WHAT ARE KNOTS? ADHESIONS, SCAR TISSUE, TRIGGER POINTS, AND TENDER POINTS Have you ever wondered what you are feeling when your massage therapist goes over a painful spot? Trigger points, tender points, and adhesions are frequently the cause of some of the pain and discomfort you feel in daily life and during the massage. They can be caused by things such as injury, chronic muscle tension, repetitive motion, and stress. Read below for more information. What are Adhesions?Adhesions are bands of painful, rigid tissue that are usually found in areas where there is chronic muscle tension or injury. They can also be found in areas where there is scar tissue (see below). Adhesions are usually felt as “knots” and are tender to the touch. They can block circulation, cause pain, impinge nerves, limit range of motion/movement, and cause inflammation. The massage therapist uses direct pressure or friction with or across the grain of the muscles to physically break down adhesions. Is Massage Beneficial for Scar Tissue?Yes. Scar tissue is more than skin deep. As scars are healing they can pull the deeper connective tissues and muscles into the scar causing adhesions (see above), restricting range of motion, impinging nerves, and causing pain. By gently massaging scar tissue the deeper scar tissue is broken down and the area can heal normally. The earlier and more consistently scar tissue is exercised, massaged and warmed the less the likelihood of adhesions to form. Massage can usually be done gently over scars as soon as they have healed and there is no inflammation and can assist in the recovery from surgery. What are Trigger Points?Trigger points are tight bands of tissue that have referred pain. Like adhesions, trigger points are often felt as “knots” but when the massage therapist goes over a trigger point there is usually a localized twitch response, referred pain to another area of the body, and an area of localized intense pain. When a trigger point is touched clients frequently report pain in another area of the body. For example, when the massage therapist applies pressure to a tight muscle in the neck of a client who has been complaining of tension headaches the pressure may cause localized pain as well as recreate the pain associated with the headache. By applying prolonged pressure to the trigger point the therapist is relieving the trigger point, which allows the muscle to relax. This helps to reduce localized pain in the area and the areas of referred pain. Trigger points often occur in muscles that are overused or on constant stretch like in the area between the shoulder blades on the upper back. What are Tender Points?Tender points are similar to trigger points but there is no referred pain. They frequently occur in the antagonist (opposite) muscle to where a person is feeling pain. So if you are feeling pain in your back and shoulder area there are frequently tender points in your chest muscles. Tender points are also frequently found in muscle attachment sites and tendons rather then in the belly of a muscle. Tender points are relieved in a similar way as trigger points by applying direct pressure.