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Dealing with muscle ‘knots’: causes and treatments
Written byLaura Harcourt
Reviewed byAndrew Chambler
If you’ve ever experienced a muscle knot in your back and are keen to know what they are and how to relieve them, discover all this and more in our article.
Summary
1What are muscle knots?
Muscle knots are hardened and tight muscles which feel tense, even when they’re not being activated through exercise...
2What causes muscle knots?
From the food we put into our bodies to the way we carry ourselves, there are a whole host of reasons why you could experience ‘knots’ in your back...
3How to relieve muscle knots in your back
Massage treatments such as passive rhythmic release, active rhythmic release and trigger point pressure release are thought to be some of the...
Have you ever had a pesky ‘knot’ in your back? We’ve all been there.
Experiencing ‘muscle knots’ can not only leave you feeling uncomfortable but also with a wide range of questions – from ‘What are they?’ to ‘What causes them?’ to, most importantly, ‘How can you make them better?’
Keep reading to learn the answers to all of your muscle knot-related questions and discover some of the methods to try and keep them at bay in the future.
What are muscle knots?
Muscle knots are hardened and tight muscles which feel tense, even when they’re not being activated through exercise.1
When functioning normally, your muscles will contract when needed and relax afterwards. However, when this relaxation doesn’t happen, this can lead to a muscle knot forming within your body.1,2
Muscle knots are also sometimes referred to as ‘trigger points’, which can cause pain when they’re pressed.1,3 These trigger points commonly accumulate in areas of your body that hold tension or fall victim to muscle strain or poor posture, such as your back, shoulders or neck.4,5,6
When probed with your fingertips, muscle knots can also feel like a rope under your skin, which is one of the main reasons why they get their name.1,2,6
What causes muscle knots?
From the food we put into our bodies to the way we carry ourselves, there are a whole host of reasons why you could experience ‘knots’ in your back. While research in this area is still fairly limited, here are four of the most common factors believed to cause those pesky knots to form.
It’s been suggested that people who don’t drink enough water could be more susceptible to muscle damage, including delayed onset muscle soreness (DOMS), muscle ‘knots’ and inflammation.7,8
This is because being dehydrated can cause a decrease in blood flow to your muscles, due to a reduction in blood pressure.7 Researchers believe this is especially the case when exercising , which, over time, could result in muscle damage and, ultimately, pain and fatigue.7,9
To effectively stay hydrated, the NHS recommends drinking between six and eight glasses of water a day, and avoid having too much caffeine, alcohol or sugary, high-fat foods within your diet.10
While you might think that avoiding movement can help prevent muscle knots, the answer could actually be the other way around.
Living a more sedentary, inactive lifestyle is thought to weaken your back muscles, affect the muscle fibres that contribute to muscle stiffness and, ultimately, result in muscle knots in your back.4,11
For this reason, stretching (like yoga), aerobic exercises (such as walking or swimming) and strength exercises (like weight lifting), could be recommended as a treatment option for muscle knots, as these exercises are thought to increase blood flow and improve blood pressure, allowing more oxygen to reach muscle knots and relax the surrounding muscles.12,13,14
So, adding more movement into your daily routine, such as ab workouts, could not only help get rid of any existing muscle knots you have but also potentially help you avoid getting any more in the future, while also maintaining a good posture too.11
Strengthening exercise could also help relieve pain in patients with myofascial pain syndrome (MPS) which, in turn, could target muscle knots in the areas involved in MPS.15
While it’s important to get up and keep moving, overusing your muscles could also cause more harm than good.15,16,17
In fact, emerging research shows that any kind of muscle overuse or overload could lead to the development of muscle knots.16 One hypothesis is that muscle overload could release excessive amounts of acetylcholine – a chemical messenger in the brain involved in involuntary muscle movement and attention – which could activate trigger points and make the contractions worse.17,18,19
These muscle knot contractions could also be a result of the lack of reabsorption of calcium from the affected muscles.
So, try to avoid overdoing it at the gym or in your day-to-day life and make sure you’re giving your muscles enough time to recover.
It’ll probably come as no surprise that researchers believe having a poor posture, in either the back or neck, could contribute to the formation of muscle knots.18,20,21
While many of us will have no choice but to sit down all day due to our modern-day work requirements, this repeated posture can lead to problems. This is because our muscles need a combination of dynamic loads – a variety of stresses or forces on our muscles – in order to stay healthy.19,22
Sitting, however, exposes our bodies to consistently low loads (a lack of varied muscle movement). This puts additional strain on our spines and can contribute to the development of knots in the back, shoulders and neck.21,23
If your work keeps you seated for long periods, it’s important to get up and move around regularly, take a walk, or even add in some daily posture exercises to help support your muscle health.24
Taking regular breaks from your desk to get up and move around, and maintaining a good posture at your computer/keyboard can also support your wellbeing, which, in turn, could help with easing your muscle knots.24 Although there’s no hard evidence, stress and poor mental health are thought to lead to muscle knots and other musculoskeletal symptoms.25,26
How to relieve muscle knots in your back
Massage treatments such as passive rhythmic release, active rhythmic release and trigger point pressure release are thought to be some of the most effective methods for relieving muscle knots.23,27
If you plan to massage your knots at home yourself, make sure to apply vigorous pressure to the affected area with either your hands or a foam roller or ball.28 Locate the knot and then work the tight back muscles until it starts to feel loosened.
If that fails to work, speak to your GP or a private physiotherapist. They can provide you with specific exercises to relieve your discomfort or might suggest therapies like hydrotherapy.1,29 In some cases, your GP may also recommend trigger point injections to help loosen your muscles.1,6
Tips for avoiding muscle knots
Getting rid of muscle knots completely is unlikely, but there are plenty of things you can do to keep the discomfort they cause at a minimum. For example, why not try:
Improving your posture
One of the best things you can do to prevent muscle knots is to work on your posture.18 Exercises like yoga can help correct your posture and improve spine health, reducing your likelihood of experiencing knots.30
You can also reduce your chances of developing knots by maintaining an active lifestyle complete with aerobic and strengthening exercises, such as walking, swimming and lifting weights.12
Pilates and yoga can also help improve your core strength and stability.30
If you feel sore after hitting the gym, don’t push yourself by heading back there again immediately. Give your muscles time to rest – the last thing you want is for them to tighten and develop knots from being overused.16
Your diet can make a big difference to not only the frequency of knots you experience but also your overall health. Aim to enjoy lots of delicious, water-rich vegetables and try to avoid dehydrating, high-fat or high-sugar foods.7,10
Make sure you stretch regularly throughout the day, especially if you spend a lot of your time sitting down. If you can’t find the time to get up and move around, find ways to stretch while sitting down to encourage good posture and keep your muscles supple.12
The final say
Muscle knots can be a real pain in the… back. They can get in the way of daily life too, so it’s important to take all the precautions you can to help keep them at bay.
The advice in this article can help you avoid or manage the soreness and stiffness that muscle knots can cause, so that you can get back to living your best life.
Having said that, if your aches and pains get worse or you become particularly concerned about them, make sure to seek tailored advice from your GP or a physiotherapist.
1. Guy’s and St Thomas’ NHS Foundation Trust. Trigger point injections to treat pain - Overview [Internet]. [Cited 2024 Mar 8]. Available from: https://www.guysandstthomas.nhs.uk/health-information/trigger-point-injections-treat-pain.
2. Healing through Trigger Point Therapy [Internet]. Google Books. 2024 [cited 2024 May 16]. Available from: https://books.google.co.uk/books?hl=en&lr=&id=680_MLlxzdgC&oi=fnd&pg=PA7&dq=can+dehydration+cause+myofascial+release+knots&ots=G_SSktmjKr&sig=e_go8GGafn8FmQxCdIwBcgY3C8w&redir_esc=y#v=onepage&q&f=false
3. Experimental myofascial trigger point creation in rodents | Journal of Applied Physiology [Internet]. Journal of Applied Physiology. 2020 [cited 2024 May 16]. Available from: https://journals.physiology.org/doi/full/10.1152/japplphysiol.00248.2018
4. Guideline for diagnosis and treatment of subacromial pain syndrome. Acta Orthopaedica [Internet]. 2014 [cited 2024 May 16]; Available from: https://www.tandfonline.com/doi/full/10.3109/17453674.2014.920991
5. Morikawa Y, Takamoto K, Hiroshi Nishimaru, Taguchi T, Susumu Urakawa, Sakai S, et al. Compression at Myofascial Trigger Point on Chronic Neck Pain Provides Pain Relief through the Prefrontal Cortex and Autonomic Nervous System: A Pilot Study. Frontiers in neuroscience [Internet]. 2017 Apr 11 [cited 2024 May 16];11. Available from: https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2017.00186/full
6. NHS. Royal Orthopaedic Hospital - Trigger Point [Internet]. Cited 2024 Mar 8]. Available from: https://roh.nhs.uk/services-information/pain-management/trigger-point.
7. Cleary, MA., et al. ‘Dehydration and Symptoms of Delayed-Onset Muscle Soreness in Normothermic Men.’ Journal of Athletic Training. 2006;41(1):36–45. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421497/.
8. Lewis PB, Ruby D, Bush-Joseph CA. Muscle Soreness and Delayed-Onset Muscle Soreness. Clinics in sports medicine [Internet]. 2012 Apr 1 [cited 2024 May 16];31(2):255–62. Available from: https://pubmed.ncbi.nlm.nih.gov/22341015/
9. Martinez-Silvestrini JA. Prescribing Medications for Pain and Inflammation. Elsevier eBooks [Internet]. 2007 Jan 1 [cited 2024 May 16];193–205. Available from: https://www.sciencedirect.com/topics/neuroscience/delayed-onset-muscle-soreness
10. NHS. Water, Drinks and your Health [Internet]. Cited 2024 Mar 8]. Available from: https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/water-drinks-nutrition/.
11. Marijančić, V. et al. ‘Relationship between Physical Activity and Sedentary Behavior, Spinal Curvatures, Endurance and Balance of the Trunk Muscles-Extended Physical Health Analysis in Young Adults.’ International Journal of Environmental Research and Public Health. 2023;20(20):6938–8. Available from: https://doi.org/10.3390/ijerph20206938.
12. Guzmán-Pavón, MJ., et al. ‘Effect of Physical Exercise Programs on Myofascial Trigger Points–Related Dysfunctions: A Systematic Review and Meta-analysis.’ Pain Medicine. 2020;21(11):2986–96. Available from: https://doi.org/10.1093/pm/pnaa253.
13. Ahmed S, Khattab S, Haddad C, Babineau J, Furlan A, Dinesh Kumbhare. Effect of aerobic exercise in the treatment of myofascial pain: a systematic review. Journal of exercise rehabilitation [Internet]. 2018 Dec 27 [cited 2024 May 16];14(6):902–10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323330/
14. Vitsarut Buttagat, Naruecha Taepa, Nitchakarn Suwannived, Nattanan Rattanachan. Effects of scapular stabilization exercise on pain related parameters in patients with scapulocostal syndrome: A randomized controlled trial. Journal of bodywork and movement therapies [Internet]. 2016 Jan 1 [cited 2024 May 16];20(1):115–22. Available from: https://pubmed.ncbi.nlm.nih.gov/26891646/
15. Anuphan Tantanatip, Chang KV. Myofascial Pain Syndrome [Internet]. Nih.gov. StatPearls Publishing; 2023 [cited 2024 May 16]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499882/
16. Bron, C., et al. ‘Etiology of Myofascial Trigger Points’. Current Pain and Headache Reports. 2012;16(5):439–44. Available from: https://doi.org/10.1007/s11916-012-0289-4.
17. Gerwin RD. A New Unified Theory of Trigger Point Formation: Failure of Pre- and Post-Synaptic Feedback Control Mechanisms. International journal of molecular sciences [Internet]. 2023 May 2 [cited 2024 May 16];24(9):8142–2. Available from: https://www.mdpi.com/1422-0067/24/9/8142
18. Kalichman, L., et al. ‘Effect of exams period on prevalence of Myofascial Trigger points and head posture in undergraduate students: Repeated measurements study.’ Journal of Bodywork and Movement Therapies. 2017;21(1):11–8. Available from: https://doi.org/10.1016/j.jbmt.2016.04.003.
19. None Krzysztofik, Wilk N, None Wojdała, None Gołaś. Maximizing Muscle Hypertrophy: A Systematic Review of Advanced Resistance Training Techniques and Methods. International journal of environmental research and public health/International journal of environmental research and public health [Internet]. 2019 Dec 4 [cited 2024 May 16];16(24):4897–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950543/
20. Touma J, May T, Isaacson AC. Cervical Myofascial Pain [Internet]. Nih.gov. StatPearls Publishing; 2023 [cited 2024 May 16]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507825/
21. César Fernández‐de‐las‐Peñas, Cuadrado ML, Pareja JA. Myofascial Trigger Points, Neck Mobility, and Forward Head Posture in Episodic Tension‐Type Headache. Headache [Internet]. 2006 Nov 17 [cited 2024 May 16];47(5):662–72. Available from: https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2006.00632.x
22. Duchateau J, Séverine Stragier, Baudry S, Carpentier A. Strength Training: In Search of Optimal Strategies to Maximize Neuromuscular Performance. Exercise and sport sciences reviews [Internet]. 2020 Oct 12 [cited 2024 May 16];49(1):2–14. Available from: https://journals.lww.com/acsm-essr/fulltext/2021/01000/strength_training__in_search_of_optimal_strategies.2.aspx
23. Kastelic, K., et al. ‘Sitting and low back disorders: An overview of the most commonly suggested harmful mechanisms. Core. 2018. Available from: https://core.ac.uk/download/pdf/212475583.pdf.
24. Desk health ergonomics [Internet]. Chelsea and Westminster Hospital NHS Foundation Trust. 2024 [cited 2024 May 16]. Available from: https://www.chelwest.nhs.uk/your-visit/patient-leaflets/hand-therapy/desk-health-ergonomics
25. María Palacios-Ceña, Castaldo M, Wang K, Catena A, Torelli P, Lars Arendt-Nielsen, et al. Relationship of active trigger points with related disability and anxiety in people with tension-type headache. Medicine [Internet]. 2017 Mar 1 [cited 2024 May 16];96(13):e6548–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380302/
26. M. Saleet Jafri. Mechanisms of Myofascial Pain. International Scholarly Research Notices [Internet]. 2014 Aug 18 [cited 2024 May 16];2014:1–16. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285362/
27. Jafri, MS. ‘Mechanisms of Myofascial Pain.’ International Scholarly Research Notices. 2014;2014:1–16. Available from: https://doi.org/10.1155/2014/523924.
28. Kalichman, L., et al. ‘Effect of self-myofascial release on myofascial pain, muscle flexibility, and strength: A narrative review.’ Journal of Bodywork and Movement Therapies. 2017;21(2):446–51. Available from: https://doi.org/10.1016/j.jbmt.2016.11.006.
29. NHS. Techniques - Physiotherapy [Internet]. Cited 2024 Mar 8]. Available from: https://www.nhs.uk/conditions/physiotherapy/how-it-works/.
30. Mondal, K., et al. ‘Application of yoga as an effective Tool for Improving Postural Balance in Healthy Young Indian Adults’. International Journal of Chinese Medicine. 2017. Available from: https://www.researchgate.net/profile/Deepti-Majumdar/publication/316165779_Application_of_Yoga_as_an_Effective_Tool_for_Improving_Postural_Balance_in_Healthy_Young_Indian_Adults/links/58f46a19a6fdcc11e569f53a/Application-of-Yoga-as-an-Effective-Tool-for-Improving-Postural-Balance-in-Healthy-Young-Indian-Adults.pdf
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