Muscle Knots in the Neck: Tips from Physical Therapists to Feel Better

If you’ve ever had muscle knots in your neck, you know how uncomfortable they can be. They can give you a crick in your neck, making it hard to move and turn your head, let alone do all your daily activities. They can also seemingly come out of nowhere.

What are muscle knots, exactly? “We don’t fully understand what knots are, but they appear to be a form of involuntary muscle spasm,” explains Heather Broach, PT, DPT, a physical therapist at Hinge Health. “It’s like a rug with a knot in it. The surrounding fabric has been pulled up and isn’t in line with the rest of the rug fibers. With a neck muscle knot, a small part of the muscle tenses up in the same way.” 

It's important to remember that muscle knots, sometimes referred to as trigger points, are common. For some, they can be distracting and painful, but if you went up to a friend or family member and massaged your fingers into their neck muscles, you would find a few trigger points or muscle knots on them. The goal is to reduce sensitive muscle knots, not necessarily get rid of every last muscle knot. There are a lot of ways to do this, starting with stretching and gentle movement. 

What Causes Muscle Knots to Develop in Your Neck

Although muscle knots can be a bit mysterious, we do know that there are several potential culprits, says Dr. Broach. They include:

• Muscle overuse. If you overdid it during a workout (did more than your body was prepared for or did an activity for too long) you may end up with a knot that causes neck pain. Same with spending a while with your neck in a funny position (for example, cradling your cell phone between your head and shoulders). “A neck knot actually develops because you’re not using the muscle in its full range of ability,” explains Dr. Broach. “If you’re in a position where your shoulders are hunched up for a period of time, muscle fibers can become tense and spasm.”

• Stress and anxiety. It’s no coincidence that you’re more likely to develop muscle knots in your neck when you’re under the wire. “When we’re under a lot of stress, we tend to hold certain sustained postures,” says Dr. Broach. “Many people find that they elevate their shoulders to mimic a fetal position, even if they’re standing.” As a result, your neck muscles can end up in spasm.

• Sitting for too long. When you’re sitting — whether it’s at your desk, in the car, or even just watching TV — you may unintentionally tilt your head forward. “This can cause the muscles in the back of your neck to have to work harder than usual to hold your head in position,” explains Dr. Broach. Over time, staying in those sustained positions without movement breaks can play a big role in neck pain. 

Wondering how to get rid of muscle knots? The best way to treat a knot in your neck is to stretch it out. “If you do specific moves several times a day, you can stretch out tight muscle fibers and give them a chance to get out of their spasms,” says Dr. Broach. Above are exercises recommended by Hinge Health physical therapists to try out. Aim to do those exercises three to five times per day to start and see how they feel for you. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

More Tips to Treat and Prevent Knots in the Neck

Along with stretching, there are other things you can do to help treat neck knots at home. These steps may help prevent muscle knots, too.

Take a deep breath. Slow, controlled breathing helps relax your muscles and can release muscle knots in your neck. Many people are too busy to really stop and think about how they’re breathing, so it might help to set a reminder on your phone or calendar to pause a few times throughout the day and take five deep breaths. 

Self massage. You can try to rub out the knot if you give muscles a gentle squeeze and use your thumb to massage the tissue in a circular motion. You can also spring for a few massage sessions. Several 60-minute massages a week for four weeks can help treat chronic neck pain, according to a study published in the Annals of Family Medicine.

Stay active. “A lot of my patients are hesitant to move their neck because of pain,” says Dr. Broach. But you are almost always safe to move, even in the presence of pain. Exercise keeps blood flowing to all your muscles, including your neck muscles, which can help them loosen up and relax. It’s also good to incorporate quick hits of movement throughout the day, advises Dr. Broach. “When you’re stressed, you automatically hunch your shoulders up, which can trigger a neck knot. Standing and moving around, or doing a few quick stretches, will increase blood flow to the neck area.”

Heat. A heating pad will boost circulation and can help relax the knot, says Dr. Broach. If your neck knot is due to injury or trauma — for example, a car accident — then using ice first for a couple days may help relieve pain and swelling.

Dry needling. This is a technique where a small needle is injected into the knot to help loosen it up. It’s done either by a physical therapist or an acupuncturist. Research shows that needling can help to relieve neck pain. You may get better results if you use wet needling, which includes anesthesia. “This is helpful for temporary relief, but it’s not as effective long term as other interventions, like physical therapy,” says Dr. Broach. If you opt for a technique like dry needling, it’s important to pair it with long-term healing techniques like movement. 

Assess your workstation. There are simple things you can do to adjust your office to make it less likely that you’ll develop a neck knot. “People don’t realize how big a role ergonomics can play in neck pain,” says Dr. Broach. The best way to prevent neck knots from taking hold during the work day is to change positions often. Other techniques that help include: 

• Place your computer right in front of you, at eye level. This way, you’ll avoid the strain of your head tilting forward. If you have two screens, put one in the center and the other to your left or right. 

• Use a wireless keyboard. This can help avoid neck strain by allowing you to position the keyboard in a comfortable position for you. If you can’t use a wireless keyboard, try to keep your elbows bent at 90 degrees with your shoulders relaxed and your wrists in a neutral position.

• Recline your chair. Many assume that sitting up straight is best for your neck, but it can actually contribute to neck knots for some people by causing the muscles in the back of your neck to contract and stay contracted. An alternative option: Recline your chair by 25-30 degrees, and use a good lumbar support (like a rolled up towel) to support your back. This takes more pressure off of your neck.

When to See a Doctor

Most of the time, neck pain is not serious and muscle knots go away with at-home remedies (including stretching). But if you’ve tried this for a couple weeks and aren’t getting relief, or you find that your knots persist or keep coming back, then it might be worthwhile to talk to your doctor and ask about physical therapy, advises Dr. Broach. “Physical therapy should always be the first stop. A PT can show you stretches and strengthening exercises and work with you to pinpoint situations that may trigger your neck pain,” she explains. 

While you or your doctor may be tempted to request imaging tests like X-rays, or take medications, Dr. Broach says that these usually aren’t necessary. “In certain situations, treatments like steroid injections into the knot can make the problem worse, since it weakens neck muscles,” she explains. “Most of the time, it simply takes a few sessions of PT — and some self-awareness about how you’re holding yourself during the day — to get rid of neck knots for good.”

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Sherman, K. J., Cook, A. J., Wellman, R. D., Hawkes, R. J., Kahn, J. R., Deyo, R. A., & Cherkin, D. C. (2014). Five-Week Outcomes From a Dosing Trial of Therapeutic Massage for Chronic Neck Pain. The Annals of Family Medicine, 12(2), 112–120. https://doi.org/10.1370/afm.1602

2. Martín-Sacristán, L., Calvo-Lobo, C., Pecos-Martín, D., Fernández-Carnero, J., & Alonso-Pérez, J. L. (2022). Dry needling in active or latent trigger point in patients with neck pain: a randomized clinical trial. Scientific Reports, 12(1). https://doi.org/10.1038/s41598-022-07063-0

3. How to Prevent Tech Neck. (n.d.). New York Presbyterian. Retrieved from https://healthmatters.nyp.org/how-to-prevent-tech-neck/

4. How to Set Up an Ergonomic Home Office. (2020, July 9). Cleveland Clinic. https://health.clevelandclinic.org/heres-how-to-set-up-your-office-to-avoid-aches-pain/

5. Isaac, Z. & Dec, K. L. (2022, September 20). Patient Education: Neck Pain (Beyond the Basics). UptoDate. https://www.uptodate.com/contents/neck-pain-beyond-the-basics#:~:text=Neck%20pain%20can%20be%20caused,be%20affected%20more%20than%20males.