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?

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. 

Sources

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.

 

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.

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.