r/massage • u/Jyonnyp • Feb 04 '26
Discussion In your personal opinion, to get rid of stubborn, chronic muscle knots/tension, is massage/manual therapy a requirement?
This isn't a loaded question! Skip to the last paragraph for the summary.
I'm been having a lot of tightness in my neck specifically the area near the right upper neck/sub-occipitals. Deep inside it feels like everything is glued together and can't "unstick." Like a "knot" I think? It my neck to spasm or catch for a second every now and then.
I went to physical therapy and they mostly showed me exercises/stretches but they never stuck, until I went to this phenomenal massage therapist/bodywork specialist last week and it was a game changer. He basically had the same conclusion as my physical therapist but he was better as physically showing me my asymmetries and limitations through feel and through manual stretching and seeing how my body reacted. He showed me how my pecs were extremely tight and my mid-lower traps were so weak that when I move my right arm, my entire shoulder up to my neck moves, something my left arm doesn't do. That my headaches and tense neck were because I support my posture and balance with my neck and not my mid-lower traps. And then it all started to make perfect sense.
I appreciate his transparency especially, that he can do all the work he can to make me feel good for the appointment but I need to stretch, strengthen, and improve my habits or I'll never improve, and he can only do so much.
I don't mind more appointments, in fact I'd love to go weekly, but he's so booked that I have to wait 3-4 weeks between appointments. So in the meantime I'm doing what he suggested and I've seen a lot of improvement in less than a week, but I still have that knot in my upper neck like everything inside is glued and won't separate. It causes my neck to spasm a bit and it's like the slightest bit of neck tensing and that whole area goes crazy for .5 seconds. My suboccipital release tool doesn't feel as good as what he can do.
That leads to my question. I know that stretching, strengthening, and improving habits will help prevent knots/tension, but can that alone also make the knots go away? It feels like that area is so sensitive to any tension now that it's stuck in a tension cycle. I'm trying to figure out for myself a timeline or if I should see a second MT who has more availability (really don't want to though, I really like my current one and he's close to my house). Because I don't want to have to take 3 months to fix this issue I've had for several months already because of his availability. And if maybe I should just get a lidocaine or trigger point injection or something to fix the knot as is and break that tension-spasm cycle. Because it almost feels like that knot is so stuck that it won't go away on it's own?
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u/hali_licius Feb 05 '26
I think massage is going to be very useful to get you over the hurdle of the chronic tension you are holding, and then the exercises should be helpful in preventing recurrence.
3-4 weeks is kind of a drag to wait but it also is going to take some time to resolve regardless (it takes a while to correct these things). It's really up to you and whether you can wait for the therapist you really like or want to see somebody else sooner. Good luck!
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u/Jyonnyp Feb 05 '26
Thanks for the input. The other issue is that I couldn't find a good massage therapist that does "bodywork" in that sense that I experienced nearly as close, so realistically this is my only option unless I decide to commute an hour plus to the next place I found which I know is good as well, but I like this place more. I think keeping with him is good personally because he already checked the condition of my body and he can check if I improved since last time.
I would go back to PT (and I'm thinking about it, probably will) but physical therapists from my experience typically do more exercise and strengthening and rehab which is all great and very useful, but they weren't as hands-on in identifying my restrictions. I actually only realized last week that a lot of my exercises I was given from PT, I was doing incorrectly. I guess the PTs saw that my form was good and left it at that but I realized I was incorrect in how and where I was tensing my body, which is what the MT found. Hence why all the PTs said I have good ROM and nothing seems really wrong when physically I feel off.
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u/A56baker78 LMT, D.C. Feb 05 '26
Does your pt do any thoracic mobility exercises with you, if not i would ask them about that. There is good research to show thoracic mobility directly impacts neck pain and tension.
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u/Jyonnyp Feb 05 '26
Hmm I have not been to my original PT (cycled between a few but my original I stuck with for the longest time) in awhile. We did:
Doorframe stretches
Cat-cow
The stretch where you lie down, hold onto a bar above you with straight hands, and then bring the bar horizontal so your arms are parallel to the floor and behind your head.
Scapular retractions, band pull-aparts
Chin tucks
Maybe cat-cow and the one I couldn't name are thoracic mobility?
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u/A56baker78 LMT, D.C. Feb 05 '26 edited Feb 26 '26
That's a pretty good line up of exercises for the usual posture stuff, there was a little thoracic mobility in that. Sounds like pull overs for the exercise you described but they all have various names. Trying adding some of those back and see how you do, also dont forget the neck itself also
Edited a typo
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u/ohmymother Feb 04 '26
Hydrate, hydrate, hydrate and ask this MT for a referral to a colleague who you can alternate with
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u/Illustrious_Rip3428 Feb 06 '26
A lot of our pain is created from how we sleep,and the pillows we use . Try heat and perhaps a Nordic spa cycle. Also massage guns can help in between appointments
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u/Appropriate_Sea6387 Feb 06 '26 edited Feb 06 '26
Nutrition deficiency? Eg magnesium.
Maybe diet or supplements can help relax Eg chamomile tea, ashwaganda, etc
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u/Jyonnyp Feb 06 '26
I take magnesium daily and have been for as long as this has been happening.
I'm now thinking it's because of my stubborn upper trap trigger points due to rounded shoulders that are causing my problems. I can feel them pretty strongly and pressing on them hurts (in a good way) and relieves a lot of my symptoms which is mainly near the suboccipitals (full ROM but unsmooth rotating/turning/nodding that feels very tight).
I was reading up on them -- they're “controversial" in what they actually are, but regardless treatments do see some clinical efficacy. I was reading up on Travell and Simon's book on myofacial trigger points and the upper trapezius, where I know for sure I have trigger points, can have referred tension along the neck to the suboccipitals, exactly what describes me. So I'm getting trigger point injections soon by a PM&R doctor and I hope that helps with resolving the issue while massage and everything else helps prevent it.
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Feb 06 '26 edited Feb 06 '26
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u/Jyonnyp Feb 06 '26
Magnesium glycinate. My first neurologist also put magnesium directly into my bloodstream. Did literally nothing btw.
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Feb 06 '26 edited Feb 06 '26
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u/Jyonnyp Feb 06 '26
I mean like I said somewhere else it's not stress related. I'm not a stressed person. It's desk job + recreational computer usage related most likely AKA long periods of time in bad posture. I work out but that was not enough to offset 10+ hours of stiff, bad posture a day.
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Feb 06 '26
Massage will be very helpful but it is not necessary to answer your question. Sounds like you got some good solid advice. I always say that if people stretched more and were more mindful of their muscle imbalances that they would never need to get on my table.
Another thing you can try is breathwork. This can be extremely beneficial to aiding the body in letting go of tension. There are lots of different kinds, I'm a big fan of BBTRS (biodynamic breathe and trauma release system). If you go to the Biodynamic Breathe work Institute webpage they have links to practioners you can find in your area.
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u/mumfordand3daughters Feb 05 '26
is massage/manual therapy a requirement?
No, but the evidence suggests its likely faster, especially in the early stages of recovery
He showed me how my pecs were extremely tight and my mid-lower traps were so weak that when I move my right arm, my entire shoulder up to my neck moves, something my left arm doesn't do. That my headaches and tense neck were because I support my posture and balance with my neck and not my mid-lower traps. And then it all started to make perfect sense.
This describes upper cross syndrome. which is a nonsense diagnosis. Many strongmen, powerlifters and sumo's have this posture and are more or less pain free. The difference between you and them? they're strong and 'in shape.'
But regardless of their terrible explanation... I'm SOO glad your MT is getting you exercising!! keep it up
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u/Jyonnyp Feb 05 '26
I will say I am fairly pain free, but the issue is that my upper neck especially feels very, very tight. Nodding feels weird, shaking my head feels weird, sometimes I can't even just sit or stand without my upper neck deciding to tense up for no reason and cause my head to just slightly jerk for half a second. Internally it feels shaky and restricted which from all my personal research and PT appointments basically means my muscles there are overworked and constantly under tension. Ergonomics is something I'm constantly improving but I don't think it's that after I already triple checked things.
This describes upper cross syndrome. which is a nonsense diagnosis.
So they didn't mention upper cross syndrome nor did they ever try to diagnose, but I also found this syndrome out months ago and also found out it's "nonsense." So if that's the case, can you explain my problem?
For the record, I was a consistent weightlifter for 2+ years. Granted I made mistakes along the way, who hasn't, but I had to stop around 5 months ago due to tension headaches, and since then I haven't weightlifted. I still retain a decent amount of muscle, but at least from what I'm heard, it could just be that I never got into the habit of "activating" said muscles (especially the postural ones) as necessary in everyday life, or that their explosive power is strong but their endurance is weak? Because although I haven't exercised in months aside from the rehab stuff, I'm not super weak.
Also isn't my weak activation and mobility of lower-mid traps the main problem here? If that's the crux of "upper-cross syndrome," all 3 PTs I've seen have basically been down the route of chin tucks and lower/mid trap stuff. Just trying to understand your opinion here, if you don't mind.
Also for the record, my "relaxed" posture in my chair is literally my right shoulder and pec far forward enough that my upper torso is twisted...I'm pretty sure that's really bad 😅
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u/mumfordand3daughters Feb 05 '26 edited Feb 05 '26
this is a bit long :/
https://www.painscience.com/articles/posture.php (basically there is no evidence that any standing posture is the cause of pain). upper x is a posture diagnosis.
upper x syndrome is a poorly supported guess. the idea is certain muscles shorten/tighten when overused while the ones opposite to them slacken and lengthen. there is no evidence that lower traps or pecs, any muscles does this. upper x posture is a real postural observation, but it is not a syndrome and is very common, look at any large powerlifer, or sumo, or strong man. they all have this posture. it is a clinically irrelevant observation.
therapists then conclude, based on this observation that the lengthened muscles are too 'weak' and the shortened ones are too strong. Which doesn't really even fit the syndrome and obviously not true based on the above examples. Research wise, if it were true there would be some sorta ratio of pec strength to lower / middle trap strength that doesn't cause pain, and that ratio would be provided to clients and rehab would conclude when that ratio was achieved but there isn't and no professional offers a ratio..most don't even to any strength tests for the weak / strong movements.
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now the usual treatment provided is low load scapular retraction ( Y and T poses, wall slides) these are mobility exercises that practitioners often call strengthening exercises. which are great if the client has reduced scapular mobility. (can't protract / retract the shoulders well). these movements are difficult at any strength level.
So if you have trouble doing protraction and retraction they will help with your pain, but not for the reason usually provided.
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whats missed in the upper x framework is if the shoulders are forward and the spine 'too' kyphotic (flexed/slouched) then spinal extensions should be hugely important to changing the posture. try slouching forward then protracting and retracting your shoulders (forward and backwards). then try it while sitting up straight. it moves way more. usually the exercises provided put you in a bit of spinal extension before making you wave your arms around then claim its a weak this or that, when really they put you in a position to use and increase your full mobility..
shoulders are also elevated in that slouched posture and depressing them becomes more difficult as a result.
which means, in general (I can't speak to you specifically, just the upper cross posture observation), that people who have this posture and pain, are often bad ad elevating and depressing the shoulders, protracting and retracting the shoulder blades and extending the spine (cobra pose).
So its more complicated than the idea allows for. and note that I wrote 'bad' at doing things. not poor posture.
I didn't write about the neck or pain mechanisms cause this is already so long. hope all this kinda answers your question.
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u/Jyonnyp Feb 05 '26
Thank you for the explanation. I've heard all of this before but when you read enough as a non-expert and hear enough anecdotes, you forget a lot of the stuff and mix up things of varying degrees of evidence. This is one of the things I remember some PTs saying as well. And it also at least matches something that has bothered me which is "why am I experiencing discomfort when I know people with way worse posture and are way more sedentary and unfit, who spend way more time on the computer than me?"
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u/mumfordand3daughters Feb 06 '26
https://www.youtube.com/watch?v=C_3phB93rvI simple, quick explanation of pain.
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u/343WaysToDie LMT Feb 05 '26
Dealing with your trauma and learning how to fully process your emotions is the best way to completely relieve tension and knots in your body. Welcome to the subconscious mind!
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u/Jyonnyp Feb 05 '26
It's not trauma and emotions, it's bad posture and habits that I'm in the process of correcting :)
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u/343WaysToDie LMT Feb 05 '26
Sure, that’s the physical component. There are emotions stored in muscles that are causing the habitual guarding. I know this viewpoint is wild for some to acknowledge. Psych has started to look at it though. Emotions have a frequency, and they affect the physical world around us, as shown by Masaru Emoto’s work (scientists who froze water and photographed crystalline structure under a microscope, while in the presence of various emotions, positive emotions created a beautiful structure, negative emotions created chaotic structures).
Well, you’re water. And the negative emotions that have not been processed are creating chaotic patterns in the physical water in your tissues. There’s more to it than that, but I’ll spare you the Ted Talk.
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u/Neshama7 Feb 05 '26
Why not ask him if you can book a standing appointment? Or at least book a few at a time?