What are the “knots” in my back muscles?
From the best research we have to date, those “knots” in your back are a great example of your nervous and musculoskeletal system working together in an attempt to protect you.
Your body has ways of adapting to more stress than is optimal.
It can change the way areas of your body feel and how sensitive your tissues are.
It can even alter the way you move by making your soft tissues tender in certain spots and potentially causing altered muscle function or keeping certain muscles tense.
These “knots” are most likely a result of something else rather than the true cause of your pain. Much like smoke from a fire, sore spots in your muscles can be a sign something is underlying the problem that should be addressed. That “something else” can be more complicated than a simple muscle knot and can consist of a lot of contributing factors.
Some of those factors can include, but aren’t limited to:
- an injury elsewhere in your body
- a history of overuse and overload on particular muscles
- a general lack of movement and exercise that bodily tissues need and crave
- sustained sitting or standing positions that lead to decreased blood and oxygen supply to an area
- an overload of emotional stress
- work, life and relationship related stresses
- several nights of poor sleep
Your body’s protective systems are quite intricate and looking at all the factors of your life can help you to better understand what might be causing the sensitive spots in your muscles. Focusing on treating the muscle knot itself is often much like wafting smoke away from a fire; it helps for a brief period but soon returns if other contributing factors leading to the fire aren’t addressed.
Can massage fix my back pain?
While a massage can feel quite good during and shortly after treatment, the vast majority of medical evidence to date demonstrates that there are no long-term beneficial effects of massage and that it is not a good stand alone treatment for back pain.
There are often touted benefits of massage such as improved blood flow, changes in lymphatic flow, stretching to fascia, detoxification, reduction of inflammation, breaking up “adhesions” or “knots”, and improved tissue healing, however none of these have been conclusively shown to underlie the benefits of massage in research.
The general scientific consensus currently is that much of the positive benefits felt from massage are very likely from inducing relaxation and decreasing stress. This is not to be taken lightly as stress and emotional “tenseness” can be a significant contributor to chronic medical issues such as depression, chronic pain, low back pain, etc.
You can picture how this works by imagining a glass of water in your mind. That glass of water is you. Every exercise, activity, movement, stress, fear, anxiety, health issue, and other factors in your life adds water in your glass. When your glass overflows from too many things putting water in it, you may experience pain as a message telling you to make a change to your lifestyle.
Massage can certainly be a good adjunctive treatment for short-term pain relief and to temporarily reduce the “amount of water in your glass”, but it shouldn’t be used in isolation. It should always be paired with an active care plan that involves movement and exercise to build yourself a bigger glass that can hold more water before it overflows. Other lifestyle modifications, such as getting enough quality sleep can also contribute to building a bigger glass.
Additionally, it is important to recognize and evaluate other factors that may be contributing to your experience of pain by adding water to the glass. These include excessive career, financial or relationship related stress, sustained body positions, emotional factors, and other health issues.
Is my back pain caused by tight muscles?
There is a common thought that back pain can be caused by tight muscles. However, many research studies have shown that things like the flexibility of muscles or mobility of joints does not have a close relationship with the onset or presence of back pain.
This may sound counter-intuitive to what you have heard before. However, in recent years researchers and the medical community have come to find out that back pain is a very complex experience that can have uniquely different contributors in every person.
These contributors could be:
- too much movement/ loading
- not enough movement throughout the day
- emotional issues
- social and psychological stress
- workplace dissatisfaction
- poor general health
What we have found out over time is that people who have back pain for a long period of time tend to begin moving differently. They often develop the feeling of being stiffer and more guarded in their movements. Therefore, in many cases muscles that feel tight may actually be a symptom of back pain rather than the cause. For this reason, it is now proposed that gradual exposure to more movement and exercise is among the most beneficial approaches to help improve back pain.
If you feel better from stretching and generally enjoy it, you should certainly continue to do so. Any physical activity you enjoy and can stick to consistently is very good for back pain. However, you shouldn’t be excessively concerned that tight muscles are a cause of back pain and shouldn’t force yourself to stretch if it doesn’t feel good or you don’t like doing it.
Jarod Hall, DPT is a Doctor of Physical Therapy in Fort Worth, TX whose clinical focus is orthopedics, with an emphasis on education about pain and using progressive exercise intelligently in the management of both chronic pain and acute injuries.