How do I treat a muscle knot?

Treatment of Muscle Knots

For muscle knots (myofascial trigger points), thermal interventions such as locally applied heat or cold are conditionally recommended as first-line treatment, with moist heat providing the greatest pain reduction when applied immediately after onset. 1, 2

Understanding Muscle Knots

Muscle knots, medically known as myofascial trigger points (MTrPs), are:

• Hyperirritable spots within taut bands of skeletal muscle 3
• Painful on compression and can cause referred pain and motor dysfunction 3
• Present in up to 85-95% of people with musculoskeletal pain 4

Treatment Algorithm

1. Thermal Therapy (First-Line)

• Moist heat application:

  • Apply for 2 hours immediately after noticing the muscle knot 2
  • Provides faster deep tissue penetration than dry heat 2
  • Results in greatest pain reduction when applied immediately 2

• Dry heat application:

  • Can be applied for longer durations (8 hours) 2
  • Similar benefits to moist heat but to a lesser extent 2
  • Good alternative when longer application is needed 2

2. Exercise Therapy

• Targeted strengthening exercises:

  • Focus on the affected muscle group 1
  • Perform 5-7 repetitions, 3-5 times daily 1
  • Hold contractions for 6-7 seconds, then slowly relax 1

• Aquatic exercises:

  • Performed in warm water (86°F) 1
  • Provides analgesia for painful muscles 1
  • Buoyancy reduces joint loading and enhances pain-free motion 1

3. Manual Therapy Options

• Self-massage techniques:

  • Apply firm pressure (2-4 kg/cm²) for 10-20 seconds over the trigger point 5
  • Allow referred pain pattern to develop and then release 5

• Professional massage therapy:

  • While conditionally recommended against for osteoarthritis specifically 1, massage therapy may have benefits for muscle knots 3
  • Can be considered when self-management fails 3

4. Pharmacologic Management (Adjunctive)

• NSAIDs:

  • Recommended as first-line medication for pain 6
  • Ibuprofen 1.2g daily (can be increased to 2.4g if needed) 6

• Acetaminophen:

  • Alternative to NSAIDs 1
  • Up to 4g daily 1, 6
  • Can be combined with NSAIDs for enhanced relief 6

5. Advanced Interventions (For Persistent Cases)

• Trigger point injections:
  • Consider if pain persists despite 3-6 months of conservative treatment 6, 7
  • Options include local anesthetics, corticosteroids, or dry needling 3, 7

Important Considerations

• Immediate intervention is key: Applying heat immediately after noticing a muscle knot provides better outcomes than delayed treatment 2

• Combination approach: Using thermal therapy alongside exercise and appropriate medications yields better results than single modalities 1

• Avoid high-impact activities: During recovery, avoid rapid loading of the affected muscles 1

• Return to activity criteria: Resume full activity only when there is complete pain resolution, full range of motion, and strength recovery 6

• Address perpetuating factors: Identify and correct contributing factors such as poor posture, body mechanics, psychological stress, inadequate sleep, or poor nutrition 5

Caution

While TENS (Transcutaneous Electrical Stimulation) is sometimes used for muscle pain, it is strongly recommended against for osteoarthritis pain and has limited evidence for muscle knots 1.