Muscle Knots in the Back That Are Big & Hard to Get Out

Muscle knots in your back can make everyday tasks, such as getting out of bed, painful and difficult. While annoying, muscle knots — also called spasms or trigger points — can often be successfully treated with home remedies, trigger point release, stretching, strengthening and using good body mechanics.

Read more: Symptoms of Knotted Muscle at the Shoulder Blade

Muscle knot symptoms include tightness, stiffness and a palpable "lump" when you press on your back muscle. The knot might or might not be painful. If you press firmly on the knot, you might actually feel your muscle fibers twitching.

Muscle knots can be caused by a single event, such as lifting a large or heavy object the wrong way, or they might seem to come out of nowhere. Back spasms can develop over time from repetitive lifting or poor posture. You might also notice knots in your back muscles after an intense exercise session.

Muscle knots in the back can be treated with either heat or cold — depending on a few factors. Ice is used to decrease pain and inflammation. If you've pulled a back muscle and developed a knot, apply ice for 10 to 15 minutes at a time for the first 48 hours.

Most knots in the back will respond best to heat — especially if you've had the knot for a while. Heat increases blood flow to the tight muscle fibers, encouraging them to relax. Apply heat for 15 to 20 minutes prior to other interventions, such as trigger point release.

Read more: Lump in the Trapezius Muscle

Move 1: Trigger Release

Trigger points, or overactive muscle fibers that lead to knots, can be treated with ischemic compression, or trigger point release. Although this technique is often done by using the pads of the fingers, it can be quite difficult to reach knots on your back — particularly if they are large. Use a lacrosse ball or a tennis ball as a substitute.

1. Lie on a firm surface and place the ball under your back, directly on the muscle knot.
2. Use your body weight to gradually increase the amount of pressure applied to the knot. Trigger release will initially be painful — however, as you continue to apply pressure, the pain will subside as the muscle knot relaxes.
3. Hold pressure on the knot for up to 60 seconds at a time.

Move 2: Roll it Out

Try foam rolling over the knots in your back to help relieve tightness.

1. Lie on your back with the foam roller underneath your shoulder blades.
2. Bend your knees and lift your hips off the ground.
3. Cross your arms over your chest or place them behind your head to support your neck.
4. Walk your feet forward and back to move yourself up and down on the roller several times.
5. To target one side of your back, roll to that side and repeat.

Stretching can help decrease muscle knots in the back and lengthen muscles that are tight. Hold each stretch for 20 to 30 seconds, and repeat three times. Do not stretch to the point of pain — mild discomfort and a strong pulling sensation are normal though.

Move 1: Side Stretch

The side stretch lengthens muscles in your upper and lower back, one side at a time.

1. Stand up tall with your right hand on your right hip.
2. Reach your left arm out to the side and up to your ear.
3. Lean your trunk over to the right until you feel a strong pull along the left side of your body.
4. Repeat on the right.

Move 2: Knee-to-Chest Stretch

The knee-to-chest stretch emphasizes your lower back.

1. Lie on your back on a firm surface.
2. Bend your knees and bring them toward your chest.
3. Wrap your arms around your knees and gently pull them closer to your chest until you feel pulling along your lower back.

Move 1: Cat/Cow Exercise

The cat/cow yoga exercise helps improve mobility in your upper and lower back.

1. Begin on your hands and knees.
2. Round your back up toward the ceiling while tucking your chin in toward your chest (like an angry cat arching its back). Hold for five seconds.
3. Drop your belly toward the ground and arch your back.
4. Look up toward the ceiling. Hold for five seconds. Alternate these two positions five to 10 times.

Move 2: Abdominal Draw-In

Muscle knots and strains can contribute to back pain and tightness. Strengthening your abdominal muscles, along with the deep muscles in your back, will help stabilize your spine and reduce tension on your back muscles.

1. Lie on your back on a firm surface.
2. Bend your knees and place your feet on the floor.
3. Place your hands on your hips.
4. Tighten your belly as if you are pulling your belly button back toward your spine. Your low back will press into the ground and you should feel the muscles under your fingertips tighten.
5. Hold for three to five seconds, then relax.
6. Repeat 10 to 20 times.

Back spasms can develop from a very common daily task — lifting. In November 2017, a study published by BMC Musculoskeletal Disorders examined the effect of lifting progressively heavier loads on lower back muscles. Participants bent at the waist — a movement called trunk flexion — during these lifts. The authors assessed back muscle tension in 22 healthy male college students lifting 33-, 44- and 55-pound loads. Back spasms occurred in 45 percent of the participants at 33 pounds; 68 percent at 44 pounds; and a whopping 82 percent when they lifted the 55-pound load.

This doesn't mean back spasms are unavoidable. Using proper lifting form — keeping your back straight, rather than using trunk flexion, and bending your knees, rather than bending over at the waist — can help prevent back spasms or worsening of spasms that are already present.

1. Stand with your feet staggered, at least shoulder-width apart.
2. Hinge forward at your hips while keeping your back straight.
3. Slowly squat down and grasp the object with both hands.
4. Keeping the load as close to your body as possible, push down through your heels and stand back up. Keep your chest up and look forward to help prevent bending at the waist.