How to get rid of a knot in your shoulder blade

Have you ever felt like there was a knot in or around your shoulder blades? A muscle knot is simply a tight, sensitive spot that can feel like a small bump or nodule. Muscle knots can occur anywhere in your body, but the shoulder area in particular is prone to carrying tension because it’s linked to so many different muscles. 

“Seventeen muscles attach to the shoulder blades, from your neck, shoulders, and lower back,” says Melissa Marek, PT, DPT, a physical therapist at Hinge Health. 

With all these connections, everyday activities like sitting with rounded shoulders at a desk or cleaning your home can lead to muscle tightness and sometimes muscle knots. “Muscle knots can feel uncomfortable, but they aren’t harmful,” says Dr. Marek. Conservative treatments like physical therapy, performing targeted exercises, and getting a massage can release tension and pain from a knot in your shoulder blade. 

Read on to learn what causes muscle knots in your shoulder blades, what they feel like, and how to prevent and treat them, especially with exercises recommended by our Hinge Health physical therapists.

What is a knot in the shoulder blade?

A knot in your shoulder blade can feel like a tight spot or tender area between your shoulder blade and spine. This can happen when the muscles in that region become overworked and tense, leading to discomfort. Muscle knots, also sometimes called trigger points, are focused areas of tension. This sets them apart from other types of muscle soreness or pain, which might feel more widespread.

“You can think of muscle knots as your body’s way of telling you that this area could use a bit of care and attention to get back to feeling its best,” Dr. Marek says. 

Causes of knot in shoulder blade

When muscle fibers become tense, they can bunch up and form a temporary knot. Common situations that can cause this include:

• Holding the same position for too long. Staying in one position for a long time can make your muscles feel tight and tired. “Sitting in certain ways at a desk can push your shoulders and head forward, which can strain your upper back and neck muscles,” says Dr. Marek. Think of your head as a heavy bowling ball. When it leans forward, your neck and upper back have to work harder to support it. This can make those muscles feel tired and sore. 

• Overuse. Doing too much of any activity, whether golfing, painting overhead, or playing pickleball, can make the muscles in and around your shoulder blades feel tense and sore, especially if they weren’t prepared to do those movements. Sometimes, when one set of muscles isn’t feeling up to par, other muscles step in to help out. This extra effort can cause these helper muscles to feel overworked or fatigued, and in some cases, lead to a knot.

• Muscle imbalances. When one muscle or muscle group isn’t as strong as or is tighter than another, other muscles have to pick up the slack. This can lead to tension or knots in your shoulder blade.

• Repetitive motions. Swinging a tennis racket, hammering nails, throwing a ball, rowing, or gardening for several hours or days consecutively can overwork your shoulder muscles, making them more prone to knots.

• Carrying emotional tension in your upper body. “The shoulders, upper back, and neck are common places for people to hold stress,” says Dr. Marek. When you’re stressed, your upper back muscles can tighten from hunching forward or lifting your shoulders up toward your ears. These changes in posture might cause knots to form in the shoulder blade area.

• Neck issues. Knots in your shoulder blade might ‌stem from your neck. According to Dr. Marek, a stiff neck, tight muscles, or even a pinched nerve can lead to tension that shows up as a knot in the shoulder blade area.

Knot in shoulder blade symptoms

Common symptoms of shoulder blade knots include:

• A hard lump in the muscles around the shoulder blade

• Pain specific to one spot

• Tender or painful to the touch

• Sensations ranging from sharp pain to a dull ache

• Stiffness

• Difficulty performing daily activities like reaching, twisting, working on a computer, or getting comfortable to sleep

These exercises stretch and strengthen key muscles supporting the shoulder blades to reduce tension and improve range of motion in your upper body. When you feel tense in your shoulders and upper back, try performing all of these moves to help ease pressure and reduce pain. 

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.

Treatments for knot in shoulder blade

In addition to ‌doing strengthening and stretching shoulder movements, getting a massage, practicing deep breathing, and applying heat to tense muscles in your upper body can all help relieve a knot in your shoulder blade.

• Try physical therapy and targeted exercises. Targeted exercises, like those above, can help break up tension in and around your shoulder blades, which can alleviate pain. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. “Figuring out what’s causing knots in your shoulder blades can be tricky,” says Dr. Marek. “That’s because many muscles connect to the shoulder blade, and the sensation might even come from other areas, like your neck.” A PT can also help you adjust movement patterns, habits, and office ergonomics to reduce your risk of shoulder blade knots. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Get up and move. Taking movement snacks or breaks throughout the day helps your shoulders move more easily. This helps blood flow better and releases muscle tension. “Try setting a timer to remind you to move every hour or so,” Dr. Marek says. When you get up to walk, consider also doing movements that help balance the effects of staying in one position too long or repeating the same motion. For example, doing chin tucks can help counteract forward head posture, which happens naturally when working at a computer.

• Roll on a ball. Using a lacrosse or tennis ball to self-massage can directly release tension and alleviate pain. Try placing the ball between your shoulder blade and a wall. Gently lean into the ball and move it around until you find a tender spot. When you find a sensitive area, or trigger point, breathe deeply and apply more pressure as you hold it there.

• Apply heat. Heat increases blood flow to sore and tense areas, helping muscles relax and heal. You can apply heat therapy by using a heating pad, or by taking a hot shower or bath, for example. 

• Do gentle stretching. Performing static and dynamic stretches — such as arm glides and doorway stretches — can relax the muscles in your upper body, releasing tension to loosen up knots.

• Get a massage. A trigger point massage specifically targets muscle knots, but deep tissue and sports massages also involve kneading out muscle tension, which may help release knots.

• Take deep breaths. When you feel stressed, consider taking a break to do some deep breathing exercises. Lowering stress levels can help relax ‌all of the muscles in your body.

How to prevent a knot in shoulder blade

Many methods used to treat shoulder blade knots can also help keep them at bay. Here are some more ways to reduce muscle tension and knots.

• Adjust your workspace. A good desk setup can alleviate stress from your neck and upper back. Dr. Marek recommends setting your computer screen no more than an arm’s length away from you at eye level. Try enlarging your screen so you don’t lean forward and strain your neck to see text or images. “Try keeping your head lined up over your shoulders rather than jutted out in front of them,” Dr. Marek says. Another helpful tip? Adjust your chair and desk so that your elbows are bent at a 90-degree angle, which can help support your arms.

• Get active. Movement is medicine: staying active, by doing a mix of resistance training, cardio, and stretching exercises helps keep your muscles relaxed and your joints moving smoothly, making day-to-day activities feel easier and more comfortable.

• Move in the opposite direction. There are so many ways you can do this. When you’re sitting at your desk or in a car, try opening your chest and looking up. If you usually turn to one side, try twisting the other way. “Aim to move in a way that’s opposite to any position you’ve held for too long,” suggests Dr. Marek.

• Make time to relax daily. Managing your stress can make your neck, upper back, and shoulders less tight. There are a lot of relaxation techniques, such as deep breathing, yoga, walking, being in nature, and meditation. Find one or two that work for you to practice often.

• Build strength. Focus on targeting both big and small muscles, like those in the rotator cuff. These muscles are important for keeping your shoulder blades steady. It’s easy to overlook the smaller muscles,” Dr. Marek says. “At the gym, it’s common to aim for big biceps, lats, and upper traps and forget about these little muscles in the back and shoulders that can get overstressed.” 

PT tip: Look up

Try tilting your head back and lifting your chin to the ceiling several times daily. “Your neck is meant to move in that direction,” says Dr. Marek. “But there aren’t many activities in your day-to-day life that get you to look up.” If your neck and upper back muscles feel stiff when you look up, it can create tension and lead to knots in your shoulder blades.

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. Cowan, P. T., Mudreac, A., & Varacallo, M. (2020). Anatomy, Back, Scapula. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK531475/ 

2. Alvarez, D. J., & Rockwell, P. G. (2002). Trigger Points: Diagnosis and Management. American Family Physician, 65(4), 653–661. https://www.aafp.org/pubs/afp/issues/2002/0215/p653.html 

3. Panagiotopoulos, A. C., & Crowther, I. M. (2019). Scapular Dyskinesia, the forgotten culprit of shoulder pain and how to rehabilitate. SICOT-J, 5(29), 29. doi: 10.1051/sicotj/2019029

4. Sari, H., Akarirmak, U., & Uludag, M. (2012). Active myofascial trigger points might be more frequent in patients with cervical radiculopathy. European Journal of Physical and Rehabilitation Medicine, 48(2), 237–244. https://pubmed.ncbi.nlm.nih.gov/22614890/