What is the best treatment for muscle knots

Muscle knot therapies — We review the various muscle therapies and show you which are the best

If you have pain from muscle knots you have a large number of options ranging from a variety of professional therapies through to several home remedies. When looking for your best option there are obvious considerations such as the cost, pain, and whether you like needles, but the most important is how effective they are. We’ve reviewed the clinical trials and scientific papers, plus 27 years experience as a chiropractor to give you the answers.

What we looked at to find the most effective

You would think that it would be easy to just look at the clinical trials to work out which gave the best results, but it is not that simple. Let us look at why.

In this section:

No clear "most effective" in trials
Trials consider pain rather than eliminating muscle knots
The advantages of self therapy are not considered
What we considered to recommend the best therapy

No clear most effective in the trials

It is hard to do a head to head comparison because the trials varied with things like the type and severity of the problem treated, how things were measured, and the number of treatments given. In general though most of the therapies gave similar results so there was no clear most effective therapy.

Do you want to eliminate the muscle knots, or just (temporarily) relieve their pain?

We found that most of the trials of the various therapies just measured whether they relieved symptoms, and not whether they eliminated the actual problem.

The advantage of having self therapy

A trial may show that a professionally administered and a self therapy are roughly equally effective. However, the self therapy will always give better long term results. This is because you will only have a limited number of professional treatments, whereas you are able to continue with the self treatment and have many more. The same principle will apply if a treatment is more pleasant. For example you are likely to have more “nice” massages than sessions of painful massages or needles.

What we considered to recommend the best therapy

To find the most effective muscle knot therapy for you the things considered are:

Proven therapeutic effects on muscle knots
Comfortable (or at least not unpleasant)
Able to easily be self administered (convenient, affordable, able to have more treatments)

We were able to find only one therapy that fits all these criteria. In the next section we give you background information about what muscle knots are and what therapies do, or:

you can skip ahead to the most effective muscle knot therapy

The technical name for muscle knots is (myofascial) trigger points

The technical term for muscle knots is (myofacial) trigger points. Some of the technical articles referred to in this guide will use the technical name.

Background information

What are muscle knots
Why most therapies just relieve pain
How muscle knot therapies help

What are muscle knots

Muscle knots are those tender lumps in your muscles that therapists find. They are arguably the biggest cause of musculoskeletal pain syndromes such as back neck and shoulder pain (1,2)⁠. Their technical name is (myofascial) trigger points, or trigger points for short. For more details please see our article Your Complete Guide To (Myofascial) Trigger Points , but in summary.

The trigger point feedback loop — Trigger points are the technical name for muscle knots

What are the lumps

Of course the lumps are not actually knots in the muscles. They are part of your muscle that has spasmed or “cramped” causing a lump. As this diagram shows those lumps in your muscles are actually a combination of muscle spasm, muscle tightness, reduced blood flow and a build up of waste products, all locked in what is called a positive feedback loop. A positive feedback loop is like what happens when you put a microphone in front of a loud speaker and get a huge squeal until you switch it off. In this case, once the muscle knot starts to develop:

spasm tightens the muscle
the tightness presses on blood vessels restricting blood flow
the restricted blood flow causes a build up of waste products
the build up of waste products becomes toxic causing spasm.

This cycle keeps going around and around in circles, with the muscle knot gradually growing.

There is no inflammation

We’ve read a lot of misleading (and frankly ignorant) information about muscle knots. An important example is that muscle knots involve inflammation. They do not, therefore treatments based on reducing inflammation are not appropriate.

Symptoms of muscle knots

The symptoms of muscle knots are:

easy fatigue, muscle pain (often increases with activity)
reduced flexibility, which can also cause muscle tears and “overuse” injuries where they attach (for example tennis elbow )
muscle knots refer pain, which can mimic a host of conditions including headaches and sciatica
pain, fatigue and disrupted sleep can cause feelings of being run down, emotional and psychological problems

Diagnosis of muscle knots

Muscle knots do not show up in medical laboratory tests or imaging. However they are easily diagnosed by examining the muscle looking for:

tight bands of muscle
tender lump that refers pain when pressed upon
(sometimes) the muscle will twitch when the muscle knot is pressed (the “twitch sign”)

How muscle knots grow

As shown in this diagram muscle knots (trigger points) start small and gradually grow over years or decades. At first you will only know they are there if a therapist presses on them. As they grow the muscle will gradually tighten, causing restricted movement and possibly altered posture or fatigue. Eventually something may aggravate the muscle knot causing it to spontaneously shoot pain. This is called “activation”.

Why most muscle knot therapies just relieve pain

You may feel better after a course of needles, laser or manual therapies, but what actually happens is as shown by the blue arrow in this diagram. The muscle knot is reverted back to the way it was before it was aggravated. As you can see the muscle knot is still there so they:

still cause problems such as restrict movement, alter posture and fatigue
will shoot pain again as soon as they are re-aggravated.

How clinical trials mislead (including professionals)

Every scientist who conducts clinical trials does extensive background research studying what has been done before. Therefore, all those conducting trials of trigger point therapies would have studied the proof shown in the next section, that typical courses of trigger point therapy do not eliminate trigger points. Rather than have this inconvenient fact spoil their results those who conduct trials on therapies such as needles or laser do the following.:

make the goal of the treatment “de-activation” rather than elimination (12)⁠, and
deliberately choose not to check whether the trigger points are still there afterwards, and instead measure thinks like pain and other symptoms (3).

By doing this all the scientists need to do is relieve symptoms to be able to write their trials up as a success. For our research we found over 30 such trials (see summary below). Each claimed that their treatments successfully treated trigger points. However the reality is that all any of them ever proved that was that their expensive courses of therapy give temporary symptom relief. As mentioned above even professionals are mislead by this.

Results of 12 weeks trigger point therapy

Proof that the muscle knots don’t go

If you are recommended a course of muscle knot therapy such as needles, laser or massage you would expect the problem to be fixed, but as this chart shows although pain is relieved the muscle knots (trigger points) are still there. The chart is from a trial where some of the best PhD trigger point scientists in the world did 12 weeks of very extensive trigger point therapy, and after this 2/3 of the trigger points were still there (4)⁠. If the best in the business did that and only eliminated 1/3 your typical course of therapy from a professional will barely make a dent in your trigger point population.

How trigger point therapies work

Disrupting the feedback loop

As we have seen above seen above muscle knots are a mixture of muscle spasm, tightness, reduced blood flow and a build up of waste products all aggravating each other forming a positive feedback loop. The purpose of trigger point therapies is to slow or stop that cycle. This can be done at any part of the loop. That is why we have so many different trigger point therapies. As long as they address one or more of the issues they will help (5–8)⁠. For example, massage helps relax the muscle, increase blood flow and “squeeze out” waste products. This works on three parts of the loop so it is a very good therapy.

Use continued therapy

The research discussed above showed that while typical course of therapy will not eliminate your muscle knots, the 12 weeks of intensive therapy did eliminate 1/3 of the them and the remainder had diminished. This tells us that if treatment is continued much longer the muscle knots will continue to diminish and more will be eliminated. This could easily require 50-100 treatments which is why an easy to apply self therapy is the only realistic option for most people.

Eliminate the things that cause or aggravate muscle knots

Please see our article discussing how to prevent trigger points .

The most effective muscle knot therapy

As mentioned above, the most effective muscle knot therapy needs to:

have proven therapeutic effects on muscle knots,
be comfortable (or at least not unpleasant), and
able to easily be self administered (convenient, affordable, able to have more treatments)

There is only one therapy that satisfies these, and that is vibration massage. This is where the pad of a therapeutic vibration massager ( not a massage gun ) is placed over the muscle knot, while the vibrations penetrate and have their therapeutic effect. We will explain why this is so effective, then show you how to get started using this therapy.

Vibration treatment for muscle knots — Vibration is arguably the best treatments for muscle knots, and can be easily self applied for repeated applications

Proven therapeutic effects on muscle knots

As discussed above muscle knot therapies need to work on one or more of the parts of the positive feedback loop. As shown in this diagram vibration massage is scientifically proven to help all four parts of the trigger point feedback loop. For more information please see The scientifically proven effects of vibration massage- with clinical applications .

Vibration massage is extremely easy to use on yourself

We will discuss usage in the next section, but basically all you need to do is place the head of the part to be massaged over the muscle knot and let the therapeutic vibrations penetrate and have their effects.

How to use vibration massage to treat muscle knots

Choosing an appropriate machine
How to use your massager
How to find and treat trigger points
Trigger point therapy for specific parts of your body

You will need a genuine therapeutic vibration massager

To deliver the therapeutic vibrations you need to effectively treat muscle knots you will need a professional standard vibration massager. Unfortunately most vibrating massagers on the market are either massage guns (ineffective and can hurt you) or ineffective “consumer” massagers. For more info please see How to choose a massager .

How to use your massager

Please see out Vibration massage usage guide , or check out the video below.

How to find and treat muscle knots

Please see our article How to release trigger points yourself , or check out the videos below.

muscle knot therapy for specific parts of your body

Self massage and trigger point therapy for headaches and migraines
Massage and trigger point therapy for low back pains with self help options
Massage and trigger point therapy for calf pain, with self help options
Massage and trigger point therapy for shoulder pain with self help options
Self massage and trigger point therapy for tennis elbow
Does massage help with fibromyalgia, with self help advice

Appendix: Most massagers on the market are ineffective

There are a lot of very poor massagers on the market. When we were looking for something our patients could use a few years ago we couldn’t find anything we were happy with so we started building our own. We make two hand held massagers that are easy to use and give excellent therapeutic vibrations. These are our General Purpose Massager and our Ultimate Quad Head Massager . They are very effective on trigger points. We have had the General Purpose Massager for about a decade and it is widely used by professionals across Australia, New Zealand, the UK and Europe. Our newer machine the quad head has the advantage of being able to treat a larger area at one, plus can easily be used as a “chair massager” or “cushion massager".

Appendix: what the clinical trials say about the professional muscle knot (trigger point) therapies

We decided to share with you what the clinical trials actually say about the various professional therapies you may be recommended (3,10–15)⁠⁠. Please note that they use many applications of therapy, but as discussed above their idea of success is to just (temporarily) relieve pain.

Dry needling

Most trials show that dry needling provides some short term pain relief and improved function. The risks and potential to cause pain are obvious. The mode of how needles work is still speculation. Where dry needling had been compared with laser the laser has given slightly better results.

Laser

Trial results for laser have been marginally better than those for dry needling, but still only temporary relief. Scientists attribute it’s effect to increasing micro-circulation, improving oxygenation and helping remove waste products. However, this is something that can easily be achieved, if not better, by any competent massage therapist.

Major concern

The big concern with laser is the sheer number of applications of therapy sessions needed for only temporary benefits. For example one trial (16)⁠ used 10 daily applications of laser on patients with upper back and neck pain to get a reduction in pain and tenderness for three weeks. Further, according to one review (17)⁠ applications of laser should be given from 2-3 times a week though to 5 times a week, with a total of 30 applications of therapy for long term cases. Keep in mind this is just to achieve deactivation, not to eliminate the problem. Assuming each laser consultation costs $50 and takes an hour out of your day that’s $1,500 and 30 hours of your life just for some temporary pain relief, leaving you to front up again next time the problem is aggravated.

Manual therapies

There are various types of manual therapies that involve pressure, massage and stretching of muscles. The trial results for them tend to be similar to those of laser and dry needling. However, according to one review (10)⁠ one study did show residual benefit after six months.

Professional at desk — Professionals: click the image to find out more and possibly trial vibration massage

Professionals

DrGraeme massagers were originally built by Dr Graeme for use in his clinic, and to prescribe to his patients for additional self use at home. Now these are used by colleagues and other professionals for similar purposes. If you are a professional and wish to know more about this therapy, or possibly get a sample massager to trial please check out our practitioner page.

References

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Celik D, Mutlu EK. Clinical implication of latent myofascial trigger point topical collection on myofascial pain. Curr Pain Headache Rep. 2013;17(8).
Bron C, De Gast A, Dommerholt J, Stegenga B, Wensing M, Oostendorp RAB. Treatment of myofascial trigger points in patients with chronic shoulder pain: A randomized, controlled trial. BMC Med. 2011;9.
De Las Peñas CF, Sohrbeck Campo M, Fernández Carnero J, Miangolarra Page JC. Manual therapies in myofascial trigger point treatment: A systematic review. J Bodyw Mov Ther. 2005;9(1):27–34.
Boyles R, Fowler R, Ramsey D, Burrows E. Effectiveness of trigger point dry needling for multiple body regions: A systematic review. J Man Manip Ther . 2015;23(5):276–92.
Denneny, Diarmuid et al. Trigger point manual therapy for the treatment of chronic noncancer pain in adults: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2019;100(3):562–77.
Tough EA, White AR, Cummings TM, Richards SH, Campbell JL. Acupuncture and dry needling in the management of myofascial trigger point pain: A systematic review and meta-analysis of randomised controlled trials. Eur J Pain 2009;13(1):3–10.
Cagnie B, Castelein B, Pollie F, Steelant L, Verhoeyen H, Cools A. Evidence for the use of ischemic compression and dry needling in the management of trigger points of the upper trapezius in Patients with Neck Pain: A Systematic Review. Am J Phys Med Rehabil. 2015;94(7):573–83.
Espejo-Antúnez L, Tejeda JFH, Albornoz-Cabello M, Rodríguez-Mansilla J, de la Cruz-Torres B, Ribeiro F, et al. Dry needling in the management of myofascial trigger points: A systematic review of randomized controlled trials. Complement Ther Med . 2017;33(December 2018):46–57.
Rickards LD. The effectiveness of non-invasive treatments for active myofascial trigger point pain : A systematic review of the literature. 2006;9:120–36.
Hakgüder A, Birtane M, Gürcan S, Kokino S, Tura FN. Efficacy of Low Level Laser Therapy in Myofascial Pain Syndrome: An Algometric and Thermographic Evaluation. Lasers Surg Med. 2003;33(5):339–43.
Uemoto L, Nascimento De Azevedo R, Almeida Alfaya T, Nunes Jardim Reis R, Depes De Gouvêa CV, Cavalcanti Garcia MA. Myofascial trigger point therapy: Laser therapy and dry needling. Curr Pain Headache Rep. 2013;17(9).