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Skeletal muscle pain in chest: Primary Care: Clinics in Office Practice

Primary Care: Clinics in Office Practice

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Primary Care: Clinics in Office Practice

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Musculoskeletal chest wall pain

CMAJ. 1985 Sep 1; 133(5): 379–389.

This article has been cited by other articles in PMC.


The musculoskeletal structures of the thoracic wall and the neck are a relatively
common source of chest pain. Pain arising from these structures is often
mistaken for angina pectoris, pleurisy or other serious disorders. In this
article the clinical features, pathogenesis and management of the various
musculoskeletal chest wall disorders are discussed. The more common causes are
costochondritis, traumatic muscle pain, trauma to the chest wall,
“fibrositis” syndrome, referred pain, psychogenic regional pain
syndrome, and arthritis involving articulations of the sternum, ribs and
thoracic spine. Careful analysis of the history, physical findings and results
of investigation is essential for precise diagnosis and effective treatment.

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Selected References

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Chest wall pain syndrome – PM&R KnowledgeNow


Chest wall pain syndrome (CWPS) is a painful condition that manifests as direct or referred pain to the chest wall as a result of stress/injury to the body. CWPS is used to describe a multitude of pathologies that may result in pain that can be self-limiting or chronic. CWPS is readily mistaken for more serious conditions, such as acute coronary syndrome and pulmonary embolism, which must be ruled out before CWPS can be diagnosed.1-3


The etiology of CWPS is not well understood. 6 million people present to emergency departments each year with chest pain at a cost of $8 billion per year.  Most of these patients will not have an underlying cardiac reason for their chest pain9.  While the most common cause of non-cardiac chest pain is GERD, the most common cause of CWPS is musculoskeletal.1

The more common musculoskeletal conditions that are associated with CWPS include2

Costochondritis Degenerative Pathology of the Spine
Chest Wall Tenderness Stress Fracture of the Thoracic Spine
Rib Dysfunction Cervical Angina
Cervicothoracic Angina Sternoclavicular Disease
Intercostal myalgia Costovertebral dysfunctions
Segmental Thoracic Dysfunction Myositis
Pectoral Angina
Acute Trauma: Rib/Sternal Fractures, Contusions, Aortic Dissection, Diaphragmatic Rupture, Visceral Trauma

Other Causes:2

Neuralgia from Shingles Neoplasm
Thoracic Radiculopathy Infectious Sequelae
Referred Pain from Sphincter of Oddi Seronegative Spondyloarthropathies
Thoracic Outlet Dysfunction Tietze Syndrome
Fibromyalgia Psoriatic Arthritis


Epidemiology including risk factors and primary prevention

In the primary care setting, CWPS has a mean age ± SD of 50. 3±18 years, with nearly equal occurrence in men and women. It accounts for nearly 50% of all complaints in the ambulatory and emergency room setting. CWPS is the principal cause of pain in 44.6% of patients who present with thoracic pain. Additionally, 83% of patients will also have associated comorbidity, including psychiatric dysfunction (50%), cardiovascular disease (33%), coronary disease (19%), and rheumatologic conditions (20.7%). Approximately 2% of patients have primary non-specified lung carcinomas (33%) or non-specific metastatic neoplastic disease (67%). Among pediatric patients, 31% have nonspecific chest pain. In adolescents, costochondritis accounts for 14% of chest wall pain.1.4


Musculoskeletal: the chest is bordered by 12 ribs bilaterally, 12 vertebrae posteriorly, the sternum and xiphoid anteriorly, 2 clavicles superiorly, and an overlay of musculature and fascia giving function to these structures. This integrated framework provides strength, support, and protection of the viscera. Multiple bony areas are susceptible to fracture, and several joints and articulations can be injured. Once dysfunction occurs, collateral dysfunction can occur in the musculature. Equally, muscular strain/spasm will then restrict joints, creating discomfort at costochondral joints.

Neurology: the anterior rami of the first 11 thoracic spinal nerves form the intercostal nerves. These nerves course along the inferior border of the rib. If there is damage to the rib, rami, or coursing nerve, neural impingement may occur. Alteration to the skeletal formation of the thoracic outlet can also cause neural impingement, resulting in thoracic outlet syndrome. Nerve roots are also susceptible to viral infection and are a potential site for post-herpetic neuralgia.

Visceral: there can be referred pain from the viscera that appears to be chest wall oriented.2 Visceral pain receptors are found in most of the viscera (thoracic, abdominal and pelvic) and its surrounding connective tissue.   Noxious stimulus of these receptors activates a few unmyelinated afferent fibers which in turn activate many central neurons. Combined with somatic input this often produces a poorly localized pain response.13 Obstruction of hollow organs will produce a poorly localized, deep, cramping pain referred to multiple cutaneous sites.  However, damage to the organ capsule or direct injury to the deep tissue may be more easily localized.14

Disease progression including natural history, disease phases or stages, disease trajectory

Costochondritis: presents as sharp pinpoint tenderness in multiple areas of the chest localized over the costochondral joints along the sternum; it is a self-limiting condition that resolves in days to weeks.5,6 It may become chronic.

Herpes zoster/postherpetic neuralgia: once reactivated, burning with hyperesthesia presents, followed by a vesicular rash in 2 weeks. The rash is limited to 1 to 2 dermatomes and is unilateral. The rash resolves and neuralgia may set in or resolve.2

Postthoracotomy pain: a syndrome occurring after thoracotomy consisting of burning, hyperesthesia, and ache-like pain. Women have higher incidence. Only epidural placement prior to surgery changes disease course.2

Carcinoma: progression is based on tumor pathology, as well as risk for chest pain based on treatment method.

Intercostal neuralgia: a condition caused by arthritis, trauma, and impingement, which results in a burning, sharp, stabbing discomfort in the appropriate dermatomal distribution. It may resolve on its own, although intercostal nerve block can expedite recovery.

Myofascial pain: usually caused by irritation of the thoracic fascia from trauma or muscle spasm. Its course is variable depending on treatment. Early physical therapy focusing on myofascial release is recommended.

Specific secondary or associated conditions and complications

Multiple conditions:2

Cardiac Acute Myocardial Infarction
Angina Pectoris
Aortic Regurgitation
Mitral Valve Prolapse
Hypertrophic Cardiomyopathy
Sickle Cell Crisis
Thoracic Aortic Dissection/non-dissecting Aneurysm


Pulmonary Tracheal Bronchitis
Pulmonary Embolism
Lung Abscess
Precordial Catch Syndrome
Hedblom Syndrome


Gastrointestinal Esophagitis
Gastroesophageal Reflux
Sphincter of Oddi Dysfunction
Esophageal Laceration/Rupture
Paraesophageal Hiatal Hernia
Esophageal Motility Disorders


Neurological Intramedullary/Extramedullary Lesion
Epidural Spinal Cord Compression
Herpes Zoster/Postherpetic Neuralgia
Nerve Compression/Radiculopathy
Neurogenic Tumors
Complex Reginal Pain Syndrome
Intercostal Neuralgia


Bone Fractures
Neoplasm (Primary or Metastatic)
Ankylosing Spondylitis
Costovertebral Arthritis
Diffuse Idiopathic Skeletal Hypostosis
Inflammatory Diseases
Tietze Syndrome
Slipped Rib Syndrome


Muscle Myofascial Pain Syndromes
Muscle Spasms


Skin Burns
Postoperative pain
Post-Mastectomy Syndrome
Post-thoracotomy Syndrome
Psoriatic Arthritis
Mondor Disease (an uncommon disorder characterized by superficial thrombophlebitis of the thoracoabdominal wall.


Psychiatric Conversion Reaction
Operant Learning


Extrathoracic Disorders Posterolateral disk protrusion C7-8
Thoracic Outlet Syndrome
Pancoast Syndrome
Gas Entrapment Syndrome
Peptic Ulcer Disease
Perforated Ulcer
Biliary Colic
Post-Radiotherapy Chest Pain
Subphrenic Abscess


Chest Pain – Managing Side Effects


Care During Chemotherapy and Beyond

What Is Chest Pain?

Chest pain is a painful or unpleasant sensation in your chest, which may or may
not be associated with heart tissue damage. Chest pain can happen in adults for
a variety of reasons. Some causes of chest pain may include:

  • Lung – you may have pneumonia, or another type of infection in
    your lung that may cause chest pain. Coughing may also cause pain.
  • Musculoskeletal -Common causes of chest pain include pain as a
    result of injury, joint or muscle strain. If you have had any damage to your ribs,
    from injuries or tumors, this can cause you to feel pain in your chest.
  • Gastrointestinal – You may have a type of gastro-esophageal reflux.
    This where the contents of your stomach travel up you esophagus pipe instead of
    downwards. This may cause pain after eating a large meal, lying down, or ending
    over. Antacids, such as famotidine (Pepcid®), omeprazole
    (Prilosec®), or Mylanta®,
    may relieve these symptoms.
  • Angina may cause your chest pain, which may be a feeling of “squeezing”
    in your chest. Anxiety or depression may often cause you to feel angina. Some other
    causes of angina may include:
  • Coronary artery disease (the most common cause of angina) – Fatty
    deposits (called atherosclerosis), may develop over time. This damages the walls
    of the arteries that carry blood to the heart, restricting the flow of blood to
    the heart. It causes less oxygen to reach the heart muscle. This lack of oxygen
    causes angina.
  • Coronary artery spasm – the coronary artery will “spasm” which
    creates a temporary narrowing of blood flow, and a temporary lack of oxygen to the
    heart muscle. When the spasm stops, the pain usually resolves when blood flow is
    returned to normal.
  • Anemia – low blood hemoglobin (Hgb) levels may cause angina. Hgb
    carries oxygen in the blood.
  • Polycythemia – This is when your blood has too many red blood cells
    (RBC’s). This will cause your blood to thicken. Polycythemia can be a result of
    a lifelong illness, such as Chronic Obstructive Pulmonary Disease (COPD), or due
    to problems with the blood itself.
    • Irregular heart rhythms, heart valve problems, and thyroid disease will also cause angina.

Chest pain should not be ignored for any reason. Below are some serious symptoms
to look for. If you experience any of these symptoms, you should seek emergency
care, and then notify your doctor.


  • Chest pain may start in the chest, and spread to the throat, jaw, shoulder blades,
    or arms (left or right).
  • Chest pain may be sharp or burning in character
  • You may experience a feeling of chest heaviness, or tightness.
  • You may have nausea, sweating, or dizziness associated with your chest pain. It
    may also cause you to feel short of breath.
  • Chest pain may spread to the stomach, and feel like indigestion.
  • You may feel palpitations instead of pain.
  • Some people may feel terribly excruciating chest pain, and others may experience
    a mild discomfort. The severity of pain does not indicate how severe the damage
    to the heart muscle may be.

Things You Can Do:

The goal of chest pain is to relieve the cause.

  • If your chest pain is due to musculoskeletal problems, such as muscle strain,
    there is most likely an area you can locate that is causing most of the pain. Anti-inflammatory
    drugs (such as ibuprofen), along with a local application of heat, for no more than
    20 minutes at a time, 3 or 4 times a day, may help.
  • If you have chest pain due to lung problems, such as pneumonia or pleurisy, your
    doctor may prescribe antibiotics to treat the condition. You may also have to be
    hospitalized, depending on how severe your problems are.
  • If you have chest pain due to anemia, your healthcare provider may order a blood
    transfusion, depending on your symptoms.
  • If your chest pain is due to coronary artery spasms, you may be prescribed drugs
    to control your discomfort. These include nitrates, such as nitroglycerin, which
    work by increasing blood flow to the heart. Nitrates also decrease the work of the
    heart by dilating (expanding) the arteries.
  • If you smoke, be sure to quit. Smoking can increase the chance of developing chest
    pain and heart disease.
  • Make sure to exercise, under the supervision of your healthcare provider. Walking,
    swimming, or light aerobic activity may help you to lose weight, and promote the
    flow of oxygen in your lungs and blood.
  • Make sure you tell your doctor, as well as all healthcare providers, about any other
    medications you are taking (including over-the-counter, vitamins, or herbal remedies).
  • Remind your doctor or healthcare provider if you have a history of diabetes, liver,
    kidney, or heart disease. You can try to control your heart disease, high blood
    pressure, and diabetes to decrease your chances of developing chest pain. Discuss
    this with your doctor.
  • Keep a diary of your chest pain, if it is occurring regularly. Write down the foods
    that you have eaten, the exercise or activity you were undergoing when the chest
    pain, and how you felt before the symptoms occurred. This diary may be valuable
    in determining the cause of your chest pain.
  • Questions to ask yourself, may include:
    • Did my symptoms occur gradually, or did this episode come on all of a sudden? Was
      I feeling anxious? Did I perform any kind of activity, or was I resting?
  • If you have a family history of heart disease, stroke, high blood cholesterol, or
    high blood pressure, in a first or second-degree relative, you may be at risk for
    certain problems. Notify your healthcare provider if you have any of these diseases
    in your family.
  • If you are ordered a medication to treat this disorder, do not stop taking any medication
    unless your healthcare provider tells you to. Take the medication exactly as directed.
    Do not share your pills with anyone.
  • If you miss a dose of your medication, discuss with your healthcare provider what
    you should do.
  • Use relaxation techniques to decrease the amount of anxiety you have. If you feel
    anxious, place yourself in a quiet environment, and close your eyes. Take slow,
    steady, deep breaths, and try to concentrate on things that have relaxed you in
    the past.
  • If you experience symptoms or side effects, especially if severe, be sure to discuss
    them with your health care team. They can prescribe medications and/or offer
    other suggestions that are effective in managing such problems.
  • Keep all your appointments for your treatments.

Drugs That May Be Prescribed By Your Doctor:

Your doctor or healthcare provider may prescribe certain drugs to help your heart
muscle work more effectively, or to control your symptoms. These may include:

  • ACE inhibitors – These drugs work by opening, or dilating, your
    arteries. They will lower your blood pressure, and improve blood flow to your kidneys,
    and throughout your body. Your healthcare provider may also prescribe these medications
    if you have diabetes or protein in your urine, to protect your kidneys. Some examples
    of this medication may include: enalapril maleate (Vasotec®),
    lisinopril (Zestril®), and fosinopril sodium (Monopril®)
  • Antacids – If you have stomach upset, which may cause your chest
    pain, your healthcare provider may prescribe an antacid, such as Mylanta®.
  • Antianxiety medications: If your chest pain is due to anxiety,
    your healthcare provider may prescribe an Anti-anxiety medication, called an anxiolytic. These
    medications will help you to relax. These may include lorazepam (Ativan®), or alprazolam (Xanax®).
    It is important to take these medications only when you are feeling anxious. Do
    not operate heavy machinery, or drive an automobile while taking these. If these
    medications do not control your symptoms, discuss this with your doctor.
  • Aspirin – Depending on your overall health status, and the type
    and severity of your arrhythmia, your healthcare provider may prescribe aspirin
    as a “blood thinner.” Aspirin works by preventing platelets in your blood from forming
    blood clots (anti-platelet).
  • Beta-blockers – can be used to slow down your heart rate, and improve
    blood flow through your body. You may take this drug if you have been diagnosed
    with irregular heartbeats, or high blood pressure. Some examples of this medication
    may include: metoprolol (Lopressor®), propanolol
    (Inderal®), and atenolol (Tenormin®).
  • Calcium Channel Blockers – These medications may be given to treat
    chest pain, high blood pressure, or irregular heartbeats. A few common drugs include
    verapamil HCL (Calan®), and diltiazem (Dilacor
  • Nitrates – such as nitroglycerin, work to increase blood flow to
    the heart. They also decrease the work of the heart by dilating (expanding) the
    arteries. You may take this during an episode of chest pain, if your doctor
    has determined that it is safe.
  • Non-steroidal anti-inflammatory (NSAID) agents – such as
    naproxen sodium and ibuprofen, may provide relief of musculoskeletal pain. If you
    are to avoid NSAID drugs, because of your type of cancer or chemotherapy you are
    receiving, acetaminophen (Tylenol®) up to 4000
    mg per day (two extra-strength tablets every 6 hours) may help. It is important
    not to exceed the recommended daily dose of Tylenol®,
    as it may cause liver damage. Discuss this with your healthcare provider.
  • Do not stop any of these medications abruptly, as serious side effects may occur

When to Contact Your Doctor or Health Care Provider:

  • Fever of 100. 5° F (38° C), chills, sore throat (possible signs of infection).
  • If you are sweating a lot with chest pain, or if you are taking medication to treat
    your chest pain, seek emergency assistance if the pain is not relieved by nitroglycerin
    despite taking 3 pills each, 5 minutes apart. Also notify your doctor if you:
  • Feel your heartbeat rapidly (palpitations), and have not noticed this before
  • Any new rashes on your skin, especially if you have recently changed medications
  • Any unusual swelling in your feet and legs
  • Weight gain of greater than 3 to 5 pounds in 1 week.

Note: We strongly encourage you to talk with your health
care professional about your specific medical condition and treatments. The information
contained in this website is meant to be helpful and educational, but is not a substitute
for medical advice.

Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org

90,000 Muscle pain – treatment, symptoms, causes, diagnosis

Muscle pain (myalgia) is a pulling, sometimes excruciating or cramping muscle pain : The term myalgia consists of the Greek words Myos muscle and Algos pain. Muscle pains can be localized both in a certain part of the body, and radiate or be diffuse. In principle, pain can occur in any of the more than 600 muscles in the body.

Muscle pains (myalgias) occur most often in the shoulders and neck in the back. About 75 percent of adults in Europe suffer from back pain of some kind of muscular origin. Muscles are subdivided into skeletal and smooth muscles. Skeletal muscle includes the muscles that enable a person to move and connect bone structures. Quite often, the pain is not due to skeletal muscle, but to smooth muscle (for example, problems in the smooth muscle of the heart can be a source of chest pain). Smooth muscles are located in the walls of the hollow organs of the body, such as the stomach, bladder, and blood vessels, and play a large role in normal organ function.The heart muscle, which forms the heart, is responsible for pumping blood throughout the body.

Muscles respond to commands from the brain and nervous system or other stimuli, for example reflexively, when a neurological examination is performed with a hammer. Muscles contract when stimulated and relax after contracting. Muscles can become a source of pain due to various diseases and conditions, including infections, injuries, autoimmune diseases, neurological and muscle diseases, malignant tumors (cancers), and even after taking certain medications. Muscle pain can also involve ligaments, tendons, and fascia, which are soft tissues that connect muscles, bones, and organs.

A person may feel muscle pain in certain muscles in the body, such as the back or leg muscles, or the pain may be diffuse in all muscles, such as with the flu. In a patient, during an attack of angina pectoris, chest pain is caused by problems in the myocardium. Menstrual pain is pain caused by the smooth muscle of the uterus.Temporary skeletal muscle pain often results from muscle strain from awkward movement or excessive exertion. This type of pain often affects one or more muscles and is usually sharp and intense. Abstaining from activities that cause pain, rest, topical cold and anti-inflammatory drugs usually help reduce pain associated with overuse of muscles. Muscle pain can be caused by serious medical conditions such as fibromyalgia, infections, or dermatomyositis.

Muscle pain can be a symptom of a serious medical condition such as a ruptured muscle or infection. Therefore, you should immediately seek medical attention if muscle pain is persistent or increases.

Not only muscle pain , but any pain is an important signal for the body. Various stimuli can cause pain, such as heating or cooling, pressure or shock, as well as electrical stimulation and chemicals. The so-called pain receptors are responsible for transmitting these stimulating sensations.Pain receptors are free nerve endings that are located both on the surface in the skin and in depth – in muscles, tendons and ligaments, as well as in various organs. When pain receptors are stimulated, the signal from them goes to the central nervous system, where the signal is analyzed, and a protective response occurs, which is aimed at preventing further damage.


Muscle pain can occur along with other symptoms that vary depending on the underlying disorder.For example, muscle pain caused by injury may be accompanied by bruising and swelling in the area of ​​the injury. Additional symptoms that may accompany muscle pain include:

  • Depression
  • Diarrhea
  • Symptoms of acute respiratory illness (fever, chills, sore throat, fatigue, headache, cough)
  • Concentration disorder
  • Loss of appetite
  • Muscle cramps
  • Numbness, tingling or burning (so-called paresthesias)
  • Walking problems
  • Sleep disorders
  • Swelling at the site of injury
  • Severe weight loss
  • Vomiting

Serious symptoms that may indicate a life-threatening condition

In some cases, muscle pain may occur in association with other symptoms that may indicate a serious or life-threatening condition, such as heart attack (heart attack) or meningitis.An urgent need to see a doctor if you have any of these symptoms:

  • Changes in consciousness or attention, such as loss of consciousness or severe memory impairment
  • Changes in mental state, for example, impaired perception of the environment
  • Chest pain radiating to the arm, shoulder, neck or jaw
  • Shortness of breath, shortness of breath
  • Inability to move anywhere in the body
  • Visual impairment (loss)
  • Absence of urine
  • Progressive weakness and numbness
  • Convulsive seizure
  • Occipital stiffness with high fever

Cause of pain

Skeletal muscle pain is most commonly caused by direct injury or trauma resulting from a muscle strain or muscle tear. Muscle tension occurs when several muscle fibers are damaged, while when a muscle breaks, a large number of muscle fibers break. A tear (tear) of a tendon can also lead to muscle pain. Muscles and tendons have the ability to regenerate, but with a strong rupture of a muscle or tendon, it is already necessary to quickly restore the integrity of the damaged structures. Muscle pain can be caused by cramps resulting from overload or abnormal nerve impulses that lead to excessive muscle contraction.In some cases, muscle pain can be a symptom of serious or life-threatening conditions such as heart attack, meningitis, or cancer.

Traumatic causes of muscle pain

Muscle pain can be associated with any injury, including:

  • Blunt force
  • Muscle strain or tear
  • Excessive or repetitive movements
  • Nerve compression (due to disc herniation, spinal stenosis)

Neuromuscular diseases and conditions

  • Amyotrophic lateral sclerosis (ALS, Charcot’s disease) – a severe neuromuscular disease that causes muscle weakness and leads to disability
  • Injury of the brain or spinal cord
  • Dermatomyositis (a condition characterized by muscle inflammation and skin rash)
  • Lyme disease (an inflammatory bacterial disease transmitted by ticks)
  • Multiple sclerosis (a disease that affects the brain and spinal cord and causes weakness, lack of coordination, balance and other problems)
  • Muscle destruction (rhabdomyolysis)
  • Muscle infections such as abscess
  • Parkinson’s disease (a brain disorder that causes impaired movement and coordination)
  • Polymyalgia rheumatica (a disease characterized by muscle pain and stiffness)
  • Polymyositis (inflammation and muscle weakness)
  • Stroke

Other possible causes of muscle pain

Muscle pain can be caused by a variety of other diseases and conditions, including:

  • Cancer
  • Depression
  • Fibromyalgia
  • Angina pectoris or myocardial infarction
  • Hypothyroidism
  • Influenza or other respiratory diseases
  • Renal failure
  • Electrolyte disturbances (disturbances in the level of potassium or calcium in the blood).
  • Pregnancy
  • Systemic lupus erythematosus
  • Vitamin B12 or vitamin D deficiency

Medicines and substances that can cause muscle pain , include:

  • ACE inhibitors (used to lower blood pressure)
  • Cocaine
  • Statins (drugs to lower cholesterol)

Questions that can help determine the cause of muscle pain include:

  • Are there other symptoms such as sore throat or fever?
  • Do you feel pain in one specific area or in the whole body?
  • How long does this condition last?
  • In which parts of the body are pains localized?
  • What decreases pain or increases pain?
  • What medications are being taken now or have recently been taken

Potential complications of muscle pain

Complications associated with muscle pain depend on the underlying disease or condition.For example, muscle pain associated with fibromyalgia or degenerative disease can lead to decreased motor activity and related complications. Many skeletal muscle pains, however, respond well to treatment. However, if muscle pain is prolonged and associated with a systemic disease, then it can lead to the following complications, including such as:

  • Chronic pain
  • Immobility and related complications (such as pressure ulcers and thrombosis)
  • Persistent pain resistant to treatment
  • Muscle atrophy
  • Muscle contracture
  • Permanent damage to muscles or nerves (most often due to nerve compression), including paralysis.
  • Decreased quality of life


Diagnosis of muscle pain (myalgia) is primarily based on medical history and symptoms. Most muscle pain is associated with muscle tension (for example, due to improper posture or a sedentary lifestyle) or injuries (for example, muscle strains, bruises, or muscle soreness during sports). Instrumental research methods, such as ultrasound or X-ray, CT, MRI, help to confirm or differentiate the cause of muscle pain .

Medical history (anamnesis).

The doctor will be interested in the type of pain, the location of the pain and the intensity of the muscle pain. This information can be key to understanding the causes of leg pain. Information about the presence of muscle injuries, the presence of bruises, factors that lead to an increase or decrease in muscle pain or pain persistent, for example, with a herniated disc, the time the pain appears (day or night), is very important.

Inspection. A doctor’s examination allows you to determine the presence of painful areas, the presence of areas of discoloration of the skin, the range of motion in muscles or joints, muscle strength, the presence of local pain in the tendon area, or the identification of trigger points (for example, with fibromyalgia).In addition, reflex activity, sensitivity and other neurological tests are important to detect the presence of neurological disorders. The timing of the onset of muscle pain is also relevant, as, for example, with osteoporosis or ankylosing spondylitis. Alcohol or drug abuse can be a possible cause of muscle pain and information about this is important in understanding the causes of muscle pain. Some medications can also have a side effect of muscle pain.

Laboratory research methods.

Blood tests allow to determine the presence of an inflammatory process or infections, autoimmune processes; biochemical tests can determine abnormalities in the functions of internal organs (for example, liver or kidneys).

Ultrasound examination (ultrasound). This research method allows visualizing the presence of muscle inflammation (myositis), muscle ruptures, tendons.

Research methods such as CT or MRI are necessary to visualize problems in deep muscles, where ultrasound is not very informative, or when it is necessary to visualize neurological conditions or traumatic injuries.Electrophysiological research methods (EMG or ENMG) can determine the presence of inflammatory or degenerative muscle diseases or impaired conduction along the nerves due to compression of the nerve roots or other neurological diseases.

A muscle biopsy is usually used as the last step in diagnosing muscle disease, and only if there are clear signs of such disease.


Treatment of muscle pain depends on the cause of the symptom.Therefore, the most important factor in determining the tactics of treatment is the establishment of an accurate diagnosis. For example, if muscle pain is caused by taking certain medications, then in such cases it may be sufficient to stop taking these medications or replace them with other medications. Medication for muscle pain can include NSAIDs or analgesics, or even opiates.

Acute muscle pain

In case of acute muscle pains that have arisen after an injury, it is necessary to ensure rest and unloading, in some cases immobilization.In addition, local cooling with ice wrapped in a towel gives a good effect in such cases, which helps to reduce swelling, inflammation, and pain. In addition, it is necessary to stop the exercise that led to muscle pain. It takes a lot of time to treat muscle injuries, since early recovery of normal loads can lead to chronic pain syndrome and excessive scarring of muscle tissue, and in severe cases, to the development of ossifying myositis.

Chronic muscle pain

Treatment of chronic pain may include the use of thermal treatments as well as other treatments such as:

  • Acupuncture and acupressure
  • Electrotherapy (electricity therapy)
  • Electromyostimulation
  • Physiotherapy
  • exercise therapy
  • Manual therapy

Systematic exercise (exercise therapy) is especially relevant when the cause of chronic pain is degenerative diseases of the spine, such as osteochondrosis, spondylosis, disc herniation.

Surgical methods of treatment are used for severe traumatic muscle injuries or in the presence of compression of the nerve roots.

Prevention of muscle pain consists in the following rules: maintaining a healthy lifestyle, sufficient physical activity, balanced diet, correct ergonomics of the workplace, exclusion of alcohol abuse, smoking.

90,000 Effect of massage on muscles

There are more than 400 skeletal muscles in the human body.They account for 30-40% of the total weight. The entire human body is covered with skeletal muscles. Harmoniously developed and correctly positioned muscles make the human body beautiful. Skeletal muscles are subdivided into muscles of the extremities (they make up 80% of the mass of all muscles), muscles of the head and muscles of the trunk. The muscles of the trunk are divided into muscles of the occiput and back (back) and muscles of the abdomen, chest, neck (front).

Muscles are made up of muscle fibers. Their main property is contractility and excitability.

Skeletal muscle transmits signals to the central nervous system, so it can be attributed to a special sense organs.Passing through the neuromuscular ending on the way back, the nerve impulse excites the muscle fiber, forming acetylcholine in it.

During massage, the formation of acetylcholine is enhanced, which increases the overall performance of the muscles, since nerve stimulation from one cell to another is transmitted faster. Experimental studies have shown that after massage, muscle performance increases five to seven times.

A massage session within 10 minutes after a great physical activity is enough in order not only to restore muscle performance, but also to increase it.And the thing is that during massage, special mock nerve fibers, which are located in the muscle bundle, receive irritation. One of the main factors is the equipment on which it is made. US MEDICA offers only high quality massage tables.

In the muscles under the action of massage, the redox processes, blood circulation improve, the rate of removal of metabolic products, the rate of oxygen delivery increases. Therefore, after a massage session, the feeling of soreness, stiffness and swelling in the muscles disappears.

Massage on a massage chair is also very effective. Modern models allow you to combine several massage effects, and also have such functions as stretching the leg and thigh muscles, vacuum massage with air cushions, three-dimensional massage of the hands, forearms and shoulders.

Circular massage, offered by massage chairs, stretches the muscles that support the back, which relieves pressure on the spinal discs. This massage helps to stimulate the spinal nerves, as it affects the lower and upper spine.Thanks to this, muscle pain in the back is significantly reduced. The larger the rollerballs of the massage chair and the wider the coverage area, the more beneficial the massage is for the whole body.

Such a massage effect as tapping improves blood circulation, oxygen supply to cells, increases blood flow, and decreases muscle stiffness. Lactic acid builds up in the muscles due to excessive physical exertion, and tapping on the massage chair helps to avoid this accumulation.Some massage chairs have up to 500 taps per minute.

Do regular massage and you will forget about muscle pain.

“Three causes of back pain”

Dr. Ivanov on trigger zones of pain, excessive tone and muscle carapace

Back and neck pain is common. The reason for such pain is most often associated not with osteochondrosis and hernia, but with our muscles. According to statistics, 97% of people suffer from back pain precisely because of muscle overstrain.Dr. Alexander Ivanov spoke about the nature of such pain and its treatment in his new article.

Conventionally, all causes of pain are divided into three categories: mechanical back pain (97% of cases), non-mechanical (1% of cases) and visceral (2% of cases)
Photo: “BUSINESS Online”


Conventionally, all causes of pain are divided into three categories: mechanical back pain (97% of cases), non-mechanical (1% of cases) and visceral (2% of cases).This means that out of 100 patients with back pain, the vast majority will have mechanical problems. What does it mean? That is, their pain is caused either by overload and tension of the back muscles (76% of cases), or by degeneration of the intervertebral discs and osteoarthritis of the facet joints (10%), hernia and protrusion of the intervertebral disc (4%), osteoporosis (4%) and other structural changes ( traumatic fracture, spondylolisthesis, spinal stenosis, and so on).

Non-mechanical causes of back pain can cause tumors, infections, and inflammatory arthritis.

Visceral pathology (Latin viscera – viscera, pathos – disease, which means “diseases of the internal organs”) can also give back pain. These are diseases of the pelvic organs (prostatitis, endometriosis), kidney disease (nephrolithiasis, prolapse of the kidneys), diseases of the gastrointestinal tract (pancreatitis, cholecystitis), aortic aneurysm.

A qualified physician can determine the cause of the pain.

“There are about 600 skeletal muscles in our body, and their specific gravity can reach 40% of the total body weight.”
Photo: pixabay.com


There are about 600 skeletal muscles in our body, their specific gravity can reach 40% of the total body weight. And the athletes have even more! Skeletal muscles, together with bones, form the musculoskeletal system, due to which our body moves in space. There are also smooth muscles that line the hollow internal organs and blood vessels, as well as the heart muscle.

Smooth muscle lines the walls of internal organs such as the esophagus or bladder.Smooth muscles do not obey our consciousness and are controlled autonomously by the autonomic nervous system. Therefore, we do not need to think about how to push food through the esophagus or intestines – everything is done automatically. Another type of muscle is the heart muscle (myocardium). This muscle also works autonomously, without our conscious participation.

However, we will talk about skeletal muscle. The structural unit of skeletal muscle tissue is a muscle cell – muscle fiber. Muscles are made up of a large number of muscle fibers.The more muscle fibers, the stronger the muscle – it contracts, while shortening and thickening, moving relative to other muscles. The shortening of the muscle is accompanied by the convergence of its ends, which are attached to the bones. There is movement.

Each muscle is covered with a fascia (lat. Fascia – bandage, strip) – a connective tissue case. The nerves and vessels that feed the muscles pass through the fascia. In addition, fasciae provide muscle sliding, transfer movement from muscles to bones, and support internal organs.Fasciae unite all muscles into one well-coordinated system. Fascia tension can also cause back pain.

Muscle fibers can be clearly seen on the example of a piece of cooked meat, which consists of a huge amount of fibers that easily disperse – they get loose if you knead the cooked meat with your hands. Fascia is the thin film that cooks remove from meat before cooking it.


So, muscle pain is the most common cause of mechanical pain in the back and neck, it occurs in about 70% of cases.

Experts divide muscle pain into pain with and without trigger zones.

Inset: The muscle trigger zone is an area of ​​increased irritability located within the dense (tense) bundles of skeletal muscles or their fascia (muscle sheaths). This area is painful when squeezed, can reflect pain to other areas, cause autonomic and proprioceptive disorders (for example, crawling or tickling at the place of pressure).

In other words, the trigger point (zone) is the “trigger” of pain, when pressed, under certain conditions, pain is triggered, like a shot from a gun.

Why do trigger zones appear? This is most often the case with prolonged static stress, such as during sedentary work. Static is stillness, as opposed to dynamics – movement. Static loads on muscles are caused by prolonged exposure to a certain position, most often sitting or standing. In this case, a number of muscles are in tension, which over time leads to the formation of trigger zones. Industrial gymnastics is the best way to deal with static muscle stress.

Unfortunately, many schoolchildren come to see me with muscle pains – tension headaches, neck and back pains. Static and emotional muscle overload is the main cause of pain in most people.


From an osteopathic point of view, muscle pain is the result of somatic dysfunctions (movement disorders) in regions of the body. Consider the cervical region. Restricting movement in the cervical vertebrae can create additional tension in the muscles that attach to these vertebrae.For example, the anterior scalene muscle attaches to the tubercles of the transverse processes of the III – VI cervical vertebrae and can cause pain in the chest, arm and interscapular region. To eliminate pain, first the dysfunction of the cervical vertebrae should be eliminated, and then the scalene muscle should be relaxed. In this case, the treatment will be effective as the physical causes of the pain are eliminated.

“From the point of view of psychosomatics, trigger points appear in response to a person’s internal emotional stress, in the absence of the skill to relax and rest.”
Photo: pixabay.com


From the point of view of psychosomatics, trigger points appear in response to a person’s internal emotional stress, in the absence of the skill to relax and rest. Unfortunately, most people do not know how to relax and are overweight even on vacation or at home. This state can be characterized by the following emotions: distrust, fear, closeness, self-dislike. A person is, as it were, in a muscular “shell”, protecting himself from the outside world.In order to get out of the “shell” and remove emotional trigger points, you need to work with a psychologist or use special relaxation techniques.


What can trigger pain? Muscle pain can increase when the trigger point is squeezed, when the muscle is strained or passively stretched. The pain can also increase with local cooling of the muscle, which manifests itself the next day and is defined by the patient as “blown out the neck, lower back”.Stress can also cause trigger zones to activate and cause pain. This is due to the disruption of the anti-pain system due to neuroendocrine changes in the body under stress.

Sidebar: A 35-year-old woman came to an appointment with complaints of pain in the neck and shoulders, with limited head movement due to pain. Works as an accountant. Anamnesis revealed that she works in an office and recently moved to an air-conditioned location. The very next day I felt a sharp pain in my neck and limited movement.Examination revealed myofascial pain syndrome with trigger points in the trapezius muscles. Conducted a session of osteopathic correction with post-isometric relaxation. At the end of the session, the pain was reduced by 70%. So she was sent home. He taught me the techniques of self-relaxation of muscles and prescribed a warming ointment. The next day the pain was completely gone.

Muscle trigger points can be dormant (latent) and under certain conditions go into an active mode, giving pain.Importantly, trained muscles are less prone to trigger pain. The conclusion follows from this: regular physical activity is a good prevention of muscle pain. It is known that muscle pain is much less common in manual workers than in knowledge workers who move little.

“Regular exercise is a good prevention of muscle pain.”
Photo: pixabay.com


Treatment of muscle pain is aimed at reducing the pain itself and eliminating the trigger point (zone).Treatment can be pharmacological or non-pharmacological. The standard initiation of treatment is nonsteroidal anti-inflammatory drugs and muscle relaxants to relieve acute pain.

Using heat or, conversely, cooling the affected area also helps to effectively relieve pain.

An ice pack can be used to cool the painful area and applied to the skin for 10-15 minutes. This cold compress can be repeated three to four times a day.Cold exposure is believed to be more effective than warming. It is no coincidence that sports doctors use this method.

Warming ointments (ointment with demixide, Nikoflex, Espol, Diclofenac-gel, Finalgon, Dolobene, Fastumgel and so on) are used to warm the muscles. A pepper patch gives a good analgesic effect.

Inset: Pepper patch is the first aid for muscle pain. Pepper plaster must be in everyone’s medicine cabinet.Capsaicin, a substance found in capsicum, has an analgesic effect. Before applying the patch, you must degrease the skin with alcohol. Next, glue the plaster. Exposure time – up to 48 hours. You should be careful, as there may be an allergic reaction to the components of the patch. In Russia, you can buy ointments with capsaicin – Nikoflex and Espol.

Post-isometric muscle relaxation (PIR) is very effective in relieving pain itself and deactivating trigger zones.In combination with myofascial osteopathic techniques, PIR gives very good results from the very first procedure.

From physiotherapy, magnetic stimulation, laser therapy, ultrasound and sinusoidal modulated currents are shown.

To relieve pain, you can also use acupressure, acupuncture and needle applicators (Kuznetsova, Lyapko, etc.).


1. The most common cause of mechanical back and neck pain is muscle pain.

2. Muscle pain can be triggered by trigger zones in the muscle itself.

3. Trigger zones are formed due to static muscle overload, emotional stress, somatic dysfunction of the region.

4. Activates the trigger zone of local hypothermia, excessive stretching or muscle tension, stress.

5. Medicines relieve pain, as well as heat or cold effects on the trigger zone, muscle relaxation through massage and osteopathy, emotional release, physiotherapy and reflexology methods.

6. Regular muscle training reduces the likelihood of trigger points and pain.

Sincerely yours,

Ivanov Alexander Alexandrovich – Candidate of Medical Sciences, osteopath, neurologist, naturopath, member of the Russian osteopathic association, popularizer of a healthy lifestyle and a conscious approach to health.

Personal site www.osteopat-ivanov.ru

The opinion of the author may not coincide with the position of the editors

Back muscles

There are three main types of muscles in the body: skeletal, or striated (contraction of which occurs due to their own efforts), smooth muscle tissue, and cardiac striated (their contractions occur involuntarily, that is, regardless of the person’s desire).All of the types presented can become stronger and more resilient through exercise. We’re going to go into more detail about skeletal muscle tissue, which is involved in maintaining posture and movement of the spine. Hypotension and lack of flexibility is a common cause of back pain.

Skeletal muscles involved in supporting the spine include: superficial and deep back muscles, intrinsic muscles of the chest, diaphragm, abdominal muscles, neck muscles, head muscles, shoulder girdle muscles, muscles of the free upper limb, pelvic muscles, muscles of the free lower limb.

Deep muscles of the back, abdominal muscles are involved in maintaining the posture of the spine. The muscles of the thighs and lower legs can also play a role in the formation of back pain. As you probably already know, in order for your spine to stay healthy and function properly, you need to have strong abdominal muscles that help stabilize your entire torso. There are four types of abdominal muscles.

Your muscle corset

Transverse abdominal muscle (muscle of the anterolateral part of the abdominal wall, bringing together the lower parts of the chest and taking part in the formation of the abdominal press).You can feel these muscles contracting in yourself if you put your hands on your waist and cough. On the sides of your body, you have obliques – internal , which are located deeper, and external oblique muscles , which are located more superficially. The oblique muscles allow twisting and lateral bending of the spine.

Abdominal Cubes

Finally, there is rectus abdominis , better known as “abdominal cubes”.While you can pump it into a plank shape (with incredible effort), this muscle doesn’t really play much in the stabilization of the back. When these muscles contract, the torso bends forward (for example, when doing squats or abdominal “twisting” exercises). It is partially involved in the stabilization of the spine, therefore it must be strengthened together with the transverse and internal oblique muscles of the abdomen and the muscles of the back. Among the most effective exercises for training the abdominal muscles, one should give preference to the Pilates exercises, which are aimed at strengthening all the abdominal muscles and the muscles of the spine.


Deep within the body are two muscles, on either side of the spine, called the iliopsoas, or psoas, . The iliopsoas muscle (m. Iliopsoas) is a muscle of the internal group of muscles of the pelvis. It is formed as a result of the connection of the distal muscle bundles of the large psoas and iliac muscles. The muscle from the pelvic cavity exits through the muscle lacuna and, heading downward, passes along the front surface of the hip joint, attaching itself with a thin short tendon to the lesser trochanter of the femur.She is involved in flexion and supination of the hip in the hip joint. With a fixed leg m. iliopsoas flexes the lumbar spine. When sitting for a long time, it can contract and spasm, which can cause pain when standing.

Back muscles

Like the muscles of the abdomen, the muscles of the spine are composed of several layers. The muscles of the back form three layers: superficial, middle and deep.

The deepest short muscles connect the vertebrae to each other.At the deepest level, there are interspinales (m. Interspinales). They are short paired muscle bundles that stretch between the spinous processes of two adjacent vertebrae.

The transverse spinous muscle (m. Transversospinalis) is covered by the muscle that straightens the spine. Refers to the deep muscles of the back. Fills the cavity between the spinous and transverse processes of the vertebrae. With a bilateral contraction, it unbends the spinal column, and with a unilateral contraction, it rotates in the direction opposite to the place of contraction.

The next layer is represented by muscle, erector spine (m. Erector spine). It is located most superficially among the deep muscles of the back. It is the most powerful and longest muscle in the back. The main task of this muscle group with bilateral contraction is to unbend the spinal column and keep the trunk in an upright position, with unilateral contraction, it tilts the spinal column in the appropriate direction. Often, with muscle spasms and pain in the spine, it is this muscle that suffers.

The next level consists of large rhomboid muscle ( m . Rhomboid major) – it is located under the trapezius muscle between the shoulder blades, in the form of a rhombic plate. A very large latissimus dorsi muscle (m. Latissimus dorsi) – superficial muscle that occupies the entire lower back, the upper bundles in the initial part are covered by the trapezius muscle. In addition to stabilizing the spine, these muscles are involved in movements such as pulling up and pronating the shoulder.

Finally, trapezius muscle (m. Trapezius) is a flat broad muscle, which occupies a superficial position in the back of the neck and in the upper back. This muscle helps you move your neck and is involved in lifting the scapula. When we are tense, as a rule, this muscle is tense, causing a feeling of soreness and spasm in the shoulder girdle.

In conclusion

Muscles are attached to bones through tendons. Tendon is a formation of connective tissue, the terminal structure of striated muscles, with which they attach to the bones of the skeleton.When the muscle contracts, the signal is concentrated through the tendons that control the movement of the bone. Tendons are firmly attached to bones. There are times when tendonitis, or tendon inflammation, can even occur in the spine. Symptoms of tendonitis can range from pain to burning pain and local joint stiffness that occurs around the inflamed tendons. Swelling can occur along with inflammation and redness, but the nodes surrounding the joint may not be visible in all cases.Many patients report stressful situations in their lives that precede the onset of pain, which can contribute to their symptoms.

Trigger and muscle-tonic pains

Pain is one of the most important reactions of the body, signaling the presence of a disease or injury. Pain impulses of unknown origin cannot be ignored; it is necessary to identify the cause of the pain, establish a diagnosis and carry out the necessary treatment.

One of the causes of muscle pain is trigger and muscle-tonic pain.This is a specific condition that is somewhat different from other soft tissue diseases in which a person feels pain in the muscles – tendobursitis, fibromyalgia.

Cause of trigger and muscle-tonic pain

Trigger and muscle-tonic pains are caused by persistent and prolonged spasm of skeletal muscles, accompanied by the formation of seals in the form of clear sources of local pain within the muscle. The trigger signal for the formation of this process can be injuries with excessive load, both dynamic and static as a result of a long stay in an uncomfortable position.An important role is played by the hypothermia factor.

Figuratively, muscle pain in this case can be regarded as a classic “vicious circle” – pain-spasm-pain. The longer the process takes in time, the more difficult it is to break it. The spasm in this case has a protective character, protecting the internal organs, nerves, and blood vessels from physical impact. Without treatment, the process can become irreversible and a persistent change in skeletal muscles occurs with the loss of some of the functions. As a result of tissue malnutrition against the background of prolonged spasm, dystrophic changes can occur – part of the muscle tissue will be replaced by connective tissue.The damaged muscle itself will begin to act as a source of pain.

Localization of trigger and muscle-tonic pain

Muscle pain as a result of spasm most often manifests itself in the muscles along the spine, in the neck and buttocks.

Diagnosis of trigger and muscle-tonic pain

Muscle pain is characteristic of a large number of diseases and pathological conditions. Therefore, only a specialist can prescribe the necessary examinations, establish a diagnosis and choose the right treatment tactics.Highly qualified neurologists of the Zvezda Medical Center will help to diagnose and determine further tactics for treating muscle pain.


Trigger and muscle-tonic pain can be treated with all medical prescriptions. With advanced forms, treatment may not be effective enough and a pronounced pain syndrome will remain.