You press into your shoulder and find it: a tight, ropey band that’s exquisitely tender, and pressing it sends a dull ache somewhere else. Most people call these knots. Clinicians call them myofascial trigger points.
What a knot actually is
Honest answer: nobody is certain. The traditional explanation is a small patch of muscle fibres stuck in contraction, with reduced local blood flow. The research is mixed, and imaging hasn’t settled it.
What’s reliable is the experience: a tender spot in a tight band, often referring pain elsewhere, common in muscles held in one position for hours. Upper trapezius, between the shoulder blades, the buttock and the calf are the usual suspects.
You don’t need the mechanism settled to treat it sensibly.
Heat first, pressure second
Going straight in hard on a tender knot usually makes the muscle guard more. Warming it first makes the same pressure more tolerable and more effective. Same principle as heat before manual therapy.
- Heat the area, 15 minutes, lowest setting, cover on.
- Find the spot. Press around until you locate the tender band.
- Apply steady pressure with a tennis or lacrosse ball against a wall, or your fingers. Firm enough to feel it, not enough to make you tense up or hold your breath. On the powered alternative, see heat pad vs massage gun.
- Hold 30 to 60 seconds while breathing normally. The sensation should ease a little as you hold.
- Then move. Take the muscle through its full range a few times. This is the step people skip, and it matters.
Two or three spots per session is plenty. Some tenderness afterwards is normal; sharp pain or bruising means you went too hard.
Position by muscle
- Top of the shoulder: ball between your shoulder and a wall, lean in gently.
- Between the shoulder blades: ball against the wall, roll slowly. Keep off the spine itself.
- Buttock: sit on the ball on a firm chair or the floor.
- Calf: sit with the calf resting on the ball, other leg stacked on top for more pressure. Tight hamstrings often come as a set with this.
Never roll directly on the spine, the front of the neck, or the back of the knee.
Why they keep coming back
Releasing a knot on Sunday doesn’t help if Monday puts the muscle back into the same eight hours of low-level holding. The things that keep knots returning:
- Long unbroken stretches in one position
- A screen or chair that loads one area constantly. See tech neck.
- Carrying a bag on one shoulder, or a child on one hip
- Stress, which quietly raises resting muscle tension
- A muscle that isn’t strong enough for what you’re asking of it
Movement breaks and strengthening do more over months than any amount of ball work. See upper back pain from desk work, and for the wider home toolkit, muscle pain relief at home.
Don’t use heat or pressure if…
- The area is swollen, bruised or recently injured
- You’re on blood thinners and bruise easily
- You have reduced sensation there. Full list: who should not use a heating pad.
- One calf is swollen, warm and tender. Don’t massage it; see a doctor the same day.
See someone if…
- Pain, numbness or weakness travels down an arm or leg
- The lump is hard, growing, or doesn’t feel like muscle
- The same spot returns every week despite changing your setup
- You have widespread tender points with fatigue and poor sleep, which is a different picture worth discussing with a doctor. See fibromyalgia and heat.
The heat pad we use
We’ve supplied the Bremed BD7800 since 2010. It holds a steady temperature, covers a whole lower back and has a machine-washable cotton cover. Physiotherapy clinics in Singapore use it with their patients.
Clinically reviewed by: Nigel Chua (Hand Occupational Therapist) & Louise Yow (Physiotherapist). This article is general information, not a diagnosis. electricheatpad.com sells electric heat pads.
