How To Massage Knots Out of Back? [Lower Back and Upper Back]

Muscle knots can occur at any place in your body and it can be in any muscle. In your back, these knots are either cause pain in your neck, upper back, mid back, or lower back. Surprisingly, the pain is not just limited to the area where the knot has formed, rather it can radiate to other areas.

If you are experiencing pain in the neck or shoulders, it might be radiating from a trigger point in your upper back or midback.

Similarly, lower back knots or trigger points can radiate pain to your buttocks or it can resemble a systemic pain pattern like kidney pain or urinary tract infection (UTI).

For this reason, locating muscle knots, and knowing about the referred pain pattern for each knot is essential to come to a final diagnosis.

How To Relieve Knots in Upper Back?

Location of Muscle knots in the upper back

  • Between the shoulder blades
  • Along the inner edge of the shoulder blade
  • Underneath the shoulder blade
  • Over the shoulder blade

Muscles involved:

Knots in the upper back are formed in the muscles that move your shoulders, arms, and neck. 

  • Rhomboids
  • Trapezius
  • Subscapularis
  • Serratus posterior superior
  • Supraspinatus
  • Infraspinatus
  • Teres minor

How are the knots formed in upper back?

These knots are formed due to postures that cause muscle imbalances. Excessive and repetitive movements of your neck, shoulders, or arms lead to the overuse, injury, overstretching, or shortening of these muscles.

Here is a list of daily life activities that makes your muscle tight, short, or weak over time if you don’t follow the right biomechanics.

  • Working a desk job that requires using arms held in a forward position for a prolonged time
  • Pushing heavy objects
  • Overhead activities
  • Holding the heavy bag in hand with the arm hanging
  • Driving a car while grabbing the steering wheels from the top
  • Heavy breathing due to sports or a respiratory illness

How does the pain feel like due to knots in upper back?

  • You will feel pain between your shoulder blades that sometimes radiates to the neck and head causing headaches occasionally.
  • With rhomboid trigger points, people often feel pain while lying on their backs.
  • You will feel aching pain deep under the shoulder blade.
  • You might feel referring pain in your little finger, the tip of your elbow, or the backside of your shoulder and wrist.
  • You might not always feel pain, it sometimes comes as numbness as well.
  • Pain on the side of the shoulder, arm, and shoulder tip.
  • Your pain will increase with lifting the arm forward or sideway, putting jackets on, moving your hand behind the back or neck, and lying on the opposite side.

How to get rid of knots in upper back? [Step by Step]

For massing the knots, the therapist first needs to find the exact location of these knots by palpation.

Here are the steps to locate and release knots in the upper back.

How to get rid of knots in upper back?
  1. For superficial knots, the client is lying prone (as the trapezius is a superficial muscle, its knots are easily palpable with the client lying face down).
  2. The therapist is standing at the side of the client and palpates near the inner edge of the client’s shoulder blade to identify the exact location of the knots.
  3. Once located, the therapist either uses his thumbs, elbow, or a tennis ball to apply pressure over the knot for 20 to 30 seconds, release it for 5 seconds, and then reapplies the pressure for 20 to 30 seconds.
  4. This process (ischemic compression) is repeated 5 to 7 times.
  5. For deeper knots, the client is asked to lie in a side-lying position with the side of the examination on top and the top hand placed behind the back. (Rhomboid knots are best located and released in this position)
  6. The shoulder blade pokes out in this position making it easy for the therapist to palpate the deep knots near the shoulder blade.
  7. The therapist applies pressure using his thumb, then moves the client’s hand from behind the back to the front and overhead while maintaining the pressure on the knot.
  8. After 20 to 30 seconds the pressure is released for a few seconds and the steps are repeated a few times.
  9. This approach (positional release technique) is best for massaging rhomboid knots.
  10. To reach knots under the right shoulder blade, the client sits with the right hand on the left shoulder, crossing the arm in front. This slides the shoulder blade and exposes the area of the knots for easy palpation. (for serratus posterior superior knots)
  11. The therapist massages the knot using the direct pressure or stripping method.

Self-massage to get rid of upper back knots

If these knots are superficial and easily accessible, you can massage the knots by using these steps. (for right side knots)

  1. Feel the knots on the right shoulder blade with your left hand.
  2. Take a massage ball or a tennis ball and palace it against a wall and the knot in your shoulder blade.
  3. Glide your shoulder up and down, left and right, and in circular motions while pressing the knots against the ball for 2 minutes at a time.
  4. Repeat this a few times a day and make sure to stretch afterward.
  5. To reach the knots under your shoulder blade, you need to sit slouching forward.
  6. With your three fingers, press inside your armpit against the shoulder blade to locate the knots. (for subscapularis knots)
  7. You can either use your fingers or a Thera cane or massage stick to apply pressure on the knot to break the adhesions. (it is a form of friction massage technique with a massage stick)

Let me share one of my personal experiences:

A 39-year-old receptionist was presented to me for her back pain that was excruciating and was extended to her buttocks. She reported that she is no more able to work because the pain was disabling and her job required standing all day. She mentioned that her pain only goes away in the lying position.

After an assessment, I found knots in her lower back and used friction massage in combination with a myofascial release for three sessions which reduced 60% of her pain. She also self-massaged at home after that using a tennis ball.

How to Relieve the Knots in Middle and Lower Back

Location of muscle knots in the midback and lower back

  • On the lower part of the ribcage (away from the spine)
  • Along the length of the spine on both sides
  • Just above the waistline at the sides of the lower back

Muscles involved:

These knots are formed in the muscles that keep your spine erect, support your spine, and help you bend, extend, and twist your back or trunk.

  • Serratus posterior inferior
  • Deep spinal muscles
  • Superficial spinal muscles
  • Quadratus lumborum

What causes knots in lower back muscles and middle back muscles?

Overstaining and a bad posture can lead to the shortening of these muscles and you have knots formed if you don’t correct your posture timely.

If you have weak abdominal muscles or muscle imbalance between the left and right sides of your back, it leads to the formation of knots on the side of the spine.

Here is a list of the daily activities that people usually do in a bad posture or conditions that one will not care much about,

But all these can lead to knots formation in the midback and lower back.

  • Standing while placing all weight on one leg
  • Sitting at a computer desk with the body leaning on one side for an extended time
  • Lifting heaving objects from the ground you are more prone to having superficial knots.
  • Weak hip muscles
  • Overstrained back not been treated for a long time

How does the pain feel like when you have knots in lower and middle back?

  • You will have pain in bending, twisting, or reaching across your body.
  • The pain increases if you keep doing such activities.
  • The deep knots can exert a pulling effect on your spine and that’s why the pain from these knots is right in your spine.
  • You will feel a localized pain in any region of your spine, that can refer to your abdomen as well as your tailbone.
  • However, if you have a superficial knot, the pain is not localized, instead, you feel a diffused dull ache in your whole back.
  • Radiating pain to the buttocks and tailbone.
  • You will feel a stabbing pain in or near your hips while coughing or sneezing if you have knots just above the waistline.
  • You will feel an increase in pain while turning in bed, or twisting your back.
  • Your pain resembles a kidney stone pain, UTI infection, or any other systemic illness that’s why you need medical clearance for any of these conditions before considering massage therapy if you have such a pain pattern.

How to get rid of knots in lower back and mid back?

Here is a stepwise process for releasing these knots:

How to get rid of knots in lower back?
  1. The client is lying face down. All the back muscles are relaxed.
  2. The therapist initially applies the effleurage technique for relaxation of the superficial muscles layer so that it is easy to access the knots in the deep muscles.
  3. Then the therapist works his fingers along the length of the muscles starting from the lower back and going up towards the midback to feel the knots.
  4. For knots formed just above the waistline or on the side of the lower back, the therapist locates the knots with the client either in the side-lying or laying on the back.
  5. Usually, there is more than one knot spread over a larger area in the back, so it is best to use a combination of friction massage and myofascial release methods for massaging the knot.
  6. The therapist uses his thumbs, knuckles, or tip of the elbow to apply firm pressure over the knots and drags the pressure along the length of the muscle making contact with each knot.
  7. The therapist might use a massage ball to apply pressure on the muscle knots and rolls the ball back and forth to massage the knots.
  8. After a few strokes of this friction massage technique, the therapist gently stretched the fascia in that region which further increases the range of motion and reduces the pain. (the stretch must be gently and not overstretched)

How to get a knot out of your lower back and mid back by yourself?

You can massage the knots in your mid or lower back region using a massage ball or foam roller and following these steps,

  1. Place the ball or foam roller under your back on the site where the knots are present while laying on the floor face up.
  2. Stabilize your body on the floor and shift your weight slightly to the ball that will compress the knots.
  3. Move your back side to side and in circles to roll the ball against your knots for massaging.


Each muscle is unique having a specific action and the knots formed in your back also depend on your daily life activities, your work, leisure time, posture, and habits.

Massaging knots in the back requires expert skills for certain regions, however, you can also use self-massaging techniques for knots after sufficient practice. It is always best to consult an expert professional initially for identifying the problem.

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