From the Research
The medical term for muscle knots, particularly those found along the medial scapular border, rhomboid major, and trapezius muscles, is myofascial trigger points. These are hyperirritable spots within a taut band of skeletal muscle that are painful upon compression and can produce referred pain, tenderness, and autonomic phenomena. Myofascial trigger points commonly develop in these upper back muscles due to poor posture, repetitive movements, muscle overuse, or trauma, as discussed in the context of myofascial pain syndrome 1. They form when muscle fibers remain contracted, creating localized areas of hypoxia and energy crisis, which leads to the release of inflammatory substances that sensitize nerve endings.
Causes and Development
The development of myofascial trigger points in these areas can be attributed to various factors including anatomical attachments of muscles along the medial border of the scapula, as described by studies focusing on the muscular anatomy of the region 2. The clinical presentation of patients with myofascial trigger points or muscle detachment in these areas often includes palpable tenderness along the medial scapular border, scapular dyskinesis, and decreased scapular/rotator cuff strength 3.
Treatment Options
Treatment options for myofascial trigger points include:
- Manual pressure release techniques
- Dry needling
- Massage therapy
- Stretching exercises
- Sometimes muscle relaxants or anti-inflammatory medications Trigger point injections, which can be performed with or without imaging guidance, are also a viable option, using substances such as local anesthetics, botulinum toxin, or corticosteroids 4. The efficacy of needling therapies, including dry needling, has been explored in clinical trials, suggesting that direct needling of myofascial trigger points appears to be an effective treatment, although the evidence neither fully supports nor refutes the hypothesis that needling therapies have efficacy beyond placebo 5.
Management and Prevention
Heat application can help relax the affected muscles, while regular movement and proper ergonomics can prevent recurrence. Physical therapy focusing on posture correction and strengthening of supporting muscles is often recommended for long-term management of chronic myofascial pain in these regions. In cases of medial scapular muscle detachment, surgical treatment can significantly reduce pain and improve functional outcomes, as evidenced by improved American Shoulder and Elbow Surgeons (ASES) self-report form scores post-surgery 3.