Why Do I Have a Knot in My Lower Back?

Experiencing a sensation of a knot in the lower back is common among individuals with musculoskeletal problems. These knots, also called trigger points, can be both uncomfortable and restrictive in terms of how your body can move. 

“While muscles can cause pain, they are usually hurting in response to some other dysfunction or injury to the lumbar spine,” says Charles Steger, a physical therapist with INTEGRIS Health Jim Thorpe Rehabilitation in Oklahoma City. “Your physical therapist specializes in determining the cause of your low back pain to ensure you are getting the right care.”  

This blog identifies common sources of muscle knots in the lower back and what you can do to find relief.

What is a muscle knot?

Muscle knots, also known as trigger points or myofascial pain, are hyperirritable spots (excessively prone to irritation) that occur when muscle tissue or fascial tissue over-contracts and creates tension. 

Muscles heal on their own as part of a self-repair process. But some people have muscles that take on too much strain, which then initiates a protective response that causes the muscles to tighten to avoid further injury. The more tension that occurs, the tighter muscle fibers become due to a lack of blood flow. Eventually, a knot-like sensation develops.
The symptoms of a muscle knot can vary, but most people describe it as a deep, burning ache. In the lower back, knots can cause fatigue due to tight and exhausted muscles.

Where do muscle knots occur?

Muscle knots can occur anywhere where muscles are present, including the neck, shoulders, back, legs and arms. Typically, though, most people experience them either in the thoracic spine (mid back) or lumbar spine (low back).

Here are some common examples of areas in or near the lower back where knots can occur:

• Quadratus lumborum: This muscle can be hard to reach and it lies deep in the lower back near the bottom rib and iliac crest. A knot in this location can cause pain in the lower back, hip and buttocks.
• Erector spinae: This group of back muscles runs vertically on either side of the spine and includes the spinalis, longissimus and iliocostalis. They place the spine in extension to help you bend backward.
• Iliopsoas: This compound muscle combines the iliacus and psoas muscles to aid with hip flexion. The muscle connects the lumbar spine to your legs. Trigger points in this location can refer pain to the lower back.
• Gluteus medius: Located on the outer part of the pelvis, this muscle internally rotates the hips. A knot in this location can cause posterior pelvic tilt (pelvis tilts backward).
• Gluteus maximus: Located in the buttocks, this muscle connects to the tailbone and helps the hips rotate externally. Trigger points in this location can cause low back or hip pain.
• Piriformis: This muscle is part of the buttocks and runs from the spine to the thighs. It helps with hip rotation but can easily become overworked. Trigger points here can cause pain in the outer buttock or discomfort in the low back.

What causes knots to form?

Knots can form in muscles for many reasons, ranging from a lack of stability in the lower back to overused muscles.

Poor posture: Whether you’re sitting or standing, the back is hard at work to keep your body properly aligned. Slouching, hunching over or leaning to one side can make these muscles work harder, which causes excessive tension and knots to form.

Extended periods of sitting or bed rest: People who sit for long periods of time or are confined to a bed are more likely to develop muscle knots due to weak and strained muscles.

Overuse: Repetitive motions or lifting heavy objects (weight lifting or in a work setting) can strain muscles and lead to knots.

Injury: Suffering a herniated disc or a fall that causes acute back pain can place extra strain on muscles.

Stress: Stress causes muscles to hold more tension than normal. Chronic stress may cause knots to form at work or when sleeping.

Dehydration: Water makes up the majority of muscle mass, so your muscles need daily hydration to function optimally. A lack of hydration can lead to muscle tension and tightness.

Muscular imbalances: The muscles in your back, shoulders and abdomen work together to perform a variety of movements. Whenever one group is weak, the others overcompensate and are forced to work harder. For example, weak and shortened abdominal muscles can cause the back to become overactive and develop knots.

How to get rid of muscle knots

Stretching: Muscles consist of thousands of fibers made up of proteins that are meant to stretch to support certain movements. Stretching your lower back, hips, hamstrings, glutes and abdomen is the first step in reducing or eliminating muscle knots. Stretching helps maintain flexibility and promotes blood circulation, which can prevent the buildup of tension. Without flexibility, the muscles will continue to tighten up regardless of if you use other measures (such as manual therapy) to release them. A physical therapist can suggest a stretching regime to loosen muscles.

Massage therapy: Some muscle knots are in hard-to-reach areas of the body that may not benefit from stretching or other forms of therapy. A massage therapist can target these trigger points and provide relief. Options include deep tissue massage, myofascial release or trigger point therapy.

Heat and cold therapy: Heat can warm up muscles and make them more accessible for stretching, although the muscles will tighten back up when the temperature drops. Icing muscles can reduce inflammation that may be causing the knots.

Dry needling and acupuncture: This type of treatment uses thin needles to reach trigger points in the lower back and surrounding areas. When the needles hit a trigger point, it causes the muscle to twitch and involuntarily spasm. In other words, it helps tire the muscle out to release tension and unknot muscle fibers.

Soft tissue mobilization: This form of manual therapy helps release muscle fibers through pressure, kneading or friction massage. At home, you can use a foam roller to reduce muscle tension.

Posture correction: Using the correct posture at your desk, while standing or even when you sleep can prevent knots from forming. 

Reduce stress: Use relaxation techniques such as yoga, meditation or deep breathing to avoid muscles from being under constant contraction.

Increase activity: A sore back from regular muscle knots may not inspire you to exercise, but increasing your activity can help keep muscles strong and healthy. Start slowly with something gentle like walking or swimming.

Managing underlying dysfunction: When knots are present in your back due to inflammation, injury or segmental dysfunction, a physical therapist can help promote healing and correct the dysfunction by using specific manual techniques. 

If you experience muscle knots in your back, consult with your primary care physician to discuss your discomfort and receive a recommendation for a physical therapist specialized in treating the back and spine.

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