Muscle pain

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 10, 2015
StartSymptomsMuscle pain

Muscle pain can be difficult to relieve if you are unsure what it is or what is causing it. Luckily, there are easy definitions and facts that can help.


Definition & Facts

The most basic definition of muscle pain is any sore or aching muscle that has been overused, injured, or stressed. The pain could also be from other conditions that are affecting the body, mainly infections. Any drugs or medicines used are not a substitute for a doctor's knowledge.

However, it should be recognized that if muscle soreness and pain causes an inability to complete more than half of what is normally done in a workout, the muscles are looking for a break.


On the cellular level, muscle pain happens when the cells in those muscles are not receiving oxygen. Without oxygen, the mitochondria within the cells cannot kick start the process of aerobic respiration, and the cells must start fermenting the leftover products from glycolysis, namely pyruvate.

Anaerobic fermentation begins, and the pyruvate becomes lactic acid. Once oxygen is added to the cell again, lactic acid fermentation ends. This fermentation process can be reversed, which is why muscles do not stay sore for more than a few days at a time given proper rest. With the end of lactic acid fermentation, the mitochondria within the cell begin the Krebs cycle (or the Citric Acid Cycle) and begin to run the electron chains that power ATP-kinase.

This cycle of fermentation versus Krebs cycle happens automatically when the cells recognize they do not have the oxygen needed. The lactic acid fermentation can also happen if there pyruvate is being created faster than it can go through the mitochondria - even if there is oxygen present for the end of the Krebs cycle. However, some medical conditions can also cause muscle soreness. These can include polymyositis, lupus, use of cocaine, the flu, and fibromyalgia.

When to see a doctor

There are many ways to know when to see a doctor. Immediate medical help should be sought out if there is trouble with breathing, dizziness, a high fever, a stiff neck, or an extreme weakness in the muscle. These often indicate that something more serious has happened than a simple sore muscle.

Other reasons to see a doctor, but that do not require immediate attention, include: muscle pain that occurs in exercise, but resolves with rest repeatedly; if pain starts after beginning or increasing the dosage of a medicine - most specifically, this applies to statins and other cholesterol controlling medicines; if there are any signs of infection showing around the sore muscle, particularly redness and swelling that can easily be seen or felt; any muscle pains that last longer than one week (seven days); a tick bite; and/or a rash.

Any extreme pain that only gets worse during a period of exercise and does not let up also requires a visit to the doctor's, as does a muscle or joint that is warm to the touch. This could indicate that an infection is beginning. More reasons to see a doctor or go to the hospital may include: inability to move the sore muscle, a difficulty swallowing, sudden water retention, reduction in urine volume, and possible vomiting.

Treatment & Therapy

If the muscle soreness does not warrant a trip to the doctor's, there is plenty to try before you must get help. Generic ibuprofen and naproxen sodium medicines are often the first choice for home remedies. Both of these medicines - which are often the active ingredients in well known brand names that are prescribed for the same reasons - offer anti-inflammatory benefits that help relieve some of the aches.

The general rule is to take the anti-inflammatory medicine after the work out, but ibuprofen has been shown to work better for certain people when taken before the work out. Also for home therapy, the R.I.C.E treatment has been proven time and again to help lessen most muscle aches to some degree. R.I.C.E stands for "Rest, Ice, Compression, Elevation".

The steps mean that you take a break from the activity that is causing your muscle to be sore, an ice pack or pack of frozen vegetables is placed on the muscle (three times a day for between 15 and 20 minutes each time), a compression bandage is used to reduce the swelling, and if the sore muscle is below the heart, it is elevated to reduce swelling.

If these do not do much for the muscle on their own, other treatments include: avoiding high-impact or intense activities; yoga; meditation; give it time to rest; stretch the muscle - gently; and no weight lifting until the soreness has disappeared.

Prevention & Prophylaxis

As mentioned in the "Treatment and Therapy" section, taking medicine - such as naproxen sodium or ibuprofen - before exercising may help keep the soreness to a minimum. Stretching before any exercise, however, has been scientifically proven not to help prevent muscle aches and pains.

If the warm up exercises are done (jogging in place, jumping jacks, etc.) and then are followed by the stretches (quads, arms, etc.), this has been proven to help prevent the micro tears that occur when muscles are used in ways they have not been before. One of the best things to do to prevent muscle soreness in the first place is to start off with a small or short exercise, and build up gradually. For example, starting with a five minute walk for a week, then a ten minute walk, then a 20 minute walk, etc. would help keep the calves and thighs from becoming too sore.

Light cardio on a regular basis is also a proven way to help prevent muscle soreness - especially if training for a marathon or other new activity for a competition. Another important thing to do to help prevent the soreness is to keep hydrated - with water. Water helps to flush toxins out of the body, and lactic acid is moved out of the body when water is added to the picture.

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