Causes of muscle pain

Muscle pain is a non-specific pain syndrome, which in medicine is called myalgia (myos – muscle, algos – pain). Pain can occur independently, spontaneously, as well as under objective circumstances - palpation, physical overexertion.

The etiology and pathogenesis of myalgia is still an area of study; there is no single, generally accepted hypothesis to date.

Read also:

• How does muscle pain manifest itself?
• Treatment of muscle pain

However, some types and localizations of muscle pain are well studied and pathogenetically explained by insufficient permeability of cell membranes of muscle tissue, as well as inflammatory processes in it. Muscle pain can develop in people, regardless of age and gender, its clinical manifestations are associated with the etiological factor and the localization zone. There are three types of myalgia, which are defined as independent nosologies and recorded in the classification:

1. Fibromyalgia – fibromyalgia. This is a chronic syndrome when extra-articular muscle tissues are affected, the pain is diffuse and localized by trigger points. Diagnosis of such muscle pain is extremely difficult due to the non-specificity of symptoms, fibromyalgia is differentiated from other pain syndromes if the symptoms do not subside within 3 months, and segmental palpation determines at least 11 painful trigger zones out of 18 typical ones, established as diagnostic parameters
2. Myositis – myositis. This is muscle pain of an inflammatory nature, it can also occur as a result of injury or intoxication of the body. Inflammation of skeletal muscle tissue varies in symptoms, but there are specific differences – increased pain during movement, gradual limitation of joint activity and muscle tissue atrophy
3. Dermatomyositis – DM or dermatomyositis, less often – polymyositis. The disease is associated with systemic pathologies of muscle, connective tissue, belongs to the group of inflammatory myositis, is characterized by lymphocytic infiltration and is most often accompanied by focal rashes on the skin. Chronic course of dermatomyositis, polymyositis leads to total movement disorder, damage to internal organs (heart, lungs)

Muscle pain can also be a symptom of epidemic myalgia – Bornholm disease, a disease of viral etiology (Coxsackie virus). There are also forms of myalgia that are not accompanied by organic changes in muscle tissue and dysfunctions in the joints, are volatile, transient in nature and have no visible objective symptoms manifested clinically. These undefined myofascial manifestations remain a poorly studied phenomenon, most often they are associated with psychogenic factors.

In the international classification of diseases, ICD-10, myalgia is recorded within class XIII (diseases of the muscular system and connective tissue) and group M70-M79.

ICD-10 code - M79.1 – Myalgia, Fibromyalgia, myofascial syndrome.

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Causes of Muscle Pain

The etiology of muscle pain has long been the subject of study for many specialists, reviews on this controversial issue have been published for two centuries, but the problem of a single etiological basis for myalgia remains unresolved. Moreover, in addition to the unspecified etiopathogenesis, there is no consensus on terminology and classification, and, accordingly, diagnostics are also difficult.

A typical example is fibromyalgia and MFPS - myofascial pain syndrome, which are often confused with each other due to the unclear etiology of the disease. The symptoms of muscle pain are polyvariant, it is extremely difficult to determine the nosological affiliation of the syndrome, since it is characteristic of a whole list of systemic, neurological, endocrine, infectious, rheumatic and other pathologies. It should be noted that according to the latest scientific research, relationships have been established between muscle pain and the somatic nervous and autonomic systems that form pain irritation.

If we take as a basis the versions used by practicing doctors, then the causes of muscle pain are provoked by the following conditions, diseases and objective factors:

• Infectious diseases of the body.
• Systemic, autoimmune diseases, rheumatism stands out in this series.
• Disruption of various levels of metabolism.
• Professional factors (static postures, mechanical rhythmic movements, sports training, etc.).

A more specific list of causes of myalgia, proposed by the International Association of Rheumatologists, looks like this:

• Neurogenic myopathies, when muscle pain is a symptom of neuralgia and can be considered secondary.
• Excessive tension of skeletal muscles - DOMS (delayed onset muscle soreness syndrome), muscle soreness. The syndrome is associated with intense physical exertion.
• Stretching of ligaments, muscles, tendons.
• Trauma (closed, open).
• Effects of intoxication, including drug intoxication. Drugs that provoke muscle pain – narcotic drugs, drugs that lower blood pressure, statins that regulate cholesterol levels.
• Vascular pathology.
• Idiopathic inflammatory myopathy.
• Inborn error of metabolism.
• Chronic infectious diseases.
• Congenital anatomical deformities.

Infectious pathologies, infectious myositis caused by such pathologies:

• Malaria.
• Flu.
• Lyme disease.
• Dengue fever.
• Infectious muscle abscess.
• Hemorrhagic fever.
• Polio.
• Trichinosis.
• Meningitis.
• Endocrine pathologies.
• Skeletal muscle necrosis.
• Violation of water-electrolyte balance.
• Dysfunctions of the autonomic nervous system.
• Rheumatic pathologies – systemic lupus erythematosus, polyarteritis, Still's disease, Wegener's granulomatosis.
• Parasitic invasion of muscles.
• CFS – chronic fatigue syndrome.
• Fibromyalgia.
• Postoperative muscle pain (scar contractions).

In addition, the causes of muscle pain can be due to a number of psychogenic factors, which are considered the most problematic in a diagnostic sense.

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Muscle pain during pregnancy

During the entire period of pregnancy, not only muscles, but also other systems and organs of the expectant mother undergo changes that are quite explainable from the point of view of the physiology of the process of bearing. One of the reasons for pain, in addition to purely anatomical (due to stretching), is the effect of progesterone on the cell membranes of skeletal muscles. The concentration of progesterone decreases after the 20th week of pregnancy, then the pain in the muscles subsides a little, and residual effects are associated with the preparation of the body for labor.

Muscle pain during pregnancy primarily affects the abdominal area, abdominal muscles and pelvic muscles. The rectus muscles, the muscles that hold the abdominal press, change their task, now they must support the growing uterus. The skeletal muscles are also subject to changes, since not only does the woman's weight increase, but her posture also changes. The back bends forward, the leg muscles hurt, especially in the calves. Almost all smooth muscles are involved in the transformation process, so those who have preliminary preparation, training, and those who have previously done sports or fitness, endure the period of bearing a fetus much easier.

It is not by chance that doctors recommend expectant mothers to do daily exercises to strengthen muscles, especially useful are exercises that help increase the elasticity of ligaments (stretching), it is also important to strengthen the pelvic muscles, which are directly involved in childbirth and are often injured if they are not properly prepared. To prevent pain in the calf muscles, so typical during pregnancy, you should regularly take special vitamin complexes containing calcium, magnesium, potassium, vitamins E, D, A, K. Back pain is prevented by gymnastics that strengthen the muscles of this area (muscle corset). You should also train the vaginal muscles, groin muscles, since childbirth can provoke their traumatic stretching, leading to complications, up to situational enuresis (when coughing, laughing). Prevention of pain in the chest muscles will help to avoid stretch marks, minimize the risk of loss of shape of the mammary glands. There are currently many special courses available to help pregnant women learn to manage their muscle tone to avoid pain during pregnancy, as well as to prepare the entire body for a painless birth.

The child has muscle pain

Most often, muscle pain in a child is associated with the so-called "disease" of growth, that is, the symptom is caused by a completely normal, natural process of growing up. Some children do not feel any discomfort associated with growth at all, while others react quite painfully. The etiology of myalgia in children is not fully understood, but the generally accepted version is the discrepancy between the rates of growth of the bone and muscular-ligamentous systems. The skeleton grows faster, tendons and muscle tissue do not have time to adapt to the speed and intensity of growth.

Of course, this explanation is extremely simplified, in fact, in a child's body everything is more complicated. There is an opinion that muscle pain in a child is associated with hidden congenital or acquired chronic pathologies. The most common muscle pain symptom in children aged 3.5-10 years, teenagers also suffer from myalgia, but it has a more precise etiological cause.

Muscle pain can be a symptom of an underlying disease, less often it is an independent condition.

List of factors and conditions that cause reversible muscle pain in a child:

• Cramps that may be a consequence of “growing pains” or caused by a sports injury, bruise, or torn ligament.
• An inflammatory process in muscle tissue – myositis, provoked by viral pathologies (flu, acute respiratory infections), bacterial infection, including parasitic. The pain is localized in large muscles of the body – in the back, in the shoulders, in the neck, in the arm muscles.
• Dehydration during active physical activity, which is typical for children who are fond of sports games in the hot season. Loss of fluid with sweat leads to a deficiency of magnesium, potassium, and hyperventilation during fast running can lead to cramps in the calf muscles.

In addition, there are a number of serious pathologies that are characterized by muscle pain in children:

• Duchenne myopathy. This is a pathology diagnosed in boys in early childhood. The disease has a genetic cause - an X-chromosome anomaly. The consequence is a gene mutation and a deficiency of the dystrophin protein. Pseudohypertrophy develops slowly and gradually affects all skeletal muscles, less often - the myocardium. The clinical picture is determined at the age of 3-4 years, when the child has difficulty climbing stairs, cannot run. The prognosis of the disease is unfavorable.
• Becker's pseudohypertrophy is a disease similar to Duchenne myopathy, but weaker in clinical manifestations and more favorable in its course and prognosis.
• Bornholm disease or epidemic myalgia. The disease is viral in nature (Coxsackie virus), develops rapidly, accompanied by severe muscle pain in the chest, less often in the abdomen, back, arms or legs. The disease is diagnosed by specific symptoms - fever, myalgia, vomiting. The pain is paroxysmal, subsides at rest and intensifies with movement. Epidemic myalgia is often associated with enterovirus infections, herpes, serous meningitis.

Fibromyalgia and polymyositis (dermatomyositis) do not occur in children; isolated cases are so rare that they are considered a diagnostic phenomenon or an error.

Thus, unlike adults, muscle pain in a child is 85-90% caused by physiological or situational factors. Such pain can be defined as a treatable, reversible symptom. However, if the pain interferes with the child's normal movement, is accompanied by hyperthermia, visible physical defects (curvature, protrusion, depression), parents should urgently consult a doctor to examine the child and begin adequate treatment.

Leg muscle pain

The normal motor activity of the human body depends on the elasticity of the muscle tissue and ligamentous apparatus of the lower extremities. The muscular apparatus of the legs can be divided into the muscles of the extremities and the muscles of the pelvis. The hip joint moves thanks to the piriformis, iliopsoas, gemelli, obturator, large, small and middle gluteal muscles, square, and also the tensor of the thigh muscle. The lower extremities move thanks to the muscles of the shin, thigh, foot.

Muscle tissue constantly needs blood supply, including oxygen supply, especially for the legs, since they bear the entire burden of the evolutionary skill of walking upright. The “safest” causes of leg muscle pain are physical overexertion, intense sports activities, or forced static tension (monotonous posture, monotonous movements). Such types of pain are easily relieved by relaxing massages, warm baths, rubbing, and simply resting. However, there are also more serious factors that provoke leg muscle pain:

• Vascular pathologies – a violation of the outflow of blood, mainly venous, provokes a load on the vascular wall, irritation of nerve endings, resulting in pain. Arterial insufficiency (claudicatio intermittens) is most often localized in the calves of the legs and is expressed in transient pains that subside at rest or with cooling, light massage. In fact, this is how varicose veins develop. The pain in the muscles is dull, aching in nature, the person constantly complains of "heavy" legs. In the same way, pain in the legs can be provoked by atherosclerosis, thrombophlebitis. Pain in such pathologies intensifies with movement, most often localized in the calf muscles. Thrombophlebitis is characterized by pulsating, constant pain that turns into a burning sensation.
• Pain in the legs, including muscles, can be felt with various diseases of the spinal column. The nature of the symptom is paroxysmal, shooting, radiating pain, the primary source of which is in the lumbosacral zone.
• Joint pathologies, it would seem, have nothing to do with muscle tissue, but they are also a common cause of discomfort in the leg muscles. The pain is usually excruciating, "twisting", pain in the knee area can indicate damage to the cartilage and periarticular muscles.
• Myositis, which is an independent inflammatory process or a consequence of parasitic invasion. Leg muscles hurt constantly, aching sensations increase when walking, physical activity. Specific inflammatory nodules are clearly palpated in the calf muscles.
• Cramps, cramps, the cause of which can be both elementary hypothermia and venous congestion of a situational nature (prolonged uncomfortable position, position - leg over leg). However, most often, convulsive syndrome, pain in the legs is provoked by vitamin deficiency, microelement deficiency, or an underlying chronic disease.
• Flat feet can also cause constant, dull pain in the leg muscles and a feeling of heaviness in the feet.
• Overweight, obesity.
• Fibromyalgia, which has certain trigger points that are important for differential diagnosis. Some trigger points are located in the hip and knee area.

Traumatologist, surgeon, phlebologist, vascular surgeon, and rheumatologist treat muscle pain in the legs.

Pain in the thigh muscles

The thigh muscles are a type of muscle tissue that, on the one hand, is characterized by increased elasticity and a strong structure, on the other hand, pain in the thigh muscles is a direct indication of increased stress on this area of the body. The most common cause of pain in the thigh muscles is considered to be elementary physical overload, the pain can be transient, aching, and even partially limit the movement of the legs. Irradiating pain in the groin, down the leg is already a symptom of another pathological factor, for example, osteochondrosis of the lumbosacral region, pinched nerve endings, radiculopathy.

The following factors directly trigger myalgia:

• Violation of water-electrolyte balance, which can be caused by dehydration or long-term use of diuretics. Developing deficiency of calcium (hypocalcemia), potassium (hypokalemia), increased sodium level (hypernatremia), acidosis provoke characteristic pains of a spastic nature (cramps), including in the thigh muscles.
• Myositis is an inflammatory process in muscle tissue caused by infections - viruses, bacteria, parasites. Inflammation of the thigh muscles can be provoked by diabetes, tuberculosis, venereal diseases (syphilis). Myositis can also be a consequence of hypothermia, blunt or penetrating trauma. Myositis of the thigh can occur in acute, subacute or chronic form and is expressed in pain, muscle swelling, rarely - hyperemia of the skin in the affected area.
• Fibromyalgia rarely manifests itself as pain in the thigh muscles, but among the diagnostically important trigger points there are also areas located on the thigh.
• Muscle soreness or pain caused by training. If a person intensively performs certain types of exercises aimed at increasing or, on the contrary, "drying out" the thigh muscles, he may experience post-training pain. This is due to insufficient preparation for training, poor warm-up of the muscles, or excessive strain on them.

In addition to physiological, situational causes, factors that provoke pain in the thigh muscles can also be the following pathologies:

• Coxarthrosis of the hip joints, when articular cartilage is subject to degeneration and wear, the shock-absorbing functions of the joint are reduced, nerve endings are pinched, pain develops, including in the muscles. The pain intensifies with movement, when walking, any sharp turn, bend causes discomfort, often coxarthrosis leads to intermittent claudication.
• Osteochondrosis of the lumbosacral region. This degenerative, systemic disease often manifests itself in pain radiating to the front of the thigh, to the buttock.
• Rheumatism. It would seem that rheumatic damage does not affect the muscle tissue of the thigh at all, but anatomically many remote zones are interconnected due to the ligamentous apparatus and the nervous system. In addition to the characteristic joint pain, rheumatism can also be clinically manifested in pain in the thigh area, in the muscles.

Pain in the calf muscle

The muscles of the lower back of the leg (calf) consist of the gastrocnemius, biceps, and soleus muscles. The gastrocnemius is located closer to the surface, the soleus is much deeper, but they both perform the same tasks - they provide the ability to move the ankle joint, help control balance, and provide cushioning in motion.

The blood supply to the gastrocnemius muscle is provided by a system of arteries starting in the popliteal region, and the muscle also contains many nerve endings extending from the tibial nerve. Such a rich supply of muscle tissue, on the one hand, helps it perform its functions, on the other hand, it makes the back of the leg vulnerable to factors that provoke pain in the gastrocnemius muscle.

Causes that cause pain in the musculus gastrocnemius – the calf muscle:

• Chronic venous insufficiency, stagnation of blood flow in the sinuses of the muscle tissue of the lower leg. The causes may be due to a violation of the pump function of the veins of the lower leg (phlebopathy), as well as valvular insufficiency of the deep veins (thrombosis, varicose veins). Severe pain in the calf muscle is also provoked by ischemia of the vessel walls due to excess blood flow with thinned venous walls. The pain is dull, bursting in the calves, subsides with rest, change of position, when raising the legs up. Chronic venous insufficiency is accompanied by swelling of the lower leg, foot, which increases pain in the calves of the legs and even provokes cramps.
• Acute venous insufficiency caused by deep vein thrombosis. Thrombosis localized in the shin is accompanied by severe bursting pain in the calves of the legs, the pain subsides when the legs are in a vertical position (blood outflow). The pain occurs exactly where the thrombus is located, the severity and intensity of the pain symptom depend on how widespread the thrombosis is, how many veins it affects.
• Chronic arterial insufficiency or inflammatory occlusion (blockage) of arteries of atherosclerotic etiology. The calf muscles experience a lack of blood supply, and therefore, oxygen. As a result, lactate - lactic acid - accumulates in muscle tissue, a burning sensation, severe pain and cramps develop. Also, arterial insufficiency often leads to intermittent claudication, numbness, peeling, keratosis and necrosis of the skin of the feet.
• Acute arterial insufficiency is a direct occlusion of an artery by a thrombus or embolus, causing limb ischemia. The pain does not subside even at rest, it can intensify without apparent cause. As a result, there is loss of sensitivity in the leg, paralysis of the gastrocnemius muscle, contracture.
• Osteochondrosis of the lumbosacral spine, sciatica, lumbago, and nerve entrapment are some of the most common causes of pain in the calf muscle. The pain is radiating due to compression of nerve endings. As a consequence, there is a potential threat of muscle dystrophy with the formation of fibrous growths. The pain can be treated with massage, heat, and rubbing.
• Neuritis nervus tibialis – inflammation of the nerve of the sacral plexus (tibial nerve). The pain is paroxysmal, spreading along the nerve pathway.
• Peripheral diabetic polyneuropathy, less often neuropathy is caused by intoxication (poisons, ethyl alcohol). The pain develops at night, in a state of rest, is localized in the calves of the legs, in the arms, accompanied by senesthopathy, numbness, muscle weakness. With damage to the vegetative nerve endings, pain in the calves of the legs can increase, tissue necrosis and trophic ulcers develop.
• Osteoarthritis of the knee joint, which is accompanied by characteristic pain in the calf muscles. The pain increases with movement, walking, in a static long-term position, when climbing stairs. Inflammation develops quickly and leads to stiffness of the joint and the entire leg. The calf muscle is very tense, dense and hard when palpated.
• Polymyositis, dermatomyositis - an inflammatory autoimmune process, the result of which is excruciating, persistent pain in the calves of the legs. The legs may swell, and when palpating the swollen limbs, the pain intensifies, then the muscle tissue thickens, transforming into fibrous tissue.
• Osteomyelitis, accompanied by very severe pain in both bone tissue and muscles, including the calf muscles.
• Fibromyalgia is a systemic disease of unclear etiology, for which diagnostic criteria have been defined - 18 trigger points, including the calf area. In the area of pain concentration, a dense nodule can be felt, the leg muscles often weaken, the person describes the sensation as "wooden legs".
• Cramps, which are typical for the calf muscles. A spasm can develop suddenly, without objective reasons, but a cramp can also be a consequence of a certain pathology or a provoking factor (hypothermia, physical overload). Cramps differ from metabolic cramps, which develop due to a deficiency of microelements or a violation of the water-salt balance. Factors that provoke cramping, spontaneous pain in the calf muscle, cramps, can be myodystrophy, hypothyroidism, uremia, drug intoxication.
• Pain in the calves of the legs can be a complication after infectious inflammatory pathologies, that is, caused by myositis. It should be noted that myositis can also be an independent disease, when inflammation of muscle tissue develops due to parasitic invasion, injury or overload of the calf muscle.

Muscle pain after exercise

Post-workout pain is typical for beginners, experienced athletes, bodybuilders do not allow their body to experience additional discomfort. Although in any sport there is an unspoken rule "no pain - no gain", which means without pain there is no growth, in this case muscle mass, musculature. However, almost all experts rephrase this expression in this way - "no head on the shoulders, there will be pain without growth" and this is true.

Some stiffness, muscle soreness and, accordingly, muscle pain after training is acceptable even for those who have been involved in sports for a long time, especially after intense loads. The pain is a consequence of microtraumas of muscle tissue, fascia and, as a rule, subsides after 2-3 days. This is considered an acceptable symptom that is not pathological.

The reasons that provoke “normal” muscle pain after training are not fully clarified, but the following versions exist:

• Microdamage to muscle fibers, which is accompanied by an increased level of cellular elements in the blood. Microtraumas regenerate within 1-3 days.
• Accumulation of lactic acid in muscle tissue. This hypothesis was previously extremely popular, but recent studies have proven that metabolic disorders in the form of lactic acidosis persist in muscles for no more than half an hour, and therefore simply cannot provoke delayed pain a day or more later. Lactic acidosis can provoke a burning sensation, but not DOP – delayed onset muscle pain.
• The theory of an inflammatory process in muscle tissue that develops as a result of micro-damage to fibers. According to this version, micro-traumas provoke the accumulation of exudate, irritation of nerve endings and pain.
• The theory of muscle fiber ischemia. Indeed, intense training can disrupt the blood supply to muscles, but it is unlikely that it can provoke tissue ischemia.
• The real reason that contributes to pain symptoms after training is a real injury - stretching, rupture of tendons, ligaments. If muscle pain persists for more than three days, there are hematomas, swelling, tumors, shooting pain, hyperemia of the skin, it is necessary not only to stop torturing the body with loads, but also to urgently seek medical help.

What do you need to know and do to keep post-workout pain within normal limits?

• It is essential to perform warm-up exercises.
• Create an exercise program with the help of a specialist based on anthropometric data and health status.
• Exercise in a mode of gradually increasing the load, from a minimum to an ideal maximum.
• Be sure to take breaks and drink fluids.
• Eat well.
• Use relaxing massage techniques.

Muscle pain when walking

Muscle pain that intensifies when walking can be a sign of many chronic or acute diseases, the most common of which are the following:

• Muscle pain when walking is a direct indication of developing obliterating atherosclerosis. This disease is characterized not only by pain when moving, but also by fatigue, constant muscle weakness, and if left untreated, signs of vasogenic intermittent claudication appear. Most often, men suffer from obliterating atherosclerosis; in women, this condition is diagnosed less often. Those who maintain bad habits - smoking, alcohol abuse - develop atherosclerosis twice as often. Insufficient blood supply to the legs, stenosis and blockage (occlusion) of arteries and veins lead to a complete blockage of blood flow. The disease progresses rapidly, the pain is localized in the buttock with damage to the iliac aorta, in the thigh with blockage of the femoral artery, in the foot with damage to the popliteal artery, in the calf muscles with diffuse occlusion of the deep veins and main arteries. Also, symptoms of obliterating atherosclerosis can be paresthesia, numbness, pain at rest.
• Osteochondrosis of the lumbosacral spine, accompanied by radiculopathy. Inflammation of the nerve roots, provoked by compression, causes severe muscle pain when walking.
• Inflammation of the sciatic nerve, sciatica. The inflammatory process in the largest nerve of the body can be caused by diabetes, arthritis, trauma, degenerative changes in the intervertebral disc, excessive load on the spine. The pain increases not only when walking, but also with reflex movements - coughing, sneezing, laughing.
• Damage to the femoral nerve, lumbago. The pain is usually sharp, shooting, localized in the front of the thigh, less often in the groin or inside the shin. The pain increases with movement, walking, and sitting.
• Gonarthrosis of the knee joint, often a secondary disease. Pain when walking increases when going up, also the pain symptom increases when bending the knees (squatting, kneeling).
• Developmental anomalies or injuries of the forefoot - osteoarthritis of the metatarsophalangeal joint of the big toe. Pain when walking is felt in the bone tissue, as well as in the muscles, the symptom may subside at rest or in a horizontal position of the leg.
• Polyneuropathy, when the pain is felt as burning, pulling, localized in the feet. The pain may be accompanied by cramps, especially after walking.

Muscle and joint pain

Muscle and joint pain is musculoskeletal pain or dorsalgia (back pain), thoracic pain (chest pain), cervicalgia (neck pain) and other "algias". It should be noted that the terminology defining muscle and joint pain periodically changes in proportion to the emergence of new research results.

In ICD-10, diseases of the musculoskeletal system are classified under Class XIII, and there is also a section describing non-specific musculoskeletal pain as

An unpleasant, emotional-sensory sensation. According to the classifier, this sensation is caused by a real or potentially developing injury, damage to muscle or bone tissue.

The nature and types of pain symptoms related to muscles and joints:

• Nooceptive (autonomous pain that is not subject to conscious control).
• Neuropathic pain.
• Psychogenic pain.

Obviously, the most real in diagnostic terms is nooceptive pain, which is explained by the stimulation of nociceptors located in tissues (visceral and somatic). The most "ephemeral" is psychogenic pain in muscles and joints, since it has no real physical basis.

What causes non-specific musculoskeletal pain?

• Microdestruction, damage to muscles, fascia, tendons, ligaments, joints, bone tissue and periosteum, as well as the intervertebral disc. Damage associated with everyday activities, sports, etc. is not caused by dysfunctions of organs and systems.
• Spastic muscle tension, spasm as a pathophysiological method of protection from destruction.
• Reversible dysfunctions – dislocations, sprains, ruptures as a result of industrial or household activities.
• Age-related degenerative processes

In the diagnostic sense, non-specific pain in muscles and joints is a difficult task, since it is necessary to differentiate a somatically localized symptom, reflected (visceral), projected (neuropathic) and other types of clinical manifestations. In addition, pain in muscles and joints is often diagnosed as myofascial syndrome - MBS, which is a type of somatogenic pain symptoms, the source of which is considered to be not so much the joints, but skeletal muscle tissue and adjacent fascia.

Back muscle pain

The general name for back pain is dorsalgia, but back muscle pain is not always associated with diseases of the musculoskeletal system, it is often caused by MBS - myofascial pain syndrome, that is, reflex impulses coming from damaged, degenerative or inflamed discs, joints or ligaments. The back muscles seem to "dress" the affected area of the body in a corset, immobilizing and preserving it. The causes that can cause spinal pain are varied, but the most common are the following:

• Osteochondrosis, most often in the lumbosacral region, but with myofascial syndrome, pain in the back muscles can be a reflection of degenerative morphological changes in any area of the spinal column.
• Deformation of the thoracic spine is kyphosis or, more simply, pathological stoop. Kyphosis in turn can be provoked by a person's long-term antiphysiological posture or rickets, as well as Scheuermann-Mau disease, heredity.
• Constant static tension and immobilization of the back muscles are professional costs of many office professions.
• Flat feet.
• Lordosis.
• A combination of severe hypothermia and physical overload on the back muscles.
• Scoliosis.
• Weak muscular corset, atony of the back muscles. Any physical activity, even minimal, can cause pain in the back muscles.
• Gynecological diseases of the pelvic organs often radiate to the lower back or sacrum.
• Structural anatomical skeletal abnormality – significant difference in leg length, deformed pelvic bones. These structural disorders can be either congenital or acquired.
• Internal diseases of organs that form a static forced posture. As a result, constant compensatory tension and muscle tissue spasm develop.

Back pain at the level of muscle tissue can be localized both in the shoulder-scapular area, neck, and in the lumbar region, which is most common. In fact, the pain symptom spreads along the entire spinal column and can radiate, so it is very important to determine the beginning of the impulse transmission in order to eliminate the factor that provokes pain. When diagnosing muscle pain in the back, doctors exclude compression radicular syndrome, vertebrogenic and spinal pathology. The following clinical signs are characteristic of MBS - myofascial pain syndrome:

• Direct relationship between pain symptoms and physical, and less often mental, stress.
• Pain may be associated with severe hypothermia.
• The pain is caused by postural tension in primary diseases accompanied by dizziness.
• In the muscles, the doctor can palpate painful nodes and cords.
• There is no muscle atrophy or hypotrophy.
• The pain is reflected from the tense area in the muscles to distant areas.
• The reflected pain symptom increases with pressure on trigger points. Symptom reproducibility is considered one of the main clinical signs of MBS.
• The pain can subside with a specific technique, the doctor’s impact on the tonic (tense) muscle.

Pain in the muscles of the lower back

Pain in the muscle tissue of the lumbar spine is most often associated with overexertion, overload. Moreover, the load can be both physical, dynamic, and static (sedentary work, monotonous static posture).

In addition, back muscle pain often occurs due to scoliosis, osteochondrosis or displacement of intervertebral discs, hernia. Less often, the pain symptom is provoked by vitamin deficiency (B vitamins) and pathologies of internal organs located in the pelvic area, such pain is either spastic in nature, or it is aching, pulling and does not respond to therapy with muscle relaxants, distracting (cooling, warming up) procedures.

In medical classification, pain in the lumbar muscles is divided into primary and secondary syndromes:

1. Primary pain in the lumbar region or morphofunctional pain. This is the most common type of pain symptom caused by degenerative-dystrophic pathologies of the spinal column:
   • Osteoarthritis (spondyloarthrosis), when the facet intervertebral joints and synovial joints are affected.
   • Osteochondrosis (dorsalgia) is the degeneration of bone and cartilage tissue, which results in spondylosis.
   • Instability of the spine is a typical condition of elderly people. Muscle pain increases with the slightest physical exertion. In addition, instability can be caused by obesity, excess weight or, on the contrary, its deficiency (anorexia).
2. Secondary pain symptom:
   • Metabolic disorder leading to osteomalacia, osteoporosis.
   • Scoliosis, other diseases associated with curvature of the spine or growth.
   • Bechterew's disease.
   • Reiter's syndrome.
   • Rheumatoid arthritis.
   • Vertebral fracture.
   • Oncoprocess.
   • A stroke complicated by a serious change in blood circulation in the spinal cord.
   • Infectious pathologies – epidural abscess, tuberculosis, brucellosis.
   • Reflected pain as one of the symptoms of diseases of the pelvic organs, nephropathologies (renal colic), venereal diseases.

It should be noted that a very common cause of pain in the lumbar muscles is lumbago. This disease is still considered a subject of heated debate and does not have a clear classification in terms of symptoms and diagnostic methods.

Modern doctors use a version that describes lumbago as an extensive lesion of muscle and nerve tissue, as well as joints of the lumbosacral spine. Lumbago is popularly called lumbago, since this is the most accurate description of pain, but lumbodynia can also manifest itself in the form of a subacute course. Pain in the muscles of the lower back develops suddenly as a result of a sharp turn, bend, or static tension. Some patients claim that lumbago "caught" them as a result of a draft, hypothermia. The pain symptom is diffused throughout the lower back, symmetrical, rarely radiating up to the hips or down to the buttocks. In a horizontal position, the pain may subside, but recur when coughing or sneezing. The muscles of the lower back are very tense, but with timely adequate treatment they quickly relax. As a rule, treatment lasts no more than 2 weeks, more often the main symptoms are neutralized after 3-5 days.

How to differentiate muscular lumbar pain from other types of pain symptoms?

The main distinguishing feature that distinguishes signals of spasmodic long muscles of the lower back is a clear, constant localization. The pain in the muscles is not able to move, radiate to the leg or groin, but it provokes a limitation of mobility.

Pain in the abdominal muscles

A painful symptom in the abdominal area is called abdominalgia, but it does not always relate to muscle tissue, as it is caused by diseases of the internal organs of the digestive system and the pelvis.

Often, not only patients, but also diagnostic specialists find it difficult to quickly determine the nature of the abdominal pain symptom, so skillfully it is “masked”, therefore it is very important to differentiate visceral and pseudo-visceral pain, which have different root causes.

The abdominal muscle tissue consists of 4 main muscles:

1. Obliquus abdominis externus – external oblique muscle.
2. Obliquus abdominis internus – internal oblique muscle.
3. Transverses abdominis – straight muscle.
4. Rectus abdominis – pyramidal muscle.

In all these muscles, pseudovisceral pain with a focus of neurodystrophic pathology can develop in three types:

1. Thoracic abdominalgia.
2. Lumbar-thoracic abdominalgia.
3. Lumbar abdominalgia.

If the front of the abdomen hurts, then we can talk about the anterior abdominal wall syndrome, when the pain is closely related to movements and is not caused by a food factor or a violation of the digestion process. The cause of such pain can be an injury, muscle overstretching due to training, scar tissue after surgery, and pain in the abdominal muscles can be reflected, that is, a response to pathologies of internal organs localized in this area. In addition, pain with very similar clinical manifestations can be caused by lower lobe pneumonia, coronary insufficiency, rupture of the intervertebral disc in the upper lumbar region, and even acidosis associated with diabetes. For differentiation, muscle and nerve anesthesia is used; if the pain symptom subsides, this indicates myofascial syndrome; if the pain remains, somatic pathology and organ damage should be determined.

Syndrome of the oblique abdominal muscles, less often - rectus abdominis. This complex of abnormal tone of the abdominal muscles is visually defined as a "frog belly" or "egg-shaped belly" depending on which muscles are in hypotonia. If hypotonia affects both the rectus and oblique muscles, then the person's belly is symmetrically swollen, if hypotonia affects only Transverses abdominis - the rectus muscle with shortening, contraction of the oblique, then the walls of the abdominal zone protrude forward in the form of a kind of "egg". The egg-shaped belly is accompanied by pain in the groin, in the lower thoracic region. The syndrome is practically not amenable to drug treatment until the tone of the rectus muscle is normalized, the oblique muscles return to normal later, automatically. The syndrome provokes an exacerbation of lordosis, the pelvis is displaced forward, kyphosis of the lower part of the sternum develops. Abnormal tone of the rectus or oblique muscle can be caused by both a physiological factor - pregnancy, and other processes - obesity, postoperative condition (sutures, scars). In addition, abdominal pain in the muscles of this kind is provoked by curvature of the pelvis, divergence of the pubic structures (pubic symphysis). The syndrome requires complex treatment, since advanced undiagnosed forms, a long period of overstrain of the abdominal muscles can pathologically affect the peroneal muscles, and therefore the hip joints. Thus, the main danger of the oblique or rectus muscle syndrome is coxarthrosis.

In addition, abdominalgia can develop as reflected pain, as a secondary symptom in diseases of the spine:

1. Quadratus muscle syndrome (lumbar muscles). Abdominal pain is the irradiation of a pain signal from constant aching pain in the upper lumbar region.
2. Multifidus muscle syndrome. This is a reflex pain that occurs as a result of irritation of the lumbar intervertebral discs. Chronic unilateral muscle hypertonicity of the multifidus muscle develops, pain in the iliac region, radiating to the right or left in the abdomen, groin, and thigh.

Gastrointestinal, somatovisceral, cardiac clinical manifestations in the abdominal area are also often classified as abdominalgia, however, these pains are only one of many consequences of the main symptoms of the disease, therefore, they cannot be described as myalgia.

Pain in arm muscles

Pain in the arm, in the upper limbs has its own medical terminology definition - brachialgia. Myalgia is a more specific designation of such a type of symptomatology as pain in the arm muscles, most often it is associated with overexertion, physical exertion. Pathogenetically, the pain symptom is caused by the vulnerability of cell membranes, swelling of muscle fibers, as well as their inflammation. Since the arm consists of muscle tissue of the shoulder, forearm and hand, all these zones can hurt or they suffer alternately. The main reasons that provoke pain in the arm muscles are:

• Physical overexertion, including after training (contracture).
• Metabolic disorders, diabetes mellitus (glycogenosis), amyloidosis.
• Hand injury.
• Myositis, polymyositis.
• Viral and parasitic infections - influenza, brucellosis, toxoplasma, cysticercosis.
• Intoxications, medicinal, alcoholic, chemical.
• Epidemic myalgia (Coxsackie virus).
• Rheumatism, especially in the elderly, when polymyalgia develops, starting from the neck muscles, descending through the shoulder muscles into the arm.
• Pathologies of the peripheral nervous system (neuralgia).
• Osteomyelitis.
• Strain or rupture of the biceps tendon.
• Convulsive syndrome.
• Fibrositis, fibromyalgia.

Also, arm muscles can hurt due to pathological syndromes:

• Musculus scalenus syndrome – anterior scalene muscle (scalenus syndrome). The pain intensifies at night, as well as when moving the arm backward, to the side, when tilting the head and even when inhaling. Muscle tone decreases, cyanosis of the skin, swelling, paresthesia in the hand, sweating of the hands develop. A specific symptom is a pain symptom in the little finger and ring finger. The causes of scalenus syndrome are most often associated with professional activity, when a person constantly carries heavy loads on the shoulders, performs movements associated with jerks of the head, neck (athletes). The syndrome is also provoked by trauma, pleurisy, tuberculosis, tumor processes and may have a genetic predisposition. Pathogenetically, the syndrome develops as a result of reflex hypertonicity of the anterior scalene muscle due to displacement and irritation of the nerve roots in the cervical area.
• Paget-Schroetter syndrome (deep vein thrombosis of the shoulder girdle), "effort" thrombosis. Thrombosis develops in the subclavian or axillary vein due to excessive physical exertion (sports, professional activity). Most often, pain in the arm muscles caused by "effort" thrombosis is diagnosed in young men involved in active or strength sports. Clinical manifestations are specific: the arm (hand) swells, turns red, the veins significantly enlarge, the skin of the forearm becomes pale, cyanosis develops. As a rule, the leading "working" hand suffers. The syndrome is dangerous due to the potential risk of pulmonary embolism.
• Hyperabduction syndrome (of the pectoralis minor) is not directly related to the arm muscles, but when the limb (shoulder) is strongly abducted back into the forearm, a person feels a pulling pain, then tingling and numbness. This is due to compression of the nerve bundle from the tendon of the pectoralis minor.

Shoulder muscle pain

The shoulder girdle is connected with the neck, upper limbs and all this is a rather complex system, where all elements must work harmoniously and in concert. Any pathological shift in the structural component, for example, such as pain in the shoulder muscles, can disrupt human motor activity. Among all complaints of muscle pain, pain in the shoulder muscles is considered the most typical, these are the symptoms that are not only presented by patients, but also diagnosed by doctors in 30-35% of cases of regional myalgia.

Pain in the upper limbs is generally called brachialgia, however, a pain symptom affecting muscle tissue is, first of all, a direct indication of myofascial syndrome, and only then a possible sign of neurological or somatic diseases, in which painful sensations are reflected.

Shoulder muscle pain caused by a myofascial factor has its own diagnostic points of localization of signs, these are the so-called trigger points in specific muscles of the shoulder girdle:

• In the supraspinatus muscle.
• In the scalene muscles.
• In the coracobrachialis muscle.
• In the infraspinatus.
• In the biceps.
• In the three-headed one.
• In the shoulder

The following factors may be the cause of pain in the shoulder girdle:

• Static overstrain (monotonous posture).
• Hypothermia, combined with a viral infection, is a particularly common factor.
• Immobilization of the shoulder girdle.
• Compression of the neck muscles.
• Neck muscle strain.
• Injuries.
• Psychogenic factor.

How to determine which muscle is damaged?

1. If the hypertonicity concerns the small teres brachialis muscle or the infraspinatus muscle, the pain is localized in the upper forearm. The pain is of a pulling nature, less often – shooting, however, despite its lack of expression, the pain symptom can prevent a person from performing simple everyday activities, for example, combing their hair 2.
2. The subscapularis muscle is hypertonic or, on the contrary, atonic, manifests itself as pain in the shoulder. A person cannot move his arm back, get anything out of his back pocket, or adjust his clothes on his back.

In addition, no matter which shoulder muscle is subjected to myotonic damage, a person finds it difficult to raise his hand to the opposite shoulder, to put it on the shoulder, so intense is the tension of muscle tissue. The main diagnostic criterion for myofascial shoulder pain is the patient's precise indication of the point of pain. The symptom is often aching, diffuse in nature, but in movement it seems to "gather" into one point, which is the trigger.

Pain in the muscles of the forearm

Pain in the forearm muscles can be caused by neurodystrophic, infectious diseases, inflammatory processes in the ligaments and tendons, as well as factors related only to muscle tissue.

Causes that provoke pain in the forearm muscles:

• Traumatic muscle injury, bruises. In addition to pain, injuries may be accompanied by hematomas, dysfunction of the limb (hand). In case of serious injuries, muscle tissue is damaged, subfacial hematomas, edemas (subfascial hypertensive syndrome), pain in the muscles of the forearm develop.
• Overstrain after physical exertion, training. Muscle overload is characterized by the definition of localized pain symptoms, TT - trigger points, which are clearly palpated in the forearm area even at rest.
• An inflammatory process in the muscle tissue of the forearm is myositis, which is caused by an infection, parasitic invasion, hypothermia or a professional factor (systematic static tension syndrome, for example, in dancers, waiters, etc.).
• Scalenus syndrome, also called anterior scalene syndrome. This condition is characterized by pain caused by compression of nerve endings. The pain symptom starts in the shoulder and spreads to the forearm, hand (fingers).

Round pronator syndrome caused by mechanical trauma, neuropathies, vascular pathology, infectious disease. The syndrome develops against the background of pinching, compression of the nerve between the heads of the shortest and densest muscles - pronators. The condition most often occurs due to prolonged overstrain of the pronator muscles and the extensor muscle of the fingers. This is typical for violinists, pianists, guitarists, as well as some sports and even medical specializations (dentistry). In addition, pronator syndrome is often called honeymoon paralysis - honeymoon syndrome, which has a rather romantic explanation: during the first mating season, the head of one of the lovers is on the forearm of the other for a long time, which provokes a muscle spasm, "paralysis" of the radial nerve of the forearm.

Pain in the neck muscles

Pain in the neck is called cervicalgia, which among all pain symptoms associated with the back, takes about 28-30% of cases. Pain symptom in the neck area is divided by etiology - vertebrogenic and muscular-tonic, non-vertebrogenic.

Pain in the neck muscles is of the myotonic type and can be caused by the following reasons:

• A combination of acute respiratory viral infection and hypothermia.
• An uncomfortable, non-physiological position of the head over a long period of time (during sleep).
• Excessive stress during sports (training).
• A static pose associated with a profession.
• Injuries, bruises.

Cervicalgia may be combined with pain in the head - cervicocranialgia or with pain in the shoulders, arms (hand) - cervicobrachialgia. Unlike vertebrogenic pain, acute myotonic manifestations rarely last more than 10 days, they quickly turn into chronic pain and gradually subside within a month, even without treatment (compensatory, adaptive mechanism of muscle tissue).

Pain in the neck muscles is a typical, “classic” symptom of an office worker, which, if desired, can be identified in 80% of all employees who are forced to work sitting at a desk.

Symptoms of neck pain:

• Shooting pains.
• Throbbing pain.
• Pain that increases with coughing and sneezing.
• Pain when turning or tilting the head.
• Severe pain in the back of the head.
• Headache (TTH – tension headache).
• Signs of dizziness.
• Impaired blood supply, compression disorders of the vertebral artery.
• Numbness in the fingertips.
• Tinnitus not associated with colds or other ENT diseases.

Myotonic symptoms are directly caused by hypertonicity and the following types of syndromes:

• Anterior scalene syndrome, where the nerve bundle is subjected to pressure from muscles and an additional cervical rib
• Pectoralis minor syndrome, where the nerve endings between the pectoralis minor muscle and the coracoid process of the scapula are compressed. Pain in the muscles of the neck is secondary, but nevertheless, even in a reflected form, it can provoke discomfort
• Shoulder-scapular syndrome as a type of MBS - myofascial pain syndrome caused by osteochondrosis. "Frozen" shoulder can also provoke neck pain, limiting not only joint movements, but also head movements.
• Trapezius muscle hypertonicity syndrome caused by physical overload, constant carrying of heavy objects on the back (backpacks)

In addition, spondylitis can also be the cause of muscle pain in the neck area,

Oncologic processes, psychogenic factors – psycho-emotional stress.

Chest muscle pain

Chest muscle pain can be caused by both pathology of internal organs (heart, lungs, stomach, duodenum, etc.), and diseases of the spinal column and peripheral nervous system, as well as myofascial syndrome. The main characteristics of non-visceral chest muscle pain associated with MFBS, ribs, spine:

• Specific localization of the pain symptom.
• A clear connection between the onset of pain and tension in a certain group of chest muscles (posture, body position).
• The pain is rarely sharp or intense.
• Pain is rarely accompanied by additional symptoms.
• Clear definition of the pain zone using palpation (trigger zones).
• Neutralization of pain with the help of local therapy – rubbing, mustard plasters, physiotherapy procedures, massage.

Myofascial chest muscle pain is always caused by spasm, hypertonicity of injured or inflamed muscle tissue, as well as a noticeable disruption of blood microcirculation. As a rule, MFPS (myofascial pain syndrome) develops in the extensor muscles of the back or in the muscles of the scapula, shoulder and is expressed by local or segmental discomfort. Diagnostic parameters of muscle pain in the chest are TT - trigger points, if palpated, they respond with severe pain, including reflected pain, along the direction of the muscle fibers. Pain in trigger points can be spontaneous or active, latent pain develops with constant impact on the trigger zone.

Causes of myofascial pain syndrome in the chest:

• Muscle strain as a result of physical overload or an antiphysiological body position.
• Hypothermia.
• Congenital anatomical anomalies, most often - asymmetry in the length of the lower limbs, anomalies in the structure of the pelvis and foot.
• Metabolic disorder.
• Violation of the rules of healthy eating (obesity or anorexia).
• Psycho-emotional factor – stress, depression, phobias, and so on.

Localization of chest pain in MFBS:

• Anterior chest area – damage to the pectoralis minor and major muscles, scalene muscle, subclavian, mammillary, and sternal muscles.
• The upper area of the back of the chest is the trapezius and levator scapulae muscles.
• The middle zone of the back surface of the chest - rhomboid, latissimus dorsi, as well as the posterior and anterior serratus muscles, trapezius muscle.
• Lower zone of the back surface of the chest - iliocostalis muscle, posterior inferior serratus muscle

Painful muscle symptom in the chest can be caused by the following syndromes:

• Pectoralis major syndrome. The pain is localized on the anterior surface of the sternum, shoulders and forearms. If the lateral part of the muscle is affected, the pain symptom is located in the mammary gland area. Damage to the parasternal left zone of the muscle is often similar to the symptoms of ischemic heart disease.
• Pectoralis minor syndrome. The pain is also similar to the clinical manifestations of coronary heart disease, is reflected in the subclavian zone, in the arm, and is often localized on the anterior surface of the chest.
• Chest muscle syndrome. The pain is characterized as "retrosternal", is not prone to increase in motion, and is similar in symptoms to manifestations of coronary heart disease.
• Serratus anterior syndrome. The pain is located in the front of the sternum, closer to the side and lower angle of the scapula, can be reflected in the mammary gland and intensifies with deep inhalation.
• Scalenus syndrome (scalene muscles). The pain is localized in the area of the mammary glands, along the shoulder blade and between the shoulder blades. The most specific symptom is pain spreading along the shoulder to the radial zone of the forearm and fingers, but chest symptoms are the beginning of the development of scalene muscle syndrome.
• Trapezius syndrome is the most common tension syndrome between the shoulder blades, in the posterior mid-chest (back).
• Levator scapulae syndrome most often develops from the neck (stiffness), then the tension moves down as referred pain in the upper chest

The myofascial nature of chest pain, on the one hand, significantly complicates the diagnosis of diseases due to the lack of specificity of symptoms, on the other hand, it allows one to quite accurately determine the area of the inflamed tense muscle thanks to the TT scheme - trigger points.

Gluteal muscle pain

The gluteal muscle consists of three components - the large, medium and small muscles. Pain in the gluteal muscle can be localized directly in the buttocks or be reflected in diseases of the spinal column, hip joints, neuropathies.

Causes of pain in the gluteal muscles:

1. Overstrain of muscles, most often of the middle and small muscles. The nature of the pain is pulling, reflected in the hip or lower back.
2. Deformation of certain areas of the spine.
3. Psycho-emotional stress.
4. Myalgia (primary) of traumatic, infectious etiology.
5. Rarely – fibromyalgia.
6. Secondary myalgia, which develops as a consequence of neurological diseases.
7. Myositis.
8. Polymyositis.

In addition, pain in the gluteal muscle is provoked by typical myofascial syndromes:

• Middle gluteal muscle syndrome. Pain develops due to overload, hypertonicity due to static posture, body position, and also due to deformation of the spinal column. The symptom intensifies during movement, especially when walking, in addition, pain in the buttock can also occur when turning the hips, with a certain position of the feet (on the outer edge), with prolonged standing. Typically, pain intensifies when crossing the legs, discomfort appears both in the buttock and in the sacrum, and can spread to the back of the thigh.
• Gluteus minimus syndrome. Pain develops with certain movements: when a person gets up from a sitting position, when one leg is thrown over the other.
• Sciatic nerve neuropathy or piriformis syndrome develops as a reflex response to spinal injury in the lumbosacral region. The pain is aching, dull, localized in the sacrum, in the buttock (on the side of the vertebral displacement), intensifies with movement (walking, turning, squatting, bending) and subsides in a horizontal position.

Sore throat muscles

The muscles of the throat (laryngis) are striated muscle fibers that perform 2 main functions in the larynx:

1. Movement and activity of all elements of the throat (larynx) 2.
2. Movement of certain cartilages and ligaments of the larynx

Most often, pain in the throat muscles is caused by professional overexertion, which is so typical for educators, teachers, artists, singers, announcers and all those who strain their vocal apparatus every day. The most common symptom of professional myalgia of the larynx is considered to be functional dysphonia, when hypertonia (less often hypotonia) develops in the throat muscles, the strength and timbre of the voice changes.

Dysphonia can have the following forms:

• Hyperkinetic.
• Hypokinetic.
• Mixed.
• Spastic.
• Phonasthenia.

Hypotonicity of muscle tissue develops against the background of overstrain of the vocal cords, less often after acute respiratory viral infections, tonsillitis, hormonal dysfunctions, tracheitis, more often due to psychoemotional factors, stress. During an ENT examination, no signs of inflammation of the mucous membrane are detected, just as signs of other throat pathologies are not detected.

Hypertonicity of the throat muscles can be caused by intense strain on the vocal cords - screaming, loud speech, singing, etc. Pain in the throat muscles is accompanied by pain in the abdominal muscles, which is caused by physical strain, increased movements of the diaphragm. In addition, the neck muscles may hurt, coughing may appear, and the vocal cords may close tightly.

Spastic tension of the throat muscles is associated with neurodynamic load on the internal, external and respiratory muscles of the larynx. This condition is typical for stressful situations, psycho-emotional trauma.

Sore throat muscles can also develop due to excessive strength training, after training, and as a symptom of "extended head", which is most typical for certain sports, such as tennis.

Shoulder blade muscle pain

Pain in the muscles of the scapula most often provokes scapulocorticoid syndrome (SCS), which is expressed in a feeling of heaviness, aching discomfort in the scapulohumeral zone (closer to the upper angle of the scapula). The pain can radiate to the shoulder, to the side of the sternum, the symptom develops unnoticed and intensifies with static or dynamic intense loads on the muscular apparatus of the shoulder, chest. Pain in the muscles of the scapula gradually progresses and spreads to the neck, collarbone area. Differentiation of myalgic pain in the scapulae is helped by their vegetative nature, unlike radicular symptoms, these pains are usually aching, pulling, without shooting. Often the pain intensifies under the influence of the temperature factor (weather conditions). In addition, the localization of myofascial pain does not correlate with the innervation of the roots and peripheral nerve endings.

Causes of Scapulocorticoid syndrome:

• Postural anomalies of the chest.
• Functional hypertonicity of the muscles responsible for fixing the scapula to the sternum (levator muscle).
• Hypothermia.
• Less often – psycho-emotional trauma, stress.

Diagnosis of LRS is not difficult, since trigger points in this area respond with a distinct pain signal when palpated.

In addition, pain in the muscles of the shoulder blade may be a consequence of chronic spasm or paralysis of muscle tissue - acquired winged scapula syndrome. This pathological condition is typical for people involved in sports (rowing, tennis), and can also be caused by trauma, bruising of the shoulder girdle.

Pelvic muscle pain

Pain in the pelvic muscles is not only a clinical manifestation of prostatitis, gynecological diseases, coccygodynia. Modern doctors are familiar with other causes of pain in the pelvic area, in particular with MFBS - myofascial pain syndrome. The main diagnostic criteria for confirming the myofascial nature of symptoms are clear painful signals during palpation of TT - trigger points, located in smooth muscles, including the pelvic muscles.

• Pelvic pain can develop as a result of reflex hyper or hypotonia, muscular-tonic syndrome. The mechanism of development of the syndrome is as follows:
• Pain symptom in the deformed area of the spinal column.
• Reflexive compensatory tension of the pelvic muscles.
• Destruction of muscle tissue.
• Myositis, inflammation of the pelvic muscles.
• Development of a pain symptom, spontaneous or caused by body movement.

The most common types of muscle-tonic syndromes are:

• Syndrome of the piriformis muscle, which is responsible for the rotation and abduction of the hip, tilting the pelvis. The syndrome can be caused by physical exertion, overexertion, training, buttock injuries, including drug abscess. In addition, the causes can be inflammation of the pelvic organs in women, a reflex response to the deformation of the lumbosacral vertebrae. The pain is felt both in the buttocks and in the hip joint area and subsides in a horizontal position or with the legs spread apart. The symptom intensifies in a standing position, when turning the legs, walking, squatting, throwing one leg over the other. Often the symptoms are similar to the clinic of sciatic nerve inflammation, often the syndrome of the piriformis muscle is really combined with this pathology.
• Iliopsoas syndrome, which develops against the background of deformation of the thoracic-lumbar vertebrae. The pain is felt in a standing position, localized closer to the hips, in a sitting position the rotation of the leg, hip inward is limited. If the patient is lying down, the pain subsides with the legs bent at the knees.
• Gluteus medius and small gluteal muscle syndrome. The small gluteal muscle, when overstrained, provokes pain during movement when rising from a lying or sitting position. Gluteus medius syndrome is as common as piriformis syndrome. It manifests itself as pain in the pelvic muscles when walking, in a static position (standing), when turning in a horizontal position or when squatting. The pain intensifies when crossing one leg over the other and can spread along the entire outer surface of the thigh, starting from the buttock.

Pain in facial muscles

Pain in the facial area is called prosopalgia, it is usually associated with neurological pathologies, neuropathy, in particular, the trigeminal nerve. However, pain in the facial muscles, as a rule, is caused by a completely different factor - myofascial pain syndrome, which concerns only muscle tissue. Facial myofascial syndrome is local pain in the head and neck area, with the most common pain sensations in the muscles of the neck, facial and chewing muscles. In addition, pain in the facial muscles can be localized in the temples, lower jaw, near the ear, in the back of the head, in the frontal or parietal region.

The pathogenetic mechanism of pain development in the facial muscles is identical to the process of pain development in other skeletal muscles: the onset of pain is the result of overexertion, development is chronic hypertonicity of the muscle, the result is spastic pain (cramps). An example is painful sensations in the jaw when yawning or with the mouth wide open. Constant spasms of the facial muscles can be dangerous in terms of secondary vascular and inflammatory disorders, which is the cause of a vicious circle - primary myalgia provokes secondary pain, which in turn activates myalgic symptoms.

MFPS (myofascial pain syndrome) of the face is determined by trigger points of reflected or localized pain. Typical locations of triggers are the temples, masseter and pterygoid muscles. Less often, TP (trigger points) can be palpated in the area of facial muscles; such pain can develop as a result of hypertonicity of the sternocleidomastoid or trapezius muscle.

Causes that provoke pain in the facial muscles:

• Costen's syndrome - anomalies of the temporomandibular joint, both congenital and traumatic.
• Reflected pain symptom as a consequence of hypertonicity of the muscles of the neck and shoulder girdle.
• Bruxism.
• Psycho-emotional stress.

Pain in the chewing muscle

Pain in the musculus masseter - the chewing muscle, can be associated with tension headaches, when the spastic state of the muscles provokes a pain symptom in the temples, forehead, back of the head, ear and jaw. This syndrome refers to TMJ - diseases of the temporomandibular joint, usually to Costen's syndrome - dysfunction of the joint. The cause may be of a psychoemotional nature, and is also associated with elementary overstrain, muscle hypertonicity, in addition, pain in the chewing muscle sometimes occurs with endocrine pathologies, with unsuccessful prosthetics. The mechanism of pain development is as follows:

• Hypertonicity of any type of masticatory muscle - temporal, masseter, medial pterygoid, lateral pterygoid provokes asymmetry of muscle function, in addition, overexertion can cause injury to the nerve endings of the joint, disruption of the hemodynamics of muscle tissue.
• As a consequence of hypertonicity, muscular-articular disorders and arthrosis develop.
• A one-sided pain symptom appears in the ear and temple area, which radiates to the face and head, especially during chewing.
• The pain is accompanied by clicking of the temporomandibular joint.
• Mouth movements are limited, it is difficult for the person to speak (articulate), sometimes even smile.
• The movement of the lower jaw is blocked.
• Visible facial asymmetry develops.
• The pain may be accompanied by bruxism and dental symptoms – toothache, paresthesia, tooth wear.

Pain in the abdominal muscles

In an effort to make the stomach pumped up, to see the coveted "cubes" a person can sometimes overdo it and feel pain in the abdominal muscles. What is commonly called the press is nothing more than the rectus abdominis muscle, it is the one that creates the appearance of the abdominal area, it is the one that many try to "put in order" with the help of working out and training. Less often, pain in the press is localized in the external oblique muscle, which is more stretchable and not so dense in structure.

Abdominal muscle pain is most often associated with post-workout pain, which is also called delayed pain, delayed pain, muscle soreness. The cause of the pain symptom is usually called lactate - lactic acid, although according to the latest data, it has little effect on discomfort in the abdominal area, since it accumulates and dissolves literally within half an hour. Most likely, the cause of pain is microtrauma of muscle fibers, which in untrained people do not have a high level of elasticity and extensibility. In addition, muscle fibers contain short and long myofibrils - cylindrical organelles, elements of striated muscles. Short myofibrils are very vulnerable and are injured and torn under intense loads, which provokes transient pain in the abdominal muscles. If you train in a measured manner, with good warm-up exercises, then the pain symptom may not appear or be almost imperceptible. With regular exercise and strengthening of the abs, the length of the myofibrils is equalized, muscle fibers become dense without losing elasticity.

Pain in the groin muscles

The term "groin area" is usually used when talking about the area of articulation of the hip with the body. Thus, the groin is not a separate anatomical part of the body, but a rather vulnerable, sensitive area that has a ligament and contains many attachment muscles (pullers, flexors, adductors).

Pain in the groin muscles is most often caused by damage to the adductor muscles, or more precisely, the adductors, localized inside the thigh. Contraction, inflammation, injury, stretching of these muscles is always accompanied by severe pain in the pelvic and groin area.

Causes of groin pain related to muscle tissue:

• Overtraining during exercise without proper warm-up.
• Groin strain.
• Rupture of the iliac muscle.
• Quadriceps strain (front of thigh).
• Hamstring strain.
• Static overload of the groin muscles (cyclists, equestrians).
• Dynamic overload of the groin muscles – football players, hockey players, basketball players.
• Occupational groin strain can be associated with working in a squatting position.
• Lumbar osteochondrosis.
• Coxarthrosis.

In medicine, pain in the groin muscles is called inguinal-genital myofascial syndrome (IGMS), which, in addition to pain, may be accompanied by angiopathy of the venous center of the spermatic cord in men or angiopathy of the round ligament in women.

Trapezius muscle pain

Pain in the m. trapezius – trapezius muscle – is the most common myalgic symptom. The trapezius muscle is responsible for moving the shoulder blades up or down, it is attached to the base of the skull, localized along the back of the neck, on top of the shoulder girdle and in the upper, middle zone of the back.

The main reason that causes pain in the trapezius muscle is physical or mental overexertion, less often the symptom is provoked by trauma, bruise. It is the shoulder girdle that is subject to constant stress as a result of many types of human activity - sedentary work in the office, at the computer, talking on the phone, sleeping on too high pillows, holding heavy objects. The list can be continued indefinitely, since the vertical position of the body is inevitably accompanied by a certain load on the trapezius muscle.

Pain caused by hypertonicity of m. trapezius manifests itself as discomfort in the neck, closer to the base of the skull, often such tension forces a person to compensatorily raise their shoulders, which only aggravates the muscle spasm. Chronic overexertion leads to severe headaches - TH (tension headache), localized in the temples, less often in the forehead.