Muscle knots are basically chronic muscle strains caused by repetitive movements or postures that contract muscle fibers for long periods of time. Muscles are meant to contract for short durations, then completely relax. However, performing similar movements over and over (due to athletics, weightlifting, cleaning the house, etc.) or sustaining certain postures while at work strains muscles fibers and causes them to remain contracted. As such, chronic muscle strains and knots respond well to light stretching because it relieves the tension, promotes blood flow and improves flexibility. As a general rule, hold the stretches (without bouncing) for about 30 seconds and do them at least three times daily until the achiness from the knot fades away.  While standing or sitting up straight, reach around the front of your body and grab the opposite arm with your hand - around the elbow area, but never apply force to a joint, as this can cause damage. Gently pull on the back of the arm across your chest until you feel a stretch in the corresponding shoulder. Be sure to drop your shoulder away from your ear (don't hike it up). This stretch is great for the outer and rear muscles of the shoulder. While standing or sitting up straight, reach behind your back and grab the wrist of the other hand (the one with the shoulder knot). Slowly pull down on your arm just above the wrist - avoiding grabbing the joint - until you feel a good stretch in the affected shoulder. This stretch is great for shoulder muscles that attach to your neck. To increase the stretch, you can drop your ear towards the opposite shoulder Feeling for a knot in larger muscles like those in the shoulder is not too difficult. The knot should feel harder than the surrounding tissue and get achy with applied pressure. Unlike acute muscle injuries, there likely won't be obvious evidence of inflammation, swelling or redness. So feel around your shoulder and locate the knot, which is also called a trigger point. Once found, use a handheld vibrating massager over the knot for 5 to 10 minutes and see if that works the knot out. You may need to apply more pressure for longer periods of time for noticeable results. Although handheld massagers are commonly found in pharmacies and usually inexpensive, you can also use handheld wooden massage devices for working out knots. They may require more exertion, but they typically cost less. If your shoulder knot is closer to your shoulder blade and difficult to reach, then consider using a tennis ball to roll on. Place a tennis ball right beneath your knot and lie directly on it for about five minutes or so. This may be uncomfortable at first, but you should feel the knot slowly melt away. As noted above, muscle knots are a type of chronic injury and don't typically involve inflammation and sharp pain like acute muscle injuries do. As such, applying ice to muscle knots is not appropriate because you actually want more blood flow. Instead, apply moist heat to your shoulder muscle knot. Moist heat warms up the soft tissues (muscles, tendons and ligaments) and increases blood flow, which can be helpful for chronically tight muscles and knots. Great sources of moist heat include microwavable bags filled with grains (usually wheat or rice), herbs and/or essential oils. Warm the bag in the microwave for about two minutes or so and then apply the moist heat to the muscle knot for about 15 minutes at least three times daily.  Applying moist heat before exercise can help reduce muscle tension and pain, and also increase tissue extensibility. Taking a warm bath also provides your muscles with moist heat. Try adding some Epsom salt (which is rich in magnesium) for even more muscle relaxing potential. Avoid applying dry heat from traditional heating pads because it dehydrates soft tissues and increases the risk of further injury. If your gym has a steam room, try spending some time relaxing there, as this is another good source of moist heat. Muscle relaxants (such as cyclobenzaprine) can be helpful for muscle spasms and knots because they release the tension in muscles. However, when you take medications orally (through the mouth) their effects are not limited to the problematic area. As such, muscle relaxants can cause strange sensations in some users because they reduce muscle contractions throughout the body. If your muscle knot is particularly achy, then non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen, naproxen or aspirin might be more effective and cause fewer side effects.  Some of these medications can be hard on your stomach, kidneys and liver, so it's best not to take them for more than two weeks. Regardless, of what type of medication you choose, take them on a full stomach. Always follow the instructions on the medication's package or ask your doctor for clear instructions on the appropriate dosing regimen. Try applying a pain-relieving cream such as Icy-Hot or Bengay directly over the problem area. If your shoulder knot is obviously not caused by playing sports or working out, then consider how your workstation/desk might be involved. For example, if your computer, desk or chair isn't positioned properly for your size it can put strain on your shoulders, neck and mid-back (between your shoulder blades). While sitting at your desk and looking straight ahead your eyes should be level with the top 1/3 of your monitor; your forearms should be close to parallel with the floor when typing and supported by stable armrests; your elbows should be within a few inches from your sides; and your feet should be placed flat on the floor.  If your arm position is too high or low due to the level of your desk or chair, then your risk of shoulder problems is greater. To prevent shoulder strain, minimize overhead work by using a taller ladder or getting closer to your task. Don't cradle the phone between your neck and shoulder. Use a headset or speakerphone setting instead. If you spend a lot of time in the car commuting, this may contribute to your shoulder pain. Try keeping your hands low on the steering wheel with your palms downwards.
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