Muscle Knots: Causes, Treatments and Most Common Places

If you have ever experienced tightness and pain in your neck, shoulders, or legs, you have likely experienced a muscle knot. While common, muscle knots can be incredibly painful and annoying. In this article, we will explore what causes muscle knots, their most common locations, and how you can treat them.

Key takeaways:

Muscle knots and myofascial pain


Have you ever felt tightness in one or both of your shoulders? This is one of the areas where muscle knots are found most often. But what are they?

First, let's explore myofascial pain syndrome. Myofascial pain syndrome is an acute or, more often, chronic pain condition with the symptoms of pain, tenderness, and weakness in a particular area of the muscle. Muscle knots are the reason for myofascial pain syndrome.

Muscle knots are a term that describes myofascial trigger points. Myofascial trigger points are defined as painful and tender spots that are found in the muscle. A trigger point is a highly contracted, small segment of the muscle that can be acute or chronic. Muscle knots are mostly painful in the acute phase and painful during compression in the chronic phase.

During the acute phase of muscle knots, muscles experience hypoxia (lack of oxygen) and ischemia (inadequate blood supply). This leads to a release of substances that cause pain. This explanation is only valid in an acute phase of myofascial trigger points.

Myofascial trigger points can cause local or referred pain. Referred pain is defined as the pain that a person feels far from the structure that is presumed to be a pain generator.

What causes myofascial pain syndrome?

The main reasons why myofascial trigger points appear in the muscle are overuse or overload of the particular muscle. Sometimes muscle knots appear because of the overuse of cervical or postural muscles during low-intensity work. This means that muscles are constantly contracted at a low level where movements require precision and postural stability. When they stay contracted at a low level, after a while muscles become weak and painful.

The most common risk factors for myofascial pain syndrome are:

  • Trauma or micro trauma. If you have experienced a trauma (car accident, fall, blunt force), you are at increased risk of this condition.
  • Ergonomic factors. This includes overuse activities during low-intensity work, abnormal posture during sitting or working with a computer, or any other posture that requires constant and low-intensity contraction of the muscles.
  • Structural factors. Related to structural spine disorders such as scoliosis, osteoarthritis, and spondylosis.
  • Systemic factors. Including hypothyroidism and iron or vitamin D deficiency.

Poor breathing mechanics can cause muscle knots too. In stressful situations or during sedentary jobs we increase breathing into the upper chest and shoulders. Overuse of these muscles causes pain in the neck and shoulders.

How to know you have muscle knots

Often, we become aware of muscle knots or myofascial trigger points because they are painful and cause muscle dysfunction. Sometimes trigger points cause muscle weakness or limited range of motion. The nodules in the taut band of the muscles can be felt with your fingertips. However, this method is not very comfortable to do yourself, because there are a lot of different areas where muscle knots appear and you need to have good palpation skills to find this muscle knot.

Additionally, if you have a tension-type headache, there is a probability that you have muscle knots on your neck, shoulders, or temporal area of your head. Studies show that patients who have tension-type headaches have less mobility in their neck.

The most common locations of muscle knots

Muscle knots are found throughout the human body, but there are a few specific areas where they are formed most often. These areas are related to tasks that people do daily or there is a need for constant contraction of these areas. Here are shown the most common areas of trigger points:

  • Flexors and extensors muscles of the forearm
  • Head
  • Posterior neck muscles
  • Anterior neck muscles
  • Shoulders
  • Scapular muscles
  • Lumbar spine muscles
  • Gluteal muscles
  • Front thigh muscles
  • Posterior tibia muscles
  • Pectoralis muscles

As mentioned before, the pain does not necessarily appear in these muscles. The pain can radiate to other structures.

Treatment of muscle knots


There are a lot of treatments for muscle knots. Most of them focus on pain relief. However, it is important to educate people about the benefits of stretching and ergonomic position modifications during work.

To relieve the pain of the muscle knots, nonsteroidal anti-inflammatory drugs and muscle relaxants are prescribed; their effectiveness is not proven.

Techniques to relieve muscle knots

Some of the possible ways to relieve the muscle knots include:

  • Transcutaneous electrical stimulation. This can provide short-term relief but does not help in the long term.
  • Extracorporeal shockwave and lower-power lasers. Can reduce pain for patients with myofascial trigger points.
  • Dry-needling. A small needle is inserted into the trigger point or near it to generate a twitch response.
  • Exercise therapy. This can help to stretch and relieve muscle knots. Moreover, a physical therapist can educate you about ergonomic positions and their daily modifications.
  • Self-massage. Can help to relieve pain, increase range of motion, and increase fluid flow. You can use a foam roller or small, tough balls to massage muscle knots. The advantage of rolling is that it does not decrease muscle strength, impair performance parameters, or cause fatigue as static stretching does.
  • Breathing. This can help to relieve the muscle knots on the neck and shoulders. Take a deep breath into your abdomen to release tension in your chest and shoulders.

If you have muscle knots, you can try these techniques but first consult your doctor or physical therapist to get their recommendations.


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