What is the best treatment for muscle knots

Overview

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.

CONTENTS

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.

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.

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

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

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.

References

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).