Current Pain and Headache Reports

, Volume 5, Issue 5, pp 441–446 | Cite as

Muscle pain due to injury

  • Anthony H. Wheeler
  • George W. Aaron


Voluntary muscle is the largest human organ system. The musculotendinous contractual unit sustains posture against gravity and movement against inertia. However, when exposed to single or recurrent episodes of biomechanical overloading, muscle injury may occur. Although chronic muscular injuries and myofascial pain syndromes are commonly diagnosed, they remain poorly understood.

Techniques for evaluation of the muscular components of a pain syndrome involve palpation, strength testing, range of motion, and assessment of muscle endplay. Management of acute injuries may necessitate imaging and surgery consultation for lacerations or hemorrhage. Treatment of acute syndromes consists of cryotherapy and reduced activity, whereas chronic syndromes may require multiple therapeutic approaches, applied together or sequentially.


Fibromyalgia Botulinum Toxin Trigger Point Muscle Spasm Myofascial Pain 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Simons DG, Travell JG, Simons LS: The Trigger Point Manual, vol 1, edn 2. Baltimore, MD: Williams & Wilkins; 1999. Most recent addition of a classic medical textbook that should be read and studied by physicians who treat muscular pain. Empiric and scientific evidence that support Travell and Simon’s concepts of character and causality of muscle pain is biased, but clinical observations and illustrations make this book a necessary clinical tool.Google Scholar
  2. 2.
    Wolfe F, Simons DG, Fricton J, et al.: The fibromyalgia and myofascial pain syndromes: a preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease. J Rheumatol 1992, 19:944–951.PubMedGoogle Scholar
  3. 3.
    Gerwin RD, Shannon S, Hong C-Z, et al.: Inter-rater reliability in myofascial trigger point examination. Pain 1998, 69:65–73.CrossRefGoogle Scholar
  4. 4.
    Bohr T: Problems with myofascial pain syndrome and fibromyalgia syndrome. Neurology 1996, 46:593–597.PubMedGoogle Scholar
  5. 5.
    Drewes AM, Jennum P: Epidemiology of myofascial pain, low back pain, morning stiffness and sleep-related complaints in the general population [abstract]. J Musculoskeletal Pain 1995, 3(suppl 1):68.Google Scholar
  6. 6.
    Friction JR, Kroening R, Haley D, Siegert R: Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. Oral Surg 1985, 60:615–623.CrossRefGoogle Scholar
  7. 7.
    Fishbain DA, Goldberg M, Meagher BR, et al.: Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain 1986, 26:181–197.PubMedCrossRefGoogle Scholar
  8. 8.
    Skootsky SA, Jargen B, Oyer K: Prevalence of myofascial pain in general internal medicine practice. West J Med 1989, 151:157–160.PubMedGoogle Scholar
  9. 9.
    Gerwin RD: A study of 96 subjects examined both for fibromyalgia and myofascial pain [abstract]. J Musculoskeletal Pain 1995, 3(suppl 1):121.Google Scholar
  10. 10.
    Frolich D, Frolich R: Das Piriformissyndrom: eine haufige differential-diagnose des lumbglutaalen Schmerzes (Piriformis syndrome: a frequent item in the differential diagnosis of lumbogluteal pain). Manuelle Medizin 1995, 33:7–10.Google Scholar
  11. 11.
    Russell IJ: Neurochemical pathogenesis of fibromyalgia syndrome. J Musculoskeletal Pain 1996, 4:61–92.CrossRefGoogle Scholar
  12. 12.
    Pappagallo M: Aggressive pharmacologic treatment of pain. Rheum Dis Clin North Am 1999, 25:193–209.PubMedCrossRefGoogle Scholar
  13. 13.
    Davidoff RA: Trigger points and myofascial pain: toward understanding how they affect headaches. Cephalalgia 1998, 18:436–448.PubMedCrossRefGoogle Scholar
  14. 14.
    Fields HL: Pain. New York, NY: McGraw-Hill; 1987.Google Scholar
  15. 15.
    Layzer RB: Muscle pains and cramps. In Neurology in Clinical Practice. Edited by Bradley WG et al. Boston, MA: Butterworth-Hennepann; 1991:363–368.Google Scholar
  16. 16.
    Noonan TJ, Garrett WE: Muscle strain injury: diagnosis and treatment. J Am Acad Orthop Surg 1999, 7:262–269. Clear, concise, current review of the diagnosis and treatment of acute muscle injury.PubMedGoogle Scholar
  17. 17.
    Wolfe F, Smythe HA, Yunus MB, et al.: The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Arthritis Rheum 1990, 33:160–172.PubMedCrossRefGoogle Scholar
  18. 18.
    Pillemer SR, Bradley LA, Crofford LJ, et al.: The neuroscience and endocrinology of fibromyalgia. Arthritis Rheum 1997, 40:1703–1707.CrossRefGoogle Scholar
  19. 19.
    Urban MO, Gebhart GF: Central mechanisms in pain. Med Clin North Am 1999, 83:585–596.PubMedCrossRefGoogle Scholar
  20. 20.
    Carlton SM, Zhou S, Coggeshall RE: Evidence for the interaction of glutamate and NK1 receptors in the periphery. Brain Res 1998, 83:160–169.CrossRefGoogle Scholar
  21. 21.
    Bennett RM: Emerging concepts in the neurobiology of chronic pain: evidence of abnormal sensory processing in fibromyalgia. Mayo Clin Proc 1999, 74:385–398.PubMedGoogle Scholar
  22. 22.
    Simons DG: Clinical and etiological update of myofascial pain from trigger points. In Clinical Overview and Pathogenesis of Fibromyalgia Syndrome, Myofascial Pain Syndrome, and Other Pain Syndromes. Binghamton, NY: Hayworth Medical Press; 1996:93–122.Google Scholar
  23. 23.
    Garvey TA, Marks MR, Wiesel SW: A prospective, randomized, double-blind evaluation trigger point injections therapy for low back pain. Spine 1989, 14:962–964. Benchmark, well-done study that demonstrates efficacy of dry needling compared with injections of active substances into TrPs.PubMedCrossRefGoogle Scholar
  24. 24.
    Cyriax J: Textbook of Orthopaedic Medicine: Diagnosis of Soft Tissue Lesions, edn 8. Baltimore, MD: Williams & Wilkins; 1984.Google Scholar
  25. 25.
    Garrett WE Jr, Safran MR, Seaber AV, et al.: Biomechanical comparison of stimulated and nonstimulated skeletal muscle pulled to failure. Am J Sports Med 1987, 15:448–454.PubMedGoogle Scholar
  26. 26.
    Taylor DC, Dalton JD Jr, Seaber AV, Garrett WB Jr: Viscoelastic properties of muscle-tendon units: the biomechanical effects of stretching. Am J Sports Med 1990, 18:300–309.PubMedGoogle Scholar
  27. 27.
    Berry H, Hutchinson DR: A multicentre placebo-controlled study in general practice to evaluate the efficacy and safety of tizanidine in acute low-back pain. J Int Med Res 1988, 16:75–82.PubMedGoogle Scholar
  28. 28.
    Berry H, Hutchinson DR: Tizanidine and ibuprofen in acute low-back pain: results in a double-blind multicentre study in general practice. J Int Med Res 1988, 16:83–91.PubMedGoogle Scholar
  29. 29.
    Boyles WF, Glassman JM, Soyka JP: Management of acute musculoskeletal conditions: thoracolumbar strain or sprain. A double-blind evaluation comparing the efficacy and safety of carisporodol with diazepam. Todays Ther Trends 1983, 1:1.Google Scholar
  30. 30.
    Gold RH: Orphenadrine citrate: sedative or muscle relaxant? Clin Ther 1978, 1:451–453.Google Scholar
  31. 31.
    Hindle TH III: Comparison of carisoprodol, butabarbital, and placebo in treatment of low back pain syndrome. Calif Med 1972, 117:7–11.PubMedGoogle Scholar
  32. 32.
    Wagstaff AJ, Bryson HM: Tizanidine. A review of its pharmacology, clinical efficacy and tolerability in the management of spasticity associated with cerebral and spinal disorders. Drugs 1997, 53:435–452.PubMedCrossRefGoogle Scholar
  33. 33.
    Nabeshima T, Natsuno K, Sugimoto A, Kameyama T: Antinociceptive activity induced by tizanidine and alpha2-adrenoreceptors. Neuropharmacology 1987, 26:1453–1455.PubMedCrossRefGoogle Scholar
  34. 34.
    O’Brien CF: Clinical applications of botulinum toxin: implications for pain management. Pain Digest 1998, 8:342–345.Google Scholar
  35. 35.
    Acquadro MA, Borodic GE: Treatment of myofascial pain with botulinum A toxin [letter]. Anesthesiology 1994, 80:705–706.PubMedCrossRefGoogle Scholar
  36. 36.
    Yue SK: Initial experience in the use of botulinum toxin A for the treatment of myofascial related muscle dysfunction. J Musculoskeletal Pain 1995, 3(suppl 1):22.Google Scholar
  37. 37.
    Wheeler AH, Goolkasian P, Gretz SS: A randomized doubleblind prospective pilot study of botulinum toxin injection study for refractory, unilateral, cerviothoracic paraspinal, myofascial pain syndrome. Spine 1998, 23:1662–1667.PubMedCrossRefGoogle Scholar
  38. 38.
    Cheshire WP, Abashjan SW, Man JD: Botulinum toxin in the treatment of myofascial pain syndrome. Pain 1994, 59:65–69.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2001

Authors and Affiliations

  • Anthony H. Wheeler
    • 1
  • George W. Aaron
  1. 1.Pain and Orthopedic NeurologyP.A., Charlotte Spine CenterCharlotteUSA

Personalised recommendations