Normal muscles do not hurt, but when they do, there are many treatments to help.
Just now·6 min read
Normally, muscles do not hurt.
If a person has pain when a little bit of pressure is applied to a muscle. Something is wrong.
Many people with back pain do not know that their pain could be caused by muscles. The first thing they think of is nerves, bones, and joints. Those could also be causing pain. But muscle pain is a lot more common.
We have hundreds of muscles in our bodies. There are more muscles than bones. The medical term for muscle pain is “Myofascial Pain”. “Myo” means muscle, and “fascia” is the membrane that covers the muscles, which can also be a source of pain.
Muscle pain is different from skin pain. Our skin is covered with receptors to detect abnormal activity such as heat, cold, pressure, cuts, and bruises. Because the skin had a lot of receptors to detect these things, it is very precise in the localization of injury or insult. Muscles do not have the same representation as skin, therefore, when they hurt, there is no precise localization. The pain is vague, hard to pinpoint.
What can be the causes of MSK muscle pain?
It is important to rule out other conditions that could be causing pain in the muscles. Inflammation, for example, and is called myositis. There are some disorders of the muscles that lead to deformities or weaknesses, these are myopathies, but they are rarely painful. Muscle pain can be some sort of injury to the muscle like a hematoma inside the muscle, or a tumour. When we do too much exercise and have that pain that lasts 2 days this is called delayed onset muscle soreness, or DOMS.
Muscle pain can also be a side effect of medications, like some drugs that are used to lower cholesterol, known as statins. In some cases, muscle pain can be a sign of withdrawal from medications like when a person skips one dose of opioids, they have muscle aches all over their body.
The person may also feel the pain in an area of a muscle, but it could be pain radiating from other parts, most common is a nerve impingement in this case, when we apply pressure to the muscle it does not hurt.
Some vitamin deficiencies can lead to muscle pain, such as vitamin D. There are some hormonal problems such as thyroid insufficiency, or hypothyroidism, and lastly, chronic infection such as urinary infection may perpetuate muscle pain in the lower back area.
I work as a pain doctor in a pain clinic, and when people are referred to me with muscle pain, it is generally for two reasons: fibromyalgia or myofascial pain.
Fibromyalgia is a topic for another story. Basically, it is a problem of the pain system. Like the threshold to feel pain when pressure is applied is turned down. A little bit of pressure causes pain. We need to fix the pain system, not the muscle. However, one of the most effective ways to fix the pain system is by sending healthy messages to the brain, like when we do exercises.
Myofascial pain is much more common than fibromyalgia in pain clinics. It can affect any muscle of the body. It is usually a region of the body that is affected, not the whole body, like fibromyalgia.
What causes myofascial pain?
There are a number of factors that can precipitate myofascial pain: repetitive movements, bad posture, exposure to a cold environment, other trigger points, emotional stress, muscle weakness and muscle shortening.
In myofascial pain, it is not the whole muscle that is painful to palpation. For example, in the trapezius muscle, if we put pressure anywhere it may not hurt, but there are some palpable knots that hurt a lot, and the person says “Thar is my pain, doctor you found my pain”
Myofascial pain in the upper trapezius muscle
A trigger point is a very tiny area inside the muscle that hurts when we press on it. But also hurts when we try to use the muscle or stretch that muscle.
So, if a person develops a trigger point in a muscle that muscle will not want to be used or stretched. It will prefer to stay quiet. And will become weaker and weaker. The other muscles around it will have to work harder to compensate and eventually will also develop trigger points and will give up. Like a domino effect.
What is wrong with the trigger point?
Muscles need oxygen to relax. So, lack of oxygen leads to pain. With pain, the muscle will contract, and there is less oxygen. The lack of oxygen leads to lower pH, turning to acid, and irritates the pain receptors.
The cycle of myofascial pain
How we diagnose myofascial pain?
There is no imaging study, like ultrasound or magnetic resonance imaging to show the trigger points, not yet. Some scientists are testing artificial intelligence to teach a computer to read images of muscles and detect trigger points. The results are promising. There is no electromyography, no blood test, no muscle biopsy, nothing.
The diagnosis is by palpation and the patient confirming that it is similar to the pain they have.
How do we treat myofascial pain?
Basically, we take two approaches: treating the underlying precipitating and perpetuating factors:
Checking the posture, gait problem, repetitive movements, and joint instability.
Assessing for constriction of muscles like purse straps, tight bra or belt, and tight scars.
Measuring and treating nutritional deficiencies such as Vit D, folate, and minerals.
Examining for metabolic or hormonal inadequacies.
Asking for psychological distress: depressed mood, anxiety, and tension.
Treating a chronic infection, such as urinary tract infection.
Improving sleep efficiency.
Detecting any environmental aspect that could be modified, such as cold temperature or ergonomic posture.
How do we eliminate the trigger points?
Exercises are the mainstay of treatment, and I recommend the SSAR: stretching, strengthening, aerobics (or cardio) and relaxation.
We also use physical modalities such as heat, superficial or deep, cold (ice packs), electrotherapy, and laser. There is a good response with biofeedback, relaxation techniques, and cognitive behavioural therapy for anxiety and sleep.
We use a lot of manual therapies, like massage, manipulation and mobilizations. The person can also try acupuncture and dry needling. In some cases, we perform injections with local anesthetics. I don’t inject botulinum toxin or steroids into the muscles.
We tell people to avoid drugs like opioids, benzo and baclofen. They may use NSAIDs and muscle relaxants for a short period. And they may also use tricyclic antidepressants for a longer period, if necessary.
Ergonomics, workstation, environment temperature, orthoses, shoes, sleep position, sleep hygiene are all highly recommended.
Remember the toolbox of self-management strategies
What are the key points to remember?
Remember the Toolbox. To manage chronic myofascial pain it is necessary to have access to a variety of modality options and learn how to self-manage pain without having to see a healthcare professional every time that there is a flare.
Myofascial pain is a recurrent, persistent and chronic problem, it is important to treat early to prevent central sensitization and spread to fibromyalgia.
There is a component of myofascial pain in almost all chronic pain conditions, and treating the myofascial component may improve the quality of life, even if the person has other pains like neuropathic pain, osteoarthritis or cancer pain.
This article is not intended to give you medical advice. Please talk to your physician or healthcare professional if you have any health issues. If you leave a comment about your own medical condition, I will not be able to provide you medical advice. But, please, leave a comment if you feel that this article has helped you to learn something new.
This article is available as a YouTube video on my channel https://youtu.be/CxaprWwEstc