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How to Treat Muscle Knots in Your Back, Neck, & Shoulders

By Peter Zhou / July 1, 2017

Know that sharp ache you get after an intense workout that is usually in your neck, shoulders, or upper back? It can be difficult just to move your shoulders without feeling pain, let alone continue with your workout. Even worse, this pain can linger on for weeks, or even months.

If you are active, or lift weights consistently and feel a constant stinging pain in your muscle, the culprit may be muscle knots.

What are Muscle Knots?

Muscle knots are points within a muscle where contracted fibers are unable to release1, or, as the dictionary puts it: “highly irritable localized spots of exquisite tenderness in a nodule in palpable taunt bands of muscle tissue.”

A common problem for active people, muscle knots—technically called Myofascial Trigger Points, or MTPS—feel like a small knot to your fingertips. These knots can range from the size of a pinhead in smaller muscles to the size of your thumb in larger muscles.2

Muscle knots can cause pain in two ways: (1) latent trigger points, which are knots that only hurt when you put pressure on them, and (2) active trigger points, which are knots that actively refer pain along your neural pathways, causing it in non-localized areas.

Trigger points in a constant state of contraction have excess metabolic waste and oxygen use because blood flow to this area stops—this sends pain signals to the brain. Because your brain wants to stop the pain, it commands the muscle to rest, which leads to under-usage of the muscle. This is what makes the muscle shorten and tighten up.

What Causes Muscle Knots?

The most common causes of muscle knots are:

1) Accidents – Acute trauma, such as bad falls & sports injuries that strain you joints and muscles

2) Postural Stress – Sitting too long with poor posture, sitting with no support, & lifting improperly

3) Overstimulation – Strenuous exercise and sport activities, especially lifting weights

If you are developing muscle knots frequently from lifting weights in your shoulders, neck, or upper, or middle back, the likely cause is a postural issue. For example, if you have rounded shoulders from sitting in a office, your back muscles are already overstretched because your shoulders are rounded forwards. When you complete some pull-ups, or rows, your muscle will be stretched even further when lowering the weight, then will forcibly contract when lifting the weight. This over-stretching combined with intense contractions can overstimulate your muscles causing those nasty muscle knots to form.

For more on identifying and correcting common posture problems, see 5 Most Common Posture Problems.

How Can I Treat Muscle Knots?

If you do have a painful knot, you’ll be glad to know that you can treat it yourself. While using a massage ball, tennis ball, or a lacrosse ball.

To treat the muscle knot, simply roll the massage ball pressed either to the wall or the floor one side, and your body on the other over your muscle. You can use two tennis balls, massage balls in a sock, or the best solution is a RAD Roller if you want to go firmer or deeper. The RAD Roller will conform to the tissue and surrounding area slightly, so it mimics the feel of a therapist’s hands. This helps to truly mobilize the tissue beneath, whereas a tennis ball will often fold in or simply compress and not conform.

Note that, as mentioned before, it’s possible the pain you feel might not be near its root. You might be looking at a thorough massage of multiple areas before finding the actual knot. In these cases, another tool you might want to consider is the foam roller, which looks like a giant Lincoln Log. Seen people sitting or lying down on one while rolling back and forth in your gym? They’re foam rolling to cause their muscle fibers to loosen up, which allows blood flow to increase back to the area.

As a last alternative, you could apply a deep, stroking massage directly to the muscle knot; however, not the usual “I’m going to be pampered” massage, instead, think about what it feels like to stub your toe.

But, just like stubbing your toe, when your pain vanishes, you’ll feel tremendous relief. While most people think of massages as something done with the hands, oftentimes, with knots it’s more effective to use tools.

Here are some guidelines for treating those muscle knotsii:

  • Use a tool to save your hands
  • Use a deep stroking massage, not static pressure
  • Do the massage stroke slowly
  • Use six to twelve strokes per knot
  • Work each muscle knot 2-3x per day until the pain goes away
  • Use a massage ball, foam roller, or a deep stroking massage 2-3x a day until the pain subsides and the knot releases, which can take anywhere from a couple days to week depending on the size of the knot and the intensity of the self-massage. This should be able to clear up any muscle knots you may have. However, just because you’ve gotten rid of them doesn’t mean they won’t come back.

    To avoid muscle knots in the future, it’s best to focus on overall posture, mobility, and strength, while staying consistent with foam rolling and deep tissue massages, which can work wonders. If you are a runner, athlete, or you constantly get muscle knots, you should seriously consider getting the Trigger Point Therapy Total Body Kit.

    Persistence can be the difference between a successful or unsuccessful treatment. Success allows for a pain-free and more mobile body.

    Want to improve your strength, & flexibility, and conditioning? Then check out BuiltLean’s 12-Week Body Transformation Program.

    Show 2 References

    1. Travell, J. G., & Simons, D. G. Myofascial Pain and Dysfunction – The Trigger Point Manual. Philadelphia: Lippincott Williams & Wilkins. 1993.
    2. Davies, C., Simons, D. G., & Davies, A. The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief. Oakland: New Harbinger Publications. 2004.


    • Jessica says:

      Thank you. I appriciate the article. I've gone to several dr's wondering what is wrong with me. I started getting lumps in my head and with visiting several dr's and gathering everyones information. I noticed that the knots or muscle spams from workig out. Not realizing that they could come back at any time. Which they have I've been dealing with this issue for 8 months already. Hopefully changing diet and messaging the knots will improve my spams/knots.

    • Larry says:

      I'm having a bit of a debate with a friend's spouse.

      Her husband has what appears to me a couple of knots in his lower back along the belt line on the left. This was after a weekend of golfing.

      I pressed the knots out for him for a few minutes, and he felt a little relief. The debate came when I suggested heat to release/loosen the knot then some stretching/pressing massage to stretch the knot out once heated.

      She, on the other hand, says that icing the knot is the way to go.

      The painful knot has been there since yesterday morning (not quite 48 hours).

      What do you suggest regarding ice versus heat?

      • Marc Perry, CSCS, CPT says:

        @Larry - If you find any more research, please do share.

        • Larry says:

          Check this excellent site out: http://saveyourself.ca/articles/icing-exceptions.php

          The bottom line per that website: Ice for inflammation (swelling). Never ice lower back pain. Heat is good for knots (called trigger points).

          I have a knot in my lower left back, just below the belt line. When I golf (which is the probable cause but don't ask me to quit), I have found that while I walk, I can use my finger tips to pull (this is best) and push the knot out somewhat, helping to release the knot and ease the pain considerably. I used to take pain killers but don't do that any more.

          • Marc Perry, CSCS, CPT says:

            @Thanks for sharing, Larry. That website I actually referenced in my muscle soreness article.

      • Marc Perry, CSCS, CPT says:

        @Larry - I'm not an expert on massage therapy, but conceptually, heat helps bring blood to an area. A knot is essentially a taught area of muscle that is resisting blood flow. My guess is that some heat instead of ice would likely be more helpful, but according to the research, manual palpation with either a hand, or massage ball is what works.

    • Angie says:

      I have several knots in my back and a couple in my head. I go monthly for a deep tissue massage. I always feel better till the next day and they are all right back! This last time she found one in my foot that had been hurting for months. Did't even know It was there. I have tried the tennis ball and it does not seem to help much. Would you have any other suggestions? I have multiple knots on both sides of my back and a rather large one on the left back side of my neck. Can't ever seem to get them worked all the way out!

      Looking for any help! In a of pain!

      Thank you!

      • Larry says:


        My guess is that you need to work the knots daily - not just monthly. Google search "Miracle Ball" and try those instead of the tennis ball - especially if your knots are in your lower back. I lay in bed each night and read for a while with one Miracle Ball on my lower back knot. I move it around an inch at a time to push at the knot. It helps.

        Bottom line is that once a month is not enough. It will loosen the knot but it will come back again.

        Good luck.

        • Marc Perry, CSCS, CPT says:

          @Larry - Agreed! Need to update the article with some extra info.

    • Kerry says:

      Thank you so much for this article! I often have muscle knots, which are excruciating, and make me miserable. What a great and super easy solution! Thanks again.

      • Marc Perry, CSCS, CPT says:

        @Awesome, happy it was helpful!

    • arlene says:

      thank you so much for this article. my massage therapist says i have to see her every week so she could work on the knots till they get smaller. however, i find it too tedious to go there, not discounting that it will certainly cost me a fortune since i know the knots won't ever disappear. i have resisted the temptation to see her again the last couple of weeks & tried to ease the pain i was experiencing by self-medicating when i came across your article while googling for a remedy for lactic acid build-up (coz that's what i thought was really causing these lumps on my shoulders).

      • Marc Perry, CSCS, CPT says:

        @arlene - happy you liked the article. I am a big fan of massage therapy, but as you point out, it's expensive and ideally you would be doing self massage on your own anyways.

    • Belle Sansone says:

      will a heating pad help for upper back pains??

      • Kristin says:

        Hi Belle,

        Using a heating pad could be a great short-term solution to relieve upper back pain, but if your pain is chronic, then you're probably dealing with some muscular imbalances. For a more permanent solution, you'll want to correct these imbalances with a combination of foam rolling and corrective exercise. Here are a few excellent corrective exercises: http://www.builtlean.com/2011/10/06/correct-rounded-shoulders-from-office-work-5-corrective-exercises/. Give those a shot, and keep us posted!

        -Kristin, BuiltLean Coach & Managing Editor

    • christopher walsh says:

      Hi thanks for advice my knot seems more of a thin line pos like a ham string 5mm width comes from my sholder blade through my shoulder down my arm i have had simptoms very painful for many years lifting arm very painful thanks chris

      • Kristin Rooke, CPT says:

        Hi Chris,

        I'm sorry to hear that you've been experiencing years of shoulder and arm pain! My guess is that you have more than a muscle knot going on.

        If you haven't already, I highly recommend consulting with your primary care doctor or a physical therapist to determine what's causing the pain. A physical therapist should be able to diagnose the cause, treat the pain, and give you an exercise program to help correct any muscular imbalances that could be contributing to the problem. The reality is, you should be able to raise your arm pain-free, and pain should not have to be a part of your daily life.

        I hope that helps! If you ever have any more questions, or would like some advice, feel free to reach out to us at support@builtlean.com.

        -Kristin, BuiltLean Coach & Managing Editor

    • Luke Yancey says:

      I'm pretty sure I have postural stress. I work in an office and am always sitting down. I think I need to go to the gym more often so I can get rid of the cramps. Thanks for the great information. It was even interesting to know that overstimulation can lead to knots.

      • Kristin Rooke, CPT says:

        Hey Luke,

        Sitting for extended periods of time, especially in a slouched posture, can absolutely lead to postural issues and muscular imbalances. Our expert physical therapist created a 10-minute workout to fix poor posture, which it sounds like you could benefit from. Give it a try, and let us know how it goes!

        -Kristin, BuiltLean Coach & Managing Editor

    • Lacy Katsaounis says:

      Asking questions are genuinely good thing if you are not understanding something completely, except this piece of writing offers nice understanding yet.

    • Caleb L. Jenkins | Top Up-N-Comer QuickBooks ProAdvisor says:

      I'm wondering if the information listed above would be helpful in a painful neck situation...

      • Kristin Rooke, CPT says:

        Hi Caleb - I think it depends on the source of your neck pain. Do you have muscle knots in your neck, or did you recently experience an injury? The neck is a very sensitive part of the body. If the pain has been chronic for a few weeks now, I would recommend making an appointment with your primary care doctor, a physical therapist, or a chiropractor who specializes in muscle tissue work (instead of just skeletal adjustments). Any of these professionals will be able to assess what's going on, and provide guidance on how to alleviate the issue. Hope that helps!
        -Kristin, BuiltLean Coach & Managing Editor