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Muscle Pain: Causes, Diagnosis, Treatment, Prevention
The causes of muscle pain vary. Also called myalgia, aching muscles can be caused by an injury, a symptom of a disease or infection, or a side effect of a medication.
Muscle pain can also feel different—aching, cramping, stabbing, or burning—depending on what is causing it.
This article takes a look at the different causes of muscle pain. It will also go over how myalgia is diagnosed and treated, and when you should worry about muscle pain.
Causes of Localized Muscle Pain
Localized muscle pain refers to pain that is centered around one muscle or a group of muscles.
Muscle Strain
Injuries are a common cause of muscle pain. A muscle can become injured as a result of strenuous exercise or sudden movement. When a muscle is overstretched, it can lead to a muscle strain (a.k.a. a pulled muscle).
By definition, a muscle strain is an injury to a muscle or a tendon (the fibrous tissue that connects muscles to bones). Muscle strains can sometimes be minor, while severe strains can cause these tissues to tear.
Muscle pain from a strain usually feels like a sudden sharp or tearing sensation. The pain may also be accompanied by swelling or bruising.
Muscle Contusion
Muscle pain can also be caused by a muscle contusion. Also known as a muscle bruise, this injury can occur as a result of a direct blow to the muscle, causing tiny blood vessels called capillaries to bleed and surrounding tissues to swell.
In addition to muscle pain, the overlying skin may develop bruising (known as a skin contusion). In some cases, a hematoma (a contained pool of blood) may form in or around the injured muscle.
Myofascial Pain Syndrome
Some people experience muscle pain as a symptom of a chronic condition.
Myofascial pain syndrome (MPS) is a pain disorder caused by trigger points within a muscle. Trigger points are tight bands of muscle and/or fascia (tissues surrounding muscles) that feel like tiny knots beneath the skin,
Trigger points may be tender to the touch. They can also cause shooting pains to other parts of the body (known as referred pain).
A common trigger point is in the upper trapezius muscles situated at the back of the neck above each shoulder. These trigger points can cause a deep aching or burning sensation in the back or side of the head.
Compartment Syndrome
Some causes of muscle pain are serious.
Compartment syndrome is an uncommon condition that occurs when pressure builds within a group of muscles. The pressure can arise from internal bleeding or the swelling of tissues.
Compartment syndrome can reduce blood flow to regional muscles and nerves, depriving them of oxygen and nourishment. If the pressure is severe, nerve skin, and muscle tissues can start to die.
Symptoms of compartment syndrome include pain, numbness, pins-and-needles sensations, and increasing weakness in the affected area. The symptoms can range from mild to severe.
In severe cases of compartment syndrome, emergency surgery may be needed.
Pyomyositis
Muscle pain can also be a sign of an infection. Some of these infections can be very serious.
Pyomyositis is a rare infection of muscle tissues usually caused by a bacteria called Staphylococcus aureus.
Pymositi can cause cramping and pain within a single muscle group, most commonly the thigh, calf, or buttock muscles. As the infection progresses, a fever can develop. There may even be an abscess (a collection of pus) visibly emerging from the muscles beneath the skin.
If not treated, the infection can spread to other organs, like the heart, lungs, and brain
Causes of Systemic Muscle Pain
Another kind of muscle pain is called systemic myalgia. These muscle aches are usually related to an infection, medication side effect, or underlying disease.
Infections
Certain types of infections, especially viral, may cause muscle pain. Perhaps the most common infectious cause is flu which can cause generalized aches and pains. COVID-19 is also known to cause myalgia.
Other infections that can cause muscle pain include:
• Lyme disease
• Malaria
• Dengue fever
• Rocky Mountain spotted fever
• Trichomoniasis
• Toxoplasmosis
Medications
Muscle aches are a common side effect of drugs called statins that are used to lower cholesterol. The symptom usually begins within six months of starting treatment and can take around two months to resolve once the treatment is stopped.
Other drugs that can cause muscle pain include:
-Bisphosphonates (used to treat osteoporosis)
-Aromatase inhibitors (used to prevent breast cancer recurrence)
The rapid discontinuation of antidepressants can also cause myalgia.
Fibromyalgia
Widespread muscle pain is a symptom of fibromyalgia. The pain from this chronic disorder is often described as aching, sore, stiff, burning, or throbbing.
The cause of fibromyalgia is unknown but is thought to involve genetics, mood disorders, past diseases, and chemical imbalances that cause a heightened sense of pain.
In addition to muscle pain, people with fibromyalgia often experience sleep problems, fatigue, crawling skin sensations, morning stiffness, impaired concentration, and anxiety.
Chronic Fatigue Syndrome
Chronic fatigue syndrome, also known as myalgic encephalomyelitis, is a disorder that causes overwhelming fatigue that is not improved with rest.
In addition to tiredness and malaise (the general feeling of unwellness), people with chronic fatigue syndrome commonly experience generalized muscle aches, memory problems, sore throat, and feeling dizzy when standing up.12
Chronic fatigue syndrome is closely associated with fibromyalgia, with some researchers contending that they are both parts of the same syndrome.
Polymyalgia Rheumatica
Polymyalgia rheumatica (PMR) is an inflammatory condition usually seen in adults in their 60s and 70s. PMR causes morning aches and stiffness in the shoulders, upper arms, hips, thighs, and back of the neck. Fatigue, weight loss, poor appetite, and fever may also occur.
People with PMR often complain of difficulties pulling up their socks or raising their arms above their heads to comb or wash their hair.
The cause of PMR is unknown but is thought to be the result of a combination of genetic and environmental factors.
Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the joints. However, RA can also cause muscle pain.
Autoimmune disorders are caused when the immune system inappropriately attacks its own cells or tissues.
Muscle pain from RA is usually felt all over the body. This differs from the joint symptoms of RA, which are typically isolated to specific joints on both sides of the body. in addition, RA can cause a low-grade fever, weight loss, and fatigue.
The cause of RA is unknown, but genetic and environmental factors are likely involved.
Lupus
Systemic lupus erythematosus (SLE), also known simply as lupus, is a chronic autoimmune disease that affects nearly every organ in the body, including the skin, brain, eyes, mouth, lungs, heart, kidneys, intestines, and joints.
Muscle aches and weakness are common in people with lupus and are often the reason why a person first seeks diagnosis and treatment. Other symptoms include fatigue, skin rashes, hair loss, headaches, joint stiffness, weight loss, and chest pain with breathing.
Inflammatory Myopathy
Inflammatory myopathies are a group of autoimmune diseases characterized by slow but progressive muscle weakness. Some people with myopathy also have muscle pain or tenderness when touched.
The term myopathy refers to disorders of the muscles of the skeleton. These include myopathies like polymyositis (which affects muscles on multiple parts of the body), dermatomyositis (which causes muscle pain and skin rash), and inclusion body myositis (which causes muscle tissues to clump abnormally).
Thyroid Disease
Hypothyroidism (an underactive thyroid gland) commonly causes muscle aches and cramps in addition to fatigue, weight gain, constipation, cold intolerance, and dry skin. Less commonly, an overactive thyroid gland (hyperthyroidism) can cause muscle cramps.
The thyroid gland is responsible for producing hormones that help regulate metabolism (the conversion of calories to energy) and numerous other body functions. When thyroid hormone levels are too low or too high, they can interfere with the transmission of nerve signals that regulate the contraction of muscles, leading to muscle pain.
Primary Adrenal Insufficiency
Addison's disease, also known as primary adrenal insufficiency, is a rare disorder that occurs when your adrenal glands do not produce enough of the hormones needed to regulate metabolism or sexual function.
Addison's disease is often related to an autoimmune disease that attacks the adrenal glands but may also be caused by injuries or tumors.
Addison's disease can cause generalized muscle pain, fatigue, nausea or vomiting, darkening of the skin, weight loss, and salt cravings. Muscle pain associated with Addison's disease is often centered around the legs and lower back.
Osteomalacia
Osteomalacia is the softening of bone due to the loss of bone minerals. It is commonly associated with a deficiency of vitamin D and calcium. It is common in older people and linked to certain diseases (like celiac disease) and medications (like anticonvulsants).
People with osteomalacia can have muscle pain from muscle spasms and cramps. They often have aching bone pain and tenderness. Osteomalacia can also increase a person's risk of bone fractures (referred to as pathologic fractures).
Depression
Depression, while a mental health condition, is commonly associated with physical symptoms such as muscle aches and joint pain. In fact, generalized aches and pains are commonly reported by people with undiagnosed or untreated depression.
While the pain may be psychogenic (related to the mind), there is evidence that the imbalance of hormones that regulate moods, such as serotonin and norepinephrine, may contribute to chronic pain symptoms.
Rhabdomyolysis
Rhabdomyolysis is a disorder in which muscle tissues begin breaking down and releasing harmful substances into the bloodstream. The classic triad of symptoms in people with rhabdomyolysis is muscle pain, muscle weakness, and dark urine.
There are many causes of rhabdomyolysis, including excessive strenuous exercise, medications, illicit drugs, heatstroke, muscle trauma, and blood clots.
If left untreated, the accumulation of toxins can lead to acute kidney failure.
When to See a Healthcare Provider
If your muscle pain is worsening or persistent, it's important to see your healthcare provider for a proper diagnosis.
You should also seek immediate medical care if muscle pain is accompanied by some or all of the following symptoms:
• Trouble breathing
• Trouble swallowing
• Profound muscle weakness
• Stiff neck
• High fever
• Confusion
• Seizures
• Muscle pain that is extreme or sudden
Diagnosis
The diagnosis of muscle pain starts with a detailed history and physical exam. Lab and imaging tests may also be ordered.
Medical History
During the evaluation, your healthcare provider will ask several questions to narrow down the possible causes of your muscle pain, such as:
• Did your muscle pain develop gradually or suddenly?
• Have you undergone any strenuous activities recently?
• What medications are you taking?
• Do you have other symptoms such as fever, headache, or fatigue?
• Are you experiencing muscle weakness?
• Is there any redness, swelling, or warmth around the muscle?
Physical Examination
During the physical exam, your healthcare provider may press on various muscles to check for pain and tenderness (including trigger points). They may also inspect the skin and surrounding tissue for signs of swelling, warmth, redness, or discoloration.
Blood and Urine Tests
Blood tests can be useful in diagnosing certain causes of muscle pain. These include tests called erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) that detect inflammation that can occur with certain diseases or infections.
If an autoimmune disease is suspected, there are blood tests that can check for autoantibodies. These are proteins produced by the immune system that target and attack normal tissues. An example of a test is the anti-citrullinated protein antibody (anti-CCP) assay used to diagnose rheumatoid arthritis.
Thyroid function tests can also check for thyroid disease, while a creatine kinase (CK) test can check for an enzyme caused by the breakdown of muscle in people with rhabdomyolysis.
Urinalysis is also commonly used to diagnose rhabdomyolysis based on toxins and waste found in the urine.
Imaging
Muscle pain causes can also be narrowed done more through imaging tests. Your provider can use these tests to check for abnormalities in your muscles, including tears, lesions, bleeding, and abnormal growths.
Imaging tests that can be used to diagnose muscle pain include:
• Ultrasound: An imaging test that uses sound waves to create detailed images of internal structures
• Computed tomography (CT): A technology that captures multiple X-ray images to create three-dimensional "slices" of internal structures
• Magnetic resonance imaging (MRI): An imaging tool that uses powerful magnetic and radio waves to create highly detailed images of soft tissues
Treatment
Once the cause of your muscle pain is diagnosed, your healthcare provider will create a treatment plan that addresses both the symptomatic muscle pain and the underlying cause.
Self-Care Strategies
There are some ways you can get muscle pain relief at home. When muscle pain is related to overuse, strain, or contusion, it may be treated with the R.I.C.E. protocol which involves:
• Rest: Rest the injured muscle as much as possible to allow the inflammation to subside.
• Ice: Apply a cold compress to the muscle for 15-minute sessions every four to six hours.
• Compression: Wrap your muscle with an elastic bandage to reduce pain and swelling.
• Elevation: Raise the injured muscle above the level of your heart while recuperating.
Medications
Your healthcare provider may prescribe various medications to treat the underlying problem causing the muscle pain.
Nonsteroidal Anti-Inflammatories (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs) like Aleve (naproxen) or Advil (ibuprofen) can treat swelling and pain caused by muscle strains and myofascial pain syndrome.
Muscle Relaxants
Muscle relaxants like Flexeril (cyclobenzaprine) and Zanaflex (tizanidine) may help ease the pain of an acute muscle injury.
Antidepressants
Tricyclic antidepressants such as Elavil (amitriptyline) are sometimes prescribed for the treatment of myofascial pain syndrome, fibromyalgia, and chronic fatigue syndrome.
Other types of antidepressants like Cymbalta (duloxetine) may be used to treat myofascial pain syndrome and fibromyalgia if a tricyclic antidepressant cannot be tolerated.
Corticosteroids
Corticosteroids (steroids) are used to treat many inflammatory conditions such as polymyalgia rheumatica and inflammatory myopathies. With that said, the long-term use of steroids like prednisone can cause serious side effects due to the prolonged suppression of the immune system.
There are also steroid-sparing drugs like methotrexate that can also reduce inflammation and may be safer for long-term use.
Vitamin Supplements
The treatment of osteomalacia often involves prescription vitamin D supplements to slow the loss of bone minerals. You would also be encouraged to eat foods high in vitamin D.
Anti-Infectives
If you are diagnosed with a bacterial infection like pyomyositis, antibiotics may be needed to clear the infection. Other viral, fungal, or parasitic causes may require antiviral, antifungal, or antiparasitic drugs respectively.
Complementary and Alternative Therapies
There are also some natural ways to treat muscle pain. Complementary and alternative therapies are commonly used to ease the symptoms of fibromyalgia and chronic fatigue syndrome. The treatments are focused on alleviating stress and reducing a person's physical and emotional response to pain.
Examples of alternative treatments for muscle pain include:
• Tai chi
• Massage
• Mindfulness meditation
Another alternative therapy, called trigger-point release massage, is sometimes used to treat myofascial pain syndrome. It is a daily practice that involves the compression of trigger points using your fingers, a foam roller, or a massage ball.
Physical Therapy
Physical therapy can be helpful for certain types of muscle pain. Massage and a special kind of therapy called "spray-and-stretch" are commonly used to treat myofascial pain syndrome. Spray-and-stretch therapy involves spraying a vaporized coolant over muscles while massaging the skin in the direction of the referred pain.
Physical therapy is commonly advised for people with fibromyalgia or chronic fatigue syndrome. It is also a standard part of rehabilitation for muscle injuries.
Surgery
Surgery is not commonly needed to treat muscle pain, except for certain serious conditions. This includes the surgical drainage of an abscess in people with pyomyositis. Severe compartment syndrome may require a fasciotomy in which the fascia covering a muscle or group of muscles is cut open to relieve pressure and restore blood flow.
Prevention
You cannot prevent all types of muscle aches and pains, but you may be able to reduce your risk for certain types, like muscle strains, muscle cramps, and chronic compartment syndrome,
To reduce the risk of acute or repetitive muscle injury:
Run on soft surfaces, like grass or trails, as opposed to hard surfaces like concrete.
Wear cushioned shoe inserts.
Remember to warm up before exercising and cool down afterward.
Switch to low-impact sports like swimming or biking.
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