Muscle knots are a major cause of back and neck pain, yet they remain relatively underdiagnosed. Muscle knots can also be stubborn to treat, especially if you don’t know what causes them! Let’s take a look at what a muscle knot really is, and what you can do about them.
What Causes Muscle Knots?
Commonly known as muscle knots, myofascial trigger points (MTrPs) are hard spots of tissue that cause pain upon movement or when palpated. The pain associated with muscle knots is specific and is caused by localized dysfunction rather than a systemic health issue.
It’s important to note that fibromyalgia and muscle knots are different things. Back and neck pain can certainly be associated with fibromyalgia, but this condition is one of widespread pain (“it hurts all over”). Fibromyalgia also typically has other symptoms such as cognitive issues and fatigue.
Muscle knots are a result of localized thickening of individual muscle fibers. This thickening is itself caused by contraction of sarcomeres, a unit of muscle tissue made up by thick and thin muscle fibers.
Muscle knots are thought to develop when muscle is stimulated to release excessive amounts of acetylcholine, a neurotransmitter that tells the muscles to contract. Muscle contraction puts pressure on surrounding blood vessels, which can impair circulation if it goes on too long. This can then prompt the body to release substances that sensitize nerves in the surrounding tissue (Mense, 2008).
What’s the result of all this activity? Pain and tenderness in that muscle, and possible referred pain nearby.
Understanding the physiological processes behind muscle knots is important, as it gives us a better idea of what will and won’t work to relieve the condition.
For example, because circulation is decreased or cut off to the affected area of muscle, oral non-steroidal anti-inflammatory medications (NSAIDs) probably won’t work.
So, what does work to treat muscle knots and back pain?
Treating Muscle Knots and Back Pain
Direct injection of NSAIDs into muscle knots may help to relieve inflammation and muscle contraction. This can restore circulation and help relieve pain. Interestingly, injecting saline into the trigger point also seems to work, which suggests that such injections serve to dilute the chemicals responsible for creating increased sensitivity to pain.
Myofasical Release for Muscle Knots
Trigger point injections are not the only treatment option for muscle knots. Massage can also work well for ‘unravelling’ these knots. Specifically, a type of massage called myofascial release (MFR) therapy may be helpful.
Practitioners of MFR therapy first aim to identify the areas where muscle is compromised. They will assess any decrease in motion or asymmetry in the muscles and will usually then apply gentle pressure or a sustained low load to stretch out the affected muscle.
It may take several sessions to fully relieve muscle knots in some people. Others may experience significant relief in just one session.
Complementary Treatments for Muscle Knots
In some cases, acupuncture can help relieve knots in back muscles. This is because acupuncture provides alternative stimulation to the muscle that can prompt it to relax.
Acupuncture can help improve quality of life in people with chronic myofascial pain, according to some research (Sun et al., 2010). There is also some evidence that acupuncture can help to relieve myofascial pain (Ma et al., 2010). Another technique, mini-scalpel needling, appears to be better than acupuncture and stretching at relieving myofascial pain in the neck, however (Ma et al., 2010).
Once the muscle knot has been released, certain medication may help relieve pain. Analgesics and anti-inflammatory drugs can encourage the muscles to remain relaxed and heal from any damage. A warm compress may help to restore circulation to the affected muscle, while a cold pack can help calm any swelling.
Going forward, range of motion exercises may help decrease the risk of muscle knots and back pain. Regular physical activity that enhances flexibility and circulation to the muscles might also help.
Yoga has proven to be extremely helpful when it comes to reducing knots in the back with its specific stretching elements. An awesome course that I’ve taken is this one. Click here to watch a short yoga video.
Ma, C., Wu, S., Li, G., et al. (2010). Comparison of miniscalpel-needle release, acupuncture needling, and stretching exercise to trigger point in myofascial pain syndrome. Clin J Pain, Mar-Apr;26(3):251-7.
Mense, S. (2008). Muscle Pain: Mechanisms and Clinical Significance. Deutsches Ärzteblatt International, 105(12), 214–219.
Sun, M.Y., Hsieh, C.L., Cheng, Y.Y., et al. (2010). The therapeutic effects of acupuncture on patients with chronic neck myofascial pain syndrome: a single-blind randomized controlled trial. Am J Chin Med, 38(5):849-59.