Muscle Pain (Myalgia)

Muscle pain, or myalgia, may be localised to one muscle group or felt throughout the body. Localised pain usually follows overuse, a strain or sustained posture, and often involves tight, tender bands known as trigger points (myofascial pain). Widespread muscle aching is more likely to have a general cause such as a viral illness, a medicine, a hormone or vitamin problem, or a chronic pain condition such as fibromyalgia.

A key distinction is between pain and weakness. Pain with normal strength is common and rarely sinister. True weakness, such as difficulty climbing stairs, rising from a chair or lifting the arms above the head, points to disease of the muscle itself (myositis or myopathy) and calls for investigation. Most muscle pain resolves within days to weeks with simple measures.

Symptome

• Aching, soreness or stiffness in one area or all over
• Tender knots that refer pain elsewhere when pressed
• Soreness peaking 24 to 72 hours after unaccustomed exercise
• Cramps, often in the calves at night
• Aching with fever, headache and tiredness during an infection
• Stiffness of the shoulders and hips for more than 45 minutes each morning in someone over 50 (polymyalgia rheumatica)
• Widespread pain with unrefreshing sleep and fatigue (fibromyalgia)
• Weakness, dark urine or marked swelling, which are warning features

Ursachen und Risikofaktoren

Common causes are exercise-related soreness, strains, postural overload, tension and viral infections including influenza and COVID-19. Medicines are an important cause: statins produce muscle symptoms in a minority of users, and others include some antibiotics, aromatase inhibitors and steroids on withdrawal. Medical causes include underactive thyroid, vitamin D deficiency, low potassium or calcium, polymyalgia rheumatica, inflammatory myositis, lupus and fibromyalgia. Rhabdomyolysis, the breakdown of muscle after extreme exertion, crush injury, heatstroke or drugs, is rare but dangerous to the kidneys.

Wie es diagnostiziert wird

• History and examination: Distribution, relation to exercise, medicines, and above all a formal test of muscle strength.
• Creatine kinase (CK): A blood marker of muscle damage; mildly raised after exercise, very high in rhabdomyolysis and myositis.
• General blood tests: Thyroid function, vitamin D, electrolytes, kidney function, CRP and ESR.
• Autoantibody tests: For suspected myositis or connective tissue disease.
• EMG and nerve conduction studies: Distinguish muscle disease from nerve disease when weakness is present.
• Muscle MRI and biopsy: Identify inflamed muscle and confirm the type of myopathy in selected cases.

Behandlungsmöglichkeiten

• Relative rest, then graded activity: For strains: protect for a few days, then progressively load. Complete rest prolongs recovery.
• Heat, stretching and massage: Ease postural and myofascial pain.
• Short-term pain relief: Paracetamol or anti-inflammatories, topical where possible.
• Physiotherapy and ergonomics: Strengthening, posture and workstation changes; trigger point techniques or dry needling as an addition.
• Reviewing medicines: A statin may be paused, switched or reduced under medical advice. Do not stop it without discussing your cardiovascular risk.
• Correcting deficiencies and hormone problems: Vitamin D replacement and thyroid treatment.
• Low-dose steroids: Polymyalgia rheumatica responds quickly, then needs a slow taper over 1 to 2 years.
• Fibromyalgia care: Aerobic exercise, sleep improvement, psychological therapies and, for some, low-dose amitriptyline or duloxetine.

Wenn es dringend ist

Seek emergency care locally for severe muscle pain with dark, cola-coloured urine, muscle pain with high fever and a stiff neck or rash, rapidly developing weakness, difficulty breathing or swallowing, or a swollen, tense, extremely painful limb after injury. In someone over 50 with shoulder and hip stiffness, a new headache, scalp tenderness, jaw pain on chewing or visual disturbance suggests giant cell arteritis and needs same-day treatment.

Reisen nach Türkiye zur Behandlung

Ordinary muscle pain does not warrant a journey. If widespread pain has gone unexplained for months, a focused work-up with blood tests, specialist examination and, if indicated, EMG can be completed in a few days and may give you a diagnosis to take home. Fibromyalgia, polymyalgia rheumatica and myositis all require long-term follow-up and medication adjustment locally. A short physiotherapy course while visiting can teach a programme but will not replace continuing it.

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