No One Really Knows What Muscle Knots Are

We sometimes get hard, painful, or tender lumps in our muscles. This is pretty common, and we often call them muscle “knots.” Go to a massage therapist and you may be told you have “trigger points” or need “myofascial release.” But is that really what’s going on? The truth is a little more complicated.

We don’t really know what “knots” are

Look up muscle knots, and you’ll find lots of people overconfidently explaining exactly what is going on in your muscle tissue when you feel a tight and tender spot. But any time science has tried to get a handle on what’s really going on, answers remain elusive.

There have been several studies that asked pairs or groups of professionals (including physical therapists, doctors, and chiropractors) to locate muscle knots in patients. In most cases they did not agree about where the knots even were. There’s no definitive test or definition for what a knot even is, which makes it hard to study what it’s made of or what causes it.

There is a long history of scientists arguing over what is really going on when a muscle has a spot in it that we might describe as a knot. This article on PainScience.com summarizes one debate. One camp considers knots to be “trigger points” where inflammation in muscle causes pain, and the pain makes the muscle tighter, making the knot worse until it can be relieved somehow. The other proposes that no such thing is going on, and that the problem may be irritated nerves telling our brains we’re in pain even though the muscle itself is fine.

So far, none of the explanations for muscle knots are proven. Everybody seems to agree that knots are real, and that certain treatments like massage seem to help—we just don’t know for sure what causes the knots, or whether the treatments are doing anything or just appearing to work through the placebo effect.

What to do if you have a muscle knot

It may be frustrating to learn there isn’t a “just do this and it will get better” solution. On the bright side, there are many things that seem to relieve muscle knots, so you might as well try a few and see whether they help.

Massage or self-massage

One thing that seems to help is massaging the area with the knot. If you get regular massages, be sure to point out any knots and let your massage therapist know you’d appreciate some extra attention there. There’s no evidence that harsh massage techniques are needed, so if the massage is rougher than you’d like, feel free to request a gentler touch or even switch providers to someone who doesn’t apply as much pressure.

One theory for why massage helps is that it increases blood flow to the area; another is that it physically softens some of the fascia tissue around the knot. On the other hand, the irritated nerve theory is consistent with the idea that pain comes from the brain perceiving a threat to the tissue (whether anything is wrong in the tissue or not). Adding an extra sensation of pain in a safe environment may help your nervous system to realize nothing is actually wrong, and it can turn down the pain signals.

Foam rolling

Foam rolling, sometimes known by the fancy term “self-myofascial release,” is essentially a form of self-massage. Whatever the mechanism, foam rolling often helps a knot to feel better.

Massage balls can help to get a more focused amount of pressure on a muscle knot. Put the weight of your body onto a tennis ball, lacrosse ball, or a specialized massage ball—you can get spiky ones, vibrating ones, and more. Again, you don’t need to apply a ton of pressure, just as much as it takes to get the knot to feel a little bit better.

Exercise

One theory holds that knots form more easily in muscles that are overworked, whether from exercise or from everyday actions like sitting in uncomfortable positions. If this is the case, a stronger muscle will be harder to overwork. Exercise will also increase blood flow to the tissue, if that turns out to be helpful; and stretching can also help knots to feel better. Add all of that up, and you have a good argument for starting a general exercise program (if you don’t already do one) that includes some cardio, some strength training, and some stretching.

Time

As with many of the aches and pains we encounter in everyday life, muscle knots tend to be temporary. We can thus include them in the same category as sore muscles and muscle cramps, and apply the same rules: Do whatever makes them feel good, stay active as much as the pain will allow, and give them time to heal. Eating well, staying hydrated, and getting plenty of rest won’t hurt, while we’re at it.