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Why Do I Get Painful Knots in My Neck/Back?

Getting knots (trigger points) in your neck, shoulders, and/or back is something that nearly everyone has experienced. Some may even feel that they have this constantly and it can be a very frustrating thing to live with. You have someone massage your shoulders and it feels better for a bit and then comes back. Why does this happen and what can you do to fix it?

Why does this happen?

Developing a knot/trigger point is actually a protective mechanism from the brain. When an area of the body is unstable, the brain sends a neurological signal to the muscle(s) in charge of that area that causes the muscle fibers to contract. This decreases the range of motion of that joint, due to the constant contraction of those muscle fibers. Let’s use the shoulder as an example… The glenohumeral joint (the shoulder) is the most mobile joint in our body. However, as nice as that mobility is, it comes at a price, and that price is a lack of stability. If the stabilizing muscles around our shoulder aren’t properly co-activating, that lack of stability will allow our shoulder to be put in compromised positions when performing regular activities. Our brain understands this and sends a neurological signal to permanently tighten the muscle fibers in the muscle in charge of that shoulder range of motion. This shoulder example is what causes us to get that knot/trigger point inside of our shoulder blade. These knots are painful due to nociceptors (pain signals) coming the other way, into the brain, due to the constant firing of those muscles. In addition to the pain, it can also decrease performance, due to the lack of full mobility in each joint. All of this revolves around what anatomy isn’t moving enough, and what is moving too much.

Another example that can be directly related to this concept is low back tightness. Low back tightness can be a protective mechanism in response to the lumbar spine (low back joints) being asked to do more than they are designed to. For this, we can use the example of a desk worker that likes to golf (or do any sort of activity). As this individual sits at their desk, likely leaned forward a majority of the day, the muscles/tendons/ligaments physiologically shorten in their mid/upper back as that posture is maintained. The more time our body spends in a given posture, the more our brain thinks that is the “normal” and those structures actually shorten in the part of the spine that is put in that compromised position. So now this patient has a tight upper back (thoracic spine), which is biomechanically designed to produce the rotation in our spine. The low back is not designed to rotate. However, this desk worker has developed physiological shorting, AKA restricted joints, in the upper back. Now when they go to swing their golf club (or turn to pick up their kid, etc.), their low back is being asked to do a job it is not designed to do. This is where injuries happen. Does their low back need adjusted? … I would argue not. They need stability exercises in their low back and manipulation (adjustments) to get their upper back moving properly again.

What can you do to fix it?

As you know, there are ways to get some relief from these knots. Using a lacrosse/tennis ball to roll over these knots via ischemic compression can help loosen the tight muscle fibers. To do this, find a ball and roll on it on the floor or a wall until you find the spot that hurts and just hold it there. It should loosen up in a minute or 2. This can loosen you up for a while, but based on what you’ve read so far, I think you understand these knots/trigger points will continue to come back unless function is changed. This is why our doctors at SWAT Chiropractic and Rehab use techniques like Dynamic Neuromuscular Stabilization rehabilitation. Using this rehab with some soft tissue techniques such as: dry needling, instrument assisted soft tissue work, and post-isometric relaxation stretching can help fast track the road to fixing these issues. Your pain revolves around what isn’t moving enough (like the tight upper back example) and what is moving too much (unstable shoulder and low back examples). Everyone’s body is different, so your site of pain may not be your source of pain. We want our patients to come in and fix their issues to make a lasting effect, not have a lifelong sentence of care that you need keep coming back forever for. We want to show you how you can be in control of your own health and handle these issues such as preventing these nasty knots in your back on your own!

1. Yoshida R, Yasuda T, Kuruma H. Analysis of cervical and upper thoracic spinal segmental rotation angles during end-range neck rotation: Comparison with and without neck pain. J Man Manip Ther. 2022 Apr 6:1-6. doi: 10.1080/10669817.2022.2056309. Epub ahead of print. PMID: 35384789.

2. Ziaeifar M, Arab AM, Mosallanezhad Z, Nourbakhsh MR. Dry needling versus trigger point compression of the upper trapezius: a randomized clinical trial with two-week and three-month follow-up. J Man Manip Ther. 2019 Jul;27(3):152-161. doi: 10.1080/10669817.2018.1530421. Epub 2018 Oct 15. PMID: 30935341; PMCID: PMC6598483.

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