SaveYourself.ca • Sensible advice for aches, pains & injuries
published 5/12/08, updated 11/18/09
![[Clinical science update on the physiology of muscle knots or trigger points.]](/resources/images/clinical-science-update.jpg)
EXCERPT This article is an excerpt from an extremely detailed tutorial, SaveYourself.ca’s advanced troubleshooting guide for muscle knots: 
Advanced Tutorial: Save Yourself from Trigger Points & Myofascial Pain Syndrome!
I have some exciting new muscle knot science to report on. And this is a really a thrill for me, because my professional life revolves around muscle knots: they are both clinically important and full of mystery, yet their secrets are yielding to scientific investigation right now. It’s wonderful to be alive for that, to learn things about myofascial trigger points that no one has ever known before.
Today’s muscle knot science news concerns their chemistry, specifically the toxicity of the tissue fluids in and around them. The science of myofascial trigger points (MTPs) has been dominated since 1995 by the theory of a poisonous feedback loop, a vicious cycle. The idea is that knots generate a lot of tissue fluid pollution, waste products of muscle cells that are metabolically “revving” with intense contraction … and those “exhaust” molecules are then accumulating, causing pain and other symptoms, and irritating the MTP even more. This is called a metabolic energy crisis, and it’s why I’ve been informally calling trigger points “sick muscle” syndrome for several years now.
But this picture of a vicious cycle perpetuated by toxicity has always been just an educated scientific guess. “The feedback loop suggested in this hypothesis has a few weak links,” writes David Simons, the world’s leading trigger point researcher.
Fortunately, new research has really helped to firm up the theory.
It may be more literally true than you realized. A muscle knot is a patch of surprisingly polluted tissue: a nasty little cesspool of waste metabolites. No wonder they hurt, and no wonder they cause so many strange sensations: it’s more like being poisoned than being injured.
It may be more literally true than you realized. A muscle knot is a patch of surprisingly polluted tissue: a nasty little cesspool of waste metabolites. No wonder they hurt, and no wonder they cause so many strange sensations: it’s more like being poisoned than being injured.
Starting with a simpler study in 2005, and then a more thorough one early this year, a group of scientists using “an unprecedented, most ingenious, and technically demanding technique” have confirmed that there really are irritating metabolic wastes floating around the neighbourhood of trigger points: “… not just 1 noxious stimulant but 11 of them,” Simons explains. “Instead of just a few noxious chemicals that stimulate nociceptors [pain sensors], nearly everything that has that effect was present in abundance.”
Basically, what the researchers did was analyze tissue samples from in and around trigger points and compared it with healthy muscle tissue. The differences were significant. The tissue of MTPs is rotten with irritating molecules: molecules associated with inflammation, with pain, and with immune function.
Trigger points are rotten with irritating molecules.Personally, I was particularly pleased to see evidence that trigger points are also strongly acidic.
I guessed that this might be the case several years ago. (The pioneer of trigger point research, Dr. Janet Travell, had already suggest the same thing, but I didn’t know that at the time.) I often told my patients that trigger points were “acidic,” because it seemed likely to be true and because … well, it just sounded good, I guess! In those days I was not as scientifically literate as I am today, and I hadn’t noticed that I was being intellectually dishonest, presenting a sketchy theory as though it were a meaningful fact.
Fortunately, the scientific evidence now supports my opinion! (And Dr. Travell’s.)
Trigger points really are strongly acidic which means that, for instance, it is actually plausible that deep breathing — which lowers blood acidity — could be relevant to treatment. One of the possible goals of massage therapy is to “flush” trigger points by pushing stagnant tissue fluids out. Perhaps if blood arriving in the area is significantly less acidic, the TrP will recover more easily? It’s certainly possible. But these days I know better how much I don’t know, so I’ll stop with just the suggestion.
Professionals are strongly encouraged to read David Simons’ analysis of both the new evidence about the chemistry of energy crisis in trigger points, as well as another new scientific article on the use of magnetic resonance elastography (MRE) imaging — a very promising new way of taking pictures of muscle knots!
Simons writes that this technology “may open a whole new chapter in the centuries-old search for a convincing demonstration of the cause of MTP symptoms.”
Unfortunately, most casual readers will be stumped by Simons’ thick scientific jargon.
For much more information about muscle knots, see my tutorial for patients and professionals.
Myofascial trigger points — muscle knots — are increasingly recognized by all health professionals as the cause of most of the world’s aches and pains. This detailed tutorial focuses on advanced troubleshooting for patients who have failed to get relief from basic tactics, but it’s also ideal for starting beginners on the right foot, and for pros who need to stay current. 232 sections grounded in the famous texts of Drs. Travell & Simons, as well as more recent science, this constantly updated tutorial is also offered as a free bonus (2-for-1) with the low back, neck, muscle strain, or iliotibial pain tutorials. Add it to your shopping cart now ($19.95) or read the first few sections for free!
