What Are Knots, Adhesions and Trigger Points? By Amy Harrop 


When you have a sports massage you may have experienced certain areas when pressed that are more painful, sometimes in areas you didn’t even think should hurt and you may of heard the terms knots, adhesions or trigger points. 

Knots & Trigger points are small sections of the muscle that has remained contracted (Ingraham & Taylor, 2018). They will often feel like lumps within the muscle and will range in size. This section of muscle fibres is cut off from the nervous system meaning it’s not getting signals to relax (Garrison, 2014). It then starts to lose blood supply, so becomes starved of oxygen and rich in toxins (Ingraham & Taylor, 2018). Not all trigger points and knots will cause pain but if left untreated it could get worse and pain may increase. 


Adhesions can feel similar but generally have more of a bubble wrap feel. Garrison (2014) states it can feel like “Snap, crackle and pop”. The body contains fascia which is a continuous connective tissue that partitions and supports structures in the body (McGuinness, 2006)

. It’s like a big smooth sheet with pockets containing all your muscles and organs keeping them; separate, the correct shape and allowing them to slide past each other without becoming mixed up and tangled. This normally smooth tissue can become ‘sticky’ meaning that structures within the body that normally glide past each other now do not creating tension and limited movement (McGuinness, 2006 & Garrison, 2014). If untreated the area effected can expand, if you think about 2 surfaces one smooth and one with abrasions on as they are rubbed together the abrasive surface will damage the smooth making that abrasive too. 


You may not experience the pain directly where the knot, adhesion or trigger point is, the body is connected so manipulating one area will have an effect on others, also known as pain referral (Ward, 2004). For example I have treated people with aches and pain in their upper back and shoulders by releasing trigger points in the muscles in the front of the neck (scalenes and Sternocleidomastoid).  The pain generally felt in this situation is the overworking or stretching of the opposing muscles to counteract the shortened area of the muscle. Often you will feel an increase in the referred pain when the right trigger point is massaged (Ward, 2004). So treating ‘sciatic pain’ by releasing the piriformis (muscle in the bum) trigger point often sees an increase in pain down the outside of the leg sometimes reaching the toes. 


So why do we get these knots, adhesions and trigger points?

They can be caused by lots of different things and sometimes it can be frustrating that there is no one answer. They can be caused: excessive training, not training, postural imbalances, trauma, stress, illness, diet, exposure to cold and many more reasons (Ward, 2004). One of the most common I have come across is from posture, whether it’s an imbalance in muscles from a sedentary computer based job or an imbalance from always swinging the racket with the right hand. As a therapist I feel it’s important to address the cause as well as the symptoms. If you work out the knots, adhesion and trigger points you will get relief from pain but if you don’t address the cause it is very likely that they will keep returning. 



(1) Ingraham, P. & Taylor, T. (2018), ‘Trigger Points & Myofascial Pain Syndrome.’Sesnible advice for aches, pains & injuries, 9 June. Available at:https://www.painscience.com/tutorials/trigger-points.php (Accessed: 24 June 2018)

(2) Garrison, Liz. (2014) ‘Deep Tissue: What are Knots, Adhesions and trigger points?’ Elements Massage, 22 December. Available at: https://elementsmassage.com/preston-hollow/blog/deep-tissue-what-are-knots-adhesions-and-trigger-points- (Accessed: 24 June 2018)

(3)  Ward, K. (2004), Hands on Sports Therapy, Hampshire: Cengage Learning, pp. 256, 418, 426

(4) McGuinness, H. (2006) Anatomy & Physiology, London: Hodder, pp. 105