Muscle pain • Symptoms, causes and therapies

Those who sit in a cramped posture in front of the computer for too long or are constantly stressed often feel uncomfortable pain in their muscles. If the sensations are due to this or to cramps or muscle injuries during exercise, there is no need to worry. Muscle pain is also a frequent companion of infectious diseases, such as a cold or flu. Then the cause of the pain does not lie in the muscle itself. However, if there are injuries or serious illnesses behind it, for example muscle inflammation or soft tissue rheumatism, caution is required.

Doctors generally refer to muscle pain as myalgia (Greek: myos = muscle, algos = pain). They are usually just a symptom that occurs in connection with various causes and diseases.

Acute or chronic: the classification for muscle pain

Myalgias can be divided on many different levels: They can occur acutely – for example during exercise – or chronically. Chronic muscle pain becomes a disease in its own right. This is the case, for example, with long-term bad posture. In addition, doctors differentiate myalgias in terms of their pain character into stinging, pulling or burning. The intensity and duration of the pain can also be classified.

Depending on the cause, the pain occurs locally on a specific muscle or muscle group (tension, sports injury) or generalized on the entire body. Patients with a cold, flu or fibromyalgia usually have pain everywhere. For the doctor, this information plays an important role in the diagnosis. If the pain persists for a long time or occurs suddenly and violently, it is better to always have the symptoms clarified by a doctor.

From infections to tumors: causes of myalgia

At first glance, it is not easy to see the reasons for muscle pain. Particularly common but less worrying causes are:

• Muscle tension and hardening, for example due to lack of exercise or poor posture when sitting for long periods. Often the neck, back or shoulders are affected.
• Sore muscles after intense physical activity, overuse / overload, long breaks in training or unfamiliar movements
• Muscle cramps (often calf cramps) due to a lack of magnesium or after strenuous exercise. Muscle spasms usually only last a few seconds to minutes.
• Muscle injuries such as torn muscles, torn muscle fibers, contusions or strains

Inflammation of the muscles (myositis, inflammatory myopathies)

Muscle inflammation can cause muscle pain. The following diseases are associated with muscle pain:

• Infectious diseases: They can be caused by bacteria (e.g. staphylococci, Borrelia), viruses (e.g. adenoviruses, coxsackie viruses, flu viruses) or parasites, e.g. tiny roundworms (trichinae).
• Immune system disorders (immunogenic myositis): Dermatomyositis – the body's own immune system attacks the skin, muscles and internal organs (such as kidneys or lungs); Polymyositis – an inflammatory disease of the skeletal muscles; interstitial myositis – the connective tissue between the muscles is destroyed.

Other muscular disorders (myopathies)

There are also a number of other diseases that affect the muscles and lead to muscle pain. Examples are:

• Degenerative muscle diseases: In patients with degenerative myopathies, the muscles gradually break down and change their structure. Doctors then speak of muscle wasting. The best known are those Duchenne muscular dystrophy and the Becker muscular dystrophy. Both are hereditary diseases and the children are born with the muscle disease.
• Muscle disorders in which the muscles relax after a period of vigorous tension (Myotonia)

• Rheumatic diseases: In fibromyalgia (also fibromyalgia syndrome, soft tissue rheumatism or soft tissue rheumatism) patients say they have "muscle pain everywhere". The Polymyalgia rheumatica ("rheumatic multiple muscle pain", PMR or polymyalgia) is accompanied by inflammation of the blood vessels (vasculitis). Typical are muscle pain, muscle stiffness and sometimes a weakness of the muscles in the shoulder girdle, neck and pelvis.
• Tumors of the muscles

Other causes of muscle pain

• Nervous system disorders: an example is the Parkinson's Disease (Parkinson's disease, paralysis), which is associated with muscle stiffness and muscle cramps. Also the Amyotrophic Lateral Sclerosis (ALS) is associated with sore muscles.
• Diseases of the skeleton and joints: examples are the Bone loss (Osteoporosis), Joint wear (Arthrosis), Bechterew's disease, herniated disc or lumbago. Patients feel pain not only in their bones and joints, but also in their muscles.
• Metabolic diseases (metabolic myopathies), for example disorders of the carbohydrate, fatty acid or purine metabolism, which affect the structure and function of the muscle.
• Hormonal disorders (endocrine myopathies), such as one Hypothyroidism (Hypothyroidism)
• Infectious diseases, like one cold (flu-like infection) or flu viruses
• Borreliosis: Infection with the Borrelia (bacteria) after a tick bite
• Depression / anxiety: muscle pain occurs accompanying it
• Menopause: In addition to hot flashes, sweats, and low moods, many women also suffer from muscle pain.

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Medicines, drugs and poisons as triggers

Some medications can cause pain in the muscles as a side effect. These include certain antibiotics (penicillins), cholesterol-lowering drugs (statins, for high blood lipids), the cardiovascular drug quinidine, the active ingredient cimetidine for heartburn or the Parkinson's drug levodopa. A high consumption of alcohol or heroin can also cause myalgia. The toxins strychnine and tetanus toxin are also linked to muscle pain.

Muscle pain: local or everywhere?

Most often, pain occurs as a result of muscle tension. They are limited to certain parts of the body or muscles or muscle groups. Like the muscles that are painful due to injuries, doctors class them as localized muscle pain. Overloading or improper stress is usually to blame – for example incorrect sitting postures, stress or monotonous movements, for example when driving a car or working on the computer (so-called mouse arm).

Parts of the muscles contract more intensely and remain tense. The hardened areas are sometimes palpable as small nodules. Doctors also speak of myofascial pain syndrome when it comes to this clinical picture caused by muscle tension. In the vernacular, however, "muscle tension" or "muscle hardening" are the common terms.

If the pain is not limited to individual muscles or parts of the body, but affects the entire body, experts speak of generalized muscle pain. They develop, for example, in the context of infectious diseases, such as a cold, flu or borreliosis. In fibromyalgia syndrome, too, the muscles all over the body are painful. It is not possible for those affected to narrow them down to certain regions. They often describe their condition as "pain everywhere". Medication and drug use can also cause generalized muscle pain.

Consult a doctor if the pain persists

Aching muscles can be harmless, temporary, or indicate serious illness. Above all, have long-lasting muscle pain clarified by a doctor. Doctors must also treat muscle injuries such as bruises, pulled muscles or tears quickly so that the injury heals and no consequential damage occurs.

Diagnosis: a tricky puzzle for the doctor

At the beginning of the diagnosis there is a conversation between you and the doctor, who asks you about your precise symptoms and your medical history.

The following questions are important for the doctor:

• How long have you had muscle pain?
• Where do you feel the pain: localized in a specific part of the body or generalized all over the body?
• How would you describe the character of pain: burning, pulling, tearing, spasmodic?
• How often do the myalgias occur: with interruptions several times a day or permanently?
• In which situations do you feel the pain: when moving, when exercising, at rest?
• When does the pain start: during or after physical activity?
• Are there moments when the pain improves: during exercise or after a short break?
• Can the pain be triggered by pressing or tapping the affected part of the body?
• Do you sit a lot at work and do you suffer from a sedentary lifestyle?
• Do you have a lot of stress at work and in everyday life?
• Have you recently played any sport that may have overloaded or injured you?
• Are there any other symptoms in addition to muscle pain, for example muscle cramps or muscle stiffness?
• Do you have any underlying illnesses, such as an underactive thyroid, a herniated disc or Parkinson's disease?
• Do you take any medication: if so, which ones?

Physical examination: palpate muscles

This is followed by a physical examination in which the doctor scans the painful areas of the body. Among other things, he checks whether the pain can be triggered by tapping or pressure, whether small, pressure-sensitive nodules or a dent in the muscles (muscle tear) can be felt and whether a hematoma (indication of a muscle fiber tear) is visible. Sometimes the doctor examines other organs and structures, such as the bone and joint system or the skin. In dermatomyositis, skin discoloration is found on the face.

The doctor will also assess your movements, reflexes and your gait. These provide evidence of a nervous disorder such as Parkinson's disease.

Blood, CT scan, or biopsy – further tests

Further examinations often follow in order to trace the cause even more precisely. Examples are:

• Blood test: Laboratory doctors use a blood sample to take a differential blood count (composition of the white blood cells) and determine various values, for example the erythrocyte sedimentation rate (BSK) or C-reactive protein (CRP). The values ​​show whether there is inflammation in the body. The creatine kinase value (CK value) provides information on a muscle disease: Elevated CK values ​​can be found in muscle injuries, muscle inflammation, polymyositis and dermatomyositis, among other things. In contrast, elevated liver values ​​indicate increased alcohol consumption as the cause. But they can also be caused by certain drugs
• Ultrasound examination (sonography): for example, to detect muscle inflammation
• Computed Tomography
• Magnetic resonance imaging (MRI, magnetic resonance imaging)
• Electromyography (EMG): Doctors measure the electrical voltage in the muscle and make it visible on a screen. In this way, muscle diseases can be identified that are associated with sustained muscle contractions and delayed relaxation of the muscles after tension. Electromyography also provides information on inflammatory or degenerative muscle diseases, in which there is a progressive breakdown of muscles and remodeling processes.
• Tissue sample (biopsy): The doctor takes tissue from the suspected muscle (muscle biopsy) and a pathologist examines it under a microscope. This is how muscle diseases can be discovered.

On the basis of these examinations, the doctor usually finds out the cause and designs an individual therapy.

Muscle pain: therapy depends on the trigger

Therapy always depends on the cause. If an existing underlying disease is to blame for the myalgia, doctors treat it first. Then the muscle pain usually also improves. Usually they use a combination of several measures for myalgia therapy.

Rest and rest

In the case of sore muscles, strains, bruises as well as a torn or torn muscle, rest and rest are required. Sometimes you have to forego physical activity and strain on the muscles for several weeks or even months for the injury to heal without consequences, not just for a few days. In rare cases, surgery is necessary.

Cold and warmth

Cold is a good remedy for acute muscle pain. Ice packs from the freezer or ice cubes, which you crush and wrap in a towel, are suitable for cold treatment. Attention: Never put the ice directly on the skin, instead place a towel, for example, in between. Otherwise there is a risk of frostbite. Wet towels or quark compresses that you apply to the painful muscle areas also have a cooling effect.

Heat is more suitable for chronic muscle pain. You can supply your aching muscles with warmth, for example with a hot water bottle or a cherry stone pillow, baths, warm showers, fango packs or when visiting the sauna. Heat patches are also good for tense muscles and loosen them up.

Pain medications and muscle relaxants

Painkillers relieve pain, have anti-inflammatory and decongestant effects. Pain medication from the group of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac or naproxen, are often used. Preparations with arnica, devil's claw or comfrey also work against aching muscles. Painkillers come in the form of tablets, creams, gels, or pain patches. If you need to take these for more than a week to relieve the pain, be sure to see a doctor.

In addition, muscle relaxants (muscle relaxants) can loosen tense muscles, but they should not be taken over a long period of time and should always be prescribed by a doctor. Sometimes doctors inject pain medication directly into the muscles to block the transmission of pain impulses. Physiotherapy is often only possible afterwards. However, movement is still important – in consultation with the doctor: the muscles break down when you are at rest and a downward spiral develops from increasing pain and increasing relieving posture.

Physiotherapy, relaxation and alternative healing methods

Physiotherapists try to mobilize muscles, bones and joints again, relieve muscle pain and improve mobility using exercise therapy and physical therapies. To do this, they use massages, electrotherapy, water treatments as well as cold and heat applications. If you suffer from muscle tension and back pain more often, it is best to try a back school. You strengthen your muscles and learn back-friendly behaviors, for example when sitting or lifting heavy loads.

Acupuncture, relaxation techniques (autogenic training, progressive muscle relaxation), yoga, tai chi or qigong are also worth a try. If the pain is psychological in nature, psychotherapy is the way to go.

Treat chronic muscle pain

Muscle pain can also become chronic and thus become an independent disease. One example is fibromyalgia syndrome. Then the multimodal pain therapy is used according to the level scheme of the World Health Organization, which consists of several components:

• Pain medication for pain relief
• Movement therapy (sport)
• physical therapy
• physical treatments
• psychotherapy
• Relaxation training
• Patient education: Experts impart knowledge about their chronic pain diseases to those affected

The aim of multimodal pain therapy is to deal with the disease better and to be able to cope with everyday life. This has a positive effect on the quality of life.