Pain in the muscles (muscle knots and trigger points)
Pain in the muscles (muscle knots and trigger points)
Pain in the muscles can be caused by muscle knots also known as trigger points.
When the muscles reach a stage of malfunction where they risk permanent damage, the body sends out pain signals to the brain. The pain is therefore a sign that something is wrong, and that changes must be made to avoid further damage or breakdown. Perhaps you yourself have noticed that the neck muscles are getting tighter and tighter? And that the back muscles are just waiting for the next chance to give you a real stab in the lower back when you least expect it?
- Let us help you understand your muscles (and become friends with them again)
In this article, we will take a closer look at muscle pain, why you get it and what happens physically in the muscles when they tell you that not everything is going well. We hope you find this guide, written by a multidisciplinary team (including both physiotherapists and chiropractors), useful. for you. Feel free to contact us, or one of our clinic departments, with any questions or suggestions.
"The article has been written in collaboration with, and quality checked by, publicly authorized health personnel. This includes both physiotherapists and chiropractors at Pain clinics Interdisciplinary Health (see clinic overview here). We always recommend having your pain assessed by knowledgeable healthcare personnel."
Tips: At the bottom of the guide, we show you a video with exercises that are good for the back and neck. In addition, you also get good advice on self-help measures, such as neck hammock and use of foam roll.
What is really muscle pain?
To understand muscular pains better, it can be useful to divide them into different categories. Let's divide muscle pain into these 4 subcategories:
Muscle knots (trigger points)
muscle tension
Myofascial bands
Damaged tissue and scar tissue
In the next part of the article, we will go through these four categories, point by point. We hope it can help give you a better understanding of muscle pain - and thus gain a better insight into how it can be treated.
1. Muscle knots (trigger points)
[Picture 1: An ultrasound image showing a muscle knot. From the study Trigger points–ultrasound and thermal findings (Cojocuru et al, 2015) published in the medical the Journal of medicine and life]¹
Muscle knots and trigger points are the same, although the terms are often used interchangeably. They are very real and can, among other things, be seen on ultrasound (picture 1).
In the medical study, they found that muscle knots appear with a darker signal (hypoechogenic) due to the fact that the muscle fibers are contracted and have reduced circulation. On clinical examination and palpation (when the clinician feels the muscles) these will be experienced as "contracted knots» – and this is also where they got their name from (myomas).
- Trigger points can cause referred pain
[Image: Travell & Simons]
Trigger points and muscle knots can refer pain to other relevant places in the body. Among other things, tight muscles in the neck and jaw can lead to headaches, dizziness and other symptoms. Another research study was able to document, through biopsy tests, that muscle knots had concrete findings in the form of hyper-irritability and increased electrical activity.² It is therefore about contracted, pain-sensitive and overactive muscle fibres, which gradually reduce their own blood supply - which in turn leads to gradual deterioration.
"With documentation in the above studies, it becomes easier to understand how physical treatment methods can process and loosen muscle knots."
2. Muscle tension
Muscle strains mean that one or more of your muscles are partially contracted for an extended period of time. In other words, they work even when they shouldn't. The muscular fibers may feel hard and painful to the touch. Such muscle tension occurs most often in the neck, shoulder arches (upper trapezius), the lower back and in the legs. The tensions can vary in extent, from a mild discomfort to obvious muscle pain. Relaxation, exercises and physical therapy can help.
3. Myofascial band
Myofascial bands mean that the muscle fibers contract so much that the longitudinal fibers feel like a tight band. In certain cases, it can become so tense that they put pressure on nearby nerves (for example in piriformis syndrome).³
4. Damaged tissue and scar tissue
Muscles consist of muscle fibers - these can be in good condition (elastic, mobile and without damage tissue) or in poor condition (less mobile, with reduced healing ability and accumulation of damage tissue). When we have muscles that are improperly loaded over time, this can lead to the build-up of damaged tissue in the muscular structures. By this we mean that they physically change the structure as shown in the picture below:
- Normal tissue: Normal blood circulation. Normal sensitivity in the pain fibers.
- Damaged tissue: Which involves reduced function, changed structure and increased pain sensitivity.
- Scar tissue: Unhealed soft tissue has a significantly reduced function, greatly altered tissue structure and increased risk of recurring problems. In phase 3, the structures and structure may be so weak that there is a higher chance of recurring problems.
Picture and description: The pain clinics department Råholt Chiropractic Center and Physiotherapy
By using illustrations as shown above, it is often easier to get an understanding of why muscles and tendons hurt. The picture shows how not taking care of your own muscles and functionality leads to physical changes in the muscle structure and pain as a direct consequence of this.
- Break down damaged tissue to stimulate the build-up of healthy fibres
Conservative treatment by a publicly authorized clinician therefore aims to re-model the soft tissue structure and improve the function of given muscle fibres. The investigation and clinical examination can reveal everything from reduced joint mobility in the neck and back (which thus leads to less blood circulation, reduced range of motion and incorrect use of the muscles) to insufficient stability muscles.
Pain clinics: Contact us
Our clinic departments at Vondtklinikkene (click here for a complete overview of our clinics), including in Oslo (Lambert seats) and Akershus (Eidsvoll Sound og Raw wood), has a distinctively high professional competence in the investigation, treatment and rehabilitation of pain in muscles, tendons, nerves and joints. Toe contact us if you want help from publicly authorized therapists with expertise in these fields.
Treatment of Sore Muscles and Muscle Nodes
Effective treatment of muscle pain and muscle knots includes a thorough examination where the clinician examines your overall biomechanical function. For example, it is often the case that the problem is more complex than that "there's a tight muscle here", and that the treatment should therefore consist of muscular work, joint mobilization and rehabilitation exercises in combination.
- We are all different and need an individual assessment
Treatment modalities that are often used for tight muscles and muscle pain are muscular techniques (stretching, massage and trigger point treatment), intramuscular needle treatment, and then often in combination with joint mobilisation. But again, we want to emphasize that the functional assessment is particularly important when it comes to this type of problem. At our clinic departments, we always emphasize the importance of such an examination.
What can I do even with muscle pain?
More mobility in everyday life is always a good start. Movement leads to increased circulation to pain-sensitive and dysfunctional muscle fibers - which in turn leads to enhanced repair processes in the damaged muscle fibers and hence less pain. Other good measures can include regular use of foam roll or massage ball against the tense muscles.
We recommend: Complete set with foam roller and 2x massage balls
Above you see what constitutes good self-help methods for muscle tension and muscle pain. You can use the foam roller to actively roll against tight muscles, but also to stimulate increased mobility in the back (especially the thoracic spine). The massage balls are used against what we call muscle knots (trigger points). Visit the link here or click on the image above to read more about the set. The links open in a new window.
Tips: Use a large foam roller against tension in the thighs, seat and calves
Sometimes it can be more practical to have a larger foam roller. This model is 60 cm long and medium-hard. Such foam rollers are very popular with athletes and exercisers, but are really suitable for everyone. Press the image or here to read more about how it works.
Other popular self-measures
acupressure mat
Neck hammock
Back and neck stretch
Self-massage with pain-relieving heat salve
Trigger point Balls
One of the most important things when it comes to self-help against muscular tension and pain is a certain balance. You must gradually work your way into the areas and not go too hard. Over time, such measures as we mention here could play a central role in functional and symptomatic improvement.
Exercises and training against muscle pain
Regularly getting enough movement is one of the most important things in the fight against muscle problems. This will help you stimulate circulation and maintain the elasticity of the muscle fibers. The video below shows chiropractor Alexander Andorff you a training program with five good stretching exercises and mobility exercises for muscular pain in the neck.
VIDEO: 5 exercises for a stiff and tense neck
The neck is a place on the body that is often affected by muscle pain and tension. With regular use, these five exercises can relieve muscle tension and improve neck mobility. In addition, several of the exercises are good for the transition between the neck and between the shoulder blades.
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The pain clinics: Your choice for modern treatment
Our clinicians and clinic departments always aim to be among the elite in the investigation, treatment and rehabilitation of pain and injuries in muscles, tendons, nerves and joints. By pressing the button below, you can see an overview of our clinics - including in Oslo (incl Lambert seats) and Akershus (Raw wood og Eidsvoll Sound). Feel free to contact us if you have any questions or are wondering about anything.
Article: Pain in the muscles (muscle knots and trigger points)
Written by: Our publicly authorized chiropractors and physiotherapists at Vondtklinikkene
Fact check: Our articles are always based on serious sources, research studies and research journals - such as PubMed and the Cochrane Library. Please contact us if you spot any errors or have comments.
Research and sources
1. Cojocaru et al, 2015. Trigger points – ultrasound and thermal findings. J Med Life. 2015 Jul-Sep;8(3):315-8.
2. Jantos et al, 2007. Understanding chronic pelvic pain. Pelviperineology 26 (2).
3. Bordoni et al, 2024. Myofascial pain. PubMed. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
Frequently asked questions (FAQ): Pain in the muscles
I am on sick leave with muscle knot pain. What should I do to be good?
The public health authorized clinician who registered you sick should also be able to give you a prognosis and various measures, in the form of active and passive forms of treatment. You should use the time on sick leave to get away from bad habits you have - perhaps you sit too much in everyday life? Are you moving enough? Is your training varied enough? Maybe you should work on your postural muscles too?
Can you get muscle knots in the leg? And how should they be treated?
The calf, like other areas, can get muscle knots - it often occurs at the back of the calf against the gastrocnemius and soleus muscles. Muscle knots occur, theoretically, due to muscular imbalance and dysfunctions. Manual treatment is beneficial for getting help to loosen up the worst muscle knots, and then you should address the reason why you get muscle knots (overload, wrong load or the like).
Some of the most common muscles in the leg involve the tibialis anterior, extensor digitorum longus, extensor hallucis longus, peroneus longus, peroneus brevis, peroneus tertius, gastrocnemius, soleus, flexor hallucis longus, flexor digitorum longus and tibialis posterior.
The chiropractor says I have gluteal allergy, what does that really mean?
Myalgia simply means muscle pain, or muscle symptoms / muscle tension. Gluteal is simply the seat region (buttock muscles). So it simply means over-tension in the musculature of the gluteal muscles. The myalgias are often seen in the gluteus medius, gluteus maximus and gluteus minimus.
Treatment for back muscles?
Treatment for muscle knots in the back can involve varied physical treatment, which will focus on improving both muscle function and joint movement. Often the muscles will calm down a bit when the joints move in a more functional way.
- Related questions with the same answer: "Can you get a muscle knot in the lower back?"
Pain in the muscles. How does it feel?
The pain presentation for muscle knots varies, but terms such as tightness, stiffness, immobility and a feeling of being constantly tired in the muscles are often used by people who have muscle knots. Trigger points and muscle knots are also described in certain cases as active or passive – when a muscle knot is active, it will refer pain in a known reference pattern belonging to the specific muscle. It was doctors Travell and Simons who mapped this (read: complete overview of muscle knots). Among other things, muscle knots in the neck can cause cervicogenic headaches, which can be felt in the back of the head, towards the temple and sometimes in the forehead and behind the eyes.
- Related questions with the same answer: "Can you get knots in the muscles after training?"
Muscle knot in the neck. What should I do?
Muscles can tighten due to long-term improper loading or sudden overload. The muscles will feel tight and tender to the touch. Tight muscles in the neck can also lead to cervicogenic headaches and cervicogenic vertigo. It can be useful to have any muscular dysfunctions you have mapped out by a musculoskeletal expert, who can then tell you exactly which exercises you should do. They can naturally help you with the tight muscles too.
Common neck muscles involve upper trapezius, sternocleidomastoid (both sternal and clavicular part), splenius capitis, splenius cervicis, semispinalis capitis, semispinalis cervicis and suboccipital muscles.
- Related questions with the same answer: 'What are the symptoms of muscle knots in the neck?'
What could be the cause of acute pain in the triceps?
The most likely cause is overuse or trauma. Try to calm down the amount of training / workload and use nedicing on the triceps attachment to calm down the overactivity in the area in question.
Got a muscle knot in my thigh after running. What muscle is that?
It depends on whether you are familiar with it on the front or back of the thigh. On the front we find the quadriceps (knee extensor) muscles which consist of 4 muscles (hence quad-); vastus medialis, vastus lateralis, vastus intermedius and rectus femoris. All four of these can develop muscular dysfunctions in the form of muscle knots or trigger points. Among other things, these are known to refer pain to the knee when it is at its worst. On the back we find the hamstrings (the knee benders), there are 3 muscles and these are the biceps femoris, semitendinosus and semimembranosus.
Quadriceps - Wikimedia Commons
Could there be a link between muscle knots and dizziness?
Yes, muscle dysfunction or facet joint locking in the neck and cervicothoracic junction (where the thoracic spine meets the neck) can cause cervicogenic vertigo. The word 'cervicogenic' indicates that the vertigo comes from structures related to the neck. It is especially the upper neck and the base of the neck that most often contribute to such dizziness. Remember that dizziness is often multifactorial, meaning that it can have several causes at the same time (muscle knots, dehydration, blood sugar imbalance and the like).
Where can muscle knots in the chest / trigger points in the chest be located?
Some possible muscle knots in the chest are pectoralis major, pectoralis minor, sternalis, subclavius and partly serratus anterior. Other muscles that can refer trigger point pain to the chest region are the serratus posterior superior which can have a mild reference to the chest on the involved side.
Where can neck muscles / trigger points in the neck sit?
Some of the most common ones that become overactive in the neck are the suboccipitalis (those that attach to the back of the head), longus colli and the paraspinal muscles - as well as the attachments from the levator scapulae, upper trapezius and sternocleidomastoid. Other neck muscles that can create trigger point pain in the neck include the semispinalis capitis, semispinalis cervicis, splenius capitis, and splenius cervicis.
Where can muscle knots in the foot / trigger points in the foot sit?
Some of the most common ones that become overactive in the foot are flexor digitorum brevis, adductor hallucis, flexor hallucis brevis, 1st dorsal interossi, extensor hallucis brevis, extensor digitorum brevis, abductor hallucis, abductor digiti minimi and quadratus plantae.
Where can the jaw muscles / trigger points in the jaw be located?
Some of the most common ones that become overactive in the jaw are the masseter, digastric, medial pterygoid and lateral pterygoid. Temporalis can also refer trigger point pain to the jaw area.
Where can the muscle knots in the groin / trigger points in the groin sit?
Some of the most common ones that become overactive in the groin are the iliopsoas, gracilis, adductor brevis, adductor longus, adductor magnus and pectineus. Other muscles that can refer trigger point pain to the groin region are quadratus lumborum and external abdominal oblique.
Where can the muscle knots in the thigh / trigger points in the thigh be located?
Some of the most common ones that become overactive in the thigh are the tensor fasciae latae (TFL), sartorius, rectus femoris, vastus medialis, vastus intermedius, vastus lateralis, gracilis, adductor brevis, adductor longus, hamstrings, semitendinosus, semimembranosus, biceps femoris and pectineus. Other muscles that can refer trigger point pain to the thigh region are obturator internus, gluteus minimus, piriformis, iliopsoas, external abdominal obliqus and multifidi.
Where can muscle nodes in the seat / butt sit?
Some of those that can become overactive in the seat / buttocks are the obturator internus, sphincter ani, levator ani, coccygeus, gluteus minimus, gluteus medius, gluteus maximus and piriformis. Other muscles that can refer trigger point pain to the seat / gluteal / buttock region are quadratus lumborum, iliocostalis lumborum, longissimus thoracis and sacral multifidi.
Where can muscle knots in the shoulder blade / trigger points in the shoulder blade sit?
Some of the muscles that can become overactive in the shoulder blade are the upper trapezius, levator scapulae, serratus posterior superior, latissimus dorsi, supraspinatus, infraspinatus, teres minor, teres major, subscapularis, rhomboideus and deltoid. Other muscles that can refer trigger point pain to the shoulder blade are the middle trapezius, lower trapezius, serratus anterior, anterior scalenius, middle scalenius and posterior scalenius (also known as the scalenii muscles).
Where can muscle knots in the forearm / trigger points in the forearm be located?
Painful muscles in the forearm can constitute what we call trigger points or muscle knots. Some of those that can become overactive in the forearm are the anconeus, extensor carpi ulnaris, extensor carpi radialis longus, extensor carpi radialis brevis, brachioradialis, digitorum extensor, supinator, flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, pronator teres and flexor pollicis longus. Other muscles that can refer trigger point pain to the forearm are triceps brachii, scalenii, pectoralis major, pectoralis minor, subclavius, serratus anterior, serratus posterior superior, latissimus dorsi, supraspinatus, infraspinatus, subscapularis, coracobrachialis and brachialis.
Pain in the muscles between the ribs - what helps?
Pain in the muscles between the ribs, also called the intercostal muscles, can cause relatively sharp and obvious pain - these are often worsened when the upper body is twisted towards the side where the pain is and sometimes also when taking a deep breath. Myalgias and muscle pains in this musculature often occur in combination with joint locking and joint stiffness - also called rib locking. Joint mobilization carried out by, for example, a chiropractor or manual therapist, in combination with muscular treatment, is among treatments that often work well.
