Why does the galley muscle hurt?

• Unilateral (most common);
• Intensity of 'stinging pain'.

myalgia

Myalgias can vary in severity and duration, but are all grouped together under the term 'myalgia'. Statistics show that myalgia is one of the most common reasons for seeking medical attention. This is all the more true since myalgia can partially or completely incapacitate the patient and affect his daily activities. In addition, the total mass of muscle fibers in the human body consists of about 40-50 % muscle fibers, so any disease causes noticeable discomfort and requires immediate measures to relieve pain.

Muscle tissue is not only part of the musculoskeletal system, but also lines the structure of internal organs - intestines, stomach, bronchi, etc. Therefore, pain can have various causes caused by external or internal factors:

• Injuries of various kinds. These can be sprains, tears or ruptures of the connective tissue, which can lead to inflammation, hematomas or contractures that make movement difficult.
• Intense physical activity with relatively weak muscles or failure to warm up before intense exercise.
• The development of rheumatic diseases, which are characterized by damage to the muscular and skeletal system and connective tissue.
• Inflammatory processes in the muscle fibers, which are of an infectious or undetermined nature and often indicate epidemic myalgia.
• Taking medications that cause inflammation or partial necrosis of muscle fibers.
• Consequences of body intoxication when the muscle pain is accompanied by fever, sore throat and symptoms of respiratory infection.
• Neurological abnormalities that cause weakness and muscle soreness.
• Potassium and magnesium deficiency, which makes it difficult for nerve impulses to reach muscle fibers and causes involuntary contractions that result in severe pain.
• Vascular abnormalities that cause the muscles to suffer from the effects of 'oxygen deprivation'.
• Metabolic and endocrine abnormalities causing swelling and muscle pain.
• Mechanical injuries or hypothermia as a result of severe stress, causing muscle spasms and a reduced pain threshold.

symptoms

Most people who have noticeable discomfort in their muscles say that the discomfort eases when they are at rest and becomes very severe when they move. The type of pain may be aching or stabbing, jerky or boring, aching or dull, or sporadic. These complaints are accompanied by stiffness of movement, palpable thickening and tension of the muscle tissue at the site of pain. Myalgia often spreads to other parts of the body and causes loss of sensation in the body or limbs.

Depending on the severity of the pain, a distinction is made between:

• Acute intercostal myalgia. Acute intercostal myalgia is caused by mechanical damage to muscles, trauma or physical exertion, and infectious diseases. The severity of the symptoms varies greatly and the pain disappears completely within 3-6 days.
• Chronic pain lasts several weeks and its occurrence and persistence is indicative of myofascial syndrome.

The types of myalgias are classified into different degrees:

• Grade 1 is a localized pain felt when the injured or inflamed muscle is affected. The fibers are perceived as thickened and involuntary twitches occur when palpated.
• Grade 2 – the pain is self-limiting and pulling, muscle strength is reduced and the pathological process partially penetrates the subcutaneous layer.
• Grade 3 – pronounced pain during activity and at rest affecting a muscle group. Muscle strength is reduced by 30 % or more.

Common complications after coronavirus are.

• Cephalgia (headache)
• Dyspnea (shortness of breath)
• Cardiac arrhythmias
• rise in blood pressure.
• Myocarditis, endocarditis, pericarditis
• thrombosis
• pulmonary embolism
• Liver, kidney dysfunction
• insomnia
• cognitive disorders
• depressive and other conditions.

Patients should seek medical attention at the first signs of thrombosis, as lack of treatment leads to irreversible consequences, including amputation or death.

Causes of muscle pain after coronavirus

Joint and muscle pain after coronavirus infection is due to the following factors

• increased inflammatory markers
• Production of antibodies against SRP (post-Covid necrotizing autoimmune myositis)
• Toxic poisoning of muscle and cartilage tissue by virus components and cell breakdown products
• Exacerbation of chronic musculoskeletal diseases

More than 55 % patients suffer from localized or diffuse post-coronaviral myalgia, which occurs spontaneously both during exertion and at rest. In most cases they are accompanied by bone and joint pain.

For diagnosis

The diagnosis is made by a neurologist and, if necessary, a consortium of oncologists, radiologists, otolaryngologists, ophthalmologists and other specialists is formed.

This makes diagnosis easier:

If necessary, a tissue biopsy of the suspected tumor is performed.

A general clinical and biochemical blood test and, if spinal hemorrhage is suspected, a spinal blood test are mandatory.

Initial care and treatment

• Keep your posture as gentle as possible to relieve muscle tension;
• Pain relief: taking painkillers, warming with dry heat (not a hot water bottle);
• Referral to a doctor or call a specialist at home.

Depending on what is the cause of muscle neuralgia and what symptoms accompany it, treatment can be conservative medical or surgical (in the presence of a tumor, when fixing a fracture of the spine and for other reasons).

If there is an acute infection, an exacerbation of an infectious and inflammatory process with a chronic course, all measures appropriate to the situation are applied:

An essential treatment measure is the use of muscle clamps:

If the disease persists, spa treatment in a hot, dry climate is indicated.

The therapy of the main localizations of muscle neuralgia includes the treatment of tunnel syndrome with:

• anti-inflammatory drugs, including injectable analgesics, NSAIDs, novocaine blockers and the like;
• antiepileptics, anticonvulsants and muscle relaxants;
• tissue therapy (subject to contraindications);
• Vitamin therapy (vitamins or complexes of groups B and C);
• Kinesio and reflex therapy, physical therapy.

In the treatment of herpetic neuralgia, in addition to the main areas, attention should also be paid to the prescription of antiviral (herpetic) drugs, as well as the medical regime and safety with a strong analgesic effect.

diagnosis

The diagnosis is made during a conversation with a podiatrist based on the symptoms and external examination. X-rays of the lower leg and ankle, MRI and ultrasound of the ankle are used as additional diagnostic methods. In some cases, foci of calcification may be visible on x-rays. In tendinitis they are 'scattered' throughout the tendon, whereas in enthesopathy they are mainly found in the lower part of the tendon. The absence of calcifications is not a reason to confirm or reject the diagnosis of tendonitis.

Ultrasound and MRI are more accurate methods for examining the soft tissues in detail and detecting foci of inflammation and areas of degenerative changes. In addition, MRI of the ankle can detect the acute phase of inflammation - at this stage, a large amount of fluid accumulates in the tendon tissue, but there is little or no external swelling, making clinical diagnosis difficult.

Treatment of Achilles tendonitis

The majority of treatment is conservative and takes place on an outpatient basis in a trauma center. In the acute phase, rest, elevation of the limbs and tight bandages while walking are indicated. In the first few days of the disease, cold should be applied to the affected area. The patient is prescribed NSAIDs for a maximum of 7-10 days to eliminate pain, eliminate inflammation and restore tendon function.

As soon as the pain is eliminated or significantly reduced, training begins. The exercise program for tendonitis includes light strengthening and stretching exercises to restore the tendon and strengthen the calf muscle. Strength exercises are gradually introduced later. In addition to LFC, physical therapy treatments such as electrical stimulation, electrophoresis, and ultrasound therapy are used to repair the tendon.

Massages are used to improve blood circulation, strengthen and stretch the tendon. In case of valgus or varus deformities of the foot, wearing special ankle splints is recommended. Fixation with a plaster cast is rarely used, only for severe, persistent pain in the tendon area. If the pain is particularly severe, therapeutic blocks with glucocorticoids are sometimes carried out. Glucocorticoids are only injected into the surrounding tissue; Injections into the tendon itself or into the tendon insertion are strictly prohibited as they stimulate degenerative processes and can provoke a tendon rupture.

Surgical intervention is indicated if conservative treatment fails for six months or longer. The operation is routinely performed in a traumatology or orthopedic department. A midline skin incision is made along the posterior surface of the tibia, the Achilles tendon is isolated, the degenerated tissue is examined and excised. If 50 % or more of the Achilles tendon tissue had to be removed during surgery, the removed areas are replaced with extensor muscle tendons. The postoperative phase consists of stabilization for 4-6 weeks with an orthosis or a plaster cast. The patient can put weight on the foot again after 2-4 weeks, and rehabilitation takes place after 6 weeks.

Stages of myalgia formation

Myalgia is accompanied by an increase in muscle tone and progresses in three stages:

• Stage 1 is pinpoint pain that occurs at the site of damage or inflammation of muscle tissue. On palpation, a thickening can be felt, which causes an involuntary contraction of the muscle when touched.
• Stage 2 - the pain begins suddenly, usually in the evening, and lasts for a long period of time, the muscle becomes weaker, the pulse quickens, breathing becomes faster and the inflammatory process can penetrate the skin and cause increased sensitivity.
• Stage 3 – constant pain, even during sleep, affects the muscles of the arms and legs, the muscles of the shoulder girdle, the chest and abdominal muscles and can lead to muscle wasting.

diagnosis

The first symptoms of myalgia are a signal to see a doctor, who will make a preliminary diagnosis during the consultation based on the patient's descriptions and physical examination. Following the appointment, the patient may also be referred to another doctor or for further comprehensive testing to make the diagnosis. The doctor can make a diagnosis and recommend drug therapy based on the following factors:

Determining the underlying cause of myalgia, taking into account the nature of the pain and the specific impact on the body, helps the doctor prescribe diagnostic tests and make an initial diagnosis. Myalgia usually has clear symptoms, but external symptoms alone are not enough to make a diagnosis. In the treatment of myalgia, laboratory diagnostic procedures are used in medicine:

• Detailed blood test;
• Biochemical blood test;
• blood test for the presence of TTG, T3, T4;
• blood tests for acute inflammatory proteins;
• PCR and blood tests for antibodies;
• Blood tests for CK, CK and CPK (creatine phosphokinase).

To diagnose vaginal myalgia, that is, myalgia caused by trauma:

• Ultrasound – Ultrasound examination. An examination of a muscle that shows the extent of tissue damage.
• CT – Computed Tomography. An examination that shows the condition of nerve endings, ligaments and tendons.
• EMG – electromyography. An examination of the extent and development of muscle damage.

The specialist may recommend a differential diagnosis to rule out variants such as polymyalgia or fibromyalgia.

Types of myositis

Myositis in the cervical and lumbar spine

Cervical myositis is the most common of all myositis. It usually develops as a result of a cold, a muscle strain or a prolonged uncomfortable position. It is accompanied by a dull pain that is often localized to only one side of the neck. Sometimes the pain also extends to the back of the head, temple, ear, shoulder or shoulder joint region. A person with myositis may have tenderness in the neck, and the pain may limit movement of the cervical spine to some extent.

Myositis of the lumbar region is also quite common. Due to the same localization of pain, it is sometimes confused with lumbago, but the pain in this case is not so acute, usually painful, does not subside at rest and increases with movement and pressure on the muscles of the affected area.

Myositis of the cervical and lumbar muscles usually needs to be differentiated from an exacerbation of osteochondrosis, and myositis of the lumbar muscles also needs to be differentiated from a spinal fracture. When making a diagnosis, attention is paid to the type of pain (muscle soreness), the severity of the pain when the muscles are palpated, and the presence or absence of neurological symptoms. An X-ray of the spine, magnetic resonance imaging of the neck, or computed tomography may be performed to confirm the diagnosis.

Note that constant low-intensity back pain sometimes indicates kidney disease. Therefore, in case of such pain, a doctor should always be consulted to assess the clinical signs, confirm or exclude the diagnosis of myositis and, if necessary, refer the patient for further examinations (blood and urine tests, renal ultrasound, etc.).

Dermatomyositis and polymyositis

Dermatomyositis belongs to the group of systemic connective tissue diseases. It is quite rare - according to international researchers, it occurs in 5 people per 1 million people. It usually affects children under 15 years of age or older people (50 years of age and older). It occurs twice as often in women as in men.

Treatment of myositis

Myositis is treated by different doctors, and the choice of specialist depends on the cause of the disease. For example, myositis of parasitic origin is usually treated by parasitologists, infectious myositis by internists or infectious disease specialists, traumatic myositis and myositis after significant physical stress by traumatologists, orthopedists, etc. Myositis therapy includes pathogenetic and symptomatic measures. For bacterial lesions, antibiotics are prescribed, for parasitic lesions, anthelmintics are prescribed. In the case of myositis as a result of an autoimmune disease, long-term treatment with immunosuppressants and glucocorticoids is indicated.

In acute myositis and exacerbations of chronic myositis, bed rest and limitation of physical activity are recommended. Fever is treated with antipyretic drugs. Analgesics are used to combat pain and usually from the NSAID group (ketoprofen, ibuprofen, diclofenac, etc.) to reduce inflammation. Warming ointments are effective for localized myositis. The local irritant effect of these ointments relaxes the muscles and reduces the intensity of pain. Massages (contraindicated in purulent myositis), physiotherapy and exercise therapy are also used. Treatment of purulent myositis includes opening and drainage of the abscess, as well as prescribing antibiotics.

diagnosis

If the longitudinal muscles of the back near the spine and lower back hurt constantly for no reason and the reasons for this are not known, a specialist should be consulted to clarify what to do and how to treat it.

To find out what exactly could be the cause of your back muscle pain, a series of tests will be ordered:

1. A general and biochemical blood test helps determine whether there is an infection in the body and what type of infection it is.
2. X-rays or CT scans can be used to determine whether a disease is developing that changes the structure of the bones.
3. An MRI scan is used to examine the condition of the muscles. This examination can detect tumors, injuries, spasms and inflammations. [4]

Treatment

When deciding how and with what to treat a person who has pain in all the muscles of the back along the spine or in the chest area, it is important to take into account the symptoms and also the place where the muscles hurt: above, on the sides, under the shoulder blades, above the lower back, on the right or left side, in women or men, at rest or after work and while walking, after illness.

The doctor diagnoses the problem and chooses an individual treatment strategy. So it is dangerous to use another doctor's methods and recipes. Doctors combine several therapies. However, the treatment is lengthy. The treatment must not be stopped immediately, otherwise the pain will return and become worse.

Pharmacological treatment.

• Myorelaxants. To relax and improve blood circulation.
• B vitamins Complement other medicines and play an active role in tissue regeneration and nutrition.
• Non-steroidal anti-inflammatory drugs For pain relief.
• chondroprotectors For the nutrition of the cartilage.

Physiotherapy and physical therapy

The most effective are:

1. Electrophoresis for rapid administration of the required medication to the affected area.
2. Magnetic therapy for relaxation.
3. Special massages.
4. LFC kits. The exercises are selected by the attending physician; The first training sessions are best carried out with an experienced trainer.

Surgical interventions

Surgery is recommended if:

• It is necessary to remove a tumor or growth.
• After a serious injury, recovery is impossible without the intervention of a surgeon.

complications

Long-term untreated contractures or undiagnosed organic diseases can lead to complications in the muscular, skeletal and nervous systems:

1. Development or progression of radiculitis (damage to nerve roots resulting in reduced motor function, sensitivity, reflexes and weakness).
2. curvature of the spine.
3. Compression of blood vessels, impaired circulation.
4. Thrombosis of blood vessels.
5. Frequent temporary loss of consciousness.
6. Jaundice to earthy discoloration of the skin.
7. Necrotic changes in muscle tissue.
8. Incapacity for work.

Muscle cramps are often short-lived and resolve easily. If a muscle spasm lasts more than 2-3 days and is accompanied by pain, it is necessary to consult a specialist. Timely diagnosis and treatment can significantly reduce the risk of complications and muscle deterioration.

Muscle pain is caused by severe rheumatic diseases

Rheumatic diseases manifest themselves as muscle pain and weakness. The etiology of these diseases is largely unknown and, if left untreated, can result in permanent disability. One such disease is polymyositis. It can occur at any age but is most common in patients in their 30s and 50s.

Women are affected 2 to 3 times more often than men. Pain and muscle weakness, especially in the shoulder and lumbar regions, are a characteristic symptom for all patients. The disease can also affect the skin; in this case it is called dermatomyositis.

Inflammatory changes in these diseases also occur in the heart muscle, throat, larynx, esophagus and interstitial tissue of the lungs. Comorbidity is found in one in four patients with polymyositis and dermatomyositis.

Another rheumatic muscle disease is polymyalgia rheumatica. This is a disease of advanced age, the symptoms of which are pain and stiffness in the muscles of the shoulder girdle, more rarely the hip girdle, without weakness or atrophy. It can be associated with inflammation of the arteries, particularly the temporal, occipital and retinal arteries, often leading to blindness.

Treatment of myalgia

The most important prerequisite for successful treatment of myalgia is the correct diagnosis of its cause. Because every clinical picture requires individual therapy.

In addition to pharmacological treatment of muscle pain, therapies such as massage, acupuncture, pressure point massage, ultrasound, cryotherapy and electrotherapy can be very effective in treating muscle pain, as long as they are tailored to the individual patient. They prevent muscle weakness and relieve pain. Rehabilitation exercises play a similar role.

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