Myalgia
OtherOverview
Myalgia refers to muscle pain that may be localised to a specific region or widespread across multiple body areas. It is a symptom rather than a standalone diagnosis, arising from a broad range of causes including mechanical overload, systemic illness, inflammatory conditions, medications, and psychosocial factors. Accurate clinical assessment is essential to identify the underlying aetiology and guide appropriate management or referral.
Pathophysiology
Muscle pain arises through nociceptive activation of free nerve endings within muscle tissue, triggered by mechanical stress, metabolic byproducts (e.g. lactate, bradykinin, prostaglandins), ischaemia, or inflammatory mediators. Central sensitisation may amplify pain perception in chronic or widespread presentations. The underlying cause determines the dominant mechanism — peripheral sensitisation in localised overuse injury, immune-mediated inflammation in viral or autoimmune myalgia, and altered descending inhibition in fibromyalgia-spectrum disorders.
Patient Education
Muscle pain is common and usually resolves with rest, gentle movement, and time. Staying active within comfortable limits, maintaining hydration, and addressing sleep and stress are important for recovery. If pain is widespread, persistent, or accompanied by other symptoms such as fatigue, fever, or weakness, further assessment is recommended.
Typical Presentation
Site
Localised (single muscle or region) or diffuse/widespread (multiple regions)
Quality
Deep aching, heaviness, tenderness to touch; may be sharp with acute injury or burning in neuropathic overlap
Intensity
Variable; 2–8/10 depending on aetiology and acuity
Aggravating
Physical activity, sustained postures, palpation, psychological stress, poor sleep, cold environments
Relieving
Rest, heat, gentle movement, analgesia, improved sleep, hydration
Associated
Fatigue, reduced range of motion, muscle stiffness, weakness; systemic features (fever, malaise) if infective or inflammatory cause
Orthopaedic Tests
Test descriptions are written with AI assistance from standard clinical texts. Where a test lists Sources, its description has been checked against them; those sources are independent and do not endorse OsteoKit. Accuracy figures and grades (A–D) appear only when checked against the published study; tests without one are marked “No accuracy study”.
Further reading: full test procedures are described in standard clinical examination texts, e.g. Magee & Manske, Orthopedic Physical Assessment (7th ed.), and Cook & Hegedus, Orthopedic Physical Examination Tests: An Evidence-Based Approach (2nd ed.).
Palpation of Affected Muscle Groups
Procedure
Palpate the painful muscles and the same muscles on the other side, noting tenderness, tone, swelling and warmth. Note whether pain is in one region or widespread.
Positive Finding
Tenderness in the muscles the patient describes, reproducing their pain.
Interpretation
Confirms where the pain is and whether it is local or widespread. Widespread muscle pain with weakness, dark urine, fever, recent new medication (especially statins), or feeling generally unwell needs medical review and blood tests (for example creatine kinase) before treating as simple muscle pain.
Resisted Muscle Testing (Regional)
Procedure
Test the painful muscle groups against resistance in mid-range, comparing with the other side. Note pain and strength separately.
Positive Finding
Pain on resisted contraction, with or without weakness.
Interpretation
Pain with normal strength fits a muscle-tissue source. True weakness, especially of the hips and shoulders on both sides (difficulty rising from a chair or lifting arms overhead), suggests an inflammatory or drug-related muscle disease and needs medical referral. Weakness in a nerve pattern points to a nerve cause instead.
Functional Movement Observation
Procedure
Watch the patient perform simple movements related to their complaint, such as a squat, sit-to-stand, single-leg stance or reaching overhead.
Positive Finding
Pain, avoidance or an altered movement pattern during the task.
Interpretation
Shows how the pain affects function and gives a baseline for rehabilitation. It does not diagnose the cause of muscle pain. (This is not the trademarked Functional Movement Screen, which is a specific seven-test battery.)
⚠ Red Flags
- •Severe proximal muscle weakness with elevated CK suggesting inflammatory myopathy (polymyositis, dermatomyositis)
- •Myalgia with fever, rash, or systemic illness suggesting viral or bacterial infection (e.g. Ross River virus, influenza, sepsis)
- •Dark urine with acute severe myalgia suggesting rhabdomyolysis — urgent medical referral
- •New myalgia in patient on statins or other myotoxic medications suggesting drug-induced myopathy
- •Unintentional weight loss, night sweats, or fatigue suggesting malignancy or systemic inflammatory disease
- •Temporal arteritis pattern (jaw claudication, scalp tenderness, visual changes) in older adults with new head/neck myalgia
⚡ Yellow Flags
- •Widespread pain with fatigue, sleep disturbance, and cognitive symptoms suggesting fibromyalgia-spectrum disorder
- •High pain catastrophising or fear-avoidance beliefs amplifying symptom reporting
- •Significant psychosocial stressors, anxiety, or depression concurrent with onset
- •Prolonged symptom duration without clear structural cause suggesting central sensitisation
- •Frequent healthcare seeking across multiple providers without diagnosis
Osteopathic Techniques
Safety: Myalgia is a symptom, so look for its cause before treating. Muscle pain, weakness and tea-coloured urine are the classic triad of rhabdomyolysis, though fewer than half of patients show all three; it needs urgent medical care. Statins can cause diffuse muscle aches, tenderness or weakness that settle once the drug is stopped, so ask about medicines and refer to the prescriber.
- Reference bookRout et al. · StatPearls 2025
- Reference bookSizar et al. · StatPearls 2024
Region
Symptomatic muscle group
Technique
Rationale
Soft tissue to the painful muscle group, kept within comfort.
How it's done & evidence
How it's done
Hands-on soft-tissue manipulation of the affected muscle group: kneading, stroking, stretching and sustained pressure, with the area relaxed and supported. Use this entry when a card names no body region; regional entries describe the same work for one area.
Evidence in Myalgia
Searched 27 Oct 2026: no trials of soft tissue technique in myalgia.
Sources
- Journal articleFurlan et al. · Cochrane 2015
Region
Affected muscles
Technique
Rationale
Muscle energy technique to ease and lengthen the affected muscle.
How it's done, cautions & evidence
How it's done
The muscle is taken to its barrier. The patient pushes gently, at about 10–20% effort, against resistance for 5–10 seconds, relaxes for 3–5 seconds, and the new barrier is taken up.
Cautions
Not used with an acute fracture, a joint infection or a bone malignancy; take care with severe osteoporosis or after surgery that limits muscle contraction. Use the least force needed: too much can tear a muscle or pull off a tendon, especially in older patients.
Evidence in Myalgia
Searched 27 Oct 2026: no trials of muscle energy technique in myalgia.
Sources
- Reference bookWaxenbaum & Sina · StatPearls 2026
Region
Thoracic spine and rib cage muscles
Technique
Rationale
Soft tissue to the thoracic paraspinal and rib-angle muscles.
How it's done & evidence
How it's done
Hands-on soft-tissue work (kneading, stretching and sustained pressure) to the thoracic paraspinals, rhomboids, middle trapezius and the muscles along the rib angles, usually prone or side-lying.
Evidence in Myalgia
Searched 27 Oct 2026: no trials of thoracic soft tissue in myalgia.
Sources
- Journal articleFurlan et al. · Cochrane 2015
Rehabilitation Exercises
Gentle Walking / Low-Impact Cardiovascular
Diaphragmatic Breathing and Relaxation
Progressive Muscle Relaxation Stretching
Graded Resistance Training — Region-Specific
Referral Criteria
- •Suspected rhabdomyolysis (dark urine, severe weakness, acute onset) — emergency referral
- •Elevated CK with progressive proximal weakness — rheumatology or neurology referral for inflammatory myopathy workup
- •Myalgia in context of systemic illness, fever, or rash — GP/medical referral for infectious or inflammatory workup
- •Suspected statin or drug-induced myopathy — GP referral for medication review
- •Widespread pain meeting fibromyalgia criteria unresponsive to conservative care — pain specialist or rheumatology referral
- •Persistent unexplained myalgia >6–8 weeks without improvement — GP referral for bloods (CK, ESR, CRP, TFTs, FBC)
Consider These Diagnoses
This presentation may reflect several distinct diagnoses. Use the links below to explore conditions that may better explain the clinical picture.