Muscle knots tend to form when a muscle is overloaded, either through exercise or poor posture. They are most commonly found in the neck, upper trapezius and upper shoulder muscles, as well as the mid-back, forearms and calves.
For instance, leaning over a computer for hours a day may not feel like a workout, but it can fatigue your neck, shoulder, back and forearm muscles, said Dr. Josh Goldman, associate director of the Center for Sports Medicine at UCLA Health. “Your neck is bent down staring at a computer screen for eight hours,” he said. “That’s a pretty aggressive load on the body.”
Scientists aren’t entirely sure why some knots hurt and others don’t, or why some hurt only when pressed while others ache all the time. Many knots will go away on their own after a week or two. But a few treatments can help to reduce pain and accelerate healing.
Studies suggest that both heat and ice packs can help to reduce muscle knot pain. While they won’t break up the knots themselves, heating or ice packs are almost always useful for symptomatic improvement.
Stretching won’t eradicate knots, either, but it can also help reduce pain, in part by increasing fluid in the surrounding tissue, which allows everything to “slide and glide” more easily. Experts recommend stretching either after exercise, when your muscles are warmed up, or before bed.
Massage can help to relieve muscle knot pain, as well as temporarily relax the contractions that cause knots — but usually only for a day or two.
Researchers theorize this has to do with blood flow: When a therapist presses on the tissue around a knot, it restricts blood flow to the area, said Zachary Gillen, an assistant professor of exercise physiology at Mississippi State University. Then, when the pressure is lifted, blood rushes in, which helps the contraction to relax and brings nutrients to the area.
Self-massage with a lacrosse ball or foam roller can have a similar effect. For knots that are impacting your quality of life, a physical therapist can perform targeted massage and also guide you through strategic exercises.
Dry needling, often performed by a physical therapist or acupuncturist, appears to be among the most effective longer-term treatment for muscle knots, Dr. Gerber said. The process involves inserting fine needles directly into knots, and removing the needles after a few minutes. (It’s called “dry” because nothing is injected.)
If all else fails, consider wet needling, injecting a pain medication such as corticosteroids or a numbing agent into the knot. This is usually performed in a doctor’s office.
Some doctors have begun injecting Botox into muscle knots, which may temporarily relieve pain by paralyzing the tissue, but there isn’t much evidence for its long-term effectiveness.
How do you prevent them from coming back?
Once you’ve treated your knots, a few habits can prevent them from returning.
First, be mindful of your posture at your desk or on your phone. You want your eyes to be level with a computer screen or smartphone, and your arms level with a keyboard, so that you’re 
not craning your neck or hunching at the shoulders.
Next, be sure to incorporate regular movement breaks into your day. Every 20 minutes or so, stand up, stretch, take a lap around your home or office or do whatever feels good.
Research suggests regular exercise will help, too, particularly strength training. The stronger and more flexible your muscles are, the less likely it is that they’ll become overtaxed in your day to day life.
Finally, remember that there can be too much of a good thing: Pushing yourself too hard at the gym can actually cause knots. To avoid this, be sure to stress your muscles progressively when strength training, and gradually ramp up aerobic exercise like running.
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