Sometimes you wake up, and it feels as though there’s a sharp knife or a rock jammed deep within your muscles. Good morning from your newest muscle knot, a particularly “fun” hotspot of tension. But if you don’t know how to treat muscle knots, these lumps can lead to some not-so-fun issues down the line. Show “[A knot] is a muscle fiber or group of fibers that are tense and contracted,” says David Geier, DO, an orthopedic surgeon and sports medicine specialist. Normally, your muscle fibers run parallel to each other, he explains, however, a knot occurs when they become disorganized in a localized spot. This happens after an injury or strain to the muscle during which the muscle fibers tear. Muscle knots are also commonly known as a myofascial trigger points, because they occur in the muscle or fascia (the layer of connective tissue that encases and supports your muscles) and can make you feel limited in mobility. They’re incredibly common and are caused by a number of things, including, “the overuse of a muscle, improper use of a muscle, or can be from some type of inflammatory reaction,” says Jay Heller, DC, a New York City-based chiropractor. But you can also develop a knot from sleeping in a weird position, or from poor posture. “That’s why they almost always occur in the upper back, shoulders, and neck,” says Dr. Geier. As a large number of people across the country remain at home during the quarantine, this means lots of sitting at home in less than ergonomic positions. “Getting muscle knots could definitely be increasingly common right now as people work from home,” says Dr. Geier, who stresses that hunching your shoulders forward, slumping, or spending an extended amount of time leaning over a screen can all be culprits for the knots. Though sometimes a muscle knot can go away on its own, that isn’t always the case—and even if you think it’s not there anymore, it can still affect your body in ways you don’t even realize. “The best case scenario is that, after a short period of time, the knot goes away, which can take one to two weeks,” says Dr. Heller. “But it can—even when you don’t feel it—create a shortening in the muscle that can eventually weaken the muscle and cause problems down the line in that muscle or at the joint where the muscle connects.” Related StoriesWhen this happens, it leads to an imbalance in your body. “When one muscle group on one side is tight compared to the other side, it alters your mechanics, and your brain subconsciously shifts stress to other areas and overloads them,” says Dr. Geier, which means that you could get injured again. Or, when there’s a weakness in the muscle from being torn, it’ll throw off your form in workouts or movements. “Instead of lifting straight up, for instance, your body will angle a little bit to not stress that knotted area out,” says Dr. Heller. “So what happens is something on the other side gives out because your posture has been incorrect for a while.” Not treating a muscle knot can come with the risk of more pain or injuries down the line, which is why taking care to treat it is key. “The pain may go away but that doesn’t mean it got better,” says Dr. Heller. “How you feel could be okay, but you could very well be developing a chronic area of hypersensitivity or weakness in the muscle.” To prevent this and squelch those knots as soon as they arise, keep scrolling for the various methods of treatment. How to treat muscle knots1. Massage therapyYou can either turn to a professional massage therapist, chiropractor, or physical therapist for trigger point therapy, or you can do self-massage at home. “Digital pressure and really digging in there can help,” says Dr. Heller, adding that lying on a lacrosse or tennis ball or foam roller can help, as can a percussive massage therapy device (like a Hypervolt or Theragun). If you’re using one of these at-home methods, it’s important to not go too hard on your knot—Dr. Heller says that this can further irritate the spot of tension. So start off slow. 2. StretchingDr. Geier says that stretching can often help a lot with muscle knots. But it will typically take several sessions (hence why knots are so frustrating). “You want to stretch the muscle group every day for five days to two weeks, depending on how it heals,” he says. To make the stretching more comfortable, Dr. Heller recommends applying a topical with CBD or menthol beforehand to sort of numb the area. 3. Light activityHaving a muscle knot can often make exercise, or any kind of physical activity, seem difficult. But light movement is important to keep your blood circulating and to allow your muscles to heal themselves. If you’re stuck at home all day long, Dr. Geier recommends getting up to move every hour. “Really work on straightening your spine and pulling your shoulders back,” he says. 4. Dry needlingA little similar to acupuncture is something called dry needling, one method that’s meant for relieving the built-up tension of muscle knots. “Dry needling is when you put a certain type of needle right into the point of pain, and it works to help deflate it,” says Dr. Heller. See a certified professional for this one.
Trigger points are those tender lumps in your muscles that therapists find. Scientists have found that they are parts of the muscle that have spasmed or "cramped", forming the lump. As discussed in our article Trigger point basics these "lock on" and start to grow. They start small and you only know they are there when a therapist presses upon them. However over time they can grow and eventually become aggravated and start shooting pain spontaneously without being pressed upon.
Trigger point releases relax your muscles and reduce pain by disrupting the core positive feedback loop. This can be done at any of the stages. For example, massage will help relax the muscles, and increase blood flow which helps remove waste products. Later we will discuss what the research says about the various common therapies, but it is critical to mention that the goal of most courses of therapy is to just diminish the feedback loop enough that it stops hurting. As you now understand, as long as it is still there though the trigger point will continue to grow. We will finish off by outlining effective therapy to actually eliminate the problem.
Advovates of various therapies and releases claim to "de-activate" trigger points. To the un-informed this sounds like a fix or remedy, but it actually means to (temporarily) stop the trigger points hurting. As explained in our article Trigger point therapy: de-activation or elimination even the scientists use this deception when they test trigger point therapies (1-3). When they do their clinical trial they will deliberately use the goal of de-activating the trigger points rather than eliminating them. By lowering the bar this way they appear to show that the therapy they are testing is useful when there is really no long term benefit. The way researchers do this so it is not noticed is to simply measure things like pain but fail to check or mention whether the trigger points are still there. As we will see later they certainly will be. The consequence of just "de-activating" trigger pointsAfter de-activation the pain will be reduced or gone, again creating the illusion that the problem is fixed. However:
In this section we will show you what actually happens when trigger points are de-activated, then proof that the trigger points will still be there.
In the section below we summarise the the findings of several scientific reviews of individual trigger point therapies (2,3,5–9). Keep in mind that the clinical trials these are based on would have taken success to be pain relief rather than trigger point elimination. In summary:
As discussed in our article The complete guide to (myofascial) trigger points even when not shooting pain trigger points have the following adverse effects. This applies whether they are still developing and not yet activated, or have been (temporarily) deactivated using a release or therapy.
An effective strategy to eliminate trigger points
The trial discussed above found that 12 weeks of very extensive trigger point therapies only eliminated 1/3 of the trigger points. This shows us that typical courses of therapy will have practically no impact on the number of trigger points. However, they did manage to relieve the symptoms and eliminate 1/3 of the trigger points. This suggests that if the therapy was continued more would be eliminated. Of course for most this would need to be an effective home therapy or it would become very expensive. This is the basis of our treatment strategy. We have full details in our article How to treat trigger points at home but give a summary here. The guide has several home treatement options, but we will just give the easiest and most effective one.
You may be able to do a lot of therapy yourself, but to help you get the best possible results and to stay safe we recommend that you get some professional advice.
Avoid aggravating activitiesYou may need to at least temporarily avoid activities that aggravate the condition Effective self therapyWe’ve seen that 12 sessions from the world’s best only partially remedied the problem, so you'll need a lot more than 12 applications over time, and they need to be very effective. Luckily we’ve got the ideal solution: using a vibration massager. Vibration massagers are very easy to useWe have complete instructions in our article How to use a hand held massager, but they are basically very easy to use. You just sit the machine on the part that needs massaging and let the vibrations penetrate. You don't need any special skills.
There are some good units on the market, but a lot that are not that effective. Please see our article How to choose a massager. Be especially aware that most massage guns are based on percussion massage rather than vibration. This is a gimmick that makes them a lot less effective and potentially dangerous.
References
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What happens when a muscle knot releases?
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