Dominic Stone
Muscle pain, or myalgia, has many causes and can be temporary and non-serious, or a symptom of a chronic disease. Localized muscle pain is often related to an injury or recent stress on a specific muscle group, while diffuse pain all over the body may be caused by a disease or infection. Muscle pain can also be caused by nerve damage, autoimmune disorders, or thyroid conditions. In some cases, muscle pain may be caused by certain medications or drug toxicity. Chronic muscle strains can be caused by repetitive movements, fatigue, overuse, or physical activities like sports.
| Characteristics | Values |
|---|---|
| Muscle pain | Myalgia |
| Muscle strain | Overstretching or tearing of muscle fibres |
| Chronic muscle strain | Repetitive movements causing tiny strains that get bigger over time |
| Acute muscle strain | Muscle tears suddenly and unexpectedly, usually from injury or trauma |
| Muscle weakness | Electrolyte imbalance, nerve damage, chronic conditions, acute infections, medication side effects |
| Autoimmune disorders | Guillain-Barré syndrome, Lambert-Eaton myasthenic syndrome, Multiple sclerosis (MS), Amyotrophic lateral sclerosis (ALS), Myasthenia gravis |
| Diseases | Polyarteritis nodosa, Mixed connective tissue disease, Hypothyroidism, Hyperthyroidism, Fibromyalgia |
| Infections | Influenza, Coxsackievirus, Lyme disease |
| Other | Injury, Recent muscle stress, Disease, Anaemia, Diabetes, Spinal cord injuries |
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What You'll Learn
Chronic muscle strain
Muscle strains, also known as pulled muscles, are common injuries that can cause significant pain. They occur when a muscle is overstretched or torn due to excessive pressure. Strains can vary in severity, ranging from mild to severe tears that may require surgery. While many muscle strains can be treated at home, some may need medical attention or even surgery.
The prevention and treatment of chronic muscle strain focus on reducing the strain on the affected muscles. Maintaining good posture is essential, both when performing daily activities and during exercise. Proper lifting techniques, such as bending at the knees and lifting with the legs while keeping the back straight, can help prevent strains. Regular exercise, proper warm-up routines, and appropriate footwear are also recommended.
If you are experiencing chronic muscle strain, it is important to seek guidance from a healthcare provider. They may suggest physical therapy exercises to strengthen the affected muscles and restore mobility. In some cases, they may recommend imaging tests, such as MRI scans or X-rays, to assess the extent of the injury and rule out other potential causes.
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Acute muscle strain
Muscle strains, or pulled muscles, are common but painful injuries. They are often sports injuries caused by sudden sprinting, twisting, or jumping. However, accidental strains are also common in everyday life. A muscle strain is a tear in the muscle fibres and can be mild or severe.
Mild strains, or grade 1 strains, only pull and break a few fibres. Severe strains, or grade 3 strains, tear all the way through the muscle. Most acute muscle injuries are partial-thickness tears. These can be treated with offloading the muscle, such as using crutches for hamstring strains. Anti-inflammatory medication can help control pain, but there is no evidence that NSAIDs improve healing or speed up recovery.
The use of corticosteroid injections in acute muscle injuries is controversial. While they can help with pain, there is no evidence that they improve healing. There may be some benefit to their use in fascial injuries, which are injuries to the connective tissue between muscle bundles. The use of platelet-rich plasma (PRP) has become increasingly popular for treating acute muscle injuries. PRP is obtained by spinning a patient's blood to obtain a higher concentration of platelets. While initial small studies showed benefits to using PRP, more recent research has not shown clear evidence of decreased healing time.
Athletes with acute muscle strains can return to activity when they are pain-free and have normal strength and motion. This usually occurs after a few weeks to a few months of appropriate treatment and therapy. If there is a complete rupture, surgery may be required. Returning too soon can lead to re-injury, as scar tissue forms at the site of injury, making the athlete susceptible to another injury.
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Autoimmune conditions
One such autoimmune condition that can cause muscle damage is myositis. Myositis is a rare disease characterized by chronic inflammation and subsequent weakening of muscles over time. It occurs when the immune system loses tolerance of the muscle tissue, causing it to attack the muscles with inflammatory cells. This results in muscle inflammation and pain, particularly in the neck, shoulders, hips, and back. Polymyositis, a type of myositis, affects multiple muscles simultaneously, making it difficult to perform everyday movements such as standing up, climbing stairs, or lifting objects. Dermatomyositis, another form, affects both the skin and muscles and can, in rare cases, be fatal.
Myositis can be challenging to diagnose due to its similarity to other conditions and relative rarity. However, muscle and skin biopsies are considered the most definitive tests for diagnosis. While there is currently no cure for myositis, treatments aim to manage symptoms and induce remission. Off-label medications such as corticosteroids, immunosuppressants, and immunoglobulin have been successful in controlling inflammation and suppressing immune activity. Exercise is also critical in the treatment of myositis, helping to reduce muscle inflammation and fatigue while increasing stamina and muscle mass.
In addition to myositis, other autoimmune conditions such as scleroderma, vasculitis, and mixed connective tissue disease (characterized by an overlap of scleroderma, myositis, and lupus) can also cause muscle pain and inflammation. Furthermore, certain drugs, infections, and endocrine disorders can contribute to muscle aches and weakness, even in the absence of a primary autoimmune condition.
It is important to consult a healthcare provider if you experience persistent or unexplained muscle pain, as it could be an indication of an underlying autoimmune condition or other health issue.
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Drug toxicity
Drugs are often prescribed to manage or prevent symptoms and diseases. However, they can sometimes cause unexpected toxicity to muscles. This is known as myotoxicity or drug-induced myopathy, and it can vary significantly in its symptoms and clinical manifestations. The most prevalent and well-documented drug class with unintended myotoxicity is statins, but other drugs with unintended myotoxicity continue to be discovered.
The pathogenic mechanisms by which drugs cause muscle toxicity vary. For example, statins can cause statin myopathy, and other drugs with a high risk of muscle toxicity include hydroxychloroquine (Plaquenil), colchicine, and steroids. In some cases, drug-induced myopathies are associated with a wide range of CK levels, from normal to markedly elevated. Other muscle enzymes that may be studied in cases of suspected myopathy include aspartate aminotransferase (AST, SGOT), alanine aminotransferase (ALT, SGPT), and lactate dehydrogenase (LDH). These enzymes may reflect both muscle and liver disease.
The challenge posed by drug-induced myotoxicity lies in recognizing and preventing its occurrence. The key to managing myotoxicity is prompt recognition that a patient's symptoms may be drug-related and understanding that individuals differ in their susceptibility to drug-induced toxicity. Needle EMG can be a helpful test in diagnosing drug-induced myopathy, as it provides information on the location, type, and severity of the underlying disease process. Additionally, muscle biopsy may reveal muscle fiber necrosis and regeneration, and pathological mechanisms and management strategies can be employed for specific drugs.
Rhabdomyolysis is a dangerous and potentially fatal condition caused by muscle toxicity. It leads to muscle disintegration and death, allowing toxic components of muscle fibers to enter the circulation system and kidneys, potentially causing kidney damage. Rhabdomyolysis can be caused by various factors, including substance use disorder, long periods of inactivity, and certain medical conditions, such as genetic or metabolic disorders. Symptoms of rhabdomyolysis include weak muscles, muscle stiffness, and a change in urine color. It is crucial to seek immediate medical attention if these symptoms are observed.
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Chronic conditions
Muscle pain, or myalgia, is usually temporary and not serious. However, chronic conditions can cause ongoing and widespread myalgia.
Muscle pain can be a symptom of chronic conditions such as Lyme disease, meningitis, HIV, polio, and rabies. It can also be caused by certain neurological conditions, such as:
- Cervical spondylosis: Age-related changes to the cushioning spinal disks in the neck can cause cervical spondylosis, putting extra pressure on nerves and resulting in muscle weakness.
- Guillain-Barré syndrome: This rare neurological disorder can cause mild to severe muscle weakness.
- Lambert-Eaton myasthenic syndrome: An autoimmune disorder that interferes with how nerves and muscles communicate, resulting in muscle weakness.
- Multiple sclerosis (MS): An autoimmune disorder in which the immune system attacks and damages nerves in the brain and spinal cord.
Muscular Dystrophy
Muscular dystrophy is a group of diseases that cause muscles to become weaker and lose mass over time. It is caused by changes in the genes responsible for producing proteins necessary for healthy muscle formation. There are over 30 types of muscular dystrophy, with symptoms ranging from stiff joints to trouble swallowing, learning difficulties, and heart conditions.
Rhabdomyolysis
Rhabdomyolysis is a dangerous condition that causes muscles to break down and leak toxic components into the circulatory system, potentially leading to kidney damage or failure. It can be caused by overexertion, trauma, medications, or underlying health conditions such as Duchenne muscular dystrophy.
Muscle Atrophy
Muscle atrophy refers to the wasting or thinning of muscle mass. It can be caused by disuse of muscles, neurogenic conditions affecting nerves connected to muscles, malnutrition, age, genetics, or lack of physical activity. Physiologic atrophy can often be reversed with exercise and a healthy diet, while neurogenic atrophy typically cannot due to permanent nerve damage.
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Frequently asked questions
Myalgia is the medical term for muscle pain, which has many causes. It is usually temporary and not serious, but it can also be a symptom of a disease.
Muscle pain can be caused by an injury, recent stress on a muscle group, or an underlying disease. Chronic conditions, acute infections, autoimmune disorders, and certain medications can also cause muscle pain and weakness.
Conditions that cause muscle pain include fibromyalgia, hypothyroidism, hyperthyroidism, hyperparathyroidism, hypoparathyroidism, scleroderma, vasculitis, lupus, and inflammatory myopathy.
If your muscle pain is not improving or is getting worse, you should seek medical attention. A healthcare provider will use your medical history, a physical exam, lab tests, and imaging to help determine the cause of your muscle pain.
