A Better Way to Explain What Clients Feel Most massage and soft tissue therapists have heard a client say, ‘I’ve got a knot in my shoulder’, or ‘Can you get rid of this knot?’ It is familiar language, and it makes sense. When an area feels tight, tender, heavy, lumpy, sore or uncomfortable, ‘knot’ gives […]
A Better Way to Explain What Clients Feel
Most massage and soft tissue therapists have heard a client say, ‘I’ve got a knot in my shoulder’, or ‘Can you get rid of this knot?’ It is familiar language, and it makes sense. When an area feels tight, tender, heavy, lumpy, sore or uncomfortable, ‘knot’ gives the client a simple way to describe what they feel.
The problem is not the client’s word. The problem is when therapists turn that word into a physical claim.
For many years, massage has often been described as if therapists are finding knots in muscle and breaking them up, rubbing them away or smoothing them out. It is a simple story, but it is not an accurate one. Muscles do not tie themselves into little knots like string, and there is no good evidence that a therapist can feel a literal knot and mechanically break it apart.
What the client feels is real. Their tenderness, tightness, pressure, heaviness or discomfort is real. The change they may feel after massage can also be real. The explanation just needs to be better.
A therapist may feel an area that seems firmer, warmer, more resistant or different from the surrounding tissue. That is part of palpation. However, a therapist cannot know that an area is tender or sensitive from touch alone. Tenderness is something the client reports. Sensitivity is part of the client’s experience, not something the therapist can diagnose through their hands.
A better conversation might be:
‘When I press here, how does that feel?’
The client may say, ‘That’s the spot’, ‘That feels tender’, or ‘That feels like the knot I was talking about.’ At that point, the therapist and client have identified an area that feels relevant to the client. The therapist has not discovered a physical knot. They have used touch, observation and client feedback to guide treatment.
Some of these areas may overlap with what have traditionally been called myofascial trigger points. These are often described as tender areas in muscle, sometimes associated with taut bands and referred discomfort. However, the science around trigger points remains debated. There are ongoing questions about what they are, how reliably therapists can identify them, and whether palpation alone is enough to make confident claims.
This does not mean therapists are imagining what they feel. It means we need to be careful with language. When a therapist presses into soft tissue, they are feeling skin, superficial fascia, fat, muscle, fluid, tone, temperature and resistance. They are also interpreting those findings through training, experience and clinical reasoning. The client’s feedback is essential.
A ‘knot’ is probably best understood as a client description of a felt experience. It may involve tenderness, increased tone, guarding, pressure sensitivity, local discomfort or an area that the nervous system is paying more attention to. It may also be influenced by stress, sleep, workload, repeated movement, previous pain, confidence and general health.
Massage may still help. Hands on therapy can provide steady, reassuring sensory input. It may help a client feel calmer, less guarded, more comfortable and more confident in movement. It may change how the area feels and how the person responds to it. That is valuable, but it does not require the story that a therapist is breaking up knots.
A more accurate explanation would be:
‘You are describing this area as tight or tender. I may feel some increased resistance here too, but I need your feedback to understand how it feels to you. We can work with it gradually and keep the pressure useful rather than overwhelming.’
Or:
‘It is common for people to describe areas like this as knots. It may be more helpful to think of them as areas that feel guarded, tender or more noticeable at the moment.’
This keeps the client’s experience respected without turning a metaphor into anatomy. It also avoids making the client feel damaged, full of adhesions or in need of being fixed.
Good massage does not depend on claiming to break up muscle knots. It depends on listening, asking, adapting and explaining clearly. The client’s perception is real. The therapist’s hands can be useful. The old story just needs updating.
References
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Mak, S., Allen, J., Begashaw, M., Miake-Lye, I., Beroes-Severin, J., De Vries, G., Lawson, E. and Shekelle, P.G. (2024) ‘Use of massage therapy for pain, 2018 to 2023: a systematic review’, JAMA Network Open, 7(7), e2422259. Available at: https://doi.org/10.1001/jamanetworkopen.2024.22259
Müggenborg, F., de Castro Carletti, E.M., Dennett, L., de Oliveira-Souza, A.I.S., Mohamad, N., Licht, G., von Piekartz, H. and Armijo-Olivo, S. (2023) ‘Effectiveness of manual trigger point therapy in patients with myofascial trigger points in the orofacial region: a systematic review’, Life, 13(2), 336. Available at: https://doi.org/10.3390/life13020336
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Rathbone, A.T.L., Grosman-Rimon, L. and Kumbhare, D.A. (2017) ‘Interrater agreement of manual palpation for identification of myofascial trigger points: a systematic review and meta-analysis’, The Clinical Journal of Pain, 33(8), pp. 715 to 729. Available at: https://doi.org/10.1097/AJP.0000000000000459
Zhai, T., Jiang, F., Chen, Y., Wang, J. and Feng, W. (2024) ‘Advancing musculoskeletal diagnosis and therapy: a comprehensive review of trigger point theory and muscle pain patterns’, Frontiers in Medicine, 11, 1433070. Available at: https://doi.org/10.3389/fmed.2024.1433070
Established in 1992 and officially recognised by the Scottish Government, the Scottish Manual Therapists Organisation (SMTO) is the foremost and longest-standing association for soft tissue, massage, and manual therapy practitioners in Scotland.
