Muscle Pain: Complete Guide

You wake up with a stiff neck. After an unusual workout, going down the stairs becomes difficult. Muscle pain can affect a small area or multiple muscles. Our physical therapists evaluate these pains and their impact on your movement.

Many temporary muscle aches improve over time and with appropriate activities (progression of muscle pain). For sports injuries, a review reports good outcomes in terms of functional recovery for the majority of athletes treated without surgery. A severe injury, however, may require more extensive care and delay a return to sports.¹

Muscle soreness after unusual exercise usually subsides within a few days (post-exercise muscle soreness). Researchers classify it as a mild muscle injury. It differs from a severe muscle tear.²

• The time it takes to return to sports after a muscle strain depends on the severity of the injury, known as its grade. Two studies on the hamstrings and the calf report longer average recovery times for higher grades. These time frames refer to the resumption of sports, not the complete healing of the tissue.^{3, 4}
• Persistent pain may also benefit from active treatment. For chronic back pain, recommendations include education and appropriate exercise. This approach does not guarantee the elimination of all muscle tension.⁵

This guide helps you understand muscle pain, distinguish between different types, know when to seek medical attention, and learn about possible treatments and ways to reduce certain risks. To understand how physical therapy can help you, check out our comprehensive guide to physical therapy.

What is muscle pain?

Muscle pain, or myalgia, is pain felt in one or more muscles. It can be localized or widespread (definition and causes). Muscles enable us to move and support the body. They make up a significant portion of the body’s mass.⁶

A muscle’s sensitivity can change. Pressure that is normally tolerable may become painful, and pain may also be felt at a distance from the stimulated muscle. These phenomena are studied in the context of muscle and joint pain.^{7, 8}

Your muscles are involved in a variety of tasks: carrying groceries, climbing stairs, typing on a keyboard, or holding a certain position. The demands vary depending on the activity; not every muscle remains contracted all the time.

Unusual exertion, an injury, or stress-related tension can cause muscle pain (common causes). The location of the pain, when it began, and any associated symptoms guide the evaluation. A specific position or sensation alone is not enough to explain all cases of pain.

Let's look at the different types of muscle pain.

What are the different types of muscle pain?

Muscle pain includes, among other things, soreness after exercise, muscle strains, tender areas known as trigger points, and cramps. These categories describe different conditions; their symptoms may be similar.^{9, 10}

Muscle soreness after exercise

Delayed-onset muscle soreness occurs after unusual physical exertion. According to the American College of Sports Medicine, it often begins 12 to 24 hours after exercise and may be most severe between 24 and 72 hours (guidelines on muscle soreness). Hotfiel’s review indicates that it peaks between 48 and 72 hours.² For example, moving on Saturday can make climbing stairs difficult on Sunday or Monday.

Muscle soreness is a reaction of the muscle to unusual exertion, which may involve microscopic changes. It does not, on its own, indicate a significant tear. Eccentric contractions—in which the muscle exerts force while lengthening—are a common cause of muscle soreness; walking down a slope or slowly lowering a weight are examples of this.² (review on muscle soreness). To learn more, see what causes muscle soreness and cramps.

Typical characteristics:

• The pain often gets worse during the first three days after exercise.
• Muscle soreness usually subsides within a few days and rarely lasts more than five days (typical duration).
• Muscles tender to the touch and stiff
• Gentle movement can temporarily relieve pain (the effect of light exercise).

Muscle Strain

A muscle strain refers to a tear in muscle fibers. The term “pulled muscle” can also refer to excessive stretching without a complete tear (muscle injuries). The severity ranges from minor damage to a severe tear.¹ Classifications vary: the study on the hamstrings uses four grades, while the study on the calf uses a classification based on medical images of the muscle.^{3, 4}

The pain of a muscle strain often occurs during physical exertion or a sudden movement. A tearing sensation, weakness, or bruising can help identify the injury (signs of a muscle injury). The patient’s account must be combined with a physical examination; not being able to recall a specific moment is not sufficient to rule out an injury.

Muscle strains can affect the hamstrings(at the back of the thigh), the quadriceps(at the front of the thigh), the calf, the adductors(on the inner thigh), or the lower back muscles.

Trigger Points

Trigger points, sometimes called muscle knots, are small, tender areas felt within a taut band of muscle. Pain may be present at rest, triggered by pressure, or felt at a distance.¹¹ The definition and mechanisms of these points remain a subject of debate in research.¹⁰

A pressure-sensitive area alone does not confirm the presence of a tear. The explanation that trigger points result from a small, persistent contraction remains a hypothesis.¹² Sensitivity may persist, but the examination should also consider other causes. Our guide to chronic pain explains pain that lasts.

Cramps

A cramp is a sudden, painful, involuntary muscle contraction.¹³ A calf cramp that wakes you up at night is one example.

A leg cramp can last from a few seconds to ten minutes. The muscle may remain tender after the episode (leg cramps). A persistent tender area and a brief contraction therefore do not describe the same phenomenon. Intensity alone is not enough to distinguish between them.

Recurrent cramps that disrupt sleep, last longer than ten minutes, or are accompanied by numbness or swelling warrant a medical consultation (reasons for seeking medical care for cramps).

Let's see how to distinguish these pains from joint or nerve pain.

How to tell if my pain is coming from a muscle, a joint, or a nerve?

A healthcare professional distinguishes between muscle, joint, and nerve pain by considering your description of the symptoms, along with your range of motion, strength, and tenderness. No single sign is sufficient to make a definitive diagnosis.^{14, 15, 16} Muscle and joint pain can overlap.¹⁵ Nerve pain can be spontaneous or triggered by touch or movement.¹⁶ The following guidelines help describe your symptoms but are not a substitute for a physical examination.

Muscle pain may be localized to a small area or spread throughout the muscle. It may vary with exertion and pressure (muscle pain). A tender muscle may also cause pain felt elsewhere.⁷ Heat may provide relief, but this relief does not prove that the pain originates in the muscle.

Joint pain can be felt in or around a joint. It may be accompanied by stiffness, especially upon waking, and may vary with activity.¹⁵ Its location alone is not enough to distinguish it from a related problem. Our guide to joint pain covers these situations.

Nerve damage can cause a burning sensation, tingling, numbness, or weakness (symptoms of nerve damage). These sensations are not exclusive to nerves. Sciatica, for example, can cause pain that radiates down the leg.

Let's look at what causes muscle pain.

What are the main causes of muscle pain?

Muscle pain can result from unusual physical exertion, stress-related tension, or an injury. It can also be caused by an infection, certain medications, or diseases that affect multiple parts of the body.¹⁷ (causes of muscle pain) The specific circumstances help determine the appropriate tests and treatments.

Unusual exertion can cause muscle soreness or an injury. A new exercise routine, moving, or a day of gardening can put extra strain on your muscles. Microscopic changes may occur after certain types of exertion, particularly those in which the muscle resists movement.^{2, 1} However, not all pain indicates a tear.

Psychological stress can accompany and influence pain. A review describes how anxiety and repetitive thoughts can prolong certain bodily responses to stress, such as changes in heart activity.¹⁸ For pain in the neck, shoulders, or upper back, the evaluation takes both activities and stress into account.

For some people, the fear of getting hurt leads them to avoid certain movements and reduces their participation in activities. The so-called “fear-avoidance” model describes this possible process in chronic pain.¹⁹ This model does not explain all types of pain, nor does it mean that you are responsible for your symptoms.

Staying in the same position for long periods can become uncomfortable. You can try changing your position and alternating tasks, then see what works best for you. A single posture doesn’t explain all pain, and changing your position doesn’t guarantee that the pain will go away. Our guide to ergonomics offers tips for making adjustments at work.^{20, 21}

A blow to a muscle can cause a contusion—that is, an impact injury that can result in a bruise. A sudden strain can also stretch or tear muscle fibers.¹ Our comprehensive guide to back pain covers other possible causes of back pain.

Problems affecting multiple areas of the body can cause muscle pain. The flu is one example (widespread muscle pain). Statins, medications that lower cholesterol, can also cause muscle symptoms. If a new symptom appears after starting a medication or changing the dose, you should discuss it with your prescriber without stopping the treatment on your own (symptoms following medication). Muscle damage related to a reaction of the immune system—the body’s defense system—can also occur in a small proportion of people taking statins.²²

In a study called ASCOT, the first phase compared a statin to a placebo, with neither the participants nor the researchers knowing which treatment had been assigned. Reports of pain or other muscle symptoms were similar. During the extension phase, when the treatment was known and was no longer randomly assigned, people taking a statin reported more of these symptoms.²³ This comparison suggests a role for expectations, though it does not prove that every instance of pain stems from them. A large meta-analysis of trials conducted without the knowledge of participants or researchers confirms a small but real excess of muscle pain or weakness, especially during the first year (2022 analysis).

Fibromyalgia can also involve widespread pain, fatigue, and non-restorative sleep.²⁴

Let's look at how to treat muscle pain at home.

How to treat muscle pain at home?

Home care for mild muscle pain includes adjusting activities and taking steps to promote comfort. Heat can provide short-term relief from some types of pain.²⁵ A serious injury or any of the warning signs described below requires evaluation; do not wait to see if home care helps.

Relative rest involves reducing activities that worsen the pain, then resuming movements that you can tolerate. If your arms are sore, walking or using a stationary bike can help you stay active without putting as much strain on them (training adaptation). For recent back pain, a review found small benefits to the recommendation to stay active compared to bed rest. This finding does not define the treatment for all muscle tears.²⁶

Cold therapy can be tried as a comfort measure after an acute injury. Protect the skin with a cloth and avoid direct contact with ice. The NHS guide recommends applying ice for no more than twenty minutes for sprains and muscle injuries (care after an injury). Using ice does not guarantee better tissue healing.²⁷

Heat can provide temporary relief or a feeling of relaxation.²⁵ It does not automatically correct a muscle or other tissue. A lukewarm bath or a wrapped hot water bottle can provide comfort. Avoid temperatures that are too hot, and stop if symptoms worsen. After a recent sprain or muscle injury, the NHS recommends avoiding heat for the first few days (precautions after an injury). Our article on heat vs. cold can help you decide.

Gentle stretches should be tailored to the specific issue. For a calf cramp, gentle stretching can help relieve the cramp (steps to take during a cramp). After an injury, do not push through sharp pain. A professional can show you how to adapt the stretch to your situation. The duration and number of repetitions should be based on your tolerance and the goal of the exercise.

Self-massage refers to a massage you perform on yourself using your hands, a ball, or a roller. Massaging the calf can relieve a cramp, although most cramps subside on their own (massage during a cramp). This benefit does not guarantee the same effect for all types of pain or all massage tools. After a recent sprain or muscle injury, avoid massage for the first few days (precautions after an injury).

If home treatments are not enough, let's see how physiotherapy can help.

How can physiotherapy help with muscle pain?

Physical therapy helps manage muscle pain and resume activities through assessment and tailored exercises. For certain persistent pain conditions, particularly back pain, education and exercise are part of the recommended treatment.⁵ Resistance training—for example, using weights or resistance bands—can also increase strength, reduce pain, and improve function for several specific muscle and joint conditions.²⁸ Our page on physical therapy for muscle pain provides detailed information about treatment.

The evaluation begins with your description of your symptoms: the location of the pain, when it started, activities that are difficult for you, and factors that affect your symptoms. The physical therapist then assesses your range of motion, strength, and sensitivity. They may recommend a medical evaluation if the signs suggest another issue. Find out how a physical therapy evaluation works at Physioactif.

Manual techniques encompass a variety of interventions performed by hand. Massage can temporarily relieve certain types of muscle soreness. In a trial involving 20 healthy women with induced muscle soreness in the neck and shoulders, ten minutes of massage or exercises using elastic resistance reduced pain more effectively than rest. The pain relief provided by both approaches was similar and wore off in less than an hour (trial on massage and exercise).

In another trial involving ten healthy adults, one arm received a massage after an unusual exercise, while the other did not. The massage reduced certain types of muscle soreness and swelling, with no clear difference in the recovery of strength or mobility (effects measured after exercise). These trials do not demonstrate accelerated healing or the same benefit for all types of pain.

A review presents general hypotheses regarding the nervous system's responses to manual therapy.²⁹ This model does not prove that pressure repairs tissue. Myofascial release refers to techniques that target the fascia—the tissues that surround muscles, among other structures. This specific method differs from general massage.

Dry needling involves inserting a needle into a muscle without injecting any medication. Studies are being conducted on this method.³⁰ Physioactif does not offer this treatment and instead focuses on tailored exercises and patient education.

The exercise program may focus on strength, ease of movement, and movements to be re-learned. Resistance training uses weights, resistance bands, or body weight.²⁸ A review found increases in strength and improvements in pain and functional ability among people with conditions such as chronic back pain, knee osteoarthritis (which affects the joint tissues), tendon problems, or a hip replacement (an artificial joint).²⁸ These results do not mean that all muscle pain has the same cause. Depending on your evaluation, exercises related to posture and movement may be incorporated.

Education helps you understand the problem and adjust activities that are difficult for you. For example, a professional can help you pace yourself and then gradually increase the amount you do. The goal is to resume meaningful activities, without promising to prevent any recurrence.⁵

In Quebec, you can see a physical therapist directly at a private clinic without a doctor's referral. (access to physical therapy)³¹

Let's look at when to seek treatment.

When should you see a doctor for muscle pain?

Muscle pain requires urgent care if it is accompanied by muscle weakness, a high fever, a very stiff neck, difficulty breathing, or very dark urine. Pain that persists or limits your activities also warrants an evaluation, even in the absence of these warning signs (when to seek medical attention). The situations below specify the timeframe and context; do not wait two weeks if you experience an urgent symptom.

Also call 911 if you have difficulty breathing or swallowing along with muscle pain (medical emergencies). After an injury, severe or worsening pain, significant or increasing swelling, or an inability to put weight on the affected area requires urgent medical attention (when to have an injury evaluated). A new deformity without an obvious injury also warrants prompt medical evaluation.

See your doctor right away if:

• The pain persists or does not improve with appropriate treatment.
• The pain appeared without any obvious reason
• You experience widespread pain with fatigue
• The pain occurs after a medication is administered or the dose is changed.

See a physical therapist if:

• Pain limits your daily activities
• You have chronic tension that won't go away
• Do you want to get back into sports after an injury?
• Home treatments are not enough

How to prevent muscle pain.

How to prevent muscle pain?

Preventing muscle pain relies on appropriate activities, a gradual increase in training intensity, and programs that prepare the body for sports movements. Some programs reduce injuries in specific populations; however, no single practice can guarantee the prevention of all pain.³³ A distinction must be made between the effects of warm-ups on performance and those on injuries.^{34, 35}

Stretching alone does not show a clear reduction in injury risk in Hart’s review. The data were limited; this finding does not prove that stretching is never beneficial.³⁶

A structured warm-up can prepare you for physical activity. A study of 1,892 female soccer players aged 13 to 17 tested a program that combined strength training and movement control, among other elements. The group that followed the program had fewer injuries overall, fewer overuse injuries, and fewer serious injuries. The main finding regarding leg injuries remained inconclusive: the analyses did not allow for a clear distinction between the observed difference and chance.³³ This was a comprehensive program, not just a few minutes of slow walking.

For your training, tailor your efforts to what you’re already doing and to your recovery. A journal article suggests gradually building up your ability to handle the workload.³⁵ This does not provide a fixed rule that applies to everyone.

Ergonomics involves adapting tools and workstations to the tasks at hand. A review of 15 studies involving 2,165 office workers found mixed results. The combination of an armrest and a mouse different from the usual one reduced certain neck and shoulder problems. The evidence is inconclusive for several other adjustments.²¹ You can try adjusting your monitor, footrest, or forearm rest, and incorporating breaks, and then see how comfortable you feel. These personal experiments do not guarantee injury prevention.

Regular exercise helps improve your abilities. Strength training builds strength; walking, cycling, or other sustained activities build endurance. Flexibility exercises can round out your routine based on your needs. Vary your activities and adjust the difficulty rather than aiming for muscle soreness after every session.^{28, 34}

Hydration deserves special attention during exercise, especially in hot weather. Dehydration can contribute to certain types of cramps, but cramps have several possible causes (causes of cramps). Research is also investigating changes in the activity of the nerves that control the muscles.¹³ Drinking more, therefore, does not resolve all cramps.

Stress management can be part of the support provided when pain and anxiety intensify. Calm breathing, an enjoyable activity, or adapted yoga are options to discuss based on your preferences. These measures do not guarantee the prevention of muscle pain.^{18, 19}

What are the most common questions about muscle pain?

Frequently asked questions about muscle pain focus on its duration, soreness, continuing to exercise, stretching, and fibromyalgia.

Muscle soreness usually subsides within a few days (duration of muscle soreness). It often peaks within three days after exercise.² A muscle tear or persistent pain follows a different course. Recovery is also judged by strength and the activities you can perform, not just by time. See a doctor if the pain worsens, remains unexplained, or does not improve; the urgent symptoms described above require immediate medical attention.

Muscle soreness isn't a measure of the quality of your workout. It usually occurs after an unusual level of exertion; your body can adapt to repeated exertion. A workout can therefore challenge your abilities without leaving you sore (muscle soreness and exercise). Extreme pain should be evaluated rather than considered a sign of success.

Mild muscle soreness may allow you to continue with light activities. Light exercise can temporarily relieve pain, though there is no evidence that it speeds up muscle recovery (the effect of light activity). Reduce the intensity or work a different muscle group before resuming strenuous activity that targets the same muscles.

Stretching before or after exercise does not significantly reduce muscle soreness, according to a review of studies involving healthy adults.³⁷ Stretching may serve other purposes, such as improving flexibility, but it does not provide reliable protection against muscle soreness.

Fibromyalgia is a real condition that often involves widespread pain, fatigue, and sleep disturbances. Research has identified changes in the way the brain and spinal cord process pain. The spinal cord is a bundle of nerve tissue located within the spine that transmits messages between the brain and the body.²⁴ This is not evidence of widespread muscle tears, but another injury may coexist. Treatment may include education, exercise, sleep aids, psychological approaches, and sometimes medication.

References

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