When someone is "working out knots" during a massage, what is actually happening to the muscles?

It's tension that tends to make the muscles and tendons go really tight and rigid. So when they are massaged the process is squeezing out this rigidity. When your muscles and tendons start to go back into their normal shape and relaxed state then you will get some pain - depending on the amount of tension present.

As the muscles and surrounding tissues re-shape themselves into normal position, this will of course jangle a few nerves as well, that have also been caught up in the tense muscles. It is definately progress. Unfortunately it can range from painful to uncomfortable depending on the muscles, the area of the body being massaged and each indiviuduals pain threshold.

But the pain involved is the process of muscles etc. , going back into a normal state.

Massage allows for increased blood flow to the "knots. " When someone is working specifically on a knot or knots directly it is commonly known as Trigger Point therapy. Direct pressure to the knotted area causes the contracted muscles to twitch and sends a signal to the brain to send fresh blood to the area.

Upon doing so the muscle will then relax and the knot will either disappear or become dormant. Many knots usually are caused by a remote trigger point (a knot located in another area but feels like the local area) and until the main trigger point in addressed the knot and the pain associated with it remain.

My understanding is that a "knotted" muscle is simply tightly contracted for what ever reason. The massaging action simply helps the muscle relax and return to its normal state. At least, that's what I was told ...

Massage is the manual manipulation of soft body tissues. Rubbing, kneading, rolling, and pressing the tissue increases blood flow and warmth, relieves muscle tension, and promotes relaxation.

When you receive a massage, it allows the muscles to relax and fresh blood with oxygen and nutrients to flow back in.

A knot is a contraction or spasm in a muscle. The most common cause is over-work. That means that you are over-working some of your muscles.

The knots form because the spasm keeps the muscle continuously "on". Normally, even when doing heavy lifting, no muscle is working continuously. Instead, as the body moves in normal activities, different muscles cycle on and off.

The muscle spasm makes the muscle work continuously, around the clock.

After some amount of time the muscle overloads and forms these knots.

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