What Knot

by Matt

“What is that thing, anyway?”

I’m always getting asked this question. I’m a massage therapist, and “that thing” is a knot. But what’s a “knot”? The short answer is “I don’t fully know,” but I’m not fully convinced that anyone else does either. Given my experience and education I will try my best to explain what we’re talking about when we say “knot” in massage.

Embarrassingly, the word “knot” occupies a kind of conceptual no man’s land between clinical definition and common language. Basically, we know one when we see one, but no one really knows of what it is comprised, or what set of criteria its qualities must satisfy to be called a knot. There is no medical definition of a knot.

photo by woodleywonderworks

It would probably be more accurate for me to say that no one really agrees on every aspect of what constitutes a knot, how you get knots, and how to treat them. However everyone agrees that a knot forms in muscle tissue. This includes connective tissue such as fascia and maybe tendon. Blood almost certainly plays a role, as does our nervous system. They are raised from the rest of the surface, and sometimes they are tender.

Secondly, knots also tend to form in stressed or damaged muscle. Overdoing it in the gym or on the trail will certainly aid this, but most massage therapists I work with are more inclined to find knots in muscles associated with desk work. These associate with the commute and compute postural distresses of holding your head and arms away from your body for too long.

Knots, as we vaguely understand them, are also likely to form in stressed or challenged people. I don’t mean to overstep my scope of practice here, but I will simply observe that people undergoing emotional stress due to family, career, or other life events often are also going through emotional stress. I’m constantly hearing, “Oh I keep all my stress in my neck and shoulders.” And I often find knots up there.

In my experience adhesion between muscle fibers or muscles, trigger points, and/or some combination of the two commonly present as something we clumsily describe as a “knot.” The term is nonspecific and could refer to cases that are dissimilar in most other aspects, but knots of any variety are non-lethal. Massage, rest, stretching, detoxification, lifestyle changes all contribute positively to their mitigation, though there is some debate as to whether they can actually be removed. This is true for which ever classification of knot we describe.

Still, knots remain elusive to clinical definition. To my knowledge no one has tried to biopsy one, I don’t know if they show up in cadavers. Based on the indications for treatment from my perspective as a therapist, I suspect most knots are masses formed from thickened muscle tissue and attendant metabolic wastes and associate with the combination of adhesion and trigger points.

Some knots seem to invest more than one muscle tissue. Comprised of inflamed myofascial layers, and almost always including a concentrated degree of connective tissue, these knots feel gristly, and their size does not predict sensitivity to pressure. These knots tend to sound and feel “crunchy.” I’ve heard this crunchiness comes from either connective tissue build up or from calcium crystal build up. It may not even be associated with the muscle, but with the ribs underneath the tissue.

Knots that refer pain within the domain of a predictable pain pattern are more accurately described as trigger points, and I get the feeling that most practitioners and quite a few clients are really talking about trigger points when they are speaking about knots. Trigger points are germane to our weird little world where a phenomenon of objective anatomical pathology overlaps with the intellectual property of their namer, Dr. Janet Travel, but the medical field officially recognizes them.

Where knots are general, trigger points are specific, predictable, and often don’t even present as knots. I find the most common ones show up in the upper back and in the calves. Trigger points by definition form within tight bands of muscles in predictable locations, they grow in mass, sometimes produce greater heat, and are sensitive and painful to the touch. Frequently, the pain associated with a trigger point refer to other points in the body. In my opinion treating trigger points are clinically more significant than the general presentation of knots.

Most therapists will treat knots of any variety with localized pressure delivered directly to the knot. More sophisticated practitioners, whether from training or experience, will undoubtedly apply different techniques to your knots based on what they feel. Generally speaking, true trigger points respond better to direct pressure than the more gristly “adhesion” knots. Releasing trigger points in this way can relax the entire muscle. Adhesive knots seem to respond better to being “ironed” or “combed” out of the tissue. Sometimes separating one muscle from the other through movement can deal with those types of knots.

So, if you suffer from knots, be they trigger points or of a more general character, massage can certainly help. But keeping in mind that they seem to form in relation to how we use our bodies, I would also suggest taking the time to assess your lifestyle and how you inhabit your body throughout the day. You may be able to change a habit or arrangement so that you don’t form the knots as quickly in the first place.

Massage: It's real medicine

Knead Massage?

Massage: It's real medicine - CNN.com

POSTED: 9:48 a.m. EST, March 8, 2007

By Kristyn Kusek Lewis
Health.com

Having your honey rub your back is sweet, but it's tough to compete with the hands of a pro. A good massage therapist can make you feel like a new person. And now research suggests massage can ease insomnia, boost immunity, prevent PMS, and more. Maybe that's why hospitals are making it a standard therapy.
"All of our surgery patients are offered the treatment -- I call it 'service with a smile' -- and it's a mandatory weekly prescription I give myself," says Mehmet C. Oz, M.D., director of the Cardiovascular Institute at New York Presbyterian Hospital--Columbia Presbyterian Medical Center and a member of the board at LLuminari, a health-education company.
Our advice: Enjoy your hands-on time with your sweetie, but set aside some time for a real massage, too. Here are some feel-good reasons:
Goodbye, pain
It sounds like a no-brainer, but rubdowns are especially effective for aches like low-back pain. Researchers at the Group Health Center for Health Studies in Seattle, Washington, found that massage works better than common treatments including chiropractic therapy and acupuncture. It's not clear why, but several studies show massage reduces levels of the stress hormone cortisol while boosting the feel-good hormones serotonin and dopamine. Those changes slow your heart rate, reduce blood pressure, and block your nervous system's pain receptors. Massage also increases blood flow to the muscles, which may help them heal. (Health.com: Frequently asked questions about massage )
A bonus: Massage also seems to ease distress from migraine, labor pain, and even cancer, as well as the body tenderness seen with fibromyalgia, says Tiffany Field, Ph.D., director of the Touch Research Institute at the University of Miami School of Medicine. Plus, the benefits may last as long as a year after just a few treatments, says Partap Khalsa, Ph.D., a chiropractor and a program officer at the National Institutes of Health's National Center for Com­plementary and Alternative Medicine, the agency funding many major studies on massage.
Hello, dreams
Fluctuations in several types of brain waves either relax you or wake you up. Massage increases delta waves -- those linked with deep sleep -- according to a study at the Touch Research Institute. That's why it's easy to drift off on the massage table, Field says.
Nice to have you back, brain power
The Touch Research Institute study that connected massage to sleep also found that a 15-minute chair massage boosted alertness. "Subjects reported that it felt like a runner's high," Field says. Tests also show that brain-wave activity stimulated by massage is linked to improved attention.
Take that, colds
Massage helps ward off bugs by boosting your "natural killer cells," the immune system's first line of defense against invading illness. "We know that cortisol destroys natural killer cells," Field says. "Therefore, since massage decreases cortisol, your immune cells get a boost." Massage even seems to boost immunity in those people with severely compromised immune systems, such as breast-cancer patients.

Blues, be gone
Less cortisol and more serotonin and dopamine in your system may also mean less stress, anxiety, and depression. "We know that the right side of the frontal lobe of the brain is more active when we're sad, and the left side's activated when we're happy," Field says. "Our studies have observed that massage decreases activity in the right lobe and increases functioning in the left." The well-being people feel after a massage is a big reason why some hospitals offer it to anxious patients pre­paring for surgery and cancer patients going through chemo.
Shove off, PMS
A small study of 24 women with severe PMS found that massage reduced symp­toms such as pain, water retention, and mood swings. Try it with proven remedies such as exercise (and who-cares-if-they-work solutions like a little dark chocolate).

Hydrotherapy at Home

Simple Ways To Complement Your Massage

By Marybetts Sinclair

Originally published in Body Sense magazine, Autumn/Winter 2010. Copyright 2010. Associated Bodywork and Massage Professionals. All rights reserved.

Hydrotherapy treatments can be relaxing, healing ways to extend the benefits of your massage. Treatments you perform at home can help you take charge of your own health. Aches and pains, injuries, muscle tightness, and even joint stiffness can all be soothed with these simple, at-home hydrotherapy treatments.


Epsom Salts Footbaths
Epsom salts footbaths may be helpful for bruises, sprains in the subacute stage, soreness after exercise, soreness after massage, chronically cold feet, edema of pregnancy, or arthritis pain. You will need a water thermometer, a chair, a plastic tub, 2 cups of Epsom salts for an adult (1 cup of Epsom salts for a child), 1 bath towel, and a bath mat.


Procedure
1. Place a bath mat on the floor in front of the chair.
2. Fill the tub with warm (not hot) water, about 98-102F. Pour the Epsom salts directly under the spigot as soon as you begin filling the tub to make sure they dissolve completely. If your massage therapist has suggested you add essential oils to your footbath, add them after you have finished filling the tub.
3. When the tub is full, place it on the towel, then sit on the chair and put your feet in the water.
4. Keep your feet in the water for 15-20 minutes.
5. At the end of your footbath, rinse and dry your feet.
6. Apply a moisturizing lotion to your feet and then put on socks.`


Shower Exercises
A hot shower and neck-limbering exercises may be helpful for chronically tight muscles, stress, injury, soreness after exercise, muscle spasms, or arthritis pain. These exercises may be performed as frequently as three times a day.

Do not stay in a long, hot shower if you have any of the following conditions: cardiovascular problems, diabetes, hepatitis, lymphedema, multiple sclerosis, seizure disorders, hypothyroid conditions, loss of sensation (lack of feeling), or any condition that might make you unsteady on your feet or unable to tolerate heat, including alcohol or drug use. If pregnant, reduce the temperature of the shower.

You will need a water thermometer, bath towel, and bath mat.


Procedure
1. Turn on your shower to hot and get in carefully.
2. Adjust the temperature so it is toasty, but to your tolerance (about 105-115F). Let the water beat on your neck for at least three minutes. Move your head as if you were drawing all 26 letters of the alphabet with your nose. This will release muscle tension and make your neck more limber.
3. Stay in the shower for no longer than 10 minutes.
4. Get out of the shower carefully so you do not slip.
5. Dry off and get dressed. Select a shirt that will keep your neck warm.

Marybetts Sinclair has been a massage therapist in Oregon for more than 30 years. She is the author of Modern Hydrotherapy for the Massage Therapist (Lippincott Williams & Wilkins, 2004). For more information, visit www.marybettssinclair.com.

Your Massage Session

Dialing in the Details for a Great Experience

By Karrie Osborn

These basic bodywork etiquette guidelines will help you get the most out of your massage, create a healthy client-therapist relationship, and address some of those unknowns.


It's All About Timing
Be good to yourself, and show up a few minutes early for your session. This allows you to transition into calm, healing space and focus on the massage. It also ensures you'll receive your full time allotment for the massage.

When scheduling at a spa, most guests are asked to arrive early to prepare for their session, stow belongings, and even enjoy the facility's amenities, such as a steam room, before the scheduled service begins. New massage clients will also need to fill out health history intake forms.

If you do get held up in traffic and arrive late to your appointment, the therapist will probably not be able to give you a full session. Respect your therapist's time, call if you're going to be late, and understand that your session must end on time, regardless of when you arrived.

When it comes to cancellations, most spas and private practitioners require a 24-hour notice to avoid fees. Every situation is different, so check with your therapist about his or her specific cancellation policy, and then honor it.


Honor Your Body
Some people have a hard time even considering massage because they are so unhappy with their body. Primarily a female issue, poor body image can be extremely damaging. While it's hard to imagine that taking your clothes off and lying on a massage table will make the situation any better, massage therapy can do wonders to bring an individual back into body awareness. Bodywork can help mend the body-mind chasm that is created through self-hate, bringing the two pieces back together in a peaceful, healthy union.

Massage therapists and bodyworkers not only have advanced knowledge of tissues and structure, they also have a great appreciation for the human body as a whole, no matter its shape or size.


Communicate
One thing that will make your massage both more enjoyable and more beneficial is communicating with your therapist. If the room is too warm, if the bolster under your legs isn't in the right spot, if the music is driving you batty--whatever the issue--let your therapist know right away so you can get back to the business of enjoying your massage.


Skip Alcohol for Water
In resort settings, it can be hard to step away from icy margaritas on the beach to make that afternoon spa appointment. But the last thing you want is to be "tipsy" on the massage table. There are several downsides to being under the influence during a massage, the most important being how alcohol wreaks havoc with the body and can have a negative interaction when combined with bodywork. The result can be dizziness and nausea. That's no fun and a waste of good massage time and money. Leave the alcohol for another time. Water, before and after a therapeutic massage, is what the body really wants.


Won't Find That Here
It's unfortunate that massage therapists even have to address this subject, but they do. So the answer to late-night callers is, "No, we don't give happy endings. No, you may not pleasure yourself. Therapeutic massage has nothing to do with sex." If a misinformed client somehow ends up in the massage room of a professional therapist and asks for something other than therapeutic massage, they will be asked to leave. Flirting, inappropriate touching, and sexual innuendos will not be tolerated. Keep the relationship professional and above board and your therapist will be a valuable member of your healthcare team.


You're Human
The body can have a lot of responses to therapeutic massage. While avoiding food at least one hour before your massage will help, there's still the chance that you'll have tummy gurgles or even pass gas. It's okay. As the body relaxes and systems get moving, the body can play all kinds of tricks. Your therapist has seen it all, yet sees well beyond those kinds of issues.

For men, there's even a possibility that massage will cause an erection--a normal response to nervous system activation. It rarely occurs, but if it does, your therapist will likely shift the focus of the work.


Time To Wake Up
While a nap after your massage may sound lovely, other massage clients will be arriving soon and the room must be readied for them. When your massage concludes, your therapist will say something along the lines of, "Our session is over. Take your time getting up." That's your cue to take a moment as you come back to the here and now. Carefully sit up, allowing your body enough time to readjust. Go slow or else your body will knock you for a dizzying loop. Also, be careful not to slip getting off the massage table, especially if your therapist used oil on your feet.


Insights on Tipping
While it's customary to tip 15-20 percent, most experts say it's ultimately the client's decision. Like in other service industries, providing a tip is usually done in response to excellent service. A couple of notes: Many therapists who work in spas earn only a small percentage of what you've paid for their services. For these therapists, tips are an important part of their income. On the other hand, tips are usually not accepted for massage performed in a medical environment. Unsure what to do? Ask if tipping is customary and what is the policy.

Making the Most of Your Massage

How To Achieve Lasting Effects

By Nina McIntosh

Originally published in Body Sense magazine, Autumn/Winter 2005.
Copyright 2005. Associated Bodywork and Massage Professionals. All rights reserved.

It may seem like all you have to do to get the most out of a massage is show up, relax, and let the massage therapist do the rest. In some ways, that's true. But there are also some things you can do that will make your experience even more enjoyable, all while building a solid working relationship with your massage therapist. Following are some "insider tips" to help you get the most out of your sessions.

Speak up about your concerns and questions.
I've learned that expressing myself to my massage therapist is an important key to my sense of security during the treatment. Of course, you want to let your massage therapist know if the room is too hot or too cold, whether the music suits you, and so forth.

But beyond those comforts, you also have a right to ask questions related to the work at hand -- for instance, the therapist's training in a particular technique or any risks involved. Also, don't be embarrassed to ask for a clearer explanation of anything the massage therapist says that is too technical or in jargon you don't understand.

Don't be embarrassed by "betrayals of the body."
Your massage therapist knows that, as people relax, they can have responses not considered "acceptable" in polite society. People can pass gas or, when on their stomach, drool on the sheet. Men may have erections if they fall asleep or simply from the pleasure of relaxation and not because they are thinking about sex. Your massage therapist will generally ignore such unintentional occurrences.

Go regularly.
Though treating yourself to a massage every now and then is a valuable boost to your self-care, you're likely to see even more benefits with regular treatment. Try getting massage at least twice a month for a while to see the power of the cumulative effects.

Enhance the benefits both before and after the massage.
Most clients know they will get more out of their massage if they try to wind down before it starts and give full attention to it once it's begun -- turning off cell phones while also clicking off the mental switch on the day's concerns and problems. It's also helpful if you know to schedule your massage at the end of your workday and bring along your casual clothes to wear when you leave. Struggling into panty hose or retying a tie can be a nuisance after a relaxing hour.

Keep appointments, and pay at the time of the appointment.
As with other professionals, massage therapists expect you to keep your appointments and pay for them at the time of the service, unless you make other arrangements ahead of time.

If you show up late, understand that your session will likely be shortened to be able to keep the therapist on schedule. Even if your therapist has no other appointments that day, she has a right to keep to her schedule.

Similarly, if you show up early, your massage therapist probably won't be able to begin your appointment until the arranged time. Even if your therapist isn't with a client when you arrive, she may need the time to return phone calls or just gather herself so she can be at her best for you.

If you must break an appointment, know your therapist's policies. Most ask for at least a 24-hour notice. Because they need that time to fill the slot with another client, many therapists will ask you to pay if you cancel without enough notice. Of course, if you have an emergency, you usually won't be charged.

If you miss an appointment altogether without notifying your therapist, don't be surprised if she crosses you off her client list. If you are able to make another appointment, expect to pay for the missed hour.

Be ready for home sessions.
If you receive massages in your home, be ready for the session to start at the appointed hour. You'll enjoy it more if you turn off the phone and don't have children running about or a baby to attend to. Try to give yourself uninterrupted time for the session.

In a spa, ask about tipping.
If you receive your massage at a spa, ask the therapist (or the front desk person) if tipping is appropriate. Often those who work in spas count on gratuities to supplement a relatively low salary. If the spa doesn't have an automatic percentage, adding 10 percent to 15 percent is customary.

When in doubt, shower beforehand.
Most people perspire as they go about their normal day, especially in warm weather. A slightly moist client isn't a problem for most massage therapists. However, if you've been working in the yard, jogging, playing tennis, or the like, jump in the shower or take a relaxing bath before you go to your appointment. If you're slippery with perspiration, the therapist will find it difficult to work on you, to say nothing of not wanting to push grime into your body. And it will only help you relax that much more in preparation for your appointment.

Mums the word.
If you have a friend or family member who also sees your massage therapist, don't try to engage your therapist in conversation about them. While it's fine for you to talk about these folks, know that it will be a one-sided conversation. Your therapist is bound by confidentiality and can't answer questions or gossip about clients.

Let your massage therapist know ahead of time about illnesses or contagious conditions.
Your massage therapist probably asked your about your history of physical conditions when you had your first appointment. However, keep your therapist current on any physical problems that come up, even if they seem to be temporary.

If you have a cold or flu, talk with your therapist before you go for your session. Your therapist may decide that a massage that day isn't a good idea, either because you may be contagious
or because you might feel worse afterward.

If you have any contagious skin conditions, such as athlete's foot or poison ivy, be sure to let your massage therapist know.

***

While it's your massage therapist's job to make sure you are pampered and taken care of, being "in the know" can make your massage sessions feel even more relaxing and worthwhile.

Nina McIntosh has more than 20 years experience as a bodyworker. She's the author of The Educated Heart: Professional Guidelines for Massage Therapists, Bodyworkers and Movement Teachers, and Massage & Bodywork magazine's Heart of Bodywork column. Contact her through www.educatedheart.com.