Myalgia

Other

Overview

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

Palpation of Affected Muscle Groups

Procedure

Systematic palpation of symptomatic muscle regions; assess for tenderness, trigger points, guarding, or swelling

Positive Finding

Reproducible tenderness or pain consistent with patient's complaint

Sensitivity / Specificity

Unknown / Unknown

Interpretation

Confirms localisation of pain; helps identify trigger points or regional vs widespread distribution

Resisted Muscle Testing (Regional)

Procedure

Apply resistance to the affected muscle group through its range; assess for pain and/or weakness

Positive Finding

Pain with resistance (contractile tissue involvement) or weakness suggesting muscle pathology or neurological involvement

Sensitivity / Specificity

Unknown / Unknown

Interpretation

Differentiates contractile vs inert tissue involvement; weakness may indicate myopathy, nerve involvement, or pain inhibition

Functional Movement Screen (e.g. Squat, Single-Leg Stance)

Procedure

Observe patient performing basic loaded or unloaded movements relevant to their complaint

Positive Finding

Pain reproduction, compensatory patterns, or inability to complete movement

Sensitivity / Specificity

Unknown / Unknown

Interpretation

Assesses functional impact and movement quality; guides exercise prescription and identifies contributing biomechanical factors

⚠ 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

Region

Symptomatic muscle group

Technique

Soft Tissue

Rationale

Direct inhibition and myofascial release reduce peripheral nociceptive input, address trigger points, and restore local tissue extensibility

Region

Cervical/thoracic/lumbar spine (as relevant)

Technique

Articulation

Rationale

Restores segmental mobility and reduces referred muscular tension from restricted spinal segments; addresses neuromotor contributors to regional myalgia

Region

Affected musculature

Technique

MET

Rationale

Muscle energy techniques restore resting muscle length, improve proprioceptive input, and reduce protective guarding around painful regions

Region

Rib cage and thoracic spine

Technique

Soft Tissue / Articulation

Rationale

Improves respiratory mechanics and autonomic tone; addresses widespread myalgia with a postural or respiratory component

Add-On Approaches

Chinese Medicine

Acupuncture to local ashi points and distal points for pain modulation; cupping for localised muscle tension

Chiropractic

Spinal manipulation for segmental contributors; soft tissue adjuncts; ergonomic and activity advice

Physiotherapy

Graded exercise therapy, hydrotherapy, pain neuroscience education, sleep hygiene, activity pacing

Remedial Massage

Trigger point therapy, myofascial release, lymphatic techniques for inflammatory myalgia

Rehabilitation Exercises

Gentle Walking / Low-Impact Cardiovascular

CardiovascularBeginner

Diaphragmatic Breathing and Relaxation

PosturalBeginner

Progressive Muscle Relaxation Stretching

StretchingBeginner

Graded Resistance Training — Region-Specific

StrengtheningIntermediate

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.

→Fibromyalgia→DOMS (Delayed Onset Muscle Soreness)→Viral Myalgia / Post-viral Fatigue→Inflammatory Myopathy (Polymyositis / Dermatomyositis)→Statin-Induced Myopathy→Chronic Fatigue Syndrome / ME→Referred Pain from Spinal Pathology