Muscle Pain

WHEN TO SEE YOUR DOCTOR

* You also have tender areas in the neck, shoulders, chest, hip, back and buttocks.

* You also have a fever.

What Your Symptom Is Telling You

Last Saturday you spent the morning painting the kitchen ceiling. Then in the afternoon you played touch football with your nephews. You probably would have been okay—if only you hadn't decided to clean the garage on Sunday.

All that activity felt great while you were doing it. But by Monday morning, your muscles let you know—in no uncertain terms—that they didn't like the way they were being treated. Unfortunately, they only have one way of communicating this sort of thing: pain.

Think about it. They can hardly drop you a note that says, "Stop what you've been doing and let us rest a while!" But pain delivers that message very effectively.

When you take a look at what's going on inside the muscle itself, it's easy to understand why overuse hurts so much. Once they're pushed beyond what they're used to doing, muscle fibers start to tear. Muscles that are severely overworked may develop hundreds of tiny tears.

Overuse is not the only cause of muscle pain. If your muscles hurt all the time—particularly those in your shoulders, neck and hips—you could have what doctors call fibromyalgia. This simply means "pain in the fibrous muscle tissue." Fibromyalgia can hurt so bad that it keeps you from getting a good night's sleep and leaves you tired throughout the day.

Some doctors believe fibromyalgia is triggered by muscle stress, injury or illness. Others believe a sedentary lifestyle and the muscle tension it causes plays a major role. "Muscles are made to move," says Paul Davidson, M.D., associate clinical professor of medicine at the University of California School of Medicine in San Francisco and author of Chronic Muscle Pain Syndrome. When they're held immobile—while you're sitting at a desk all day, for instance—muscles tense up. They can actually tense up to the point of pain. This triggers a vicious cycle: The achiness interferes with deep sleep, so you wake up tired, stiff and sore. Movement becomes difficult, so your muscles remain tense and achy.

You may have fibromyalgia if pressing on tender points in your neck, shoulders, chest, back and buttocks makes you jump with pain, says Dr. Davidson. Suspect fibromyalgia if you've also had all-over achiness longer than three months, especially if you are in your late forties or older.

In addition, general muscle soreness can be from a flulike virus or a reaction to a diuretic or blood pressure medication. If the pain worsens, it could indicate a thyroid condition or arthritis.

Symptom Relief

Whether your muscle pain is recent or long-standing, here's how to deal with it.

Put your muscles on RICE. Even athletes follow the RICE rule (rest, ice, compression and elevation), especially following the first day of practice, according to Robert Nirschl, M.D., assistant professor of orthopedic surgery at Georgetown University School of Medicine in Washington, D.C. When muscle pain from overuse strikes, rest your sore muscles for at least 48 hours so they can begin to repair. During rest time, apply ice—"the most effective anti-inflammatory agent around," says Dr. Nirschl. Ice works to constrict blood vessels, dull the pain and also relax muscle fibers that have locked into spasm. Wrap some ice cubes in a thin cloth and apply the pack to the sore area for 20 minutes at a time.

If the sore muscles are in your arms or legs, you can also control swelling by compressing the affected area with a not-too-tight elastic bandage. Then, elevate the limb above the heart. Lie down and prop it up on some pillows.

Get help from your medicine cabinet. Taking aspirin or ibuprofen should reduce pain within a half-hour or so, says Dr. Nirschl. If it doesn't make a dent in your pain, see your doctor for a review of the problem.

Melt the pain away. If your muscles aren't swollen, you can't beat a warm bath for soothing lingering soreness or stiffness, says Dr. Davidson. Warmth improves circulation to damaged muscles and also carts off lactic acid, muscle waste products that build up in overused muscles and contribute to pain. "If you can't slip into a bath, use a heating pad on the painful muscle for 15 minutes," says Dr. Davidson. For longstanding achiness, a steam bath or sauna seems to penetrate deeper, he adds.

Get stroked. "There's a reason why animals lick their wounds," says Carol Warfield, M.D., assistant professor of anesthesia at Harvard Medical School and director of the Pain Management Center at Boston's Beth Israel Hospital. "The massaging action may provide pain reduction," she says. In people, massaging an aching muscle could increase the body's output of natural painkillers, combat stiffness and help restore movement. For the best results, warm the area, then gently massage it. Stop rubbing if it makes the pain worse.

Balm the soreness. Those tingly, icy-hot sports liniments containing menthol, such as Ben-Gay, may cause warming just below the skin, according to Christopher MacGrew, M.D., assistant professor in the Department of Family Practice at the University of New Mexico Medical Center in Albuquerque. "Just don't use these creams under heating pads or elastic wraps," he says. "This can damage the tissues." Using the two together can also cause severe burns.

Fight Off Fibromyalgia

Skip some rope. Or go for a brisk walk. Or take your bike out for a spin. Studies show that regular aerobic exercise helps reduce tenderness and promotes sound sleep. Continual movement also increases oxygen to the muscles and may boost endorphins, the body's natural painkillers. The key is to adapt to exercise gradually, says Dr. Davidson. "If your muscles ache early in your exercise program—like aching calves when you first start walking—work through the pain gently. Slow down but don't stop. You won't harm any muscles by doing this," he says. Aim for a minimum of 30 minutes of exercise three times a week.

Take a seventh-inning stretch. Tender spots typically settle in the upper back and shoulders, often as a result from sitting in a fixed position doing desk work, says Dr. Davidson. You need to get up periodically, he says. Stretch your arms like you're reaching for the sky. Roll your head in circles. Remember to breathe deeply while you stretch, he adds. This also releases tension and brings oxygen to your muscles.

Practice good sleep habits. "People with fibromyalgia who often wake up with aches and pains each day are not getting healthy, deep sleep," says Robert Bennett, M.D., professor of medicine and chairman of the Division of Arthritis and Rheumatic Diseases at Oregon Health Sciences University in Portland. Without this restorative sleep, he says, they actually produce less of the growth hormone needed for muscle repair. Restful sleep can do a lot to promote healing, he says.

His advice? Keep the bedroom quiet, dark and about five degrees cooler than the rest of the house. Avoid alcohol, caffeine or heavy meals at supper. And don't exercise strenuously within six hours of bedtime. If these measures fail, your doctor can prescribe a low-dose antidepressant for better sleep. (For additional tips for getting a good night's sleep, see Insomnia on page 274.)