Our muscles are constantly being flexed, whether we’re working out or not. Even typing on a keyboard tenses some muscles in your hands, arms and wrists.
But for one reason or another, certain bands of muscle in your body can flex and remain flexed, even if you’re not actively flexing them. These areas of sustained muscle contraction and increased tension — what doctors call myofascial trigger points and laypeople know as muscle knots — are a common culprit of neck and back pain.
If you’ve ever felt a tightness or tenderness in your neck, back or buttocks, then you may have very well experienced a muscle knot or two. You might have even felt an actual lump underneath the area where it’s sensitive or hurts.
What causes these knots to form in the first place and how can you get rid of them? Dr. Jeremy Fleeks, a primary care sports medicine physician at Houston Methodist, provides the answers.
What causes muscles knots to form?
There are lots of ways you can get a muscle knot, but they all primarily involve some sort of injury to the muscle in question, according to Dr. Fleeks. This trauma, for a variety of potential reasons, causes your body’s normal muscle relaxation mechanisms to fail, leading to persistently tense areas of muscle that just won’t relax, says Dr. Fleeks.
For example, one of the most common ways people get muscle knots is by overusing a particular muscle, such as pushing too hard during a workout or not allowing muscles to rest and recover enough before subjecting them to further stress, he says.
Conversely, you can also develop muscle knots by not moving at all, such as sitting at a desk all day. This example of poor posture creates extra strain on muscles that are supposed to be relaxed, creating opportunity for injury. Over time, repeated strains to a particular muscle can further contribute to the development of muscle knots, says Dr. Fleeks.
(Related: 3 Work Desk Mistakes That Can Lead to Bad Posture & Pain)
“While trigger points can develop in any skeletal muscle, among patients with myofascial pain, most trigger points are found in the trapezius muscle,” says Dr. Fleeks. “Back muscles are particularly susceptible.”
The trapezius muscle is a large, trapezoid-shaped muscle in your upper back and neck responsible for stabilizing your head, neck and shoulders and promoting good posture.
Other areas of muscle that Dr. Fleeks says are most susceptible to forming muscle knots include your buttocks, lower back and neck.
Some people are also more susceptible to developing muscle knots, says Dr. Fleeks. Poor posture, a sedentary lifestyle, stress, conditions that affect muscle metabolism and previous muscle injuries or trauma are all additional risk factors that make certain people more at risk to developing muscle knots over others, he says.
What do muscle knots feel like?
The most common symptom of muscle knots is pain, but how do you differentiate muscle knots from, say, a strain or cramp?
“Strains are partial stretches or tears in a muscle that usually are the result of an acute injury, while a cramp is a temporary and involuntary muscle contraction that usually resolves spontaneously,” says Dr. Fleeks. “Trigger points or muscle knots can cause pain through a combination of local tissue changes and nerve inflammation. They’ll include a hypersensitive spot within a taut band of muscle that contains sensitized receptors.”
“When palpated or touched, these trigger points produce characteristic referred pain patterns along specific zones or areas of the body, a local twitch response or at least two complementary symptoms, such as limited range of motion or pain during muscle contraction,” he adds.
Referred pain is when you experience pain in a different location than what’s causing it, such as getting a brain freeze when you eat something super cold; a local twitch response is a brief muscle spasm that happens when you stimulate a trigger point — either with a needle or palpation (your hands).
(Related: Is Your Pain Just Muscle Soreness or a Serious Injury?)
How do you get rid of muscle knots?
With enough rest, hydration and movement, most muscle knots will loosen up and relax on their own. That said, Dr. Fleeks shares a few treatments that can help to reduce irritation and pain and accelerate healing.
“Massage, physical therapy and osteopathic manual medicine are first-line treatments for muscle knots that have some supporting research in clinical trials,” he says. “Evidence supports the use of local anesthetic injections, but trigger point injections are mainly reserved for refractory cases or ones that are harder to treat.”
Injections like these are what people refer to as “wet needling,” when doctors inject trigger points with a pharmacologic agent, such as a local anesthetic, corticosteroid, botulinum toxin or another substance. Dry needling is similar but different in that the needle is inserted into a trigger point without injecting medication. That said, Dr. Fleeks adds that no single pharmacologic agent has proven superior to another — or even over placebo, for that matter.
And while massage is a first-line treatment to loosen up muscle knots, massage guns should be used with caution, particularly on the neck, says Dr. Fleeks.
“The concern with massage guns and neck use relates to potential relates to potential vascular injury and disruption of sensitive neurovascular structures,” he says. “While specific published guidelines are limited, general principles include avoiding direct application over areas of acute injury or inflammation, bony prominences and vascular structures such as the carotid arteries on the side of the neck and the back of the neck. You’ll also want to limit the duration and intensity as to prevent any potential tissue damage.”
How can you prevent muscle knots from coming back?
“Although I do not believe you can lower your risk of developing muscle knots to zero, reducing the risk factors as discussed will go a long way,” Dr. Fleeks says.
Such practices include:
Giving your muscles time to heal in between workouts
Avoiding sedentary lifestyle habits by moving your body more throughout the day
Avoiding overexerting yourself during workouts
Increasing exercise intensity gradually
Staying hydrated
(Related: Common Weightlifting Injuries & How to Prevent Them)
What if muscle knots don’t go away?
“If myofascial pain characteristic with trigger points is not controlled, significantly limits your daily activities or lasts more than one or two weeks, it’s recommended that individuals seek medical evaluation,” says Dr. Fleeks. “Myofascial pain can coexist with or mimic fibromyalgia, a chronic condition involving widespread pain with multiple tender points, fatigue, sleep disturbance and cognitive symptoms.”
“Myofascial pain syndrome typically presents with regional pain and specific trigger points," he adds. "That’s why taking a good history and physical exam of each patient is so important.”
