Can Anxiety Lead To Stress Knots In Neck Or Upper Back Areas?

Medically reviewed by Elizabeth Erban, LMFT, IMH-E
Updated April 26, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention trauma-related topics that could be triggering to the reader. Please see our Get Help Now page for more immediate resources.

Do you experience knots in your neck or upper back, also known as tense muscle fibers or active trigger points? Do you feel anxious, stressed, or scared often? You're not alone. In some cases, anxiety may cause demonstrable physical effects. Causes of muscle knots may include a sedentary lifestyle or sitting for long periods, heavy lifting, or stress. 

Although the most common physical symptoms of stress include elevated heart and respiratory rates, there are several physical anxiety symptoms, from clenched teeth and headaches to nausea and unexplained dizziness. To relieve these knots, consider consulting a doctor or physical therapist for guidance.

While anxiety might initially seem like a primarily mental or emotional condition, it can possess physiological consequences beyond fear or worry.

Find out if knots in your neck are due to anxiety

What is anxiety?

Anxiety can be defined as “feelings of tension, worried thoughts, and physical changes like increased blood pressure.” It is not the same thing as fear. When a stressor is eliminated, anxiety may subside.

When feelings of worry and tension are persistent and difficult to control, they may significantly impact daily functioning for some individuals. In some cases, this may indicate the presence of an anxiety disorder.

There are various anxiety conditions, including:

  • Generalized anxiety disorder
  • Panic disorder
  • Social anxiety disorder
  • Specific phobias
  • Obsessive-compulsive disorder (OCD)

While each condition has a distinct set of symptoms, general characteristics of an anxiety disorder may include unexplained fear, a sense of impending doom, racing thoughts, difficulty concentrating, or avoidant behavior.

Physical symptoms of anxiety may also appear alongside the emotional ones, including:

  • A racing heart
  • Excessive sweating
  • Trembling
  • Physical weakness
  • Difficulty sleeping
  • Gastrointestinal issues
  • Chest pain

Living with anxiety may feel overwhelming and isolating, so reaching out for help may initially prove difficult. However, many mental health practitioners have previously treated people with some form of anxiety and know how to recognize the signs and symptoms of anxiety disorders.

How is anxiety diagnosed?

Anxiety disorders are diagnosed through carefully cataloging patient-reported symptoms, discussion, and observation. The first step when meeting with a therapist may be explaining why you have reached out for help. Panic attacks, racing thoughts, difficulty sleeping, and persistent fear are some potential reasons to seek help for anxiety.

Once you have gone through your anxiety symptoms, a therapist might ask you to pinpoint any triggers you experience. For instance, someone with general anxiety disorder (GAD) may experience anxiety triggers that differ from those of someone with social anxiety disorder (SAD). Similarly, someone with post-traumatic stress disorder may have different triggers from someone with OCD. Identifying triggers may help you and your therapist determine your type of anxiety.

From there, a conversation regarding treatment may be the next step. Treatment types can depend on the therapist you see and the symptoms you experience. Pharmaceutical intervention may be best for some, so a psychiatrist could be the ideal fit. For others, self-management is the desired focus, so cognitive-behavioral therapy may be a good fit.

In many cases, the possibilities are wide open. In these cases, patients and therapists can review all possible treatment modalities to find something that suits the person’s specific needs, goals, and symptoms.


Physical symptoms of anxiety

A racing heart and high blood pressure are two of the most common warning signs of a panic attack or the onset of a stress response. Although these are areas to focus on, they may overshadow other common physical anxiety symptoms.

Upset stomach

One of the most significant physical symptoms of anxiety is an upset stomach. A fight-or-flight response can cause persistent intestinal troubles, ranging from simple nausea to regular episodes of constipation, diarrhea, or a back-and-forth of the two.

This particular physical symptom is problematic for many individuals with anxiety, as the presence of intense bowel discomfort can cause stress to compound and pile up, resulting in a constant cycle of stress, stress response, stressor, and stress again.

Feeling “on edge”

Feelings of being tense, wired, or on edge are typical anxiety symptoms. When your body’s stress response is triggered, you may enter a state of fight or flight. In this state, your heart and respiratory rates accelerate, your muscles tense, and your body enters a state of watchfulness, which allows you to attack or flee.

Although this is immensely useful if you are about to be attacked by a wild animal, it may be problematic if the danger is a false alarm, an imagined scenario, or another similar issue. In these instances, your body is not allowed to release the stress response it has created, which may cause fight or flight symptoms to stick around without a safe, healthy outlet.

Anxiety and musculature: The physical effects of stress

Your body tenses during a stress response. Your muscles might be taut, your jaw clenched, and your fists balled up in case of an attack. Occasionally, anxiety causes muscle knots.

If someone is coming at you with a weapon drawn, the tension in your body can be invaluable in warding off danger. However, when this response repeatedly occurs, without an actual predator involved, your body may begin to train itself to stay in a tense, agitated state permanently. This experience is common in those who have experienced prolonged or repeated trauma and those with an anxiety disorder.

Permanently engaging in a fight-or-flight mentality can be exhausting and can exert your muscles beyond the point of immediate recovery. People with anxiety disorders might often feel weak, drained, and overwhelmed. While some of this may be a mental phenomenon, some of it may be a physical response to the stress anxiety places on your physical body and your musculature.

When you sit within prolonged periods of stress, your body can develop a rigid, uncompromising stature, often taking on the poor stature, taut muscles, and rigidity of your fight-or-flight physicality. This stiffness may lead to muscle knots in the neck, shoulders, back, jaw, and head. Muscle aches, spasms, and cramps are not uncommon in people with anxiety, as the body is involved in how we experience and manage stress.

What is a stress knot, and how does muscle pain develop?

A muscle knot is caused by irritation from a repeated motion stressing the same muscles. While many people think of exercise or movement when they hear this, it may also refer to holding a position or stance for a prolonged period.

You can develop muscle knots from frequently tensing your body in response to stress or having poor posture when sitting at a desk. When we feel stress or anxiety, it is common for muscles along the spine, especially the upper back and neck, to become tense. This tension may not be something you notice or control.

Over time, this tension can cause more noticeable knots. Some of this pain may be minor and quickly resolved with time, rest, and proper recovery. However, long-term stress or tension in the body may result in chronic pain.

Because the body and the mind are closely intertwined, anxiety may lead to myofascial pain syndrome in some people. This chronic pain disorder is characterized by muscle pain, particularly when touching a trigger point.

Myofascial trigger points can often cause referred pain—or pain in other, unexpected body regions. Massage, self-massage, and stretching can all be beneficial in relieving some myofascial pain. However, a qualified healthcare professional may use trigger point injections to relax muscles and temporarily ease the pain if the pain is severe.  

Can anxiety cause stress knots in the neck and back?

Anxiety may cause knots in your back, shoulders, and neck. Although a racing heart and high blood pressure are the two most frequently mentioned physical symptoms of anxiety, these are not the only physical symptoms.

The presence of stress and anxiety may negatively impact all your body’s systems and functions, and each of these systems has its reaction to the prolonged presence of stress.

Your muscular system is adversely affected by the presence of stress. Muscles tense, jaws clench, and your body may vibrate as it gets ready to run or defend itself, both of which require heightened reflexes, speed, and agility.

To create these conditions, your body releases adrenaline and cortisol. These hormones make you alert and on edge, and you can react far faster than you would normally. When even one of these hormones is consistently flooding your system, disease, pain, and discomfort may ensue, including the development of knots and tightness in your neck, shoulders, and back.

When these symptoms are present, treatment with a mental health professional can help ease them. Still, body-specific therapeutic techniques can also help disengage some of the tension created by anxiety and give your body a chance to rest and relax. Physical therapy may be another option available to you. Studies show that physical therapy can alleviate neck pain related to anxiety or stress.

A pain in the neck: Stress and recovery

Like the mental and emotional effects of stress, the physical effects of anxiety can be overwhelming to navigate. However, there are ways to combat your body’s physical and physiological responses to anxiety, in addition to the usual therapeutic avenues used to treat anxiety disorders.

iStock/Kobus Louw
Find out if knots in your neck are due to anxiety


One effective way to treat muscle tightness and stress at home is yoga. Yoga practices have been consistently linked to higher physical performance, reduced stress, and greater flexibility, all of which may aid in eliminating the physical effects of anxiety.

10 to 30 minutes per day of yoga, or three one-hour sessions per week, may be enough to reap the benefits of yoga practice and alleviate the pain and discomfort caused by knots in the neck, shoulders, and back.

Aerobic activity

Aerobic activity is another valuable way to release physical tension. Running, jogging, or swimming can increase blood flow and reduce stress. According to studies, five minutes of cardio can have anti-anxiety effects.

While 30 minutes of brisk exercise five days a week goes a long way, even a 10-minute walk can stimulate positive results. For some people, frequency tends to be key over intensity as it relates to anxiety. So, a short daily walk might be more beneficial than solely waiting till the weekend for that long hike or run. 


Massage has been proven to treat anxiety and knots simultaneously. Massage allows the tense, knotted muscles to relax and let go of tension, improving your physical response to anxiety and giving you a sense of comfort, connection, and calm. Massage can be expensive, but even engaging in a single massage therapy session per month can be helpful.

If you cannot afford a massage, stretching and self-massage can be great at-home substitutes. You might ask a partner or friend to give you a massage if you trust them with the task.


Regular stretching may help prevent muscle knots by elongating the connective tissue. Knots shorten and tighten a muscle, while stretching can help lengthen it back to its previous form and increase blood flow to support tissue healing.

Foam rollers

For some people, a foam roller may serve as an effective tool to treat muscle knots and tight muscle fibers. By applying weight, one can roll over portions of the body that may be experiencing muscle pain. If a particular spot is tender or causing pain in the region, gently massage back and forth on this area to release muscle tension.  

Physical therapy

Physical therapists are often trained to support patients’ movement and reduce pain. They can use various techniques, such as dry needling, massage, and exercise regimes. Another approach, trigger point pressure release, applies pressure to trigger points manually or with tools. It can be beneficial in releasing tension stored in one area but causing referred pain elsewhere.

Physical therapy may be beneficial if the pain is severe or in a sensitive region. Neck pain can interfere with daily life because we need neck mobility to move our heads or even walk properly. Seeking professional advice can help you determine the best action and techniques to treat and prevent muscle knots in these sensitive areas.

Therapy for chronic stress, anxiety, and pain

In combination with other techniques, talk therapy (especially cognitive-behavioral therapy) may effectively reduce anxiety. Once your mind is less stressed about the triggers that caused discomfort in the first place, your body may follow suit. If you’re uncomfortable going into a therapist’s office for anxiety, you can seek an online therapist. A review of the literature has shown that online counseling is just as effective as traditional counseling.

In addition, online therapy can be convenient and flexible, allowing you to connect with a licensed mental health professional from a setting that is already comfortable for you. With sites like BetterHelp, you can remain in contact with a therapist through live chat, which may help you develop the skills necessary to manage your anxiety and alleviate your stress knots.


Anxiety can manifest physically in the neck, back, or other body regions. Muscle pain, shakiness, weakness, or general pain may be common in anxiety conditions such as general anxiety disorder or trauma conditions such as post-traumatic stress disorder (PTSD).

If you’re considering reaching out for expert advice, consider contacting a mental health professional. At times, talking through your feelings may be beneficial in healing physical symptoms as well.

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