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Unraveling the Chain: How Muscle Knots Lead to Tears That Create Disability and Dysfunction

Updated: Aug 20, 2023

Hand over shoulder blade pressing a trigger point

The human body is a complex and remarkable system of interconnected components that work harmoniously to enable movement, strength, and function. Muscles play a crucial role in this intricate dance, allowing us to perform everyday activities effortlessly. However, this intricate balance can be disrupted when trigger points come into play, Aka "Muscle Knots." In this blog, we will delve into the world of trigger points, their formation, and how they can contribute to muscle tears, ultimately leading to disability and dysfunction.

What is a Muscle knot?

A Muscle knot is a trigger point, simply a dysfunction of the actin and myosin cross bridge. They are tight bands of muscle fibers that develop when muscle fibers contract and remain in a shortened state. These knots can form due to various factors, including poor posture, overuse, stress, trauma, and muscle imbalances. Trigger points are notorious for causing discomfort, pain, and restricted movement, often radiating to other areas of the body.

We can essentially think of trigger points as a kink in a chain. The muscle is trying to fire but it is stuck in a cocked position. So the body is really smart and decides to send some molecules down there to help it out, such as acetylcholine (ACh) and calcium which are what causes a muscle to contract to attempt to "unkink" the muscle. However, this causes the system to increase its acidity lowering the pH level of the muscle causing more tightness and pain! The pain you feel with a trigger point is the body's Alarm System alerting you to a problem in that area.

Two types of Trigger Points: Latent and Active

Latent trigger points are painful when you compress them, but are not painful during activity or rest. At this stage, it is still a taut band that increases muscle tension and can restrict range of motion. It is fairly easy to get rid of this trigger point with massage, mobility, and recovery techniques such as cupping. Active trigger points however are when you have pain at rest and due to the pH balance in the muscle. There has been a build up of ACh and Calcium overtime, causing even more tightness and pain even with rest.

Active Trigger Points

How can we get rid of active trigger points? The best way is to prevent them from forming. If you are an active individual, getting a massage regularly, cupping, and recovery. This will help keep your muscles functioning properly as well as addressing the root cause of your tightness such as postural, overuse, stress or muscle imbalances.

Dry Needling trigger point in the upper traps

When this fails, there is a solution to get rid of these nagging trigger points that no matter how hard you press or how many times you massage it out they keep coming back.

Dry Needling has been proven to be able to eliminate active trigger points completely by clearing out the ACh and calcium that is stuck inside of the muscle, unkinking the chain to allow the muscle to slide freely and smoothly. However, the accuracy must be precise which is a why a skilled clinician is needed and may take multiple sessions. With the use of Ultrasound Guided Dry Needling, we can actually see the trigger point on the scan and dissolve it!

Ultrasound image of a Trigger point

On this image, the black space in the muscle strands is the trigger point. With Ultrasound Guided Dry Needling we can see it, attack it, and immediately regain function within that muscle.

This is what true Recovery looks like, especially for active individuals with high demanding jobs, sports, and lifestyle.

When a trigger point forms in a muscle, it creates an area of increased tension and decreased blood flow. This compromised blood flow leads to reduced oxygen and nutrient supply to the muscle fibers, making them more susceptible to injury.


What happens when a Active Trigger Point Continues?

This is the million dollar question that can either save you a lot of time, money, and discomfort or eventually lead to dysfunction, disability and lower quality of life.

Body Builder curling weight

When a active trigger point is causing tightness in a muscle, it restricts its range of motion and ability to exert force. This places greater stress on passive structures such as the tendon, bone, cartilage, and ligaments. This can lead to tendon dysfunction often called tendinitis and even arthritis over a long enough time horizon (years) combined with other factors.

However, this is not inflammation of the tendon but rather stress due to the inability of the muscle to take on that stress of the particularly activity/movement we are doing. Rather, this is tendinosis, this is deterioration of the tendon area that attaches to the bone. Very difficulty to get rid of once it has formed and requires extensive rehab to correct the root cause, fix the tendon, and teach our nervous system how to load properly.

Where is this all going? The Muscle Tear.

Once a tendon reaches tendinosis, it goes through another stage called tendinopathy and then disrepair. Scar tissue and different types of collagen fibers form inside of the tendon where the stress is and its not as strong or elastic as the original. This area is now susceptible to greater injury and through constant stress without full relief can lead to tears and full ruptures. This can significantly impact your lifestyle, function, and lead to other disabilities/complications such as the formation of secondary conditions.

Read this excellent article on Tendonitis written by Steven Low if you wish to know more! There are other routes that can lead to this condition and the more you know the better prepared you will be!

Where do we go from here?

If you get to this stage, have no fear there are a number of solutions out there now that do not include surgery!

Platelet Rich Plasma (PRP) Injections

PRP injections involve taking your blood, spinning it, and collecting the platelets among other cells that help to repair damaged tissues to their original function.

Ultrasound Guided Dry Needling

Sports Rehab and Strengthening

Long Story Short: Get your Trigger Points Fixed!

That nagging shoulder injury, the long dull discomfort in your hip, the tightness in your low back, the constant self massage you attempt to do on your forearm to get relief, all of these are your body telling you it needs to release those trigger points!

The Vicious Cycle: Disability and Dysfunction

When trigger points are left untreated, they can create a vicious cycle that ultimately leads to disability and dysfunction. Here's how it unfolds:

  1. Pain and Discomfort: Trigger points themselves cause pain and discomfort. This can result in altered movement patterns as individuals instinctively avoid using the affected muscles, leading to muscle imbalances and compensatory movement.

  2. Limited Range of Motion: As trigger points limit the muscle's ability to stretch and contract properly, the affected muscle's range of motion becomes restricted. This limitation affects everyday activities and can even hinder the performance of athletes and active individuals.

  3. Increased Risk of Injury: With compromised muscle function and reduced flexibility, the risk of muscle tears and other injuries significantly increases. Engaging in physical activities without addressing trigger points can lead to more severe tears and longer recovery times.

  4. Chronic Pain: If trigger points remain untreated and continue to contribute to muscle tears, chronic pain can develop. This pain can become a constant companion, affecting the quality of life and mental well-being.

  5. Disability: In severe cases, the cumulative effects of trigger points leads to muscle tears leading to disability. Individuals may find themselves unable to perform routine tasks, work, or pursue their hobbies.

Prevention and Treatment

Preventing the formation of trigger points and minimizing their impact on muscle tears is crucial for maintaining optimal musculoskeletal health:

  1. Maintain Good Posture: Proper posture reduces the strain on muscles and prevents the development of trigger points.

  2. Regular Exercise: Engaging in regular, balanced exercise routines can help prevent muscle imbalances and maintain muscle flexibility. Cross training is another great way that will work other muscles you normally wouldn't work with a specific activity.

  3. Massage and Recovery: Targeted massages can help release trigger points and prevent their formation, finding a local Sports Physical Therapist is imperative in maintaining your function and save you a ton of time and money in the future.

  4. Hydration and Nutrition: Staying well-hydrated and maintaining a balanced diet supports muscle health and recovery.

  5. Stress Management: Managing stress through relaxation techniques can reduce the likelihood of trigger point formation.

  6. Seek Professional Help: If trigger points are causing persistent pain or dysfunction, consult a medical professional or physical therapist for proper diagnosis and treatment.


The interplay between trigger points and muscle tears can create a domino effect that leads to disability and dysfunction. Understanding the relationship between these two phenomena underscores the importance of early intervention and proper care. By taking proactive measures to prevent and treat trigger points, we can safeguard our muscles, maintain mobility, and ensure a higher quality of life. Remember, your body is a harmonious symphony, and keeping every instrument in tune is essential for optimal functioning.

Bron C, Dommerholt JD. Etiology of myofascial trigger points. Curr Pain Headache Rep. 2012 Oct;16(5):439-44. doi: 10.1007/s11916-012-0289-4. PMID: 22836591; PMCID: PMC3440564.

Celik D, Mutlu EK. Clinical implication of latent myofascial trigger point. Curr Pain Headache Rep. 2013 Aug;17(8):353. doi: 10.1007/s11916-013-0353-8. PMID: 23801006.

Hakim IK, Takamjani IE, Sarrafzadeh J, Ezzati K, Bagheri R. The effect of dry needling on the active trigger point of upper trapezius muscle: Eliciting local twitch response on long-term clinical outcomes. J Back Musculoskelet Rehabil. 2019;32(5):717-724. doi: 10.3233/BMR-181286. PMID: 30636729.

Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician. 2002 Feb 15;65(4):653-60. PMID: 11871683.

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