Skip to main content

Abstract

Muscle tension, known for its association with generalized anxiety disorder, is a complex symptom with a potentially broad differential diagnosis and several contributing factors for a clinician to keep in mind. The goals of this chapter are to provide more incisive definitions of muscle tension and related pathologies, aid the reader in their evaluation and assessment of muscle tension as a presenting symptom, and discuss the contributing factors (histological, neurological, physiological, inflammatory processes, and neurotransmitters) of muscle tension in detail. As muscle tension may encompass diseases from both the medical and psychiatric realms, this chapter aims to assist clinicians in “honing in” on the most likely cause for muscle tension and educate the reader regarding the vast yet still poorly understood epidemiological data regarding muscle tension. This chapter concludes with both a psychiatric and medical differential diagnosis for muscle tension, with the goal of outlining common disorders where muscle tension is implicated.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Bhimani R, Gaugler JE, Felts J. Consensus definition of muscle tightness from multidisciplinary perspectives. Nurs Res. 2020;69(2):109–15. https://doi.org/10.1097/NNR.0000000000000404. PMID: 31702702

    Article  PubMed  Google Scholar 

  2. Bhimani R, Soomar D. Understanding symptoms of muscle tightness, weakness, and rigidity from a nursing perspective. Rehabil Nurs J. 2019;44:271–81. https://doi.org/10.1097/rnj.0000000000000151.

    Article  Google Scholar 

  3. Cram JR. The history of surface electromyography. Appl Psychophysiol Biofeedback. 2003;28(2):81–91. https://doi.org/10.1023/a:1023802407132. PMID: 12827987

    Article  PubMed  Google Scholar 

  4. Sainsbury P, Gibson JG. Symptoms of anxiety and tension and the accompanying physiological changes in the muscular system. J Neurol Neurosurg Psychiatry. 1954;17(1954):216–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Biga LM, et al. Anatomy & physiology. https://open.oregonstate.education/aandp/chapter/10-4-nervous-system-control-of-muscle-tension/. Publication date unknown.

  6. Adeyinka A, Kondamudi NP. Cholinergic crisis. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2021. PMID: 29494040.

    Google Scholar 

  7. van’t Groenewout JL, Stone MR, Vo VN, Truong DD, Matsumoto RR. Evidence for the involvement of histamine in the antidystonic effects of diphenhydramine. Exp Neurol. 1995;134(2):253–60. https://doi.org/10.1006/exnr.1995.1055. PMID: 7556545

    Article  Google Scholar 

  8. Schwarz PB, Yee N, Mir S, Peever JH. Noradrenaline triggers muscle tone by amplifying glutamate-driven excitation of somatic motoneurones in anaesthetized rats. J Physiol. 2008;586(23):5787–802. https://doi.org/10.1113/jphysiol.2008.159392.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Mir S, Yee N, Brooks PL, Peever JH. Noradrenergic control of motoneurons during natural sleep in rats. Sleep. 2006;29:A27.

    Google Scholar 

  10. Guilleminault C, Wilson RA, Dement WC. A study on cataplexy. Arch Neurol. 1974;31:255–61.

    Article  CAS  PubMed  Google Scholar 

  11. Onofrj M, Luciano AL, Thomas A, Iacono D, D'Andreamatteo G. Mirtazapine induces REM sleep behavior disorder (RBD) in parkinsonism. Neurology. 2003;60:113–5.

    Article  CAS  PubMed  Google Scholar 

  12. Dvir Y, Smallwood P. Serotonin syndrome: a complex but easily avoidable condition. Gen Hosp Psychiatry. 2008;30(3):284–7. https://doi.org/10.1016/j.genhosppsych.2007.09.007. PMID: 18433663

    Article  PubMed  Google Scholar 

  13. Sakai M, Matsunaga M, Kubota A, Yamanishi Y, Nishizawa Y. Reduction in excessive muscle tone by selective depletion of serotonin in intercollicularly decerebrated rats. Brain Res. 2000;860(1–2):104–11. https://doi.org/10.1016/s0006-8993(00)02022-9. PMID: 10727628

    Article  CAS  PubMed  Google Scholar 

  14. Hanna T. Load pattern and pressure pain threshold in the upper trapezius muscle and psychosocial factors in medical secretaries with and without shoulder/neck disorders. Int Arch Occup Environ Health. 1988;69:423–32.

    Google Scholar 

  15. Joormann J, Stöber J. Somatic symptoms of generalized anxiety disorder from the DSM-IV: associations with pathological worry and depression symptoms in a nonclinical sample. J Anxiety Disord. 1999;13(5):491–503. https://doi.org/10.1016/s0887-6185(99)00017-1. PMID: 10600050

    Article  CAS  PubMed  Google Scholar 

  16. Bordoni B, Sugumar K, Varacallo M. Muscle cramps. [Updated 2020 Nov 20]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2020. https://www.ncbi.nlm.nih.gov/books/NBK499895/.

  17. Batla A. Dystonia: a review. Neurol India. 2018;66(Suppl):S48–58. https://doi.org/10.4103/0028-3886.226439. PMID: 29503327

    Article  PubMed  Google Scholar 

  18. Schmidt J. Current classification and management of inflammatory myopathies. J Neuromusc Dis. 2018;5(2):109–29. https://doi.org/10.3233/JND-180308.

    Article  Google Scholar 

  19. American Psychiatric Association Content Provider. Anxiety disorders: DSM-5 selections; 2016. Web.

    Google Scholar 

  20. Pluess M, Conrad A, Wilhelm FH. Muscle tension in generalized anxiety disorder: a critical review of the literature. J Anxiety Disord. 2009;23(1):1–11. https://doi.org/10.1016/j.janxdis.2008.03.016. Epub 2008 Apr 7. PMID: 18472245

    Article  PubMed  Google Scholar 

  21. Lundberg U, Dohns IE, Melin B, Sandsjö L, Palmerud G, Kadefors R, Ekström M, Parr D. Psychophysiological stress responses, muscle tension, and neck and shoulder pain among supermarket cashiers. J Occup Health Psychol. 1999;4(3):245–55. https://doi.org/10.1037//1076-8998.4.3.245. PMID: 10431284

    Article  CAS  PubMed  Google Scholar 

  22. Hägg GM, Aström A. Load pattern and pressure pain threshold in the upper trapezius muscle and psychosocial factors in medical secretaries with and without shoulder/neck disorders. Int Arch Occup Environ Health. 1997;69(6):423–32. https://doi.org/10.1007/s004200050170. PMID: 9215929

    Article  PubMed  Google Scholar 

  23. Grim PF. Anxiety change produced by self-induced muscle tension and by relaxation with respiration feedback. Behav Ther. 1971;2(1):11–7., ISSN 0005-7894. https://doi.org/10.1016/S0005-7894(71)80141-7.

    Article  Google Scholar 

  24. Ruscio AM, Hallion LS, Lim CCW, et al. Cross-sectional comparison of the epidemiology of DSM-5 generalized anxiety disorder across the globe. JAMA Psychiat. 2017;74(5):465–75. https://doi.org/10.1001/jamapsychiatry.2017.0056.

    Article  Google Scholar 

  25. Faravelli C, Castellini G, Benni L, Brugnera A, Landi M, Lo Sauro C, Pietrini F, Rotella F, Ricca V. Generalized anxiety disorder: is there any specific symptom? Compr Psychiatry. 2012;53(8):1056–62. https://doi.org/10.1016/j.comppsych.2012.04.002. Epub 2012 May 11. PMID: 22578985

    Article  PubMed  Google Scholar 

  26. Maldonado JR. Acute brain failure: pathophysiology, diagnosis, management, and sequelae of delirium. Crit Care Clin. 2017;33(3):461–519. https://doi.org/10.1016/j.ccc.2017.03.013. PMID: 28601132

    Article  PubMed  Google Scholar 

  27. Grover S, Sharma A, Aggarwal M, Mattoo SK, Chakrabarti S, Malhotra S, Avasthi A, Kulhara P, Basu D. Comparison of symptoms of delirium across various motoric subtypes. Psychiatry Clin Neurosci. 2014;68(4):283–91. https://doi.org/10.1111/pcn.12131. Epub 2013 Dec 25. PMID: 24372977

    Article  PubMed  Google Scholar 

  28. Naeije G, Bachir I, Gaspard N, Legros B, Pepersack T. Epileptic activities are common in older people with delirium. Geriatr Gerontol Int. 2014;14(2):447–51. https://doi.org/10.1111/ggi.12128. Epub 2013 Aug 4. PMID: 23910220

    Article  PubMed  Google Scholar 

  29. Fink M. Catatonia from its creation to DSM-V: considerations for ICD. Indian J Psychiatry. 2011;53(3):214–7. https://doi.org/10.4103/0019-5545.86810. PMID: 22135438; PMCID: PMC3221176

    Article  PubMed  PubMed Central  Google Scholar 

  30. Unal A, Bulbul F, Alpak G, Virit O, Copoglu US, Savas HA. Effective treatment of catatonia by combination of benzodiazepine and electroconvulsive therapy. J ECT. 2013;29(3):206–9. https://doi.org/10.1097/YCT.0b013e3182887a1a. PMID: 23965606

    Article  CAS  PubMed  Google Scholar 

  31. Carroll BT. The universal field hypothesis of catatonia and neuroleptic malignant syndrome. CNS Spectr. 2000;5(7):26–33. https://doi.org/10.1017/s1092852900013365. PMID: 18197153

    Article  CAS  PubMed  Google Scholar 

  32. Solmi M, Pigato GG, Roiter B, Guaglianone A, Martini L, Fornaro M, Monaco F, Carvalho AF, Stubbs B, Veronese N, Correll CU. Prevalence of catatonia and its moderators in clinical samples: results from a meta-analysis and meta-regression analysis. Schizophr Bull. 2018;44(5):1133–50. https://doi.org/10.1093/schbul/sbx157.

    Article  PubMed  Google Scholar 

  33. Tse L, Barr AM, Scarapicchia V, Vila-Rodriguez F. Neuroleptic malignant syndrome: a review from a clinically oriented perspective. Curr Neuropharmacol. 2015;13(3):395–406. https://doi.org/10.2174/1570159x13999150424113345. PMID: 26411967; PMCID: PMC4812801

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Gurrera RJ, Simpson JC, Tsuang MT. Meta-analytic evidence of systematic bias in estimates of neuroleptic malignant syndrome incidence. Compr Psychiatry. 2007;48(2):205–11. https://doi.org/10.1016/j.comppsych.2006.10.004. Epub 2007 Jan 2. PMID: 17292713

    Article  PubMed  Google Scholar 

  35. Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin syndrome. Ochsner J. 2013;13(4):533–40.

    PubMed  PubMed Central  Google Scholar 

  36. Scotton WJ, Hill LJ, Williams AC, Barnes NM. Serotonin syndrome: pathophysiology, clinical features, management, and potential future directions. Int J Tryptophan Res. 2019;12:1178646919873925. https://doi.org/10.1177/1178646919873925.

    Article  PubMed  PubMed Central  Google Scholar 

  37. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed., text rev. Washington, DC: American Psychiatric Association; 2022.

    Google Scholar 

  38. Reddy MSS, Thippeswamy H, Ganjekar S, et al. Anti-NMDA receptor encephalitis presenting as postpartum psychosis-a clinical description and review. Arch Womens Ment Health. 2018;21(4):465–9.

    Article  PubMed  Google Scholar 

  39. Kayser MS, Dalmau J. Anti-NMDA receptor encephalitis in psychiatry. Curr Psychiatr Rev. 2011;7(3):189–93.

    Article  CAS  Google Scholar 

  40. Dalmau J, Gleichman AJ, Hughes EG, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol. 2008;7(12):1091–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Blinder T, Lewerenz J. Cerebrospinal fluid findings in patients with autoimmune encephalitis-a systematic analysis. Front Neurol. 2019; 10(804).

    Google Scholar 

  42. Tomaszewski M, Stępień KM, Tomaszewska J, Czuczwar SJ. Statin-induced myopathies. Pharmacol Rep. 2011;63(4):859–66. https://doi.org/10.1016/s1734-1140(11)70601-6. PMID: 22001973

    Article  CAS  PubMed  Google Scholar 

  43. Le Quintrec JS, Le Quintrec JL. Drug-induced myopathies. Baillieres Clin Rheumatol. 1991;5(1):21–38. https://doi.org/10.1016/s0950-3579(05)80294-8. PMID: 2070426

    Article  PubMed  Google Scholar 

  44. Scripter C. Headache: tension-type headache. FP Essent. 2018;473:17–20. PMID: 30346680

    PubMed  Google Scholar 

  45. Chowdhury D. Tension type headache. Ann Indian Acad Neurol. 2012;15(Suppl 1):S83–8. https://doi.org/10.4103/0972-2327.100023.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Song TJ, Cho SJ, Kim WJ, Yang KI, Yun CH, et al. Anxiety and depression in tension-type headache: a population-based study. PLoS One. 2016;11(10):e0165316. https://doi.org/10.1371/journal.pone.0165316.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Lundberg I, de Visser M, Werth V. Classification of myositis. Nat Rev Rheumatol. 2018;14:269–78. https://doi.org/10.1038/nrrheum.2018.41.

    Article  PubMed  Google Scholar 

  48. Stanley M, Chippa V, Aeddula NR, et al. Rhabdomyolysis. [Updated 2021 Jul 10]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2021. https://www.ncbi.nlm.nih.gov/books/NBK448168/.

  49. Zimmerman JL, Shen MC. Rhabdomyolysis. Chest. 2013;144(3):1058–65. https://doi.org/10.1378/chest.12-2016. PMID: 24008958

    Article  CAS  PubMed  Google Scholar 

  50. O'Connor AD, Padilla-Jones A, Gerkin RD, Levine M. Prevalence of rhabdomyolysis in sympathomimetic toxicity: a comparison of stimulants. J Med Toxicol. 2015;11(2):195–200. https://doi.org/10.1007/s13181-014-0451-y.

    Article  CAS  PubMed  Google Scholar 

  51. Ghai A, Garg N, Hooda S, Gupta T. Spasticity - pathogenesis, prevention and treatment strategies. Saudi J Anaesth. 2013;7(4):453–60. https://doi.org/10.4103/1658-354X.121087.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Tysnes OB, Storstein A. Epidemiology of Parkinson’s disease. J Neural Transm (Vienna). 2017;124(8):901–5. https://doi.org/10.1007/s00702-017-1686-y. Epub 2017 Feb 1. PMID: 28150045

    Article  PubMed  Google Scholar 

  53. Balestrino R, Schapira AHV. Parkinson disease. Eur J Neurol. 2020;27(1):27–42. https://doi.org/10.1111/ene.14108. Epub 2019 Nov 27. PMID: 31631455

    Article  CAS  PubMed  Google Scholar 

  54. Roos RA. Huntington’s disease: a clinical review. Orphanet J Rare Dis. 2010;5:40. https://doi.org/10.1186/1750-1172-5-40.

    Article  PubMed  PubMed Central  Google Scholar 

  55. McColgan P, Tabrizi SJ. Huntington’s disease: a clinical review. Eur J Neurol. 2018;25:24–34. https://doi.org/10.1111/ene.13413. Epub 2017 Sep 22. PMID: 28817209

    Article  CAS  PubMed  Google Scholar 

  56. Zarei S, Carr K, Reiley L, Diaz K, Guerra O, Altamirano PF, Pagani W, Lodin D, Orozco G, Chinea A. A comprehensive review of amyotrophic lateral sclerosis. Surg Neurol Int. 2015;6:171. https://doi.org/10.4103/2152-7806.169561.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Marin B, Boumédiene F, Logroscino G, et al. Variation in worldwide incidence of amyotrophic lateral sclerosis: a meta-analysis. Int J Epidemiol. 2017;46(1):57–74. https://doi.org/10.1093/ije/dyw061.

    Article  PubMed  Google Scholar 

  58. Bashford JA, Wickham A, Iniesta R, et al. The rise and fall of fasciculations in amyotrophic lateral sclerosis. Brain Commun. 2020;2(1):fcaa018. Published 2020 Feb 20. https://doi.org/10.1093/braincomms/fcaa018.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Brotman RG, Moreno-Escobar MC, Joseph J, et al. Amyotrophic lateral sclerosis. [Updated 2021 Jun 8]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2021. https://www.ncbi.nlm.nih.gov/books/NBK556151/.

  60. Cervantes CE, Lee Lau H, Binazir TA, O’Brien KO, Cross JS. Why it is not always anxiety: a tough diagnosis of stiff person syndrome. Case Rep Neurol Med. 2017;2017:7431092. https://doi.org/10.1155/2017/7431092.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Hadavi S, Noyce AJ, Leslie RD, Giovannoni G. Stiff person syndrome. Pract Neurol. 2011;11(5):272–82. https://doi.org/10.1136/practneurol-2011-000071. PMID: 21921002

    Article  PubMed  Google Scholar 

  62. Ciccotto G, Blaya M, Kelley RE. Stiff person syndrome. Neurol Clin. 2013;31(1):319–28. https://doi.org/10.1016/j.ncl.2012.09.005. PMID: 23186907

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kyle Hodges .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hodges, K., Bourgeois, J.A. (2023). Muscle Tension. In: Meyer, E.G., Cozza, K.L., Bourgeois, J.A. (eds) The Medical Evaluation of Psychiatric Symptoms. Springer, Cham. https://doi.org/10.1007/978-3-031-14372-4_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-14372-4_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-14371-7

  • Online ISBN: 978-3-031-14372-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics