Muscle knots are highly irritated muscle fibers that have tightened into a ball in one area of your muscle. These painful, tender spots can feel sore and often occur in your upper back, shoulders, or neck. Also called myofascial trigger points, you can get muscle knots anywhere.
Active trigger points contract your muscle to cause discomfort without touching it. But hidden (latent) trigger points may not hurt until they're pressed and can sometimes refer pain to another area.
Although muscle knots aren't usually harmful, trigger points can be uncomfortable. That's because tight muscles can put pressure on your nerves. Your muscle knots can also be a sign of a long-term, chronic pain condition, such as myofascial pain syndrome. Find out what causes muscle knots, what they look like, and how to get treatment.
What Are Muscle Knots?
Knots are small, intense contracted bands of muscle fiber in one area of your muscle. Some experts think the tense fibers can cut off blood flow, causing waste buildup inside your muscle tissues. The knot you feel may be a buildup of this waste.
Your muscle isn't kinked, the fibers are squeezed into a tight pea-sized ball. And if your knot gets too tight, the spasm can tear the muscle fibers.
"It’s a spasm of the tissue," says John Gallucci, Jr, DPT, chief executive officer of JAG Physical Therapy and assistant chief medical officer for Major League Soccer (MLS) in New Jersey. "Sometimes the knot can become so intense that it can strain the muscle and cause some bleeding and fibrous tearing."
What Causes Muscle Knots?
Many things can cause knots, but most research shows that sudden muscle injury or small repeated tears lead to trigger points. Researchers call it the Cinderella hypothesis because smaller muscle fibers called "Cinderella fibers" repeatedly work over and over, but larger ones remain relaxed.
You may repeat the same motion for your job, playing a sport, or even exercising. The smaller, Cinderella fibers actively work all the time and get damaged. Eventually, you can form a myofascial trigger point after training the same muscle group for a long time.
But the opposite can happen too — not using your muscles enough. After you've been in an awkward position (poor posture) for too long, your muscles can knot up. Sitting at your desk or driving a car can also inflame your muscles to the point of "knotting up."
That's because your muscles need regular movement — without it, muscle fibers start to stick together, which can lead to muscle knots.
But you can also develop muscle knots because you're:
- Stressed
- Fatigued
- Not getting enough sleep
- Having joint problems
- Injured
- In one position too long (bed rest, poor posture, or sitting too long)
- Dehydrated
- Not eating well (poor nutrition)
"When people have hydration issues or nutrition issues, they can become more prone to getting muscle spasms," says Gallucci. "And people who start sports and do too much, too quickly are very prone to muscle spasms and knots as well, mostly in their calves and hamstrings."
No matter what causes your muscle knots, the discomfort can linger for days or weeks. This can distract you, affect your work, or make it hard to do things you enjoy. Learning about what muscle knots look like can help you get treatment.
What Does a Muscle Knot Look Like?
You can't usually see your muscle knots because they're inside your muscle, below your skin. If you could look underneath your skin, you might see little raised bumps on the surface of your muscle.
Sometimes, you can feel the tightened muscle fibers. Your muscle knots may feel like:
- A ball
- A little egg
- Tiny little peas
- A tight band
If your doctor orders an ultrasound, the tight muscle tissue bands can sometimes show up. But an ultrasound usually isn't necessary. That's because your doctor can probably diagnose you after an exam and medical history review.
How Do You Get Rid of Muscle Knots?
You can often manage your muscle knot at home. A key to healing is moving your muscle. But the pain may prevent you from moving your trigger point. Not moving can actually make things worse for your trigger point. That's because movement brings blood flow to the muscle fibers and can help with healing.
"We recommend getting your heart rate up to bring blood flow to the area," says Gallucci. Moving your muscle helps the fibers let go of the spasm, which also lowers your pain. "One of the hardest things to explain to patients [is to move the muscle], because everybody wants to immobilize it and not move," says Gallucci. "But movement is the best thing for the body."
Hydrate
Your muscles need water, without it, muscle fibers can cramp and form knots. Drink enough water each day to stay hydrated. This can also help flush out any waste buildup from your muscles as you release knots, too. And eat a healthy diet, full of muscle recovery foods such as:
- Whole-grain carbs for higher insulin levels to help glucose enter your muscles and provide energy
- Lean proteins to repair and strengthen your muscle fibers
- Anti-inflammatory foods, such as berries, fatty fish, and leafy greens to boost your immune system after a workout
Stretching
Here are some ways your can stretch:
Get up and move around if you've been in one position for too long, it can loosen up your muscles.
Try gentle stretching exercises to relieve any knotted muscles and prevent trigger points from forming.
Ask your physical therapist about how to loosen any stiff muscles and lower your risk for more knots.
Try to add stretching to your bedtime routine — habit stack. Combine stretches with another habit that's already in your routine, such as brushing your teeth. Brush your teeth, then stretch. This way, you'll remember --- and nighttime stretching can help prevent tight muscles and prevent new knots.
Heat
Try alternating heat and ice, you can:
Use heat for 15-20 minutes to help ease muscle pain, then use a cool ice pack for 10 minutes --- usually best for new injuries to lower swelling.
If your muscle knot isn't new, heat may be all you need. Figure out what works best for your muscle knots.
You can try a cool ice pack on your knot for a short while, especially if you can't move around. Then switch to a warm compress or heating pad.
Moist heat can often get into the muscle fibers to loosen them up better. Try a warm, damp towel or soak in a warm bath.
If you notice that heat helps more, stick with heat and then move around to get the blood flowing in your muscle.
Trigger point massage
Sometimes, firm pressure can help loosen your muscle fibers. You can try your hands, a foam roller, or a massage ball:
Apply pressure using the foam roller for larger muscle groups like your back or hamstrings. Find the knot and press on it as hard as you can tolerate, several times a day until the muscle feels better.
For smaller muscles in your neck or other areas, try your hand or massage ball. Roll the ball, using moderate pressure, across your muscle knot to loosen it.
Professional massage
A professional massage therapist can sometimes loosen your muscle knot. They can likely find knots that you didn't know you had! The therapist can work out kinks, muscle tightness, and tell you about any problem areas, too. But keep in mind that a deep tissue massage can be too intense and may cause you more trouble.
"Deep tissue massage can get a knot in a flame and cause [you] more restriction and pain," says Gallucci. "Sometimes with trigger point or a myofascial release, it is too aggressive and can irritate the knot itself."
Instead, try a "low-level effleurage" to keep up the "blood flow to the area," says Gallucci. And "with some stretching, you should get some simple relief — more so than a deep tissue massage.” An effleurage massage uses long, gliding strokes and gentle pressure.
What if Muscle Knots Don't Go Away?
Some muscle knots can take several weeks to heal. But you can think about the trigger and what caused the knot in the first place. Repeat your at-home treatments to fully heal and listen to your body. Be patient with yourself and if other treatments aren't working, your doctor can help.
They may suggest treatments such as:
- Muscle relaxers and nonsteroidal anti-inflammatory medicines (NSAIDs): Used to bring down swelling and ease pain
- Antidepressants: Can ease pain for some people
- Physical therapy: Helps build muscle strength and endurance
- Myofascial release therapy: Involves applying gentle, sustained pressure, easing pain and restoring motion
- Trigger point injections: Involves injecting a numbing medicine or onabotulinumtoxinA (Botox) into the painful spot
- Dry needling: A thin needle is inserted into the trigger point to help lower pain (acupuncture may also help some people)
- Ultrasound: Penetrates the muscle knot with soundwaves and speeds up healing
- Laser therapy: Uses low-energy lasers to break up the muscle knots
- Spray and stretch method: Sprays your muscle with medicine to numb the knot before stretching it
- Transcutaneous electrical nerve stimulation (TENS) therapy: Uses low levels of electricity to relax the muscle
- Extracorporeal shock wave therapy: Directs sound waves at your trigger point to help lessen your pain
Although acupuncture can help you with pain relief, it doesn't actually get rid of your muscle knot. "You get better relief with dry needling," says Gallucci.
When to call the doctor
Sometimes, a muscle knot doesn't go away and could be a sign to see a doctor. See your doctor right away if you get:
- Muscle pain that doesn't go away or worsens
- Pain that keeps you awake
- A persistent sore, red spot on a muscle
- A hot place (to your touch) on your muscle
- Drainage, blood, or pus
Takeaways
Muscle knots are tense, irritated spots inside your muscles where the blood flow slows because the muscle fibers contract into a tight ball. Also called myofascial trigger points, the knots can often happen from repetitive motion or inactivity. Stretching, massage, and heat usually help, but some trigger points need physical therapy, medicine, or a procedure for relief. See your doctor if your muscle pain worsens, isn't going away, or shows signs of infection.
Muscle Knots FAQs
Do muscle knots pop when massaged?
Your doctor typically looks for a twitch in your myofascial trigger point during diagnosis because the knot is so tight, it can sound like a strum or snap. Typically, a popping sound comes from your joint moving — it's called joint manipulation.
Do muscle knots go away on their own?
Most of the time, if you have a minor muscle knot, it can goes away after you stretch, hydrate, and avoid repeating the movement that caused it. But if your knot isn't going away, your pain gets worse, or shows signs of infection, call your doctor. They can check to see what may be causing your muscle knot and offer treatments.
How long do muscle knots last?
It depends on what's causing your muscle knot, but it could last a day to several weeks. If your muscle knot lingers longer, talk to your doctor about ways to ease the discomfort.
