How do we get them, and how do therapist massage them out?
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I edited and combined my comments on this top level for clarity. This topic is dear to my heart as a yoga teacher (fascia is a big factor in yoga) and as my PhD is related to fascia as well.
Muscle knots are also known as sites of myofascial pain. We have something called fascia running between and inside every muscle all through the body. It is all connected in lines spanning the whole body. When fascia sticks together it creates knots. The reason fascia will stick together is due to the muscles not moving enough (in the right ways), giving the proteins in each layer the chance to entangle with one another. (eventually this will make muscles actually stick together and reduce your mobility!) This in turn reduces the fluid flow between the layers, lessening the exchange of waste products of the muscle (toxins) to the blood.
Grab a handful of your shirt and twist it. Notice how there is now tension on the whole shirt? Similarly, that twist happens in the fascia. This happens naturally and accelerates with dehydration, bad posture, and incorrect movements. This tension will hinder the mobility and strength in the whole line.
When a muscle uses energy required to contract it creates waste products, we can call them toxins. The toxins (reactive oxygen species and others) build up which causes an inflammation reaction which causes pain. The mechanism is quite complex. Other explanations here are more focused on the muscle itself which I believe plays a big part in this as well.
By placing pressure and stretch on the knots you are moving the muscle and layers of fascia apart, breaking the tangles of the “knot”. Now fluid can flow, and toxins will release. This is why you need to drink lots of water after a deep tissue massage to reduce the concentration of toxins as you process them out of the body. Else you will get headaches and the toxins will not wash out of the muscle. When massage therapist talk about toxins they are correct. But they can sound a bit woowoo because they do not know this explanation.
Unfortunately, fascia is not as known as it should be due to it not being given any attention on during cadaver prosection during medical school. It is deemed to be in the way of the interesting muscle and organs. Partly this is due to the preserving agents used to conserve cadavers changing the texture of the fascia.
Please allow me to include an excellent reference:
Jafri,M. S. (2014). Mechanisms of Myofascial Pain. International Scholarly ResearchNotices, 2014, 1–16.[https://doi.org/10.1155/2014/523924 ](https://doi.org/10.1155/2014/523924 )
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