Why Not Every “Knot” Should Be Worked Deep: Understanding Abnormal Bumps, Safety, and Conservative Bodywork

There is a misconception that clients often assume that every tight spot or raised area under the skin is a knot and simply needs heavy pressure to make it disappear. The body is far more complex, and not everything should or even can be pressed, pushed, or forced into release. True deep connective tissue work as well as general massage, takes time and gradual patience with the tissues.

Sometimes what feels like a knot is actually something completely different:

• natural bony landmarks

• areas of scar tissue

• myofascial contradictions

• calcification or small bone spurs

• sebaceous tumors or benign cysts

• lipomas

• abnormal lumps that require medical evaluation, including cancer

• swollen lymph node(s)

In rare cases a lump can indicate something that needs medical evaluation. This is why I work conservatively and never try to aggressively force tissues to change. If an area does not respond like normal muscle or connective tissue, I approach it with caution and clear boundaries.

It is not advisable to attempt to break or burst a cyst, lymphoma, or abnormal bump. Doing so can cause inflammation, can possibly spread infection, or can create unnecessary harm to the connective tissue or muscle. I do not diagnose or treat these conditions, but through experience I can recognize when something does not feel like typical muscular tension. There have been times when I have come across abnormal bumps that clients later learned were cancer, which is why safety, awareness, and proper referral matter.

Myofascial release, deep connective tissue therapy and massage are not about pushing through resistance. They are about allowing the tissues to respond appropriately and naturally to touch. Too much aggression can cause the body to push back or brace. Muscles may tense, tighten, or become ischemic, which makes the work more difficult and far less effective. In many cases the body can enter a protective or traumatic response when pressure is too forceful, and avoiding that response is essential to the type of work that I do.

I also want to address the conditioning and belief system many people have been taught about deep tissue work. Deep pressure is not always appropriate or safe for every individual. It might be fine for some, but not for most. Going aggressively after what someone believes is a knot is not always advisable, especially when the structure under the skin may not be muscular at all.

I have extensive experience in knowing what to look out for, and if I notice something unusual, I inform the client so they can make an appointment with their primary physician. Once I bring something to a client’s attention, it becomes the client’s responsibility to follow up with their physician to ensure it is nothing serious. Not every abnormal bump is cancer or a cyst. Sometimes it is something simple or benign. However, it never hurts to have it evaluated by a primary physician for peace of mind and proper care.

If something does not release immediately, it does not mean something is wrong. It usually means the body needs time, patience, and mindful, gentle work rather than force. The goal is always safe, effective treatment, never unnecessary pressure.

With care and support,

Suzan (Susan) Walker LMT

Massage therapy is not a substitution for medical treatment. The massage therapist cannot diagnose, treat or prevent disease. The therapist can only recommend products and provide massage therapy services. Please consult a medical physician for further treatment.​

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