Sunday 18th June, 2023

What is the best treatment for muscle knots

Muscle knot therapies
We review the various muscle therapies and show you which are the best

If you are looking for relief from muscle knot pain you will be offered a wide range of therapies ranging from home remedies through to professional therapies such as massage, needles or laser. Will the home therapies work, or should you be forking out for one of the professional therapies, and if so which should you get?

Also, if you have had experience with these before you will probably understand that whichever you do the pain usually comes back again. Is there anything you can do to stop this?

In this article will look at what the clinical trials say works best. Of these, there is one therapy you can easily do at home for practically no ongoing cost that works as well, if not better than any of the professional therapies. We will also look at why the pain usually keeps coming back and what you can do about it.


If you have muscle knot pain simple home remedies such as heat or stretching may give short term relief, while according to clinical trial results (details below) there is little difference between the common professional therapies such as massage techniques, needles or laser. They all typically need a course of treatments, but once the treatments stop the pain eventually comes back.

The reason the pain comes back is that most treatment do not actually eliminate the muscle knots. What happens is muscle knots start as small lumps which gradually grow, then when they are large enough they can be aggravated and cause pain. Therapies typically just stop them causing pain and maybe diminish them slightly, but once the treatment stops the lumps continue to grow and are eventually re-aggravated.

The good news is that scientists have done a lot of work in finding out what muscle knots are and how they form. From this we have put this together for you as a very effective solution to help you permanently get rid of your muscle knot pain. This includes:

  1. the effective home therapy that should rid pain as well as the professional therapies, but you can also easily keep doing after the pain goes to rid the muscle knots completely, and
  2. effective prevention strategies to stop muscle knots forming and re-forming.


What are muscle knots
Treatments for muscle knots
Your strategy to eliminate muscle knots

What are muscle knots

Muscle knots are those tender lumps in your muscles that therapists find. They are arguably the biggest cause of musculoskeletal pain syndromes such as back neck and shoulder pain (1,2)⁠. Their technical name is (myofascial) trigger points, or trigger points for short. For more details please see our article Your Complete Guide To (Myofascial) Trigger Points , but in summary.

The trigger point feedback loop
Trigger points are the technical name for muscle knots

What are the lumps

Of course the lumps are not actually knots in the muscles. They are part of your muscle that has spasmed or “cramped” causing a lump. As this diagram shows, when part of the muscle spasms it tightens the muscle, causing it to press on the blood vessels restricting blood flow. This in turn causes a build up of waste products causing further spasm. This cycle keeps going around and around in circles, with the muscle knots gradually growing.

There is no inflammation

We’ve read a lot of misleading (and frankly ignorant) information about muscle knots. An important example is that muscle knots involve inflammation. They do not, therefore treatments based on reducing inflammation are not appropriate.

Symptoms of muscle knots

The symptoms of muscle knots are:

  • easy fatigue, muscle pain (often increases with activity)
  • reduced flexibility, which can also cause muscle tears and “overuse” injuries where they attach (for example tennis elbow )
  • muscle knots refer pain, which can mimic a host of conditions including headaches and sciatica
  • pain, fatigue and disrupted sleep can cause feelings of being run down, emotional and psychological problems

Diagnosis of muscle knots

Muscle knots do not show up in medical laboratory tests or imaging. However they are easily diagnosed by examining the muscle looking for:

  • tight bands of muscle
  • tender lump that refers pain when pressed upon
  • (sometimes) the muscle will twitch when the trigger point is pressed (the “twitch sign”)

Treatment for muscle knots

In this section we will show you:

  1. why there are so many different therapies,
  2. why these typically fail to get rid of the problem, and
  3. the therapy you can easily do yourself that is highly effective.

Why there are so many different therapies

As we have seen muscle knots involve muscle spasm, tightness, restricted blood flow and a build up of waste products combining together in a cycle we call a positive feedback loop. Because of this any treatment that helps part of this cycle will help reduce the severity of a muscle knot.

Example one: heat

Heat helps increase blood flow, so is a helpful home therapy

Example two: massage

Massage helps relax muscles, stimulates blood flow, and helps mechanically squeeze out the waste products. This helps three parts of the cycle, so is a more effective therapy.

Trigger point cycle
Muscle knots (trigger points) develop slowly over time, then eventually be aggravated to start shooting pain. Most treatments just reverse the last step., relieving the pain but leaving the muscle knot

Why these usually do not get rid of the problem

As this diagram shows muscle knots (trigger points) start small and gradually grow. As they do they will cause issues such as fatigue and tight muscles, but will not shoot pain. Eventually they become large enough and something may aggravate them , causing them to start shooting pain. This is called “activation”.

Typically treatments and courses of treatment will just stop the muscle knot shooting pain, causing it to be like it was before it was activated. The technical term for this is “de-activation”. The pain will go so it feels like the problem is fixed, but of course the muscle knot is still there and will eventually be re-aggravated and start causing pain again.

Both the public and professionals are mislead that these treatments actually fix the problem.

Clinical trial evidence proves that these treatments do not get rid of the muscles knots, but their proponents mislead both professionals and the public that they do. Details in the appendix below

Vibration treatment for muscle knots
Vibration is arguably the best treatments for muscle knots, and can be easily self applied for repeated applications

The therapy you can easily do yourself that is highly effective

We discussed above how muscle knot therapies work by helping parts of the cycle. As this diagram shows vibration massage is highly effective because it targets all four parts of the muscle knot cycle. Further, it is very easy to do yourself. As discussed in our article How to release trigger points yourself all you need to do is place a vibration massager (not a massage gun) over the muscle knot and let the vibrations penetrate.

Self massage using balls and rollers

Massage using balls or rollers is often recommended as a home therapy for muscle knots. However, clinical trial results for these are usually poor, and as a Chiropractor for 27 years I saw a lot of people hurt themselves for very little benefit. For details please see our article Can foam roller be harmful .

Your strategy to eliminate muscle knots

In this section we will show you a simple strategy to help eliminate muscle knots completely. Rather than just temporarily relieve pain we aim to:

  • relieve pain
  • eliminate the non-pain effects such as fatigue and muscle tightness
  • prevent the muscle knots from coming back.

To do this we will use a three part strategy:

  1. Continued (self) treatment
  2. Prevention
  3. Other issues
Residual trigger points after treatment
Residual trigger points after treatment

Continued (self) treatment

In a trial conducted by the best trigger point scientists in the world (3), after 12 weeks of extensive therapy patients felt much better, but as this chart shows 2/3 of muscle knots (trigger points) remained. While showing that typical treatments or courses of treatment will have little effect on the number of muscle knots the treatment did manage to diminish them and eliminate some. What this means is you need continue to diminish and eliminate muscle knots by continuing treatment for long after the pain has gone.

For most doing this using professional therapies will be prohibitively time consuming and expensive. However, you will easily be able to do this if you use self massage as described in our article How to release trigger points yourself .

Tightened muscles press on blood vessels
Tightened muscles press on blood vessels, restricting blood flow


There are many causes of muscle knots including injury, muscle overload and emotional stress. However, the biggest cause is where muscle tightness restricts blood blood flow creating an environment of accumulated wastes and reduced nutrients in your muscles. This is why muscle knots are so common where postural issues (eg. sitting at a computer) or repetitive activities cause muscle tightness. It is also important to note that psychological and emotional issues can cause your muscle to tense, restricting blood flow and causing muscle knots to develop. Here are some basic ways you can help stop muscle knots from re-developing or forming.

Avoid postures or activities that tighten your muscles

We have used the common example of sitting at a desk. However, there are may other activities that could cause issues. Our government worksafe has this  excellent practical reference that covers most situations, including how to set up your chair and desk.

Regular breaks

If you are in a situation such as sitting at a desk where your muscles may tighten take regular breaks, doing some light stretches or exercises.

Muscular maintenance

Likely you will be able to reduce the amount of muscle knots that form but not stop them completely. Regular massages or vibration massage will help find muscle knots and take care of them while they are small.

Psychological and emotional stresses

Is these issues are causing you to tighten your muscles a lot seek some professional help on how to deal with them.

Other issues

Muscle knots are often part of a more complex musculoskeletal problem. Therefore we recommend that you seek advice from a properly qualified professional who deal with these conditions, such as a Chiro, Osteo or Physio. This is especially important is the muscles knots are stubborn or keep re-occuring.

Appendix one: both the public and professionals are mislead that these treatments actually fix the problem

Most treatments do not eliminate trigger points

The chart above showed that the even after an extensive 12 weeks of multiple therapies performed by the best trigger point scientists in the world 2/3 of the trigger points were still there (3)⁠ . If the best in the business did that and only eliminated 1/3 after 12 weeks your typical course of therapy from a professional will barely make a dent in the trigger point population.

How therapy proponents mislead professionals and the public

Any scientist conducting a clinical trial of a trigger point therapy would be well aware that the trigger points will not be eliminated, so they very conveniently don’t check whether the trigger points actually go (4)⁠. All they measure is symptoms such as pain, so as long as the patients feel better they can write the report as a success.

They over up this fact by using the term “deactivation”. Reports will say things such as the their treatment is clinically proven to “deactivate” trigger points. This sounds like fixing them, but is more like re-setting an electrical circuit breaker but leaving the fault.

Appendix two: what the research says about individual trigger point therapies

As mentioned above the clinical trials show that there is little difference between the effectiveness of the common professional therapies. Below is a summary of the findings (4–10)⁠⁠. Keep in mind though that as discussed above clinical trials of trigger point therapies generally (conveniently) do not check whether the knots are eliminated, so this is just a measure of how they stop pain.

Trigger point dry needling
Trigger point dry needling

Dry needling

Most trials show that dry needling provides some short term pain relief and improved function. The risks and potential to cause pain are obvious. The mode of how needles work is still speculation. Where dry needling had been compared with laser the laser has given slightly better results.

Laser therapy


Trial results for laser have been marginally better than those for dry needling, but still only temporary relief. Scientists attribute it’s effect to increasing micro-circulation, improving oxygenation and helping remove waste products. However, this is something that can easily be achieved, if not better, by any competent massage therapist.

Major concern

The big concern with laser is the sheer number of applications of therapy sessions needed for only temporary benefits. For example one trial (16)⁠ used 10 daily applications of laser on patients with upper back and neck pain to get a reduction in pain and tenderness for three weeks. Further, according to one review (17)⁠ applications of laser should be given from 2-3 times a week though to 5 times a week, with a total of 30 applications of therapy for long term cases. Keep in mind this is just to achieve deactivation, not to eliminate the problem. Assuming each laser consultation costs $50 and takes an hour out of your day that’s $1,500 and 30 hours of your life just for some temporary pain relief, leaving you to front up again next time the problem is aggravated.

Manual trigger point therapy
Manual trigger point therapy

Manual therapies

There are various types of manual therapies that involve pressure, massage and stretching of muscles. The trial results for them tend to be similar to those of laser and dry needling. However, according to one review (10)⁠ one study did show residual benefit after six months.


DrGraeme massagers were originally built by Dr Graeme for use in his clinic, and to prescribe to his patients for additional self use at home. Now these are used by colleagues and other professionals for similar purposes. If you are a professional and wish to know more about this therapy, or possibly get a sample massager to trial please check out our practitioner page.


  1. Chiarotto A, Clijsen R, Fernandez-de-las-Penas C, Barbero M. The prevalence of myofascial trigger points in spinal disorders: a systematic review and meta-analysis. Physiotherapy. 2015;
  2. Celik D, Mutlu EK. Clinical implication of latent myofascial trigger point topical collection on myofascial pain. Curr Pain Headache Rep. 2013;17(8).
  3. Bron C, De Gast A, Dommerholt J, Stegenga B, Wensing M, Oostendorp RAB. Treatment of myofascial trigger points in patients with chronic shoulder pain: A randomized, controlled trial. BMC Med. 2011;9.
  4. De Las Peñas CF, Sohrbeck Campo M, Fernández Carnero J, Miangolarra Page JC. Manual therapies in myofascial trigger point treatment: A systematic review. J Bodyw Mov Ther. 2005;9(1):27–34.
  5. Boyles R, Fowler R, Ramsey D, Burrows E. Effectiveness of trigger point dry needling for multiple body regions: A systematic review. J Man Manip Ther . 2015;23(5):276–92.
  6. Denneny, Diarmuid et al. Trigger point manual therapy for the treatment of chronic noncancer pain in adults: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2019;100(3):562–77.
  7. Tough EA, White AR, Cummings TM, Richards SH, Campbell JL. Acupuncture and dry needling in the management of myofascial trigger point pain: A systematic review and meta-analysis of randomised controlled trials. Eur J Pain 2009;13(1):3–10.
  8. Cagnie B, Castelein B, Pollie F, Steelant L, Verhoeyen H, Cools A. Evidence for the use of ischemic compression and dry needling in the management of trigger points of the upper trapezius in Patients with Neck Pain: A Systematic Review. Am J Phys Med Rehabil. 2015;94(7):573–83.
  9. Espejo-Antúnez L, Tejeda JFH, Albornoz-Cabello M, Rodríguez-Mansilla J, de la Cruz-Torres B, Ribeiro F, et al. Dry needling in the management of myofascial trigger points: A systematic review of randomized controlled trials. Complement Ther Med . 2017;33(December 2018):46–57.
  10. Rickards LD. The effectiveness of non-invasive treatments for active myofascial trigger point pain : A systematic review of the literature. 2006;9:120–36.
  11. Hakgüder A, Birtane M, Gürcan S, Kokino S, Tura FN. Efficacy of Low Level Laser Therapy in Myofascial Pain Syndrome: An Algometric and Thermographic Evaluation. Lasers Surg Med. 2003;33(5):339–43.
  12. Uemoto L, Nascimento De Azevedo R, Almeida Alfaya T, Nunes Jardim Reis R, Depes De Gouvêa CV, Cavalcanti Garcia MA. Myofascial trigger point therapy: Laser therapy and dry needling. Curr Pain Headache Rep. 2013;17(9).

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Dr Graeme

About Dr Graeme

Several years ago Dr Graeme, a Chiropractor practicing in Victoria, Australia was looking for a serious hand held massager his patients could use at home to get the extra quality massage they needed. The ones he found in the shops and on-line for home use looked nice but were not serious, and... read more

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