Maybe you went to bed just fine, but you wake up with hardened, sensitive spots in areas including your neck, shoulders, or back? Or these develop over the course of a day, causing distracting discomfort. You’re likely dealing with muscle knots, often due to overuse related to exercise, or underuse related to sitting too long.

Muscle knots, which people may also know as "trigger points," are specific areas of muscle contracture or stiffness, says Jake Price, a chiropractor at MVMT Chiropractic in Houston. They occur when stress applied to muscle tissue exceeds the muscles' capacity to recover. They can also be a literal pain to deal with, as they can cause muscle aches and limit your range of motion.

What causes muscle knots?

If you notice that your muscle knots pop up when you’ve been consistent about working out regularly, that’s because they are typically a result of repetitive activity or overloading the muscle tissue, Dr. Price says.

“As the muscle gets overworked, it will become more tense, which can reduce blood flow and circulation,” he says. “This will result in poor exchange of nutrients and oxygen to the tissue which ultimately leads to the local contracture of the muscle.”

Muscle knots can also be caused by ergonomic factors, such as sitting at your desk for extended periods of time without enough breaks in between. It also certainly doesn’t help matters much if your desk set-up isn’t a comfortable one that promotes good posture.

Other causes of muscle knots include traumatic events like car accidents, slips or falls, or muscle strains or injuries, Dr. Price says. Blunt trauma can damage muscle tissue, as can the muscle being stretched beyond its limits. “When these injuries occur, there will be inflammation in the area, which can change the blood flow and nutrient flow in and out of the injured muscle. This ultimately changes the way the muscle functions and the development of trigger points or knots are not uncommon,” he says.

Nutritional and environmental factors can also be a culprit in muscle knots—even electrolyte deficiency, heat-related factors, excessive training and increased sweat production can contribute, Price adds.

What are the symptoms of a muscle knot?

“Knots or trigger points are often super tender to the touch and can refer to pain to other areas of the body, usually in the vicinity of the knot (check out trigger point referral patterns),” says Dan Giordano, D.P.T., C.S.C.S., founder of Bespoke Treatments.

“Using the muscle or contracting the muscle in which the knot may be found can also be very painful,” adds Dr. Price

How can you prevent muscle knots?

While you can’t prevent muscle knots that come on as the result of an event like a car accident or fall, you can take steps to prevent them when they’re related to your level of activity, Dr. Price says.

“Appropriate training and recovery is the best way to prevent these muscle knots from forming, as they are most commonly a result of repetitive stress/strain on the muscles,” he says. “Making sure you have ‘easy’ days in your training is important, and gradually progressing any type of training program is an important concept as well to make sure the muscles are able to adapt to the load placed on them.”

Muscle knots also commonly develop as a result of engaging in new activities, such as doing a new movement, or taking up a new sport or even from overuse in terms of workout load or volume, adds Giordano.

If you suspect your muscle knots may be the result of a poor ergonomic setup, you can evaluate your workspace and consider replacing your chair for one that promotes better posture, or even opting for a standing desk. Be sure to take breaks to stretch or walk around and avoid sitting for several hours straight.

How to treat muscle knots at home

According to Dr. Price, a number of techniques can be effective in relieving muscle knots:

1) Massage. If you can’t reach the area, “having a partner massage over the areas or muscles with trigger points can help,” he says. “Remember that these trigger points are typically very painful and sensitive to pressure, though, so your partner should be mindful of this when treating it with direct pressure.” Dr. Price recommends five to 10 repetitions of direct pressure for 60 seconds each, increasing pressure with each rep.

“Massaging around the knot may be useful to make the area more comfortable and tolerable for the direct pressure,” he adds. It can also just increase some blood flow to the area which will be helpful as well.

2) Direct pressure. Price says this is the most effective way to treat a muscle knot. To do this, apply sustained deep pressure over the trigger point (ischemic compression) using a tennis ball, door frame corner, or other objects that allow you to apply direct pressure to the muscle knot, or roll over it. “This should be applied with gradual pressure and for no longer than 60 to 90 seconds at a time,” he says.

3) Epsom salt baths. These, plus the hot water in the bath, help relax muscles and relieve pain and swelling.

4) Stretching. Gentle stretches can promote mobility and reduce pain in your back and neck.

The fifth way requires a little help.

When should you seek professional treatment for muscle knots?

You might need professional help to get relief from muscle knots more often than you think. Much of the time, muscle knots won’t go away on their own, Dr. Price says. If at-home remedies and techniques like stretching, pressure, and hot baths haven’t brought relief, he recommends seeing a health care provider such as a chiropractor, massage therapist or physical therapist.

“General massage can sometimes be effective in reducing the knots or helping the muscle recover,” he says.

If this doesn’t work, and you’re still feeling pain or discomfort, aggressive techniques may be necessary, which can involve them performing ischemic compression, or dry needling—this involves inserting a fine needle directly into the muscle knot or trigger point. “This can help decrease muscle tightness, increase blood flow, and stimulate the body's natural healing responses,” he explains.

Finally, if your muscle knots just won’t subside, you may need trigger point injections. These involve injecting steroids or Botox into the muscle tissue to aid in healing or reducing the muscle tension, Dr. Price says. These usually work best in combination with physical therapy, says Giordano. The injections can provide quick relief from the muscle spasms, and by modulating the pain, he says “you can get the most out of your physical therapy and create long-term change.”

If you keep getting muscle knots, don’t hesitate to back off the training plan you’re on. “We are still learning about what these knots/trigger points are, so listen to your body and understand that if it hurts, it is probably a good idea to back off a bit and seek help from a professional,” Giordano says.