You might think you know what it feels like to have sore, tight muscles. But, sometimes, what feels like a muscle ache is actually a more complex problem — one that’s related to nerves.
“It’s much more common than you would think,” Dr. Pavan Tankha, medical director of comprehensive pain recovery at the Cleveland Clinic, tells TODAY.com.
“That’s because, if there’s an injury, you damage not only muscle, but you can sometimes also damage the nerves,” he explains. “So it could be a little bit of both going on.”
In other cases, it’s related to the basic anatomy of the spine, Dr. Christopher Standaert, a physiatrist and board-certified in physical medicine and rehabilitation at the University of Pittsburgh Medical Center, tells TODAY.com.
The vertebrae of your spine house your spinal cord and nerves, and between the vertebrae are soft disks that act as shock absorbers. If the spinal nerves are compressed (by a disk pushing out and putting pressure on them, for instance), that can cause pain specifically related to the nerve and vertebrae that are affected.
“When you compress a nerve and get nerve pain, it follows a path of the nerve down your leg or wherever it happens to be,” Standaert explains, adding that you won’t necessarily feel the pain at the root.
A compressed nerve in your lumbar spine, for example, might not cause low-back pain, but instead lead to nerve-related pain in the buttocks, hip or leg. And a compressed nerve in your middle back area can cause pain in the ribcage, says Standaert, who specializes in the non-operative management of spine and neuromusculoskeletal conditions.
Muscle pain is far more common than nerve pain, Tankha says. “But it’s difficult to differentiate between the two — even for physicians — because there’s overlap in terms of how they feel,” he says.
Muscle pain symptoms
Most of us have felt the pain of a sore muscle after too many squats or a long walk.
“The muscle will hurt when you use that muscle, and when you stop using that muscle, it doesn’t hurt,” Standaert explains.
Experts typically recommend a short period of rest after straining a muscle followed by loosening up and stretching that muscle. “If you strain your hamstring, you do want to stretch it out a little bit and get it loose,” he says. “Whereas, if that’s your nerve, that’s not going to feel very good.”
Muscle pain typically…
- Gets worse when you use the affected muscle.
- Feels achy, sore or tight.
- Starts after a specific event, like performing a challenging new exercise or pulling a muscle during a sports game.
- Feels better with light movement and stretching after an initial period of rest.
- Starts to show improvement within a few days.
Nerve pain symptoms
Pain that’s due to nerve compression can feel very similar to muscle pain. But there are some key differences.
Most commonly, people describe nerve-related pain as numbness and tingling, Standeart says. “Sometimes they’ll describe an itchy sensation or water running down their leg or sensation of heat or burning,” he adds. Other times, people may feel like their arm or leg is heavy or faintly weak, he says.
Tankha says patients also frequently describe nerve pain as an electric shock feeling. “And that could be the only symptom you have,” he says.
“The difficult thing is you can get just pain, you can get just numbness and you can get just weakness, or you can get a combination of all three,” Standeart says. That makes it very challenging for patients and even doctors to properly diagnose these conditions.
And nerve pain doesn’t always occur in the part of the body that’s the root of the pain. Sciatica, for instance, is a condition in which a nerve is compressed in the low-back and causes pain down the leg.
Another clue that your tight muscles are actually the result of nerve pain? Your usual stretch routines don’t help. “If you use a muscle that is somewhat weak, it will get stronger,” Standaert says. “If you just keep using a pissed-off nerve, it will get more pissed off, like an angry snake.”
Nerve-related pain often…
- Feels tingly, tight, heavy, weak or hot. Sometimes, it can be hard to describe the way the pain feels to others. One limb may simply feel “different” than the one on the other side.
- Radiates to other parts of the limb, following the path of the nerve.
- Is unaffected by muscle stretches or may even be exacerbated by stretches.
- Starts after a specific event, like an injury, but can also be chronic.
Home remedies for muscle pain and nerve pain
In the beginning, the at-home treatments for muscle and nerve-related pain might look very similar, Tankha says.
He says those options can include:
- Applying ice or heat.
- Warm showers.
- Epsom salt baths.
- Over-the-counter medication, like ibuprofen or acetaminophen.
However, ice and heat tend to work better for muscle pain, Standaert says. The over-the-counter medication also isn’t usually as effective for nerve-relate pain, Tankha says.
If your pain continues to last more than three to five days, your doctor might recommend physical therapy, massage or other modalities, Tankha says.
When to see a doctor
“Most acute pain resolves on its own within four to six weeks,” Tankha explains. In general, if your pain lasts longer than six weeks, you should check in with your doctor, Standaert says.
“If the pain continues longer than that, in the range of eight to 12 weeks or longer, that’s when you want to look for a more serious underlying cause,” Tankha says.
Additionally, if your symptoms are getting worse or just not responding to the usual at-home treatments, that’s a good time to get an in-person evaluation, he says.
Serious warning signs
Most nerve pain isn’t an emergency. But there are some symptoms that require immediate medical attention, which Standaert says are referred to as “red flag conditions.”
- Profound weakness or numbness.
- Fever, which could suggest an infection.
- You had significant trauma, like a car accident or a hard fall.
- Loss of bowel or bladder control.
- Unexplained weight loss.
- A history of cancer or an immunosuppressive condition.
Even if your pain isn’t a medical emergency, it may be interfering with your life — and that alone is reason enough to figure out what’s going on.
“Everybody’s back hurts at some point, and everybody doesn’t need a hospital emergency room, by any means,” Standaert says.
But, when the pain becomes persistent and makes it hard to sit at work, walk your dog or do tasks around the house, then maybe you should seek help. “Even if you don’t have something horrible going on, we should try to see if we can help you function better,” Standaert says.
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