Muscle Aches and Pains

Common causes of muscle aches

Exercise and overuse

Delayed-onset muscle soreness (DOMS) starts 12 to 24 hours after new or more intense exercise, especially exercise with lowering or downhill movements, and peaks at 24 to 72 hours. It improves with gentle activity. A sudden sharp pain during activity is more likely a muscle strain.

Viral infections

Body aches are a hallmark of flu, COVID-19, dengue and many other viral illnesses, caused by the immune response. They come with fever, chills, tiredness and headache, and fade within about a week.

Tension and stress

Stress, anxiety, poor sleep and long hours at a desk cause aching in the neck, shoulders and upper back. Myofascial pain syndrome involves tender knots (trigger points) that refer pain elsewhere.

Dehydration and electrolyte shifts

Low potassium, magnesium or calcium, or heavy sweating, can cause aching and cramps.

Causes of muscle aches all over the body that persist

Medicines

• Statins: muscle aches in the thighs, calves, shoulders or back, usually in the first months or after a dose increase. Most symptoms are mild, but severe pain with weakness needs checking. See statin-induced myopathy.
• Others: some antiretrovirals, colchicine, fibrates, steroids (weakness), aromatase inhibitors, and withdrawal from opioids or antidepressants.

Fibromyalgia

Widespread pain above and below the waist on both sides for 3 months or more, with fatigue, unrefreshing sleep, brain fog and tenderness. It is a pain-processing condition, not muscle damage. See fibromyalgia.

Polymyalgia rheumatica

In people over 50, sudden aching and stiffness of the shoulders, upper arms, hips and thighs, worst in the morning. Blood inflammation markers are high, and it responds dramatically to low-dose steroids. About 1 in 10 people with polymyalgia rheumatica also develop giant cell arteritis.

Hormone and vitamin problems

• Hypothyroidism: aches, cramps, stiffness, fatigue and cold intolerance.
• Vitamin D deficiency: aching muscles and bones and weakness near the hips.
• Adrenal insufficiency and low or high calcium.

Infections

Lyme disease, other tick-borne infections, hepatitis, HIV and post-viral fatigue can all cause prolonged aches.

Autoimmune and inflammatory conditions

• Inflammatory myositis (polymyositis, dermatomyositis): progressive weakness of the shoulders and hips, sometimes with a rash. Muscle enzymes (CK) are raised. See myositis.
• Lupus, rheumatoid arthritis and other connective tissue diseases.

Mood and sleep

Depression, anxiety, chronic stress and sleep disorders such as sleep apnea amplify body pain.

Serious causes

Rhabdomyolysis

Rapid muscle breakdown releases myoglobin into the blood, which can damage the kidneys. Triggers include extreme exercise (especially in heat or when unaccustomed), crush injuries, heat stroke, prolonged immobility after a fall, some drugs (cocaine, amphetamines, statins with interacting drugs) and severe infections. Signs are severe muscle pain, swelling, weakness and dark urine. See rhabdomyolysis.

Clues to the cause

How doctors find the cause

A doctor will ask where you ache, when it started, whether you are weak or just sore, about exercise, infections, medicines, mood, sleep and other symptoms. They examine muscle strength, tenderness and joints.

Blood tests may include creatine kinase (CK, a muscle enzyme), inflammatory markers (ESR, CRP), thyroid function, vitamin D, calcium, kidney and liver function, and blood count. Further tests such as autoantibodies, EMG, MRI or muscle biopsy are used if myositis is suspected.

Relief and treatment

• Rest and gentle movement: keep moving within comfort; light walking or swimming improves blood flow.
• Heat for stiffness and tension; ice for a recent strain.
• OTC pain relievers: acetaminophen (paracetamol) or ibuprofen; follow the label dose. Do not give aspirin to children or teenagers.
• Fluids after exercise, illness or heat.
• Stretching and massage for tension and trigger points.
• Sleep and stress management.
• Treat the cause: for example, steroids for polymyalgia rheumatica, thyroid hormone for hypothyroidism, vitamin D supplements, or switching statins under medical advice.
• Fibromyalgia: graded aerobic exercise is the most effective treatment, with sleep improvement, CBT and sometimes medicines such as duloxetine or amitriptyline.

Do not stop a prescribed statin without speaking to your doctor; many people can continue a different statin or dose.

Frequently asked questions

What causes muscle aches and pains all over the body?

Short-term aches all over are usually from a viral illness like flu or COVID-19, or from hard exercise. Aches lasting weeks can come from statins, fibromyalgia, polymyalgia rheumatica, an underactive thyroid, low vitamin D, depression or autoimmune conditions. Blood tests help find the cause.

When should I worry about muscle aches?

Seek urgent care for severe pain with weakness or dark urine, aches with confusion or a rash that does not fade, or severe limb pain after an injury. See a doctor for aches lasting more than 2 weeks, new weakness, or shoulder and hip stiffness after age 50.

Can statins cause muscle aches?

Yes. Muscle aches are the most commonly reported statin side effect, though many aches in statin users are not caused by the drug. Mild symptoms can often be managed by changing the dose or type of statin. Severe pain with weakness or dark urine needs urgent assessment.

Why do my muscles ache when I have a fever?

During infections, the immune system releases chemical messengers such as cytokines and prostaglandins that cause fever and make muscles ache. This is why flu and COVID-19 cause body aches. Rest, fluids and acetaminophen or ibuprofen ease them until the infection clears.

What vitamin deficiency causes muscle aches?

Vitamin D deficiency is the best known, causing aching muscles and bones and weakness near the hips. Low magnesium, potassium or calcium can cause cramps and aches. Vitamin B12 deficiency mostly causes nerve symptoms. A blood test can check these.