Muscle knots narrative

Muscle knots narrative

What are muscle knots and how can they be treated?

Muscle knots, often called “myofascial trigger points” by clinicians, are thought to be caused by small areas of hyper-tense muscle. This may cause pain by blocking some of the normal blood flow to these areas of tension and by increasing inflammation. We believe these sensitive points within the muscle are caused by overuse or with poor posture. Stress also contributes to their development and persistence, after all, we tend to carry stress in our muscles.


We all tend to get painful muscle knots at some point. However, when these trigger points become a chronic issue, we call this myofascial pain.

Pressure on these trigger points can causes pain in seemingly unrelated parts of your body. This is called referred pain. For example, some patients with painful knots in their shoulders can have pain that is referred to the back of the head and around to the temple, leading to headaches.

Sleep problems can also ensue. It can be hard to find a comfortable position and pressure on a trigger point can cause you to wake up.

Common locations:

These trigger points can occur in any muscle but they are commonly found in the:

  • The trapezius muscle
  • Muscles along the spine (para-spinal muscles)
  • Muscles around the shoulder blade

Diagnosis of myofascial trigger points is done in the office during the physical exam. Your doctor may apply gentle finger pressure to the painful area, feeling for tense areas. Certain ways of pressing on the trigger point can elicit specific responses. For instance, you may experience a muscle twitch.


  • These muscle knots can respond to stretching and exercising the muscles.
  • Massage has also been found to be beneficial in breaking up painful knots.
  • Acupuncture is another option. While we don’t know the exact mechanism, it has shown benefit and can be used as a complementary treatment.
  • In some occasions, physicians will prescribe medications for this pain, such as muscle relaxants, for a short-period.

When simpler treatments have not been helpful or in more persistent cases, your doctor may consider doing a “trigger point injection.” During this treatment, the clinician locates the trigger point and will inject the area with either a anesthetic or even saline (salt water). The medication used has not been shown to be important. The improvement comes more from the mechanical action of the needle and the injected fluid breaking up the painful knots, flushing away the surrounding inflammation and allowing for improved circulation. I often use this treatment as a bridge to doing more exercise, stretches, or increasing the effectiveness of physical therapy.