What Is a Muscle Knot? Understanding the Anatomy, Causes, and Solutions
- Dr. Turner-Parker
- Aug 19
- 4 min read
We’ve all felt them — those tender, tense little lumps in your muscles that ache when pressed and never seem to go away on their own. Many people call them “muscle knots,” but what exactly are they, and why do they appear?
As a San Antonio massage therapist and integrative doctor, I see muscle knots all the time, and know they’re not just an inconvenience, they’re often a sign of deeper muscle imbalances. Let’s break down what’s really going on inside your body when you feel one.
Muscle and Fascia: The Basics
Muscles are made of bundles of fibers grouped into fascicles, all surrounded and supported by fascia — a thin, web-like connective tissue that wraps around muscles, bones, and organs. When this system works well, muscles contract and relax easily, and fascia moves smoothly.
But when overuse, poor posture, injury, or stress disrupts this balance, fascia can become “sticky” and muscle fibers can get stuck in a contracted state. This is when muscle knots form, and a common issue we address at Aloe Me Integrative Health.
What Is a Muscle Knot?
A muscle knot isn’t really a knot at all, but instead a small area where muscle fibers and fascia have become stuck in a contracted state. The tissue may also develop adhesions, where fibers stick to each other, nearby fascia, or even around bony structures. Knots often feel like firm, tender lumps beneath the skin, and they can limit your range of motion or cause discomfort both locally and in other parts of the body.
Why Knots Often Form Around the Scapula and Other Bony Landmarks
Knots commonly develop near bony landmarks like the scapula (shoulder blade), but not for the reason many people think. It’s not simply because the space is tighter, it’s due to how the bone moves in relation to the surrounding muscles.
When the muscles that control scapular movement aren’t working together cohesively, some may be overactive and stronger while others are underactive and weaker. This imbalance pulls the scapula out of its ideal alignment, causing it to move unevenly. As the scapula moves out of sync, its bony edges can rub or “scrape” against the underlying muscle tissue, irritating the fibers. Over time, this friction can lead to adhesions, scarring, and the formation of painful knots.
Correcting the relationship between the involved muscles allows the scapula to move smoothly again, reducing friction and giving the irritated muscle tissue a chance to heal.
Agonist vs. Antagonist Muscles
Muscles work in pairs to produce movement known as:
Agonist muscles are the primary movers that create a specific motion.
Antagonist muscles perform the opposite motion, lengthening while the agonist contracts to keep movement smooth and controlled.
For example, when you bend your elbow, your biceps (agonist) contract while your triceps (antagonist) lengthen. Around the scapula, when agonist and antagonist muscles are not balanced in strength and coordination, joint movement becomes dysfunctional, and that’s when friction-related muscle knots can develop.
Common Areas for Knots
Knots tend to form in predictable places:
Upper back and between the shoulder blades
Neck and shoulders
Hips and glutes
Calves
Trigger Points: The Map of Knots
Many muscle knots are associated with trigger points—specific, mappable spots within muscles that can cause pain. There are two main types:
Active trigger points: These are painful even at rest and can cause referred pain which is pain felt in another part of the body. For example, a trigger point in the upper trapezius may cause headaches.
Latent trigger points: These aren’t actively painful unless you press on them, but they can still restrict movement and become active later.
Trigger points are part of why knots can be stubborn and recurring.
Locked Short vs. Locked Long Muscles
Knots aren’t just about tight muscles, they can also be about imbalanced length.
Depending on your movement patterns, a muscle can be:
Locked short: Chronically contracted and tight.
Locked long: Stretched out and under tension but still unable to relax.
Both situations can cause discomfort, reduced mobility, and compensatory patterns that affect the rest of your body.
How to Address Knots and Muscle Imbalances
Breaking the cycle of knots and trigger points takes more than just a quick massage. A comprehensive approach works best:
Postural Assessment - Understanding your posture and movement patterns helps identify which muscles are overworked and which are underused.
Massage Therapy - Helps break up adhesions, improve blood flow, and encourage the tissue to relax.
Corrective Exercise - Restores balance by strengthening weak muscles and lengthening tight ones.
Hydration - Muscles and fascia need adequate water to function well. Dehydration can make tissues stickier and less resilient.
Lifestyle Changes - Adjusting work setups, daily habits, and movement routines can prevent knots from returning.
Can One Massage Get Rid of a Knot?
Sometimes, one massage session can significantly reduce a knot’s size and deactivate it, making it no longer painful. However, some knots may still be palpable in the muscle tissue even after they’re deactivated, meaning you can feel them, but they no longer cause discomfort. The goal of treatment isn’t always to make the knot physically disappear, but to restore proper function, reduce tension, and eliminate pain. Because knots often develop from ongoing postural habits, muscle imbalances, or repetitive strain, addressing them fully usually requires multiple sessions along with corrective exercise and lifestyle changes.
Will All Knots Eventually Disappear?
Every case is different. Some knots can be worked out entirely, especially if they’re addressed early. Others, particularly those tied to chronic movement patterns or old injuries, may remain as scar tissue or latent trigger points. These can be managed but not always erased.
Not Every Lump Is a Knot
Finally, it’s important to know that not every bump under the skin is a muscle knot. Some may be cysts, lipomas (fatty deposits), or other non-muscular tissue changes. A trained professional can help you determine what you’re feeling.
The Bottom Line
Muscle knots are a sign that something in your movement patterns, posture, or muscle balance is off. They don’t always vanish completely, but they can be deactivated so they’re no longer painful or restrictive. Addressing the underlying cause, whether that’s muscle imbalance, poor ergonomics, or repetitive strain, is the real key to long-term relief. Think of treatment as a two-part approach: skilled hands-on work to release tension, and corrective strategies to keep your muscles working together so those pesky knots don’t make a painful comeback.
Ready to work through those knots?
Book a massage session to get started!