What to Know About Muscle Knots

Medically Reviewed by Tyler Wheeler, MD on July 21, 2023
3 min read

A muscle knot is a painful or tender spot in a muscle. It feels tight and sore, and it often happens in the upper back or legs. They're not usually harmful, but they can certainly be uncomfortable. In rare cases, muscle knots are a sign of a long-term (or chronic) pain condition. 

If you've ever had pain in your back, in your neck, or under your shoulder blade, you've probably had a muscle knot. The name makes it sound like the muscle is twisted or kinked, but that's not the case. Knots are usually a type of spasm that causes a small portion of a muscle to tense up. This tension can often be painful.  

‌Muscle knots usually happen because a muscle has been irritated by a repetitive motion. Athletes will notice muscle knots after training one group of muscles for a long period of time. A muscle might also knot up when it’s in an awkward position for too long. Sitting at a desk or driving a car for a long time, especially without breaks, can irritate a muscle to the point of it "knotting up".

‌Researchers have found that muscle knots don't show up on scans, so they aren't entirely sure what the muscle is doing to cause pain. Some doctors think the muscle spasms may affect blood flow, and that's what makes the knotted area hurt. Other doctors say the pain could be caused by nerves that are triggered by the spasms. 

No matter what causes it, a muscle knot is painful, and this pain can linger for days or weeks. The discomfort might affect your work or make it hard to do things you enjoy. 

With some time and patience, you can often manage a muscle knot at home. Here are some simple tricks for getting your muscle to relax and stop hurting:

Stretch. Sometimes, getting up and moving or doing gentle stretching exercises can relieve a muscle that's knotted from being in an uncomfortable position for too long. Stretching can also prevent knots. If you notice certain areas knotting up often, ask your doctor about stretches to loosen those muscles and lower the chances of more knots.

Ice and heat. Most muscle pain responds well to alternating ice and heat. Use an ice pack on the spot for a short while, and then switch to a warm compress or heating pad. If you notice that one seems to help more than the other, stick with what one feels best.  

Trigger point massage. Sometimes, firm pressure encourages your muscle to release. You can use your hands or a foam roller to apply pressure. Simply find the knot and press on it as hard as you can tolerate. Do this several times a day until the muscle feels better.  

Professional massage. A massage with a professional massage therapist might be helpful. Tell them where the knot is and what may have caused it. Your therapist can work on that muscle and identify any areas around it that might be adding to the pain.‌‌

It can take some time to ease pain from a knotted muscle. You may need to repeat treatments, such as massage, to resolve the problem fully. In the meantime, try to avoid the thing that irritated your muscle in the first place.

‌Time and home care will usually loosen up a knotted muscle. Some people have a tendency for muscle knots, known as myofascial pain syndrome. Signs that you may have myofascial pain syndrome include: 

  • Pain that lingers or worsens
  • Pain that keeps you awake
  • A persistent sore spot in a muscle
  • Deep muscle pain

If you notice any of these symptoms or have constant issues with muscle knots, talk to your doctor about treatment. They may suggest: 

  • Physical therapy to build muscle strength and endurance
  • Myofascial release therapy to apply gentle sustained pressure into the myofascial connective tissue restrictions to ease pain and restore motion.
  • Injecting a numbing medicine into the spot where the pain is
  • Dry needling, in which the doctor inserts thin needles into the trigger point to reduce pain
  • Acupuncture, a traditional practice that uses needles for pain relief
  • Ultrasound waves to penetrate muscles
  • Transcutaneous electrical nerve stimulation, or TENS therapy, which uses low levels of electricity to relax the muscle.