Knots in muscle are also known as myofascial trigger points (MFTPs), trigger points and tender points. Their name, cause and identification can be contentious but they are a very common phenomenon and frequently contribute to muscular pain.
Knots usually have these characteristics:
Feel lumpy,hard or gristly in a taut band of muscle.
May be sore or tender to touch.
On pressing a knot it may cause pain to radiate outwards or produce pain in another location.
Knots can appear in groups with a primary trigger point surrounded by secondary points.
They may align with acupuncture points.
Skin over a trigger point may be slightly warmer than the surrounding area.
Trigger Points in levator scapulae. Taken from The Concise Book of Trigger Points by Simeon Niel-Asher
Trigger points are usually described as a hypersensitive group of muscle fibres. They may develop following stress or strain to muscle e.g. overuse, sustained poor posture, emotional stress. It seems likely that poor diet contributes to the formation of trigger points.
There are lots of treatment options for knots. Their efficacy varies from person to person and also depends on the location and severity of the knot. Usually it’s best to use a combination of techniques. It’s difficult to get rid of knots entirely but you can definitely minimise them and reduce pain levels.
stretching. including muscle energy techniques (METs)
It is possible to treat trigger points at home but you should see a qualified therapist or your GP to confirm the diagnosis. There are more serious conditions which can appear similar to trigger points but require medical treatment.
Intervertebral discs sit between the bones in your spine (vertebrae) and act as shock absorbers. They also contribute to the flexibility of your spine.
Spinal Anatomy taken from Functional Anatomy of the Spine Middleditch & Oliver
Discs sit in the anterior (front) part of your spine so you can’t feel them through your skin. When you touch your spine you are feeling the Spinous Processes, which are the pointy bits of each vertebra shown on the picture above.
There are a few components of the disc which are useful to understand. At the top and bottom of each disc is the vertebral end plate, which grows into the adjacent bone and helps provide nutrition to the disc.
Anatomy of intervertebral discs taken from Functional Anatomy of the Spine by Middleditch & Oliver
If you take a horizontal slice through a disc you can see outer rings. This is called the annulus fibrosus. The centre of the disc is made of a thick gel called the nucleus pulposus. This structure allows your discs to stretch and move.
The outer part of your discs are supported by several of your spinal ligaments, which join bone to bone and also grow into the annulus fibrosus.
What’s a slipped disc?
Your discs don’t actually slip anywhere, they are held firmly in your spine so they cannot come out of place. They can become injured, irritated or change shape which may lead to pain. Interestingly MRI studies have shown that many people have disc ‘injuries’ with no pain or stiffness!
We think that several different things can happen to your discs.
Firstly the outer annulus can become torn. This may lead to inflammation and then to pain and muscle guarding.
Secondly the disc may change shape and bulge outwards. This can happen anywhere around the edge of the disc but is most common towards the back and side. A disc bulge can be very small or more substantial. They can also change depending on your position.
If a disc bulge is close to a nerve root it may irritate the nerve or squeeze it. This can cause pain, pins and needles or numbness along the path of the nerve. A famous example of this is sciatica.
Disc injuries are very common. Most people make a full recovery with conservative care such as exercise, stretching and manual therapy (including osteopathy).
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Reaching a diagnosis is a bit like being a detective and collecting as many ‘clues’ as possible.
We start by looking at your symptoms. Sciatica usually presents with pain shooting down the back of your thigh and calf. You may also have pins and needles or numbness in your leg or foot. You may find it difficult to straighten your leg and prefer to bend your knee. It may also be very painful weight bearing on that leg.
Sciatica may also cause pain in your low back or buttock.
Then we move on to a physical examination. Sufferers of sciatica often have altered posture due to pain (we call this antalgic posture). You may avoid weight bearing on the painful side and you may lean to one side.
Flexibility of your low back, hips and knees may be reduced due to pain and muscle guarding, so you might find it difficult to bend. Often there will be restriction and soreness around the low back or buttock.
I usually perform some tests to your low back where I gently compress your spine. This can be quite uncomfortable if you have sciatica caused by a bulging disc.
I also use the Straight Leg Raise (SLR) test. This is very simple – you lay down on your back and I lift up your leg while keeping your knee straight. This stretches the sciatic nerve. Normally this is not painful but if the nerve is irritated for some reason, SLR will probably cause pain or pins and needles.
Sometimes I will also test your reflexes and perception of touch.
Sciatica has several potential causes including disc herniation and piriformis syndrome. There are also many other conditions which may mimic sciatica in some way. So I also examine your hip joints, sacro-iliac joints, knees and many of the muscles in your low back, buttock and legs.
I do not routinely suggest further investigation such as MRI, although they may be useful in some cases.
Once we have worked out what’s causing the problem I can focus your treatment on the most relevant areas.