Myalgia, myositis, myofascial syndrome

Myalgia (fibromyalgia), myositis, myofascial syndrome are diseases, the main symptom of which is severe muscular pain of different localization and origin. Muscle pain can occur due to various reasons:

1. muscle tissue congestion
2. muscle hypertonia (stable muscle spasm)
3. bruises and sprains
4. long or extra hard physical loads
5. comorbidities: influenza, ARVI, arthritis, radiculitis, myositis (sacritis)
6. in some cases, the muscular pain occurs on the background of emotional stress
7. long stay in a cold, damp room.

In case of myalgia, pain sensations increase with pressure on the muscles and during movement, but they may also be permanent, remaining also at rest. In addition to pain, myalgia symptoms such as headache, fever (hyperthermia), nausea, a feeling of tension and joint stiffness can also be observed.

Fibromyalgia is the most common type of myalgia, characterized by diffuse muscular pain in certain body areas (usually symmetrical). Most often, this is a complex chronic disease, in the clinic of which in addition to muscle pain insomnia, depressive disorders, fatigue, anxiety, and meteosensitivity are also noted. Women are more susceptible to this disease than men.

Most often, the pain is localized in the lumbar, cervical, occipital and humeral areas. A diffuse localization with possible accent in certain trunk or extremities areas is typical. The main clinical fibromyalgia phenomenon is painful zones (“tender” zones); even a slight impact on them causes pain.

Fibromyalgia, in its turn, is also divided into two types – primary and secondary fibromyalgia.

Primary fibromyalgia is characterized by musculoskeletal pain sensations that sharply appear during “tender” zones palpation. Primary fibromyalgia occurs mainly in women prone to anxiety, stress and depression; it is often observed in adolescent girls as well. The pain can be aggravated due to overloads, injuries and weather changes (cold, dampness). Patients suffering fibromyalgia are characterized by frequent paroxysmal autonomic disorders – panic attacks, hyperventilation syndrome.

Secondary (local) fibromyalgia is most often characteristic of men and can be caused by work- or sports overloads.

A myofascial syndrome is common musculoskeletal system pathology; it is characterized by chronic muscle pain and by the formation of painful indurations (trigger points) in the strained muscles. The reflected pain, sensitivity disorders, limitations of movement volume, vegetative dysfunctions (sweating, skin colour changes) are also noted – in addition to local pain in the area of ​​trigger points.

At the moment, there is no person who has never experienced muscles pain. Therefore, it is not surprising that we are accustomed to treat such painful manifestations calmly, assuming that they are natural. Unfortunately, similar nature of pain is not always observed. In most cases, musculoskeletal painful sensations are symptoms of myofascial syndrome, which, in turn, is provoked by the trigger point’s actions: latent or active.

The active trigger point is the focus of a maximum irritability and muscle pain, which has a certain area of painful feelings reflection, which can occur at rest and during movement. You can make yourself certain in such points appearance while palpation – pressing your fingers on the intended skin area. As a rule, the response to the trigger point’s stimulation is a local convulsive muscles movement, which is accompanied by increased pain.

The latent points cause pain during the palpation only. During palpation, the patient can feel pain in the area outlying from its focus.

The main causes of the myofascial pain syndrome are:

1. Osteochondrosis – due to irritation of the sinuvertebral nerve (Luschka nerve), which innervates the structure of the spinal column, reflex spasm of paravertebral and distant muscles often occurs. Long-lasting muscle overstrain contributes to the formation of active trigger points in it.
2. Anomalies of development. The asymmetry of the body at the different length of legs has a fundamental importance. The difference in leg length is physiological, as it is found in 92% of young people. It is a question of the length difference degree. The risk factor is the difference of the legs’ length exceeding 1 cm, as it reliably correlates with back pain. The flat feet, long second metatarsal bones at a shortened first metatarsal bone contribute to the appearance of the muscle pain. The long second metatarsal bone is a predisposing factor for the appearance of pain in the lower back, thigh, knee, shin and foot. Such foot configuration causes significant posture disorders, the restoration of which requires considerable efforts of many muscle groups. Thus the muscle pain syndromes appear as result of constant muscle tension.
3. Prolonged immobilization of muscles. A long posture maintaining during deep sleep can activate the trigger points. The pulling, deep, poorly localized, diffuse pain in the back after getting up appears exactly in these cases. The particular importance has the prolonged limbs immobilization after fractures. After plaster removal, the muscles are always painfully tensed; the condition that has been called “frozen” joints develops. Muscles require a gradual stretching, and the joints – “work out”. After the removal of plaster, pain can appear almost in all back parts, since immobilization of both upper and lower extremities after fractures leads to a major violation of movements’ stereotype and the appearance of significant body asymmetries. The muscles compression with bag or backpack straps, narrow bretelles, collar, tightly buttoned belt, tight jeans, heavy winter coat, bandages or corsets can activate the trigger points in the corresponding muscles.
4. Muscles hypothermia. Both general cooling and local cooling are important (sitting in a draft, the neck and the lower back are “chilled through”, etc.). The cooling is one of the most common provoking factors. Usually it is combined with muscle overload – when overworked tensed muscles are cooled.
5. Mental factors. Emotional stress is always accompanied by muscular tension, which ensures the readiness of the body to fight or escape. After the cessation of stress, muscles often remain stressed. The role of chronic stressful situations is also important, when many face, neck, and body muscles are reduced, and the person “lose the ability to” to control muscle tension and relax. Recollect the expression – “he is bent by sorrow”. The state of the psyche is always reflected in the movements, the so-called psychomotor changes in a person. A change in posture leads to spasms and muscle overload, pains occur, which, in turn, further disturb the gait and posture.
6. Diseases of visceral organs and joints. Myofascial pain syndromes can accompany almost any somatic pathology. The pain impulses from the affected internal organ or joint lead to protective tension of the corresponding muscles in order to immobilize the joint or to create a muscle “corset” around the diseased organ. Thus, an ischemic heart disease with angina attacks or myocardial infarction, as a rule, is accompanied by the appearance of myofascial pain syndromes in the chest region (on the left side).
7. Overloads of untrained muscles. Myofascial pain syndromes are more characteristic for people of mental work. A weak muscular corset is one of the most serious risk factors. The painful strains appear in the muscles and trigger points are activated at an unusual long-term work of weak and untrained muscles. Quite often the muscular pain occurs in patients in summer season along with physical overloads in the garden after winter inactivity. A stretching of muscles with their subsequent spasm in case of unsuccessful turn, throw and jump is a frequent cause of triggers activation. Throws in basketball, serving in big tennis, javelin throwing or shot put have a detrimental effect on unheated and trained muscles.
8. Muscle bruise. Direct muscle injury can activate triggers that remain active after hematoma regression.

Myositis is the muscle tissue inflammation, which leads to the formation of solid nodules in the muscle fibres. Usually myositis affects a specific group of muscles – and if there are many inflammation foci, then it is a polymyositis. Moreover, the disease can affect not only the muscle tissue, but skin as well- this is called dermatomyositis.

There distinguish acute, subacute and chronic variant of myositis. In the latter case, dense nodules or seals form in the muscles, painful on palpation.

Factors affecting the muscles inflammation are: hypothermia, trauma, muscle cramps, infectious diseases (flu, sore throat), constant tension of a certain muscle group (in professional activities, for example, in athletes, musicians, etc.), and diseases like scoliosis, osteochondrosis, rheumatism, rheumatoid arthritis, lupus erythematosus. There also distinguish acute purulent myositis caused by staphylococcal, streptococcal, pneumococcal bacteria

The main symptom is severe pain in a specific muscle group (neck, chest, lower back, lower leg, etc.). The pain usually increases with pressure on the affected area and during movement, weather changes. Chronic myositis can be accompanied not by sharp pains, but by aching ones, and constant muscle weakness arises. Sometimes there observed skin redness and swelling at the site of inflammation. Due to the protective tension of the muscles, the work of the joints is limited – and arthritis develops. Polymyositis is characterized by general muscle weakness, which can cause atrophy: it is difficult to stand up, to take something in the hand, and to raise the head. This is very dangerous, because vital muscles, which take part in breathing, chewing and ingesting food can mummify.