Many people may complain that their morning starts with neck pain. This is a sure symptom of cervical myositis. What can cause this disease and how to get rid of it?
does not treat cervical myositis. If you notice symptoms of the disease, immediately contact your doctor.
Neck myositis is the most common type of myositis. Almost every person is familiar with this situation: you wake up in the morning and cannot turn your head - severe pain in the neck muscles.
Causes
There are several causes of inflammation of the neck muscles - cervical myositis:
- incorrect body position during sleep;
- uncomfortable workplace;
- hypothermia or being in a draft - what is called “blown out”;
- stress, severe nervous tension.
Causes
Myositis is caused by various conditions that lead to inflammation in the muscles. The causes of myositis can be divided into several main groups:
Inflammatory diseases causing myositis
Diseases that cause inflammation throughout the body can affect the muscles, causing myositis. Many of these conditions are autoimmune diseases, in which antibodies have a damaging effect on the body's own tissues. Inflammatory diseases causing potentially severe myositis include:
- Dermatomyositis
- Polymyositis
- Myositis ossificans (Munchmeyer's disease)
Other inflammatory diseases can cause more mild forms of myositis:
- Systemic lupus erythematosus
- Scleroderma
- Rheumatoid arthritis
Inflammatory diseases are the most serious causes of myositis, requiring long-term treatment.
Infectious myositis
Viral infections are the most common infection that causes myositis. Much less commonly, myositis can be caused by bacteria, fungi or other microorganisms. Viruses or bacteria can directly affect the muscles themselves or through secreted toxins. Acute influenza viruses, as well as the immunodeficiency virus, can also cause myositis .
Medicines that cause myositis
There are many medications that can cause permanent muscle damage. Since it is not possible to confirm the inflammatory process in such cases, these conditions are sometimes called myopathy rather than myositis. Medications that cause myositis and/or myopathy include:
- Statins
- Colchicine
- Plaquenil
- Alpha interferon
- Cocaine
- Alcohol
Myopathy may appear immediately after starting medication or after some time (several months), especially when it comes to drugs. As a rule, drug-induced myositis is rarely severe.
Myositis after injury . Intense exercise, especially with untrained muscles, can lead to muscle pain, swelling and weakness for hours or days after exercise. Inflammation in the muscles is associated with microtears in the muscle tissue and, as a rule, the symptoms of such myositis quickly disappear after sufficient rest. Sometimes, with severe muscle damage, necrosis of muscle tissue is possible. This condition is called rhabdomyolysis. It occurs when a large group of muscles is damaged and is accompanied by a general reaction of the body to necrotic muscle tissue. Myoglobin molecules can change the color of urine from brown to red.
Myofascial syndrome - symptoms and treatment
An integrated approach is used in the treatment of myofascial pain. It involves eliminating pathological muscle tension and trigger points.
In case of primary syndrome, a local effect is applied to the affected structures:
- rest and moist hot wrap of the affected muscle;
- application of anti-inflammatory gels and ointments to the area of trigger points;
- ischemic compression (squeezing) of trigger points;
- post-isometric relaxation - relaxation of muscles after volitional tension;
- stretching muscles through exercises, gentle muscle relaxation techniques and relaxing massage;
- using lidocaine patches (local anesthesia);
- trigger point injections.
In case of secondary syndrome, treatment of the underlying disease comes to the fore.
Drug treatments for myofascial pain include:
- NSAIDs—nonsteroidal anti-inflammatory drugs;
- muscle relaxants;
- tricyclic antidepressants.
NSAIDs relieve pain, inflammation and lower body temperature. The mechanism of their action is based on suppressing the activity of substances that participate in the cascade of inflammatory reactions.
For severe pain, low doses of tricyclic antidepressants are prescribed. They reduce muscle pain and have a sedative effect.
Ischemic compression of trigger points is aimed at stopping or significantly reducing muscle tension and reducing pain. The trigger point is compressed with your fingertips and held for 60-90 seconds with a gradual increase in pressure.
Simultaneously with squeezing the trigger point, the affected muscle is stretched. This allows you to reduce the time of the procedure: the more the muscle is stretched, the more it relaxes, hypertonicity is relieved, and pain relief occurs faster.
Trigger point injections are sometimes performed with bupivacaine, etidocaine, lidocaine, saline, or water for injection combined with passive muscle stretching and/or coolant spray over the trigger point and area of referred pain [13][14][15][16][ 17]. All this is done for local anesthesia. In some cases, a “dry” puncture is performed - an injection into the trigger point without the introduction of any substance [16][17].
Botulinum toxin type A, injected into trigger points, reduces muscle spasm for 3-6 months [18][19][20][21][22][23]. It inhibits the release of the neurotransmitter acetylcholine, which mediates neuromuscular transmission.
The effectiveness of injection therapy with botulinum toxin type A in combination with physiotherapy was confirmed by a retrospective study by Spanish scientists. During the experiment, medical records of 301 patients with persistent myofascial pain syndrome were studied. Scientists found that after 6 months, as a result of this combined treatment, pain decreased in 58.1% of patients, including 82.9% of patients with primary myofascial pain syndrome and 54.9% of patients with secondary syndrome [23].
Complications associated with trigger point injections are rare and depend on the area of injection. They include pain at the injection site, bleeding, bruising, intramuscular hematoma formation, infection, damage to nerve or vascular trunks.
Local therapy in the form of an anesthetic patch relieves myofascial pain and does not cause discomfort, unlike injection techniques. This conclusion was made by scientists from Italy during a randomized controlled trial [24].
The patients who took part in the experiment were divided into three groups of 20 people: the first group was treated for 4 days with a lidocaine patch glued to the trigger point; the second group received a placebo patch; and the third group received injections of 0.5% bupivacaine hydrochloride.
The researchers found that in the first and third groups, subjective symptoms decreased significantly and the pain threshold increased. Moreover, the effectiveness of therapy was higher in patients of the third group, who received anesthetic injections, but they experienced more discomfort from the treatment than patients from the first group.
The patch is used only once a day. It is glued to dry, intact skin in the area of pain for no more than half a day, after which a break is taken for at least 12 hours. Before gluing the patch, the hair on the skin should be cut with scissors, not shaved.
No more than three patches can be used at a time. If necessary, the patch can be cut into pieces, but only before removing the protective film. The removed patch should not be reused.
It is important to regularly evaluate the effectiveness of such local therapy. This will determine the optimal number of patches that can be used at once to cover the area of pain or to increase the time between applications.
After 2-4 weeks from the start of treatment, the effectiveness of the applications should be re-evaluated. If during this time the response to therapy was insufficient or the therapeutic effect is determined only by the protective properties of the patch, treatment should be discontinued.
Other effective procedures that reduce pain , according to research, include phonophoresis [25][26], massage and exercise [34], stretching (work with an instructor), ultrasound [30], electroacupuncture, electrical nerve stimulation [28][29 ], a combination of the above methods [25] and EMG-BFB - biofeedback based on the electromyogram [32].
A systematic review by Canadian scientists suggested that electroacupuncture is more effective than transcutaneous electrical nerve stimulation [33]. In electroacupuncture, a needle is inserted into a trigger point and an electrical current is applied. With transcutaneous electrical stimulation, electrodes through which current is supplied are applied to the skin without damaging it.
Acupuncture and manual therapy may also be effective [31][35][36]. But, like any other non-drug treatment, they work differently for each patient.
A study conducted by scientists from Taiwan showed that a self-massage and regular exercise therapy at home improved the results of treatment of myofascial pain and significantly increased the threshold of pain sensitivity when pressure was applied to trigger points [34].
The treatment complex should include exercises for restructuring the non-optimal motor stereotype. They correct postures and movements performed in everyday life and during work.
At the University of Michigan, a study of various massage and manual therapy techniques was conducted, as a result of which a special method of influencing myofascial structures was developed - “ myofascial release ”. This technique involves performing exercises independently, without the help of a doctor or massage therapist, which makes it possible to regulate the degree of pressure on the muscles and their stretching, guided by your own sensations.
Myofascial release can be performed using a variety of tools: foam rollers, hand rollers, latex balls, or other assistive devices. They allow you to relieve excess tension in trigger points, relax muscles and ligaments by influencing the fascia. The result is complete relaxation of one or a group of muscles.
The mechanisms underlying myofascial release are not well understood. Studies attempting to illustrate the effectiveness of this technique are often poorly designed and do not answer questions about how long the procedure should be performed, how much pressure should be applied to the affected muscle, and what type of exercise device is best.
The rehabilitation program involves the use of orthoses: corsets, bandages, special shoes, insoles, etc. Orthopedic insoles, special orthopedic shoes and heel supports, for example, can be useful for correcting leg length.
Symptoms of myositis
The main symptom of myositis is muscle weakness. The weakness may be obvious or only discovered during testing. Muscle pain (myalgia) may or may not be present.
Dermatomyositis, polymyositis and other inflammatory diseases accompanied by myositis are manifested by muscle weakness with a tendency to gradually increase over weeks or months. Muscle weakness can affect numerous muscle groups, including the neck, shoulders, hips, and back muscles. Typically, there is bilateral muscle weakness.
Muscle weakness from myositis can lead to falls, and even difficulty performing simple motor functions such as getting up, from a chair or from a bed. Other symptoms of myositis that may be present with inflammatory diseases include:
- Rash
- Fatigue
- Thickening of the skin on the hands
- Difficulty swallowing
- Breathing problems
Patients with myositis caused by a virus usually have symptoms of the viral infection, such as a runny nose, sore throat, cough, nausea, and diarrhea. However, symptoms of a viral infection may disappear several days or weeks before symptoms of myositis appear.
Some patients with myositis have muscle pain, but often there is no pain. Half of patients with myositis due to an inflammatory disease do not have intense muscle pain.
Most muscle pain is not associated with myositis, but with muscle overstrain or a reactive reaction to acute respiratory diseases (acute respiratory infections or influenza). These and other common muscle pains are called myalgias.
Rehabilitation of the patient after therapy for neck myositis
After treatment, experts recommend that patients:
- during therapy and upon its completion, remain at rest and do not unnecessarily strain the neck muscles;
- follow a strict diet high in proteins, vitamins and microelements;
- periodically do therapeutic exercises. An exercise program can be developed by a rehabilitation physician;
- gradually increase physical activity;
- avoid injury and hypothermia.
Diagnostics
A doctor may suspect myositis based on symptoms such as muscle weakness, pain, and other symptoms consistent with myositis. The following are used in the diagnosis of myositis:
Blood tests. Elevated levels of muscle tissue enzymes (eg, creatine kinase) may indicate muscle tissue damage. Autoantibody tests can identify autoimmune disease.
Magnetic resonance imaging (MRI). A scan using a powerful magnet and a computer produces images of the muscles. MRI analysis helps identify areas of muscle damage currently and over time.
Electromyography (EMG). By inserting needle electrodes into the muscles, the doctor can test how the muscles respond to electrical stimulators and nerve impulses. EMG allows you to identify muscles that are weak or damaged by myositis.
Muscle biopsy. This is the most accurate analysis for diagnosing myositis . The doctor identifies the weak muscle, makes a small incision, and removes a small piece of muscle tissue to examine the tissue under a microscope. A muscle biopsy provides a definitive diagnosis of myositis .
There are many causes of muscle weakness and muscle pain more common than myositis. And therefore, the diagnosis of myositis may not be made immediately, but after some time.
Consequences and complications
Many patients do not consult a doctor with this problem, preferring to treat myositis on their own with ointments, heating, etc. This is possible if the inflammation is not severe and occurs due to an uncomfortable position or after being in a draft. However, cases of severe inflammation should not be left without medical attention, otherwise serious complications may arise.
Myositis tends to progress; more and more muscle groups are involved in the inflammatory process . Inflammation can spread to the muscles of the esophagus, larynx, and respiratory muscles. Then the patient will have difficulty swallowing, shortness of breath, and cough.
Acute inflammation without proper treatment turns into chronic, in which the pain will either subside or worsen. Atrophy of the affected muscles will gradually develop, their shortening .
Untreated myositis can lead to muscle atrophy
Treatment
Treatment for myositis depends on the cause of the disease.
The inflammatory (autoimmune) diseases that cause myositis often require treatment with drugs that suppress the immune system, including:
- Prednisone
- Imuran
- Methotrexate
Myositis caused by an infection, usually viral, does not require treatment. Myositis caused by bacteria is not common and requires treatment with antibiotics (up to intravenous administration in order to avoid a dangerous condition for the body such as sepsis).
Although acute necrosis of skeletal muscle is rare with myositis, if rhabdomyolysis is present, it is necessary to hospitalize the patient because large fluid infusions must be administered to prevent kidney damage.
Drug-related myositis is treated by stopping the medications. In cases of myositis caused by statin drugs, muscle inflammation decreases within a few weeks of stopping the drug.
Treatment of myositis in the Solnechny sanatorium
Good treatment results are achieved through an integrated approach and a developed therapy program. All conditions for high-quality diagnosis and treatment of myositis have been created in the Solnechny sanatorium in the Republic of Belarus. This is a specialized medical institution specializing in diseases of the musculoskeletal system. A powerful therapeutic base includes a variety of techniques, including hydrotherapy, mud therapy, physiotherapy, physical therapy, ultrasound and laser effects on the body. A variety of treatment and rehabilitation programs are carried out using the latest equipment. Clients are offered a balanced diet. All this, coupled with a healing climate, gives excellent healing results.
Prevention and prognosis
With the modern pace of life, it is difficult to avoid neck problems. However, it is possible to prevent the occurrence of myositis if you follow simple rules :
- Avoiding being in drafts. If you need to be in cold air for a long time, you need to cover your neck with a warm scarf.
- Timely treatment of infectious diseases.
- Avoiding neck injuries.
- Performing industrial exercises during sedentary work.
- Choosing a comfortable orthopedic mattress for sleeping.
- Taking vitamins to maintain immunity, especially during the cold season.
- Compliance with medical recommendations for autoimmune diseases.
- Regular examination for parasites.
The prognosis of the disease is favorable . Myositis of the neck is completely curable. If you follow all the doctor’s recommendations, you can get rid of the problem in 4-6 days.
Video: “Causes of neck pain”
