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Have A Knot In The Shoulder Blade That Won’t Go Away?

Dr. Sisson / April 7th, 2023

What Causes A Knot In The Shoulder Blade?

To understand what causes a knot in your shoulder blade you first have to understand and what exactly a knot in a muscle is. It may be in your shoulder blade, it may be in your neck muscles, or it may be somewhere else. Either way, the physiology is the same.

What are muscle knots?

The main cause of muscle knots is something called a trigger point.

A trigger point, or in layman's terms, a "knot", is an area in the muscle where it's contracted and can't relax.

If you look at a muscle underneath a microscope it has some overlapping filaments called actin and myosin. They overlap each other in what's referred to as a sarcomere.

These sarcomeres are lined up back to back to back in order to make up a muscle.

When you stretch your muscle, the filaments in the sarcomere slide apart, and when you contract your muscle the, myosin head attaches to the actin filament and pulls it closer to the center of the sarcomere.

That process of the filaments attaching to each each other and shortening happens automatically. It's exothermic, meaning it releases energy.

What actually takes energy is to release those those bonds and reset the myosin head so that it's in a position to contract again.

So ironically, relaxing muscles requires energy.

It's counterintuitive, but that's the way that it works.

So what happens when you have a muscle knot?

Well those actin and myosin filaments won't let go of each other creating a sustained contracture of the muscle, which produces a muscle knot.

When a muscle has been knotted up for a long period of time, it can impair the microcirculation to the area.

The small blood vessels in the muscle, the capillaries, aren't able to get oxygen to the muscle.

However, without oxygen, your muscles can't turn glucose into energy, or ATP (adenosine triphosphate).

Without ATP, the myosin heads can't detach from the actin filaments and your muscles stay knotted.

That becomes a vicious cycle where the knot just won't go away.

The longer the muscle is knotted, the less blood flow it gets. And the less blood flow it gets, the less oxygen it has to produce energy. And thus the knots get harder and harder to relax.

So how do you get a muscle knot in the shoulder blade to relax?

You have to use some tricks to make that muscle relax, and we'll go through those in the rest of this post.

3 Causes Of Knots In The Shoulder Blade

When people refer to a "knot in the shoulder blade", they usually refer to one oft three different areas.

3 Areas Where People Develop Knots In The Shoulder Blade:

  • A knot on top of the shoulder blade - the levator scapula or upper trapezius muscles
  • A knot on the back of the shoulder blade - the infraspinatus muscle
  • A knot between the shoulder blade and spine - the rhomboids and/or middle trapezius muscles


Knot On Top Of Shoulder Blade

The first area that people tend to get knots is right on top of the shoulder blade.

People may develop pain or stiffness there from working crouched over a desk or looking down at their phones all day.

It's really common for people to develop knots or trigger points in those areas.

One cause of a knot on top of the shoulder blade is your levator scapula muscle.

The levator scapula runs down from your our neck and it attaches right into the top of the shoulder blade.

Levator scapulae muscle may cause a knot on top of the shoulder blade

Additionally, the upper trapezius muscle may also cause a knot on top of the shoulder blade.

3 parts of the trapezius muscle

That can happen from that muscle being too tight and held stiff, but it can also happen from the opposite problem where the muscle is overstretched.

Perhaps you always carry heavy things in one hand or you carry a purse over or heavy bag over the same shoulder. That presses down on the shoulder blade and it overstretches the muscle.

Your muscle senses is that it's being overstretched, so it contracts or shortens in order to protect itself from injury.

That's a good thing that your body has the intuition to do that.

However, if you do that repeatedly over a period of time, you can develop a trigger point or knot in your neck and shoulder muscles.

Knots On Back Of The Shoulder Blade

Knots on the back of the shoulder blade itself are usually caused by the infraspinatus muscle. The infraspinatus is one of the four rotator cuff muscles.

Trigger points or knots in the infraspinatus muscle can cause referred pain all the way down the arm as well as local pain in the shoulder blade.

If you have a painful knot right on the shoulder blade itself, chances are that it could be the infraspinatus.

You may have difficulty with:

  • reaching across your body
  • reaching behind your back
  • reaching over your head

When you do those things, the ball of your shoulder has to be able to glide backwards in the shoulder socket, and if that infraspinatus muscle is too tight it's going to keep the ball from gliding backwards.

Knots Between The Shoulder Blade And Spine

If you get knots in the upper back between the shoulder blade and the spine, that may be caused by the middle trapezius (shown above) or rhomboid muscles (shown below).

Rhomboid muscles can cause a knot between the shoulder blades

The rhomboids and middle trapezius pull your shoulder blades backward.

You can develop knots in those muscles from sitting with military type posture trying to sit with "good posture".

You don't want to slouch excessively, but your upper back is supposed to be rounded a little bit.

As mentioned above, you can develop knots in muscles from them being overly short or overly lengthened. Therefore, it's important to find a happy medium.

How To Relieve A Knot In The Shoulder Blade

So what can you do to relieve a knot in your shoulder blade?

Well there are some treatments that we can provide in physical therapy.

Some of those treatments include:

  • Manual trigger point therapy - the therapist puts pressure on the muscle with their hands in order to release the trigger point.
  • Dry needling - putting a tiny needle into the muscle to neurologically "reset" the muscle's resting tone.
  • Spinal manipulation - if you have knot between the shoulder blades, doing a manipulation to the thoracic spine can cause those muscles to relax.
  • Rib joint manipulation - if a rib is sticking out backward, it can feel like a muscle knot even though it's a bone.

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