By Alan Williams, PT, OTR/L, ATC, CSCS

I grew up on a mint farm. When I was old enough, I spent my afternoons, evenings, and summers helping out with the millions of chores that always needed to be done. It was hard work, but I wouldn’t trade the experience for anything. I do have one small regret, however; working on the farm did not leave me enough time to join the Boy Scouts. It was the knot tying that especially interested me. They all had such cool names, too – manrope, Turk’s head, shroud, splice, granny (well, maybe not granny). My dad was especially good at tying knots. As kids, we called him “The Knot Guy.” Whenever we needed a special knot, we’d go to dad, and it was as good as done.

Despite the often-used terminology, there are no real knots in your shoulders. There’s no such thing as a deltoid double hitch (although that would be cool). The tense, painful lump you feel is called a myofascial trigger point or MTP (myo meaning muscles, fascia meaning connective tissue). According to the American Academy of Manual Medicine, a MTP is “a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. The spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction, and autonomic phenomena.” Basically, a MTP is a group of muscle fibers that have constricted, sometimes to the point of spasming, and are essentially stuck in that position. These are especially common in the neck and shoulders, but can also be found anywhere there are muscle fibers with connective tissue.

No one knows for sure what pushes a tense muscle to become a MTP, but there are several contributing factors – muscular overexertion and fatigue (such as results from too much intensity when exercising, poor posture, excessive repetitive motion, or neglecting to stretch after exercise), injury/trauma, allergies, metabolic deficiency, disease, infection, stress/tension, drug and alcohol use, and poor nutrition. And unfortunately, as the causes are numerous, the results are common – most adults will develop a MTP during their lifetime.

Because muscles are designed to alternately tense and relax while functioning, the constant constriction associated with MTPs is an unnatural state. MTPs are characterized by distinct pain when the trigger point is disturbed, diminished muscle flexibility and strength, and of course, a tender nodule or “knot.” MTPs can be either acute or chronic. They may progress from moderate pain only when the trigger point is activated (acute) to sharp, stabbing pain that remains constant regardless of the muscle’s usage (chronic). Obviously, it’s best if treatment is applied before the MTP reaches that stage.

There is no one “magic bullet” treatment for MTPs, and while everyone responds to different treatments with differing success rates, most people find that a combination of treatment techniques yields the best results. MTPs can be stubborn, and it often takes time and diligent treatment to relieve them. The goal of MTP treatment is to get the muscle to relax. This can be done with massage, heat/ice applications, stretching, electrical stimulation, and ultrasound. Your physical therapist will help you find the best combination of treatments for your needs.

In order to obtain lasting relief from MTPs, it’s important to alleviate the cause. This can be a challenge due to the large number of contributing factors, but there are some general steps you can take to reduce your risk for MTPs: 1) Eat a healthy diet, 2) Ensure you get regular exercise at an appropriate intensity for your fitness level and age, 3) Stretch after physical activity, 4) Make sure you have correct posture, 5) Manage your stress levels, and 6) Obtain appropriate treatment for any other conditions you may have, such as allergies, metabolic deficiencies, infections, etc.

Knots belong in the Boy Scouts, not your shoulders. Visit your physical therapist to find out how to “untie” the ones in your shoulders.

Don’t let shoulder pain keep you down. Call 463-0022 today for your FREE Shoulder Pain Assessment!