Understanding the Causes of Deep Knots in Shoulder Blades: Insights from Dr. Nojan Bakhtiari
Deep knots in the shoulder blades can be a source of significant discomfort, affecting daily activities and overall well-being. Understanding the causes of these knots is crucial for effective treatment and prevention. This blog explores the common causes of deep knots in the shoulder blades, providing insights from Dr. Nojan Bakhtiari, an expert in TMJ treatment and pain management.
Anatomy of the Shoulder Blades
The shoulder blades, or scapulae, are large, flat bones located on the upper back. They play a pivotal role in shoulder movement and stability, serving as attachment points for numerous muscles, including the trapezius, rhomboids, and rotator cuff muscles. These muscles are essential for various arm and shoulder movements, making them susceptible to tension and stress.
Common Causes of Deep Knots in the Shoulder Blades
- Muscle Overuse and Strain
- Repetitive Movements: Activities involving repetitive shoulder and arm movements, such as lifting, carrying, or overhead work, can lead to muscle overuse. Over time, this can cause the muscles around the shoulder blades to tighten and form knots.
- Poor Posture: Maintaining poor posture, especially when sitting or standing for long periods, can place undue stress on the muscles of the upper back. Slouching or hunching forward can cause the muscles to become overstretched and strained, leading to knots.
- Stress and Anxiety
- Emotional Tension: Emotional stress and anxiety can manifest physically, causing muscle tension and tightness. The muscles around the shoulder blades are particularly prone to this type of tension, resulting in the formation of deep knots.
- TMJ Pain: Temporomandibular joint (TMJ) disorders can contribute to muscle tension in the upper back and shoulders. Patients with TMJ pain often experience referred pain in the shoulder blades, which can exacerbate muscle knots.
- Injury and Trauma
- Direct Trauma: Injuries to the shoulder region, such as falls, accidents, or sports-related impacts, can damage the muscles and connective tissues around the shoulder blades. This trauma can lead to muscle knots as the body attempts to heal and protect the injured area.
- Whiplash: Whiplash injuries, commonly associated with car accidents, can cause significant muscle strain in the neck and upper back. The sudden jerking motion can lead to the formation of knots in the shoulder blades.
- Sedentary Lifestyle
- Lack of Movement: A sedentary lifestyle, characterized by prolonged periods of inactivity, can lead to muscle stiffness and poor circulation. This can cause the muscles around the shoulder blades to become tight and knotted.
- Desk Jobs: Individuals who spend long hours working at a desk or computer are particularly susceptible to developing deep knots in the shoulder blades. The lack of movement and poor ergonomics can contribute to muscle tension and discomfort.
- Medical Conditions
- Fibromyalgia: Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain and tenderness. Patients with fibromyalgia often experience deep knots and trigger points in various muscles, including those around the shoulder blades.
- Myofascial Pain Syndrome: This condition involves chronic pain and inflammation in the fascia, the connective tissue surrounding muscles. Myofascial pain syndrome can cause the development of painful knots, or trigger points, in the shoulder blades.
The Role of TMJ Disorders in Shoulder Blade Knots
TMJ disorders, which affect the temporomandibular joint connecting the jaw to the skull, can have a significant impact on the muscles of the upper back and shoulders. Patients with TMJ pain often experience referred pain in the neck, shoulders, and upper back, including the shoulder blades. This referred pain can contribute to muscle tension and the formation of knots.
Dr. Nojan Bakhtiari, a TMJ specialist, emphasizes the importance of addressing TMJ disorders to alleviate related muscle tension. By managing TMJ pain through targeted treatment, patients can experience relief from the secondary muscle tension and knots that develop in the shoulder blades.
Effective Treatments for Deep Knots in Shoulder Blades
- Manual Therapy
- Massage Therapy: Regular massage therapy can help release muscle tension and break down knots in the shoulder blades. Techniques such as deep tissue massage and trigger point therapy are particularly effective in targeting deep knots.
- Chiropractic Adjustments: Chiropractic care can help realign the spine and improve posture, reducing muscle tension in the upper back. Chiropractors can also perform manual adjustments to release muscle knots and improve mobility.
- Physical Therapy
- Stretching and Strengthening Exercises: Physical therapists can design personalized exercise programs to stretch tight muscles and strengthen weak ones. This can improve posture, reduce muscle tension, and prevent the formation of new knots.
- Postural Training: Physical therapists can provide guidance on maintaining proper posture during daily activities, reducing the strain on the muscles of the upper back and shoulders.
- TMJ Treatment
- Oral Appliances: For patients with TMJ disorders, oral appliances such as splints or mouthguards can help alleviate jaw pain and reduce muscle tension in the upper back. These appliances work by stabilizing the jaw and preventing teeth grinding.
- Medications: Pain relievers, muscle relaxants, and anti-inflammatory medications can help manage TMJ pain and reduce associated muscle tension. Dr. Nojan Bakhtiari may recommend specific medications based on the patient’s symptoms.
- Stress Management
- Relaxation Techniques: Techniques such as deep breathing, meditation, and yoga can help reduce stress and muscle tension. Incorporating these practices into daily routines can prevent the formation of knots in the shoulder blades.
- Counseling: For patients experiencing chronic stress or anxiety, counseling and therapy can provide valuable support. Addressing emotional factors can help reduce physical manifestations of stress, including muscle knots.
Preventing Deep Knots in Shoulder Blades
- Maintain Proper Posture
- Ergonomic Adjustments: Ensure that workspaces are ergonomically designed to support proper posture. This includes using chairs with good lumbar support, adjusting monitor heights, and positioning keyboards at the correct level.
- Regular Movement: Take frequent breaks to stand, stretch, and move around, especially during long periods of sitting. Regular movement helps prevent muscle stiffness and tension.
- Incorporate Physical Activity
- Exercise Regularly: Engage in regular physical activity to keep muscles flexible and strong. Activities such as swimming, yoga, and Pilates are particularly beneficial for maintaining shoulder and upper back health.
- Strength Training: Incorporate strength training exercises that target the muscles of the upper back and shoulders. Strengthening these muscles can improve posture and reduce the risk of knots.
- Manage Stress
- Relaxation Techniques: Practice relaxation techniques to manage stress and reduce muscle tension. Regularly incorporating activities such as meditation, deep breathing, and mindfulness can help maintain muscle health.
- Healthy Lifestyle: Maintain a healthy lifestyle with a balanced diet, adequate sleep, and hydration. Good overall health supports muscle function and reduces the risk of tension and knots.
Conclusion
Deep knots in the shoulder blades can be a source of significant discomfort, but understanding their causes and implementing effective treatment strategies can provide relief. By addressing factors such as muscle overuse, stress, injury, and TMJ disorders, individuals can manage and prevent these painful knots. Dr. Nojan Bakhtiari emphasizes the importance of a comprehensive approach to treatment, incorporating manual therapy, physical therapy, TMJ treatment, and stress management. With the right care and prevention strategies, individuals can achieve lasting relief from deep knots in the shoulder blades and improve their overall quality of life.
About Dr. Nojan Bakhtiari
Dr. Nojan Bakhtiari is a board-certified TMJ and Oral Facial Pain specialist. He focuses his practice on TMJ disorders, oral pain, facial pain and associated headaches. He treats patients in New York City. His practice is conveniently located in midtown Manhattan three blocks from Grand Central Terminal and Bryant Park.
- Assistant Clinical Professor, Columbia University College of Dental Medicine
- Treasurer and Committee Chair, NYU Dentistry Alumni Association
- Diplomate, American Board of Orofacial Pain
- Fellow, American Academy of Orofacial Pain
- Chair of Membership Committee, American Academy of Orofacial Pain
Dr. Nojan shares his in-depth knowledge of the TMJ, oral and facial pain as Assistant Clinical Professor at Columbia University College of Dental Medicine. He taught for 5 years at Yale-New Haven Hospital as a clinical attending and course director. He is one of very few diplomates of the American Board of Orofacial Pain and a Fellow of the American Academy of Orofacial Pain.
As an expert in the field, he has been invited to lecture at New York University, New York-Presbyterian Brooklyn Methodist Hospital, New York State Dental Association, Woodhull Hospital, Lincoln Medical Center, and numerous dental societies and conferences (including Greenwich and Stamford Dental Societies, New Haven Dental Association, Connecticut Society of Oral and Maxillofacial Surgeons, New England Dental Society Annual Meeting).
What are treatment options offered by Dr. Nojan?
Dr. Nojan offers the best and advanced treatment options available for TMJ, facial pain, oral pain and headaches. Treatments offered by Dr. Nojan Bakhtiari are personalized to you when looking to know more about inflammation of the jaw, and may include:
- Oral appliance therapy (custom mouthguards, nightguards, splints)
- Therapeutic injections
- Trigger point injections for muscle pain
- Nerve blocks
- Steroid injections for TMJ joint and tendons
- Botox for TMJ, nerve pain, jaw pain and headaches
- Therapeutic ointments and medication for oral, facial and TMJ pain
Overview of Treatments for TMJ, Facial Pain and Oral Pain
Dr. Nojan offers the most advanced and evidence-based treatment options for TMJ, facial pain, oral pain and related headaches.
“Don’t leave TMJ and orofacial pain treatments to guesswork.”
Treatments will always be personalized to you, your condition and your treatment approach preferences. We understand that some patients do not like taking medications, while others are afraid of needles, or have life-styles that prevent them from wearing a bite guard. Learn more about what happens at your first visit with Dr. Nojan Bakhtiari, DDS, FAAOP. For that reasons, we offer the full range of treatment options and learning about inflammation of the jaw while also including:
- Oral appliance therapy(comfortable and custom bite guards, nightguards, splints)
- Therapeutic injections(such as trigger point muscle injections, nerve blocks, and botox®), PRP
- Steroid injections jaw joint (TMJ) and associated tendons
- Compounded Topical Pain Medications and mouth rinses
- Jaw stretching exercises and physical therapy modalities
TMJ Treatment options vary depending on the individual suffering from TMJ and the specifics of their condition. Since TMJ/TMD can affect the musculature, tendons, bones and joint of the jaw, a thorough examination and diagnosis is paramount prior to initiating any treatment. Treatments include therapeutic injections of muscles and the joints, custom fabricated orthotics (also called splints, mouth guards, nightguards or occlusal guards), medications, creams, botox©, jaw stretching exercises, and physical therapy.
TMJ therapies should never include grinding down of otherwise healthy teeth. It is ill-advised to suggest to a patient that grinding of their otherwise healthy natural teeth is related to the TMJ pain they are perceiving. This treatment philosophy of “correcting the bite”, by either grinding down teeth (occlusal adjustments), restoring teeth with crowns, or moving teeth with braces or invisalign©, has been debunked in the dental and scientific literature.
What to expect at your first visit to our office
At your first visit to our office, Dr. Bakhtiari and his team will thoroughly examine your jaw, face, TMJ, bite and mouth. He will determine the source and cause of your discomfort, and devise a customized treatment solution that will work for you to help with inflammation of the jaw.
The initial consultation includes:
- Review of your medical history
- Detailed evaluation of your pain, discomfort and/or other symptoms
- Cranial nerve screening
- Muscle palpation of the muscles of your jaw, head and neck
- TMJ evaluation: evaluating the health of your jaw joints including their range of motion, tenderness and any clicking/popping sounds
- Additional imaging if necessary: X-rays, panoramic, CT scans, MRIs
- Additional testing as needed: diagnostic topical anesthetics, muscle and nerve blocks, blood tests