Is a muscle or fascia problem the cause of almost all musculoskeletal pain and dysfunction there is?

Movement is life and muscles make our bodies move. If there is a muscle problem that leads to less movement, it can go as far as depression. Neglecting body sensations and functional limitations due to muscle function problems (various types of pain, exercise intolerance, paresthesias, limited range of motion, spasms, dystonia, tinnitus, coordination problems, clumsiness, feeling of joint instability, etc.) leads to much confusion in clinical practice. You may have a specific problem with the ligaments and therefore joint instability, but if the problem with muscle function is not addressed, the functional problems (joint instability or pain) may persist after ligament surgery, for example. Clinicians' clinical knowledge of interoceptive experiences related to muscle or fascial dysfunction is poor. Many are unaware of how many health conditions are related to this phenomenon. There is much ignorance and a lack of adequate explanations for body symptoms. On the other hand, there can be too much alarm, stress and inattention when we desperately need safety, care and protection.

What do poorly functioning muscles feel like? Is there a mechanism that assigns a specific sensation to the various physiological or patophysiological disturbances in the muscle?

At the interoceptive level, this can take the form of various bodily sensations and perceptions. In the case of pain emanating from the muscle, the question is what the pain is protecting the muscle from. Try to think of bodily pain as a protective mechanism... Delayed onset muscle pain (a type of pain or muscle soreness that occurs after an inappropriate or strenuous exercise) is an example of a pain that protects the healing process after damage to the muscle that occurred during the exercise itself. It is a good example of pain that does not signal damage, but protects the healing process or muscle repair. Therefore, it does not occur until about 24 hours after the exercise. It is well localized and related to the location of the muscle most affected. This is not only a matter of controlling exercise intensity, but also depends on the condition of the muscle itself before the exercise (a recovery period?) and how well the affected muscle has been adapted to the specific activity by previous training. Delayed-onset muscle soreness serves as a prototype of muscle pain, and people generally associate the feeling of muscle pain only with exercise- and training-related muscle damage. But feeling muscle not working properly is much more than the feeling of an overworked muscle. Pain originating from a muscle like the qudratus lumborum can feel like a dull, deep ache characterized as bone or deep organ pain. It may have a sharp pain component, especially if there is a sudden contraction (such as when you bend forward) of the muscle, or a burning component if you sit for a long period of time. The qudratus luborum is a muscle that supports tonic activity. Dysfunction of this muscle is related to overuse or underuse during static activities or/and emotional/motivational challenges (e.g., wanting more) that usually occur during sedentary activities. It is very common in people with static problems of the spine, such as scoliosis. The mechanism has something to do with the dopaminergic influence on motor neurons and the fatigability of the predominantly type I postural muscle fibers in metabolically relatively inflexible (insulin-resistant) states of the body. Pain in this case serves to protect against an energetic crisis in the muscle, not so much to heal muscle fiber damage. The greater the energetic crisis in the muscle, the more contraction nodes there are in the affected muscle and the more actively a myofascial trigger point develops. For more on the patophysiology of myofascial pain, see below. Muscle pain of the erector spinae muscle can mimic joint pain and, along with fascial problems (and myofascial pain of other trunk muscles), forms the basis of "non-specific low back pain." This is the most common form of musculoskeletal pain. There is a large bias to interpret all spinal pain as disk or facet joint pain, ignoring myofascial pain. Myofascial pain of the hip muscles can mimic sciatic pain. It is possible to experience myofascial pain in the abdominal wall or pelvis if you are dealing with conditions such as endometriosis, suggesting that not all pain from this condition is related to ectopic uterine lining pathology. Muscle pain is common in conditions such as rheumatoid arthritis, but feels different from pain associated with joint inflammation. Distinguishing between the two requires some interoceptive awareness, but most people who have experienced joint inflammation in rheumatoid arthritis recognize the difference. Tension in the back and weakness in the legs or arms may be related to muscle function or fascial alignment (more on fascia in upcoming posts). Muscle spasms, spasms, involuntary movements or twitches are also phenomena of dopaminergic influence on muscles. Muscle spasms could be related to vitamin D status, magnesiuma and calcium. Muscle pain is a great mimic, playing tricks on our minds and fooling us into believing threatening and serious health conditions (such as herniated disks, nerve entrapment, and kidney inflammation) when none exist. This does not mean the pain is any less troublesome, it's just less consequential.

Pathological vs. physiological muscle pain?

Muscle soreness, or pain after eccentric exercise such as delayed onset muscle soreness, is caused by exercise-induced muscle damage that is reversible and cannot actually damage the muscle permanently. Structurally, muscle in a healthy body has tremendous regeneration potential. This type of pain is physiological and has nothing to do with the pathological conditions of myofascial pain. Experimental human models of muscle pain initiation do not approximate the clinical phenomenon of myofascial pain. Animal models of myofascial pain better describe the problem. According to these studies, the muscle appears to be not only structurally damaged but also prone to functional changes at the level of energy production. Damage to the muscle at the mitochondrial level is key to understanding the most common long-term muscle problems, including pain, fatigability, paresthesias, coordination and dexterity, stability, and others. The problem develops gradually. The same muscle can be affected by different health problems when they occur in a person (nerve damage, stroke, joint deformity) and gradually lose its energy production capacity through different mechanisms. When trying to understand the functioning of the body in movement and the interoceptive experiences associated with it, it is important to consider the whole body environment, including inflammation, especially low-grade and neuroinflammation, autoimmunity, metabolic flexibility, hormonal influences, anemia, interactions with food... but also possible presence of autism spectrum disorders, ADHD, bipolar disorder, complex post-traumatic stress disorder or other mood disorders. Each of the above disorders deserves a post on its own to better understanding the connections with chronic pain.

The road to recovery

For delayed-onset muscle soreness after exercise, there are protocols for recovery, such as taking BCAAs (branched-chain amino acids) in doses up to 255 mg/kg/day in trained subjects for mild to moderate pain after a single exercise session. Factors that could influence efficacy include: Training status, timing of treatment, or severity of pain. The studies that tested such protocols did not look at underlying health conditions that might put people at higher risk for chronic pain. I think a lot of confusion arises because there is no good case definition. Muscle pain after exercise can be a mixed problem of delayed onset muscle soreness and myofascial pain. Muscle soreness is too weak a term for what is going on in such a condition. Pain relief usually cannot be achieved quickly and with simple protocols such as the one mentioned above. For example, if the affected region is the shoulder, many receive a diagnosis of rotator cuff degeneration. The rotator cuff tendons may be affected due to muscle weakness in the area that stabilizes the shoulder joint (infraspinatus, teres minor). The muscles could be weak because of the energetic fatigue described above. A physical therapist might say that you should strengthen the muscles of your shoulder, but the muscles lack the ability to generate energy at the cellular machinery level. So every time you try to strengthen the muscles, it can boomerang in the form of severe pain (you might say no pain, no gain, right?...wrong!!). Sounds like a vicious cycle? It is... You end up with feelings of guilt for insufficient motivation and other types of self-condemnation. The solution lies first in energetic regeneration, which has much more to do with nutrition, sleep and emotional regulation than with strengthening training discipline. The latter is also important, but at the right time. Nutrition - anything that increases insulin sensitivity is helpful. If you are deficient in certain nutrients (vitamin D, B, omega 3, Mg, Ca, Vit C, ZN and others), get the appropriate supplements. Then establish good sleep hygiene. If that does not help, you need to talk to a sleep specialist. Start regulating your emotions right here and now by first noticing any guilt, resentment, blame, fear, shaming, envy, condemnation, morals ...emotions you feel about anything or anyone in your life. They all use up energy and may not be that useful to you at that moment. Muscles are involved in the body's emotional responses. Try to free them from possible emotional load. If that does not appeal to you, try to understand yourself in terms of emotional literacy (an ability to distinguish emotional states). You may perceive affect primarily in terms of bodily feelings, states, and reactions rather than in terms of emotional states. A negative affect means that you have to struggle to mobilize more energy reserves of the body. And there's another possibility: your expectations are habitually always a little too high for what your body can physically handle, so a "reward prediction error" works through dopamine and affects the muscles as well. If you can master all three (nutrition, sleep, emotional regulation), that's a good precondition for a muscle strengthening routine, and discipline may no longer be a problem.