What causes muscle knots in your back?

With regard to muscle pain, the word “knot”—medically known as a myofascial trigger point—refers to a small bump in the muscle that is painful or tender to the touch. Even when the muscle is at rest, these trigger points tend to tighten and tense up, putting pressure on nerves and causing chronic pain. These stubborn, knotty points are caused by a number of things, ranging from dehydration to emotional stress to poor posture.

Muscle knots are a type of spasm that causes a portion of muscle to tense up, creating an uncomfortable tender area. These painful knots are often located in the upper back, neck, bottom of shoulder blades, and on the legs. The name can make it sound like the muscle has twisted or tied itself up, but that's not quite the case. Muscle knots are actually fascial tissue or strained muscle fibers, that can often be very painful. They usually happen because a muscle has been irritated by a repetitive motion, such as endurance training. Athletes will notice muscle knots after training one group of muscles for an extended period of time. Muscles usually knot up when they're in an awkward position for too long.

For example, sitting at a desk all day, driving for long periods, or sleeping in an odd position, 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 can't be entirely sure what the muscle is doing to cause pain. Some doctors believe the muscle spasms may affect blood flow, and trigger pain to the knotted area. Others presume the nerves are triggering the spasms resulting in pain and discomfort. In either scenario, a muscle knot is painful, and it can linger for days, weeks, or even become a chronic long-term condition. The discomfort might affect your work or make it hard to do things you enjoy.

Muscle knots can happen all over the body, but some of the most likely places for them to occur are in the lower back, neck, and shoulders. Sometimes, they can cause pain in other parts of the body, often triggering headaches and ear pain. If you experience any of these symptoms, you may want to consider some of the common causes of muscle knots so you can prevent them from recurring and find treatments to ease the pain.

• Overuse or Injury – Whether it is from lifting something heavy, repetitive motion (overuse), trauma, or a sprain or strain, damage to the muscles in the lower back are often the impetus for stubborn myofascial trigger points. The damage to the area causes the muscles to bunch up and tighten in order to protect the back from further injury in a process known as muscle guarding. Athletes and casual exercisers alike are at risk for developing back knots from weight lifting, cardiovascular exercise, and improper stretching.
• Dehydration – You already know that being dehydrated can affect your entire body, but did you know it can cause muscle knots, too? On top of that, being dehydrated can make all kinds of pain feel worse, so it may make your trigger points extra painful. Be sure you’re drinking enough water as part of your overall health, wellness, and muscle knot prevention plan.
• Poor Posture – Ever notice that after getting a new chair or changing your sitting position you suddenly have a lingering knot or two? It’s not a coincidence. Poor posture and prolonged hunching can put pressure and stress on the trapezius muscle, in particular (the upper back muscle that helps you turn your head), but the way you sit can also lead to knots in the lower and central back. In the same vein, a poor sleep position can cause certain muscles to develop knots.

• Sitting All Day – As humanity as a whole moves toward a more sedentary lifestyle, we’re quickly learning what negative long-term effects this may bring. One of the ways that too much sitting harms your body is by overstraining the shoulders and upper back, leading to knots. A sedentary lifestyle can also cause the disks in the lower back to bulge, the hips to weaken, and sciatica to develop, so it’s generally not good for your back and your body as a whole.
• Stress and Tension – The stress, anxiety, and tension in your life have a direct impact on the physical tension you carry in your body. Indeed, tension from mental and emotional stress can cause your muscles to tense up for prolonged periods of time, which can lead to nagging muscle knots and even chronic musculoskeletal disorders.

• Stretch - Performing gentle stretches, yoga, or a myofascial release can alleviate pain and release the muscle that's been knotted up. Stretching can also prevent knots. If you experience muscle knots more often, ask your physical therapist or doctor about stretches to loosen up muscles and lower the chances of more knots.
• Exercise - Aerobic exercise may also help to relieve muscle knots. If the knots are located in your shoulders or neck, performing jumping jacks, swimming, band pull aparts, shoulder rotations, and other various movements that work the muscles in your shoulders and neck (deltoids and traps), can help release the fiber tension. This stretches the muscles fibers and increases blood supply to the muscle. Increased blood supply helps repair damaged tissue and muscle fibers.
• Ice and Heat - Use an ice pack on the area where you feel discomfort for a short period of time, and then switch to a warm compress such as a heating pad.
• 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. If you are using a foam roller, set a timer for one minute and roll back and forth applying pressure to the tender area to trigger release.
• 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.

Figuring out what causes knots in your back will help you determine how to develop a treatment plan that works for you. Among the best treatments for knotty muscles is massage therapy, stretching, and rest. A professional massage therapist or a self-massage device (such as a foam roller or deep massage ball) can quite literally work out those tense muscles, loosening them so they feel normal again.

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