Myofascial trigger points are the medical term for the knots that you feel in your muscles, for example, your upper back, neck, and shoulders. These trigger knots are muscle fibres that can’t relax.1,2

Knots can happen as the result of:2

  • Using the same body parts in the same way over and over on a daily basis from activities e.g. typing and/or mousing, handheld electronics, or gardening
  • Sustained loading as with heavy lifting, carrying babies, briefcases or boxes or even carrying your bag on the same shoulder
  • Poor posture
  • Muscle clenching and tensing due to mental and/or emotional stress (physical or emotional)
  • Direct injury such as a blow, strain, break, twist or tear. Think car accidents, sports injuries, falling down stairs and the like
  • Surprisingly, trigger points can even develop due to inactivity such as prolonged bed rest or sitting

Treating your knots

Treatment for myofascial pain typically includes physical therapy, medications or trigger point injections.3

Non-pharmacological treatment options:

  • Physical therapy methods are considered the best treatments to relieve knots4
    • A physical therapist may lead you through gentle stretching exercises to help ease the pain in your affected muscle3
    • Posture training. Improving your posture can help relieve the knots, particularly in your neck3
    • A physical therapist may massage your affected muscle to help relieve your pain. The physical therapist may use long hand strokes along your muscle or place pressure on the knots to release tension3
    • Applying heat, via a hot pack or a hot shower, can help relieve muscle tension and reduce pain3
    • This type of therapy uses sound waves to increase blood circulation and warmth, which may promote healing in muscles3
  • Spray-and-Stretch is a technique that uses a vapo-coolant spray (very cold because it evaporates the second it touches your skin) to distract the muscle into allowing a more complete stretch thereby helping to release the knots4
  • Acupuncture5
  • Get moving. Try swimming or other arm movements that engage the muscles in your shoulders and neck1

Pharmacological treatment

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used drugs to treat muscle knots.6
    Norflex® Gel is a topical NSAID that you apply directly to the skin over the painful area. It is well absorbed whilst providing a triple action effect at the site of pain (targeted relief) 7,8
    • Anti-inflammatory action which reduces the inflammation
    • Analgesic action which relieves pain
    • Local anaesthetic action which numbs the affected area to relieve pain
  • NSAID’s are also available in oral formulations such as tablet form. They can be well tolerated with few side effects 9
  • Injection with a numbing agent or anti-inflammatory3,5

The best treatment is preventing trigger points. Be aware of good posture and body mechanics. And find healthy ways to alleviate stress.1

Disclaimer: This editorial has been commissioned and brought to you by iNova Pharmaceuticals. Content in this editorial is for general information only and is not intended to provide medical or other professional advice. For more information on your medical condition and treatment options, speak to your healthcare professional

For full prescribing information, refer to the package insert. For more information, speak to your healthcare professional. Further information is available on request from iNova Pharmaceuticals. Name and business address: iNova Pharmaceuticals (Pty) Ltd. Co. Reg. No. 1952/001640/07. 15E Riley Road, Bedfordview. Tel. No. 011 087 0000. www.inovapharma.co.za.


  1. Cleveland Clinic. Knot in Your Neck? 4 Ways to Relieve Trigger Point Pain. [online] 22 May 2014 [Cited] November 2022. Available from URL: https://health.clevelandclinic.org/knot-in-your-neck-4-ways-to-relieve-trigger-point-pain/
  2. Myofascial Trigger Point Therapy – What Is It? [online] [Cited] November 2022. Available from URL: https://namtpt.wildapricot.org/MTPT_What_is_it
  3. Mayo Clinic. Myofascial pain syndrome. [online] [Cited] November 2022. Available from URL: https://www.mayoclinic.org/diseases-conditions/myofascial-pain-syndrome/diagnosis-treatment/drc-20375450?p=1
  4. Cleveland Clinic. Myofascial Pain Syndrome. [online] 7 July 2020 [Cited] November 2022. Available from URL: https://my.clevelandclinic.org/health/diseases/12054-myofascial-pain-syndrome?view=print
  5. Luo JJ and Dun NJ. Chronic Pain: Myofascial Pain and Fibromyalgia. Int J Phys Med Rehabil 2013;1(6):1-3.
  6. Desai MJ, Saini V, Saini S. Myofascial Pain Syndrome: A Treatment Review. Pain Ther 2013;2:21-36.
  7. Difflam Gel. [online] 1 January 2008 [Cited] November 2022. Available from URL: http://www.myvmc.comdrugsdifflam-gel/.

Chou R, Peterson K, Helfand M. Comparative Efficacy and Safety of Skeletal Muscle Relaxants for Spasticity and Musculoskeletal Conditions: A Systematic Review. Journal of pain and Symptom management 2004;28(2):140-175.


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