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As a Sports Therapist, one of the things I hear all the time is, ‘I’ve got a knot in my shoulder’ or ‘my calves are really knotted up’. But then equally other clients tell me that they have heard a muscle knot isn’t a real thing.
So what is a muscle knot? Is it a real thing? Can a muscle really get tied in a knot? If I’ve got one how can I treat it? Is a muscle knot the same as a trigger point?
I’ve compiled a handy guide which will hopefully answer lots of the questions that clients have asked me in this blog article:
WHAT IS A MUSCLE KNOT AND WHAT CAUSES THEM?
To fully understand what a knot is and why it’s often a problem and causes pain we need to know some background on how muscles work in their correct and un-painful way.
Muscle fibres run in all different directions in our body and are layered on top of each other from our heads to our toes. This allows for all the complex movement we do on a daily basis and is the reason why we can get our skeleton to bend, twist, dance, and play sports. Our muscles are meant to be pliable, strong, and challenged to stay healthy but there is also, importantly, an optimal length of each one, they contract to help us move and then they should relax when not in use. However, if I did an activity that caused one or more of my muscles to contract and shorten but never gave it the time to go back to its normal length and uncontract then I’m going to have a problem as my muscle may have changed to stay in this shortened contracted position - sometimes it’s incredibly hard to change these now shortened muscles. Ask anyone who has allowed their hamstrings to shorten and now cannot bend to touch their toes.
But we want to know about muscle knots - aren’t these different to just tight muscles? The answer is yes but also no, they are kind of the same thing in as much as the causes of why they have happened are normally the same as tight muscles. Now, without boring you with complex anatomy knowledge, just know that muscles work by sliding across each other so that they can shorten and lengthen and there are millions of muscle fibres that create the whole working muscle. A knot in simple terms is when a group of these fibres have stuck to each other and now won’t move. It is why you get this hard and lumpy feeling, or the knot. It is why when you try to move an area with a knot in it feels stuck and won’t move and when you then press into that muscle you can feel the lump. However, as we see later, if you can break them down then hopefully you can also get a lot of the movement back in the area.
So to summarise and give a general definition of a muscle knot we can say it’s a hard, sensitive area of muscle that is tight and often contracted even when that muscle should be at rest. These tense areas of muscle can feel sore because they are in this constantly contracted state. Try this - lift your arm above your head and hold it there for a minute or two, it doesn’t take long before the muscles in your upper traps and neck start to ache from the constant sustained contraction. If you kept persisting everyday doing this, eventually the body will adapt the muscle fibres so that it gets easier but now they are in a wrong contracted position. The basically what happens when office workers or others sit at a desk with slumped shoulders for long periods, eventually you develop a rounded upper body and almost certainly some knots in your upper back and neck muscles. It’s similar to the effects of stress. You hold tension in the muscles causing them to over contract and not relax and also with prolonged bed rest or any period of time sat or lying with muscles contracted without any stretching or returning to their normal state.
SYMPTOMS OF A MUSCLE KNOT & WHY THEY ARE A PROBLEM:
Muscle knots can develop almost anywhere on the body where muscle or fascia is present.
Places where muscle knots commonly occur include:
- Calf muscles
- Lower back
- Neck
- Shins
- Shoulders
The most common source of muscle knots is the trapezius muscle. Tension and knots in the trapezius muscles often occur due to stress and poor posture as we have discussed above.
So whilst very common, muscle knots shouldn’t be seen as normal and they aren’t harmless they can restrict movement and they will often cause the muscles around the area to tighten up to prevent more injury and pain. They are quite persistent and most will remain until the knotted area is broken up and the muscles are loosened and circulation returns to the constricted area. If left untreated, the muscle tissue will continue to lose elasticity and cause postural stress that is hard to reverse.
Muscle knots can also cause additional symptoms, including:
- Jaw pain
- Lower back pain
- Ringing in the ears
- Tension headaches* (*as I will try to explain below when talking about trigger points and referred pain.)
Causes; common causes of muscle knots include:
- Stress and tension
- Injuries related to lifting and repetitive motion
- Poor posture
- Prolonged bed rest or sitting without stretching
Is a Muscle Knot a Trigger Point and what is this referral pain stuff?
Is a muscle knot a trigger point again it’s a yes and no answer, the medical term for a muscle knots is a myofascial trigger point, however not all knots or lumps are trigger points.
A muscle knot may twitch or move when it is pressed, this symptom helps differentiate a trigger point from a tender point. A tender point is an area that hurts only in the pressed location, and the pain does not radiate to other muscles. As a sports therapist one of the tools required is to know by feel the difference between these types and also the common areas that trigger points cause referred pain.
The name ‘trigger point’ is derived from the fact that often pressing on them will cause referred or ‘triggered’ pain, which spreads from the point/knot to nearby muscles.
Doctors classify trigger points as either active or latent, an active trigger point is like an active volcano it’s already going off you don’t have to touch the trigger point itself for it to be painful. Latent trigger points are only painful if someone presses them think of it as your dormant volcano it’s there but not erupting with pain yet.
Both can cause referred pain, the most common example of this is a knot or trigger point in the upper trapezius, when pressed people often feel a pain in the temple. Most likely this is because the muscle knot is blocking good blood flow to the head and when pressed it blocks the blood supply even further, however equally when fully cleared people often feel much clearer and report less tension and stress headaches.
Who is more at risk of getting knots?
The most at risk group as you can guess from reading this article is people who have a more sedentary lifestyle and on top of this, those who have or carry bad posture. There are a couple of other risk factors that doctors have identified which mean people may be more likely to experience trigger points. These include:
- A diet that lacks a variety of vitamins and minerals
- Difficulty sleeping or insomnia
- History of joint problems and injuries
- Poor posture
- Sedentary lifestyle
Less so, but sometimes people who play sports or work with their hands may also be at risk because they engage in repetitive activities. Repeatedly, doing the same motion can cause tension and knots over time.
What can I do about a muscle knot/trigger point?
I would say the first port of call should be identifying why the muscle knot has occurred and then secondly, identifying if it’s likely a trigger point or just a tender point. A knot or trigger point will as you press it try resist you and feel a bit springy, a tender point will just be pain, imagine you had been hit on the arm and have a bruise if you press into the bruise it will just be painful and hurt directly under that one spot not radiate outwards like a trigger point.
If someone’s muscle knots are due to prolonged sitting or a prior muscle injury, engaging in regular stretching breaks may help reduce muscle tension. However ultimately you may have to break that knot down which is when you come to see myself as a sports therapist to do some soft tissue work and myofacial trigger point release.
Or you could try the following:
- Applying a cloth-covered heat pad to the affected area
- Find a way of loosening the muscles e.g. swimming, shoulder circles, cycling all dependant on where the knots and tightness are.
- Taking anti-inflammatory medications, such as ibuprofen to reduce muscle pain
- If stress is the cause of the muscle knots, they can take steps to reduce it, including, deep breathing breaks during the day, reading a book or listening to music, getting more sleep at night, spending at least 15 to 30 minutes a day on relaxation techniques, such as meditation or gentle yoga
Self-massage:
A person may be able to push or rub out the knot by applying steady pressure to the pressure point, with enough pressure; the knot will start to feel softer to the touch and may begin to release.
A person can also place a tennis ball or something similar between their back and the wall or floor and roll gently on the ball to massage the muscles, or use a foam roller.
However be cautious with this, inflaming a trigger point without removing it can lead to further pain and even less mobility, I would always advise the little and often approach unless you are being treated by a trained professional. Ultimately you are trying to work the knot out loosen and return full mobility to the muscle or muscles that are affected not to tighten them up further by making your muscles over contract and thus not relax.
I have applied some links below, to some of my videos which show how to do some self-treatments for knots and trigger points.