Pain Overview

Pain that attacks the muscles, ligaments, tendons and the bones is known as musculoskeletal pain. In many cases, the body's response to injury is to tense the injured area, which restricts blood flow. An increase in pain can result in increased tension and a pain-tension cycle that could be hard to overcome. Incorrect body mechanics and posture, coupled with stress, may also cause increased muscle tension and pain. People often reduce activity because of pain, may lead to gradual muscle weakness and de-conditioning, resulting in further pain.


There are many causes of musculoskeletal pain. Daily activities can cause wear and tear to muscle tissue. Trauma, such as jerking movements, auto accidents, falls, fractures, sprains, dislocations, and direct blows to the muscle, may also lead to musculoskeletal pain. Posture changes or poor body mechanics may cause spinal alignment problems and muscle shortening, this can lead to the misuse of other muscles.

Other possible causes of pain include:

  • Postural strain
  • Repetitive movements
  • Overuse
  • Prolonged immobilization.

Back painCommon Types of Musculoskeletal Pain

Neck Pain

Like back strain, neck strain is an irritation to tendons, muscles and ligaments in the upper back and neck area. Whiplash is characterized by a collection of symptoms that occur following damage to the neck, usually because of sudden extension and flexion, such as in a car accident.

Back Pain

Back strain is a fairly broad category called “soft tissue injury,” which covers muscles, tendons and ligaments. About 80% of back and neck pain is muscle-related.

The stomach muscles, or abdominals, enable the back to bend forward. They also assist in lifting. The abdominals work with the buttock muscles to support the spine. The oblique muscles go around the side of the body to provide additional support to the spine.

Another type of strain relates to spinal ligaments that run in front and in back of the vertebral bodies. Tendons, which also connect muscles in the spine, can develop inflammation, or tendonitis.

Some people believe that part of what makes the back muscles more prone to strain is that they are shorter than other big muscles in the body. The muscles in our thighs that enable us to walk, run and jump are longer and less prone to strain. It’s very unusual to strain a thigh muscle.

Shoulder Pain

The shoulder can be described as several joints that combine with tendons and muscles to allow a full range of motion to the arm, from scratching your back to throwing the perfect pitch. Mobility may come with a price, however. The shoulder movement can lead to increasing problems with instability or impingement of soft tissue resulting in pain. Pain may be felt only when the shoulder is moved, or all of the time. The pain may be acute and disappear in a short time, or it may continue and require medical diagnosis and treatment.

Arm & Hand Pain

One of the only physical liabilities of having an office job is a hand injury in the form of carpal tunnel. Hands, arms and shoulders can also be hurt from sports injuries, arthritis, congenital deformities, and repetitive stress. The most common types of injuries are:

  • Fractures and sprains
  • Carpal tunnel syndrome
  • Tendonitis
  • Arthritis
  • Nerve and tendon injuries or lacerations
  • Rotator cuff tear
  • Shoulder pain and instability
  • Ganglion cysts
  • Tennis elbow

Hip Pain

The primary cause of hip pain is arthritis, specifically osteoarthritis. Arthritis is the most common chronic condition and is characterized by inflammation of the joints. Common causes of arthritis include wear and tear on the bones and joint cartilage, most often when the body has too much weight to support. This can be caused by carrying heavy loads consistently for years but is more commonly a byproduct of being overweight.

Knee Pain

The most common knee problems include the following:

    knee pain
  • Knee cap pain - the pain usually becomes most noticeable when walking up stairs, going down stairs, running or sitting.
  • Pain from a torn meniscus - the meniscus is the cartilage that keeps the femur (the thigh bone) and the tibia (the shin bone) from hurting or grinding when they rub against each other. If the meniscus is torn, stretched or out of place, pain may occur when the joint is moved.
  • Pain from ligament problems - there are four ligaments in the knee: the anterior cruciate ligament, the posterior cruciate ligament, the medial collateral ligament, and the lateral collateral ligament. When the ACL is torn, it is often because the leg rotates while the foot stays planted on the ground. Often times an ACL tear is accompanied by a loud popping sound from the knee and the support of the knee gives way. A posterior cruciate injury happens when the knee is forced backwards or when it receives a hard impact. A medial collateral ligament injury most commonly occurs when the knee is hit from the outside while a lateral collateral ligament injury occurs when the knee is impacted from the inside.
  • Pain from tendon problems - inflamed tendons that connect the knee cap to the shin bone can cause pain.

Foot & Ankle Pain

foot pain

Our feet and ankles bear the brunt of every step we take. Women in particular wear uncomfortable, jarring yet fashionable shoes that can do damage to the structure of the foot over time. Athletes are at risk of foot problems from traumatic injury, joint, tendon, or ligament problems.

The most common foot problems are:

  • Foot and ankle trauma/fractures
  • Ligament sprains/tendonitis
  • Achilles tendon problems
  • Heel pain/plantar fasciitis
  • Bunions, hammertoes or claw toes
  • Ankle or foot arthritis
  • Flat feet deformities


Oftentimes, sufferers of musculoskeletal pain complain that their entire bodies ache. The muscles may feel like they have been pulled or overworked. The muscles may twitch or burn. Symptoms vary from patient to patient, but the common symptoms are:

  • Pain
  • Fatigue
  • Restlessness & Reduced sleep


Outlined below are some of the diagnostic tools that your physician may use to gain insight into your condition and determine the best treatment plan for your condition.

  • Medical history: Conducting a detailed medical history helps the doctor better understand the possible causes of your pain which can help outline the most appropriate treatment.
  • Physical exam: During the physical exam, your physician will try to pinpoint the source of pain. Simple tests for flexibility and muscle strength may also be conducted.
  • X-rays are usually the first step in diagnostic testing methods. X-rays show bones and the space between bones. They are of limited value, however, since they do not show muscles and ligaments.
  • MRI (magnetic resonance imaging) uses a magnetic field and radio waves to generate highly detailed pictures of the inside of your body. Since X-rays only show bones, MRIs are needed to visualize soft tissues like discs in the spine. This type of imaging is very safe and usually pain-free.
  • CT scan/myelogram: A CT scan is similar to an MRI in that it provides diagnostic information about the internal structures of the spine. A myelogram is used to diagnose a bulging disc, tumor, or changes in the bones surrounding the spinal cord or nerves. A local anesthetic is injected into the low back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected into the spinal canal to reveal where problems lie.
  • Electrodiagnostics: Electrical testing of the nerves and spinal cord may be performed as part of a diagnostic workup. These tests, called electromyography (EMG) or somato sensory evoked potentials (SSEP), assist your doctor in understanding how your nerves or spinal cord are affected by your condition.
  • Bone scan:Bone imaging is used to detect infection, malignancy, fractures and arthritis in any part of the skeleton. Bone scans are also used for finding lesions for biopsy or excision.
  • Injections: Pain-relieving injections can relieve pain and give the physician important information about your problem, as well as provide a bridge therapy.


With any muscle pain or injury, it’s natural for an individual to stop moving the injured area and wait for it to heal. Ironically, this is counter-productive. Restricting movement causes the muscle to weaken, become less flexible and receive less circulation. In fact, gentle stretching and exercise is the best way to resolve the injury by getting it moving and increasing circulation.
Exercise is an important factor in the treatment of chronic musculoskeletal pain. If alignment problems are not treated, muscle shortening or weakness may occur, this may contribute to alignment problems, as well as poor mechanics and body posture. The more support the muscles can offer, the less stress and therefore less pain. While running or stair climbing can be taxing to the body, the stationary bike and swimming are both excellent cardiovascular activities that put minimal pressure on the body.

For patients with spine, upper extremity or lower extremity pain or disorder, pain may be managed by prescribing low doses of medicine to increase the body's level of serotonin and norepinephrine. Sleep aid medications, including zolpidem tartrate (brand name Ambien), clonazepam, and trazadone, may offer some relief.

Dr. Fite Spinal InjectionsOther pain management options offered (including neck pain, back pain, shoulder pain, arm pain, hand pain, hip pain, knee pain, foot pain and ankle pain) might include:

  • Injections with anesthetic or anti-inflammatory medicines in or around the painful sites
  • Strengthening and conditioning
  • Physical or occupational therapy
  • Acupuncture or acupressure
  • Relaxation/biofeedback techniques
  • Osteopathic manipulation (a whole system of evaluation and treatment designed to achieve and maintain health by restoring normal function to the body)
  • Chiropractic care
  • Therapeutic massage

Precision Spine Care is the only spine center in East Texas to be included in Spine Center Network, an exclusive national listing of credentialed spine centers of excellence. Click here to learn more.

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