Muscle Pain (Myalgia): Therapy

Therapy for myalgia (muscle pain) depends on the cause.

General measures

  • Physical activity respectively sports activity (see below).
  • Aim for normal weight!Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program or program for underweight.

For statin-associated muscle pain (SAMS):

  1. Verify the causal relationship of the complaints with statin use by clinical history criteria, creatine kinase (CK) value, and by discontinuation trial for 3-4 weeks. Note: Even in healthy people after heavy muscle work (eg, bodybuilders, high-performance athletes or construction workers), after i. m. (intramuscular) injections are found significantly increased CK values (not infrequently up to 10 times the upper limit of the norm).In statin-treated patients should be discontinued at a CK increase above 4-5 times the norm or must be discontinued at a CK increase above 10 times the norm.
  2. After omission attempt: try again high titrate or combination therapy with cholesterol absorption inhibitor (ezetimibe).
  3. If symptoms recur: Switch to another statin and start at a low dose; slowly up-titrating or combination therapy with cholesterol absorption inhibitor (ezetimibe).
  4. If symptoms recur: change statin again and start at low dose; slowly up-titrate; combination therapy with cholesterol absorption inhibitor (ezetimibe) if no target value is reached.
  5. If symptoms persist or no target value is reached: switch to a PCSK9 inhibitor.

For myalgias due to intrinsic muscle injury

Conservative therapy according to classification of intrinsic muscle injury by MRI scan (see “Medical Device Diagnostics” below):

  • Grad-0-1-2-Verletzung:
    • Observing the PECH rule:
      • “P” pause: to stop exercising, to take it easy, to immobilize; is to prevent further bleeding and thus enlargement of the hematoma
      • “E” ice/cooling: immediate application of cold, this is crucial for the healing process: stop the bleeding; it prevents the expansion of tissue damage; cold also has an analgesic effectNotes on implementation: repeat every 2 to 3 hours; do not give ice directly on the skin; do not use on open wounds.
      • “C” Compression e.g. elastic pressure bandage (moderate tension = reduction of intramuscular blood flow).
      • “H” Elevation above the level of the heart: reduction of blood supply to the damaged tissue; better removal of tissue fluidNotes on implementation: elevate for 1-2 days in case of extensive swelling.
    • Physiotherapy is the basis of treatment options: early functional mobilization including painless stretching of the healing muscle.
    • Kinesio taping: application of about 5 cm wide, elastic cotton-based adhesive tapes (= tape) directly to the skin over the fascia of the muscle. This is intended to reduce muscle tension, which in turn should have a therapeutic and analgesic effect.A meta-analysis has shown that in patients with chronic musculoskeletal pain, kinesio-taping achieves better results in pain relief than minimal intervention or other therapeutic measures.
    • Topical measures: eg, ointment dressing with arnica.
    • Oral therapeutics: Bromelain, aescin, etc.. This is to trigger a partial fibrinolysis and anti-inflammatory effect.
    • Infiltration treatments: Injection of procaine or other local anesthetics, if necessary in combination with a steroid.
    • Physical therapy: see below.
  • Grade 2-3 injury: surgical therapy of muscle injuries are case-by-case decisions.

Regular check-ups

  • Regular medical checkups

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
    • A total of 5 servings of fresh vegetables and fruit daily (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
    • Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
    • High fiber diet (whole grains, vegetables).
  • Observance of the following special dietary recommendations:
    • Diet rich in:
      • Vitamins (vitamin D)
      • Coenzyme Q10
  • Other specific dietary recommendations depending on the cause of myalgia (muscle pain).
  • Selection of appropriate foods based on the nutritional analysis.
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Sports Medicine

  • Endurance training (cardio training) and strength training (muscle training).
  • In myofascial pain syndrome, adhesions cause functional shortening of the affected muscles. The shortened tonic muscles must be specifically released by stretching exercises. Only then can a muscle training be performed.
  • Preparation of a fitness plan with suitable sports disciplines based on a medical check (health check or athlete check).
  • Detailed information on sports medicine you will receive from us.

Physical therapy

  • Physiotherapy/movement therapy
  • Posture training
  • Functional training (dry and aquatic exercise) should be used twice a week (at least 30 minutes) (AWMF guideline: strong recommendation, strong consensus).
  • Thermotherapy
    • Heat* – thermal baths should be used. Evidence is available for a frequency of five times per week for two to three weeks (guideline: recommendation, strong consensus).
    • Cold therapy
  • Focused shock wave therapy – for pain therapy and stimulation of regeneration of the injured skeletal muscle.
  • Electrotherapy
  • Ultrasound therapy – for local blood circulation promotion by application of deep heat insb. in combination with muscle stretching.

* Long-term therapy!

Psychotherapy

  • Relaxation techniques: e.g. progressive muscle relaxation according to Jacobson.
  • Detailed information on psychosomatic medicine (including stress management) you will receive from us.