Muscle knots, also known as myofascial trigger points, are a common source of discomfort and pain in areas such as the neck, back, and buttocks. According to Dr. Jeremy Fleeks, a primary care sports medicine physician at Houston Methodist, these knots form when bands of muscle remain contracted even without active use.
Dr. Fleeks explains that muscle knots usually develop due to some type of injury or trauma to the muscle. Overuse is one cause—for example, pushing too hard during exercise or not allowing enough time for recovery can result in persistent tension. On the other hand, prolonged inactivity or poor posture—such as sitting at a desk for extended periods—can also contribute to knot formation by straining muscles that should otherwise be relaxed.
“While trigger points can develop in any skeletal muscle, among patients with myofascial pain, most trigger points are found in the trapezius muscle,” says Dr. Fleeks. “Back muscles are particularly susceptible.” The trapezius is located in the upper back and neck and plays an important role in stabilizing posture.
Dr. Fleeks notes that individuals with previous injuries, those who lead sedentary lifestyles, people under stress, or those with conditions affecting muscle metabolism may be more prone to developing muscle knots.
Pain is the main symptom associated with these knots. Dr. Fleeks distinguishes them from strains and cramps: “Strains are partial stretches or tears in a muscle that usually are the result of an acute injury, while a cramp is a temporary and involuntary muscle contraction that usually resolves spontaneously,” he says. “Trigger points or muscle knots can cause pain through a combination of local tissue changes and nerve inflammation. They’ll include a hypersensitive spot within a taut band of muscle that contains sensitized receptors.”
He adds: “When palpated or touched, these trigger points produce characteristic referred pain patterns along specific zones or areas of the body, a local twitch response or at least two complementary symptoms, such as limited range of motion or pain during muscle contraction.”
For treatment, rest and hydration may help most cases resolve on their own over time. Dr. Fleeks recommends massage therapy and physical therapy as first-line treatments supported by clinical research; osteopathic manual medicine is another option. Injections with anesthetics (known as wet needling) may be considered for difficult cases but no single medication has been shown to outperform others.
He cautions against using massage guns on sensitive areas like the neck: “The concern with massage guns and neck use relates to potential vascular injury and disruption of sensitive neurovascular structures,” says Dr. Fleeks. He advises avoiding direct application over acute injuries or bony areas and limiting duration and intensity.
To reduce recurrence risk, Dr. Fleeks suggests maintaining good posture; resting between workouts; staying physically active throughout the day; avoiding overexertion; gradually increasing exercise intensity; managing stress levels; and staying hydrated.
“If myofascial pain characteristic with trigger points is not controlled, significantly limits your daily activities or lasts more than one or two weeks, it’s recommended that individuals seek medical evaluation,” says Dr. Fleeks.“Myofascial pain can coexist with or mimic fibromyalgia—a chronic condition involving widespread pain with multiple tender points—as well as fatigue and sleep disturbances.” He emphasizes thorough patient assessment for accurate diagnosis: “Myofascial pain syndrome typically presents with regional pain and specific trigger points,” he adds.”That’s why taking a good history and physical exam of each patient is so important.”
