Causes of Muscle Pain and Treatment Options

Everything you need to know about muscle pain

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Muscle Pain
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Muscle pain, also called myalgia, is experienced by many. The most common cause of localized muscle pain is overuse or injury of a muscle (strain). On the other hand, viral infections like influenza (the "flu") may cause systemic muscle pain, as can taking certain medications or having a disease like fibromyalgia or hypothyroidism.

Muscle pain can feel different—aching, cramping, stabbing, or burning—depending on what's behind it. In the end, diagnosing the reason for your muscle pain requires a medical history, physical examination, and sometimes, blood and/or imaging tests. Rarely, a muscle biopsy is required.

Once diagnosed, your doctor will devise a treatment plan—one that will hopefully give you the relief you deserve.

Note: Muscle pain in infants and children may have different causes than in adults; this article focuses on the latter.

Causes

Due to the numerous potential causes of muscle pain, it's easiest to divide them into two categories—those related to localized muscle pain and those that lead to systemic muscle pain.

Localized Muscle Pain

Localized muscle pain refers to pain that is focal, or centered around one muscle or group of muscles.

Muscle Strain

A muscle (or group of muscles) can become overused, injured, or inflamed as a result of strenuous exercise and/or sudden movement. For example, when pushing off suddenly to jump during a basketball game, an athlete may overstretch or tear (strain) their calf muscle.

Muscle strains often cause a sudden sharp or tearing sensation, sometimes accompanied by swelling or bruising.

Muscle Cramp or Spasms

A muscle cramp or spasm is a contraction or tightening of a muscle that is not under your control. A classic example is a charley horse, in which your calf muscle squeezes on its own, causing a sudden, intense pain. Once the muscle relaxes (usually within seconds), your calf often feels sore.

It's unclear what exactly causes muscles to cramp, but experts suspect a multitude of triggers, such as:

  • Improper stretching
  • Muscle fatigue
  • Exercising in extreme heat
  • Dehydration
  • Depletion of salt and electrolytes

Muscle cramps may also occur with various underlying diseases, including cirrhosis and peripheral artery disease.

Muscle Contusion

A muscle contusion (bruise) may occur as a result of a direct blow against the muscle—for example, from falling onto a hard surface or getting hit during a sports game. This direct blow (or series of blows) essentially crushes the muscle fibers and surrounding connective tissue.

In addition to muscle pain, the skin around the painful muscle may become swollen and discolored. Moreover, a person may experience stiffness and weakness of the affected area, and in some cases, a hematoma (a collection of blood) forms around the injured muscle.

Myofascial Pain Syndrome

Myofascial pain syndrome (MPS) is a pain disorder caused by trigger points within a muscle or group of muscles. These trigger points, which feel like tiny knots underneath the skin, are essentially tights bands of muscle and/or fascia (the tissue that surrounds muscles). Trigger points may be tender to the touch and refer pain to other areas of the body.

A common location for trigger points is in your upper trapezius muscles (situated at the back of your neck above each shoulder). These trapezius trigger points may cause a deep aching and/or burning headache that is felt in the back or side of the head.

Compartment Syndrome

Compartment syndrome is an uncommon disorder that occurs when pressure build-ups within a "compartment" or group of muscles.

There are two types of compartment syndromes:

  • With acute compartment syndrome, muscle pain develops suddenly and is extreme, constant, and often described as a deep ache or burn. Neurological symptoms like numbness or tingling may also occur with this serious condition.
  • With chronic compartment syndrome, muscle pain comes on gradually during exercise. The classic case is a young runner who notes an aching, squeezing, tight, or cramping pain in the lower leg after running for a specific amount of time. Unlike acute compartment syndrome, the pain of chronic compartment syndrome goes away with rest, usually within 30 minutes.

Pyomyositis

Pyomyositis is a rare, pus-containing infection of muscle (usually from Staphylococcus aureus) that causes cramping muscle pain within a single muscle group, most commonly the thigh, calf, or buttock muscles.

As the infection progresses (approximately two weeks after the onset of the cramping pain), a fever often develops, and the muscle becomes exquisitely tender and swollen. At this time, an abscess (a collection of pus) may be visible within the muscle.

If not treated, the infection can spread to other organs, like the heart, lungs, and brain.

Systemic Muscle Pain

Systemic muscle pain, which is felt all over your body, is often related to an infection, medication side effect, or underlying illness.

Infection

Several types of infections, especially viral, may cause muscle pain. Perhaps the most common infectious cause is influenza, commonly known as "the flu."

Besides diffuse muscle or body aches, other potential symptoms of influenza include fever/feeling feverish, chills, headache, cough, sore throat, runny/stuffy nose, and unusual fatigue. Vomiting and/or diarrhea may also occur, although this is more common in children than adults.

Other infections that may cause muscle pain include:

Medication

One common medication that may cause mild-to-moderate muscle aches and weakness as a side effect is a statin, which is used to lower cholesterol. If muscle aches do occur with a statin, they generally begin within six months of starting the drug and resolve within approximately two months (on average) of stopping the drug.

Besides statins, other medications associated with muscle pain include:

Fibromyalgia

Fibromyalgia is a chronic pain disorder that causes widespread muscle pain, often described as aching, sore, stiff, burning, or throbbing.

In addition to muscle pain, people with fibromyalgia also may experience sleep problems, fatigue, headache, "crawling" sensations on their skin, morning stiffness, brain fog, and anxiety.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

Chronic fatigue syndrome, also known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), is a disorder that causes a person to experience overwhelming fatigue that is often worsened with physical or mental activity, yet not improved with rest.

In addition to debilitating pain, many people with chronic fatigue syndrome report diffuse muscle and joint aches, as well as concentration and memory problems, sore throat, and/or feeling dizzy or lightheaded when standing up.

The ambiguous nature of fibromyalgia and ME/CFS symptoms is, in part, why these conditions are quite difficult to diagnose.

Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) is an inflammatory condition seen in older adults, usually in their 60s and 70s, and virtually never before the age of 50. This condition causes morning aching and stiffness in the shoulders, upper arms, hips, thighs, and back of the neck.

People with PMR often complain of difficulties pulling up their socks or raising their arms above their shoulders to comb or wash their hair. Fatigue, weight loss, poor appetite, and fever may also occur.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic, autoimmune disease that primarily affects the joints, but may also cause muscle pain. The muscle pain of RA, if it exists, is often prominent and felt all over the body. Besides muscle and joint pain, a low-grade fever, weight loss, and fatigue may be present.

Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease that affects nearly every organ in the body. Muscle aches and tenderness and/or muscle weakness is very common in lupus and may, in fact, be the reason a person first seeks medical attention.

Inflammatory Myopathy

Inflammatory myopathies are systemic autoimmune muscle diseases characterized by slow but progressive muscle weakness. Some people also experience muscle pain or muscles that are tender to the touch.

The primary types of inflammatory myopathies are:

Thyroid Disease

Hypothyroidism (an underactive thyroid gland) may cause muscle aches and cramps in addition to other symptoms like fatigue, weight gain, constipation, cold intolerance, dry skin, and/or menstrual irregularities. Less commonly, an overactive thyroid gland (hyperthyroidism) may cause muscle cramps.

Primary Adrenal Insufficiency

Addison's disease, also known as primary adrenal insufficiency, is a rare (usually autoimmune) disorder that occurs when your adrenal glands do not produce enough of the following hormones:

  • Mineralocorticoids, such as aldosterone, which regulate blood volume and sodium/potassium balance
  • Glucocorticoids, such as cortisol, which enhance metabolism and help the body respond to stress
  • Androgens, such as dehydroepiandrosterone (DHEA), which are eventually converted into sex hormones within the testes or ovaries

These hormone deficiencies lead to a vast array of symptoms, including muscle pain.

Osteomalacia

Osteomalacia refers to significant bone softening as a result of decreased bone mineralization from a deficiency in vitamin D and calcium.

In addition to muscle spasms and cramps, people with osteomalacia often report muscle weakness, as well as aching bone pain and tenderness. Osteomalacia also increases a person's fracture risk due to excess bone weakening.

Depression

Depression, while a mental health condition, is commonly associated with physical symptoms, such as muscle and joint pain. In fact, sometimes, these generalized aches and pains are the only symptoms a person reports to their doctor.

Rhabdomyolysis

Rhabdomyolysis is a complex muscle disorder in which muscle tissue becomes so damaged that it begins dissolving and releasing substances into the bloodstream.

The classic triad of symptoms seen with rhabdomyolysis include:

  • Muscle pain (frequent, severe): Most prominent in the thighs, shoulders, lower back, and calves
  • Muscle weakness
  • Dark urine, which is due to the presence of myoglobin (the oxygen-storing protein in your muscles)

It's important to understand that rhabdomyolysis is a step above other causes of muscle pain in that it represents muscle pain associated with muscle breakdown.

Therefore, many causes of muscle pain—excessive strenuous exercise, taking a statin, or having a viral infection like influenza—may progress to rhabdomyolysis.

Other causes of rhabdomyolysis include:

  • Trauma and compression (e.g., from a car accident or prolonged immobilization)
  • Muscle hypoxia (e.g., from a blood clot)
  • Electrolyte imbalances (e.g., low potassium levels)
  • Change in body temperature (e.g., heat stroke)
  • Alcohol abuse
  • Illegal drug use (e.g., cocaine or amphetamine)

When to See a Doctor

If your muscle pain is worsening or persistent, it's important to promptly see your doctor for a proper diagnosis.

It's also important to seek immediate medical attention if you have muscle pain along with any of the following symptoms:

  • Trouble breathing
  • Dizziness
  • Pronounced muscle weakness
  • Stiff neck
  • High fever
  • Tick bite
  • Rash
  • Localized redness and swelling
  • Muscle pain that started after taking a new medication
  • Muscle pain that is extreme and/or came on suddenly

Diagnosis

The diagnosis of muscle pain begins with a detailed history and physical exam.

Medical History

During your doctor's appointment, your physician will ask you several questions to try and pin down your diagnosis.

Questions may include:

  • Did you muscle pain come on gradually or did it begin suddenly?
  • Have you undergone any strenuous activity recently?
  • What medications are you taking?
  • Do you have any associated symptoms, such as fever, headache, weight gain or loss, or fatigue?
  • Are you also experiencing muscle weakness?
  • Is the affected muscle tender to the touch?
  • Is there any redness, swelling, or warmth around the muscle?

Physical Examination

During your physical exam, your doctor may press on various muscles to evaluate for tenderness, as well as inspect the skin and surrounding tissue for swelling, warmth, redness, or skin changes.

More specifically, if your doctor suspects myofascial pain syndrome, he will check for potential trigger points. Likewise, for suspected fibromyalgia, your doctor will examine various tender points.

Blood Tests

Blood tests can be very useful in diagnosing certain causes of muscle pain.

For example, an elevated inflammatory marker, like an erythrocyte sedimentation rate (ESR), will be present in polymyalgia rheumatica.

With rhabdomyolysis and statin-induced myalgia, your creatinine kinase (a muscle enzyme) level will be elevated.

Other pertinent lab tests (albeit not an exhaustive list) may include the following:

Imaging

During the diagnostic process, your doctor may order one or more imaging tests. Examples of such tests include:

Other Tests

Depending on what condition your doctor suspects, she may need to perform other tests to confirm a diagnosis. For example, to diagnose (and monitor) compartment syndrome, your doctor will insert a thin needle or tube into the affected muscle to access it pressure, taking what's called a compartment pressure measurement.

In order to diagnose an inflammatory myopathy, a muscle biopsy may be performed. Lastly, urine myoglobin will be ordered if rhabdomyolysis is suspected.

Treatment

Once you receive a diagnosis for your muscle pain, your doctor will create a treatment plan that addresses both your pain and the underlying problem.

Self-Care Strategies

When muscle pain is related to overuse, strain, or contusion, it may be treated with the R.I.C.E. protocol:

  • Rest: Rest the injured muscle(s) as much as possible to allow the acute inflammation to subside.
  • Ice: Apply a cold compress to the painful muscle for 15-minute sessions, every four to six hours or so, and after exercise or muscle use.
  • Compression: Wrap your sore muscle with an elastic wrap or bandage for support.
  • Elevation: Raise the affected muscle above the level of your heart (if possible).

Medications

Besides soothing your muscle pain, your doctor may prescribe various medications to treat the underlying problem:

Nonsteroidal Anti-Inflammatories (NSAIDs)

NSAIDs, like Aleve (naproxen) or Motrin (ibuprofen), are recommended in the treatment of some muscle pain conditions, such as muscle strains/injury and myofascial pain syndrome.

Muscle Relaxants

Muscle relaxants like Flexeril (cyclobenzaprine) and Zanaflex (tizanidine) may be used to 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, or chronic fatigue syndrome.

Likewise, other antidepressants, including the serotonin-norepinephrine reuptake inhibitor Cymbalta (duloxetine), may be used to treat myofascial pain syndrome or fibromyalgia, especially if a person cannot tolerate or does not get any benefit from a tricyclic antidepressant.

Corticosteroids

Corticosteroids (also called steroids) are used to treat many inflammatory conditions, such as polymyalgia rheumatica and the inflammatory myopathies.

Keep in mind, steroids (e.g. prednisone) have serious side effects when taken for prolonged periods of time.

Steroid-Sparing Agents

For inflammatory medical conditions, your doctor may have you take a steroid-sparing drug (e.g. methotrexate for rheumatoid arthritis) early on in your treatment course to reduce the use of prednisone and help manage the disease long term.

Vitamin D

Treatment of osteomalacia requires reversal of the underlying problem—for example, reversal of vitamin D deficiency with prescription vitamin D supplementation.

Antibiotic/Anti-Viral/Anti-Fungal/Anti-Parasite

If you are diagnosing with pyomyositis, drainage of the infected muscle (if possible) and antibiotics are necessary. Likewise, systemic myalgias caused by an infection require treatment of the underlying culprit—whether that's a bacterium, virus, fungus, or parasite.

Fluids and Dialysis

Hydration and electrolyte repletion with intravenous (through the vein) fluids are vital to the treatment of rhabdomyolysis. In severe cases, if kidney function is compromised, temporary dialysis may be needed.

Complementary and Alternative Therapies

Complementary and alternative therapies are commonly used to ease the symptoms of fibromyalgia and chronic fatigue syndrome.

Some of these therapies include:

Lastly, another alternative therapy called trigger-point injection is sometimes used to treat myofascial pain syndrome.

Physical Therapy

Massage and a special kind of therapy called spray-and-stretch is commonly used to treat myofascial pain syndrome. Physical therapy, especially a plan that is tailored to a person's unique physical limits, may be advised for a person with fibromyalgia or chronic fatigue syndrome.

Surgery

Surgery is not commonly needed to treat muscle pain, except for certain serious diagnoses. For instance, pyomyositis requires surgical drainage of the abscess, and acute compartment syndrome requires a fasciotomy—a procedure in which the skin and fascia covering the compartment is cut open in order to alleviate pressure.

Prevention

While you cannot prevent all types of muscle aches and pains, you can prevent some—especially strains, cramps, and (for runners) chronic compartment syndrome:

  • Run on a soft surface, 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.
  • Stay hydrated (consider an electrolyte drink or taking an electrolyte tablet, which contains potassium, magnesium, and calcium).

A Word From Verywell

Muscle pain is a complex symptom and, depending on your diagnosis, may require a multi-faceted treatment plan. In any event, the good news is that most types of muscle pain can either be cured or managed well. With that, be sure to see your doctor if you are experiencing muscle pain, especially if it is severe, persistent, or worsening.

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Article Sources
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