the body tight as if you are in a plank.

Breaking Muscle does an excellent job of outlining how to progress to pull ups.

Daily Grind

We know repetitive habits and schedules make up our day. We eat roughly three square meals a day. We wash dishes and do laundry because it always needs to be done. Yet we forget that we need to keep up with body maintenance and recovery.

Frequency is key for keeping all your parts well functioning. Think of your foam rolling and stretching and movement like cleaning your house or eating your meals. It’s a daily practice. It’s a daily requirement.

Getting bodywork (massage, chiropractic) is important but it will not last without daily self-care.

It seems like too much work until you realize it’s just like anything else you do on a daily basis to keep you going through life. Sure you can let it slide for a bit, but what happens when you don’t take out the trash for a week or three months? What happens when you don’t take care of your recovery and exercise for a day or three months or three years? The trash builds up until it can no longer be contained.