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In many cases the knot in the muscle is caused by an abnormal nerve message being sent to the muscle. The abnormal nerve message is, in turn, caused by a misaligned bone in the spine that irritates the nerve. To keep it simple.
View Article Summary. There is a reason for the painful knots you have in your back near your shoulder blades. Most often the reason is that you have muscles pulling on your shoulder blade. That, in turn, causes your shoulder blade to pull on the other muscles nearby. The muscles that are being pulled on become taut (taut is a kind of tightness or spasm) to protect themselves. That tautness is the knot or muscle spasm or contraction that you feel.