When Should I Be Worried About Muscle Pain?

Muscle pain can be from muscle tightness, but it can be from other, more serious causes. In this article, we will discuss when you need to be concerned about your muscle pain, what can cause serious conditions with muscle pain, and when you need to see a physician.

What causes muscle pain?

Muscle pain has many etiologies (causes), the mildest being strain from use or overuse. Using your muscles for exercise, training, working, or everyday activities (activities of daily living) can cause soreness, and it does not always indicate a disease condition.

A chemical called lactic acid builds in our bodies when we exercise or when activity is pushed over a specific limit. However, current research has demonstrated that lactic acid dissipates over a few hours; thus, it is not the source of soreness and pain. Instead, we now know the source is micro tears in the muscle fibers.

What factors let me know if the muscle pain is benign or serious?

  1. Time is a key factor. With exercise, muscle soreness usually occurs around 24 hours later. If the pain lasts less than 72 hours (three days), it is usually not a serious concern, but if it lasts more than that, it should alert you to something more serious, especially if the pain lasts one or two weeks.
  2. The type of muscle pain is also a crucial factor in determining the significance. If it is a dull ache, the likelihood of seriousness is much less than a sharp or stabbing pain.
  3. If the pain inhibits your ability to perform the activities of daily living, including daily grooming and chores, there is a need for medical evaluation and treatment.

What symptoms will alert me to seek immediate medical attention?

Stiff neck and fever are signs of meningitis, an infection of the fluid and membranes surrounding the brain and spinal cord called the meninges. The infectious agent can be a bacteria, virus, or fungus.

Myositis could be present if there is an aching pain, along with weakness, that worsens over time. Myositis results from the body mistaking its own tissues for a foreign pathogen, like a bacteria or virus, and attacks itself, called an autoimmune disorder.

There are three types of myositis:

  1. Polymyositis affects several muscles and affects persons aged 30-60 years old.
  2. Dermatomyositis also affects several muscles but also causes a rash.
  3. Inclusion body myositis (IBM) affects the extremities, especially the thigh, forearms, and muscles below the knee. In addition, with IBM, there can be difficulty swallowing (dysphagia).

Polymyalgia rheumatica is a specific disorder that involves pain in the upper arms, shoulders, hips, thighs, and low back. Its cause is unknown but believed to be autoimmune-related. It usually affects persons aged sixty-five and older.

Can concerning muscle pain be caused by underlying skeletal (bony) abnormalities?

Yes, this can occur, so it is essential that presenting muscle pain be evaluated with regular (plain) X-rays to view the underlying bones.

Osteoporosis, which means porous bones, occurs when the bony matrix is thinned. In osteoporosis, the bones are weak, as well as brittle, and can easily fracture (break).

Osteoporosis is usually seen in people over fifty, women more often than men, and people with poor calcium or vitamin D intake.

Arthritic conditions like rheumatoid arthritis and osteoarthritis usually have X-ray findings, including nodules for rheumatoid arthritis and joint narrowing for osteoarthritis.

What are other causes of muscle pain that should concern you?

Sometimes, an infection can cause muscle pain. In those instances, there will usually be redness, swelling, and warmth at the infection site, in addition to the muscle pain.

Certain medications can cause muscle pain, most commonly statin medications used to treat elevated cholesterol. Any person on a statin medication that develops muscle pain, tenderness, or weakness should stop the medication immediately and consult with their physician.

Lyme disease is caused by a specific spiral-shaped bacterium called Borrelia burgdorferi and transmitted through the black-legged (deer) tick, the vector. Lyme disease received its name when it was discovered in the coastal town of Lyme, Connecticut, in the 1970s. In the United States, Lyme disease was previously present only in the northeastern states but is now found in the midwestern states, along with cases in Washington State, Oregon, and Northern California.

Lyme disease usually presents a skin rash with a "bull's eye" appearance, but a rash is not always present.

Muscle pain in the calves can be indicative of a deep venous thrombosis caused by a clot in the veins of the legs, usually due to venous stasis, from sedentary or bedridden people, or malfunctioning of the lower extremity venous valves.

Certain viral infections, including the flu, can cause generalized muscle aches called myalgias. These muscle aches should resolve a few days to a few weeks after the flu virus leaves the body.

Rhabdomyolysis is a condition that results from a muscle injury, either directly or indirectly. First, muscle injury causes the breakdown of muscle tissue. Then the protein myoglobin is released from the muscles, enters the bloodstream, and eventually makes its way to the urine, resulting in dark reddish urine, muscle pain, and weakness.

When do I need to see a physician or medical provider?

If you suspect any of the above serious conditions and feel it is not run-of-the-mill muscle soreness from a specific activity, we recommend you seek prompt medical care and treatment.

In addition to an examination by your medical provider, to help rule out other serious conditions, other tests/studies need to be done:

  • Plain X-rays of the bones (already mentioned).
  • Full lab work including blood and urine.
  • Special diagnostic tests, including ultrasound, computed tomography scan (CT), and magnetic resonance imaging (MRI).

Bibliography:

‘How to Know the Difference Between Soreness and Pain’, 2015 [accessed 20 July 2022]

‘Myositis (Polymyositis and Dermatomyositis) - NHS’, 2017 [accessed 22 July 2022]

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