Most of us have felt a muscle knot at some point. Often called a "trigger point", it's that tight, tender spot in the shoulders, neck or back that seems to hang around after an injury, a stretch of overuse or a stressful few weeks. So why do knots happen, and what can you sensibly do about them?
What is a muscle knot?
The medical name is a "myofascial trigger point". It's usually defined as a small, irritable spot of tension within a tight band of muscle, or in the fascia around it, that hurts when you press on it.
Plenty of people also notice that pressing on a knot can send an ache somewhere else nearby.
Why do they form?
This is where it gets interesting, because nobody is completely sure. The usual suspects include injury, long-term strain, joint problems, stress and sitting still for long periods. Even so, there's no clear known mechanism for how trigger points actually form.
Some researchers go further. In a 2015 paper in Rheumatology, Quintner, Bove and Cohen argued that the traditional trigger point theory doesn't stand up to scrutiny. They didn't deny that people feel these tender spots. Their suggestion was that the pain may be better explained by known processes in the nerves and nervous system, rather than by a "knot" in the muscle itself.
So the knot you feel is real. The explanation for it is simply still being worked out.
What you can do yourself
For everyday back and neck aches, the standard advice is reassuringly simple:
- Stay active and try to carry on with your daily activities.
- Avoid staying in bed for long periods.
- Try gentle exercises and stretches, walking, swimming, yoga or pilates.
- For stiffness, use a heat pack or a hot water bottle wrapped in a tea towel. For pain, try an ice pack, also wrapped.
A gentle self-massage of a sore spot can be comforting too. Press slowly, breathe, and ease off if it feels sharp rather than just tender.
Where acupuncture fits
For long-lasting pain, NICE, the national guidance body in England, allows a single course of acupuncture or dry needling to be considered for people aged 16 and over with chronic primary pain, as long as the course meets certain conditions. The UK advertising regulator, the ASA, also accepts that there's evidence for acupuncture giving short-term relief of chronic low back pain and neck pain.
That's a useful claim but a modest one, and I think it matters to be clear about it. Acupuncture isn't a guaranteed fix for knots, and the relief people find is usually temporary. At White Willow I may combine needling with massage, cupping or gua sha where it helps, and I'll always talk you through what I'm doing and why.
Chinese medicine has its own traditional language for tight, sore areas, built around the idea of Qi either moving freely or getting stuck. It's a traditional framework rather than an anatomical explanation, but it's the one Five Element acupuncture works within.
When to get checked
Most muscle aches settle on their own, but please don't put up with pain that worries you. Call 111 or ask for an urgent GP appointment if you feel hot, cold, shivery or unwell, or if severe pain starts suddenly or gets worse quickly.
Call 999 or go to A&E if you have pain, tingling, weakness or numbness in both legs, loss of feeling around your genitals or bottom, changes to bladder or bowel control, or chest pain, or if the pain started after a serious accident.
If things don't improve, your GP or a physiotherapist is a good first stop. Acupuncture can sit alongside that care, but it shouldn't replace it.
If you'd like to know what a treatment session involves, have a read of what to expect at your first visit.