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Dr Norman Marcus
Healthcare is built on the premise that accurate diagnosis leads to effective treatment. Yet for millions of Americans living with chronic pain, that sequence breaks down long before relief is ever found. The breakdown occurs not because clinicians lack tools or expertise, but because the system itself has a blind spot, a blind spot that obscures one of the most common sources of pain in the human body: muscles.
Muscles make up nearly 45 percent of our body mass. They stabilize our skeleton, protect our nerves, and power every voluntary movement. Despite this central role, muscular tissue is rarely prioritized during routine pain evaluations. Most medical evaluations begin with imaging and end with structural interpretations. Pain becomes a picture: a bulging disc, a compressed nerve, a degenerating joint. What does not show up on the MRI, when assessment centers primarily on structural change, functional contributors like muscle overload or irritation may go unexamined.
The consequences are profound.
The first consequence of ignoring muscles is misdiagnosis. In many cases, diagnostic workups prioritize structural explanations early in the evaluation process. Yet research consistently shows that structural “abnormalities” are extraordinarily common in people without pain. Meanwhile, muscular dysfunction, trigger points, tight bands, overload, microtrauma cannot be seen on traditional imaging at all.
The result is a diagnostic mismatch: clinicians treat what the scan shows, which is often not the cause of the pain- we say correlation is not causation. When treatment fails, the cycle repeats. Patients bounce from provider to provider, collecting labels - arthritis, disc disease, neuropathy - often without ever receiving any diagnosis suggesting specific muscles as a source of their pain complaints.
A second consequence is the overuse of invasive interventions. When imaging findings are misinterpreted as the source of pain, clinicians may recommend injections or surgery. Yet many of these procedures target structures that may be incidental to the patient’s symptoms.
Multiple studies have shown that a considerable number of spinal surgeries are performed on patients whose pain originates in soft tissue rather than bone or nerve. For these individuals, surgery not only fails to relieve pain but introduces new risks, costs, and complications.
This escalation of care, driven by structural assumptions rather than functional evaluations, creates a treatment pathway that may not only be costly and ineffective but potentially harmful.
A third consequence is financial. Chronic pain already costs the U.S. hundreds of billions of dollars each year in lost productivity, medical spending, and disability. When muscle pain goes unrecognized, that cost multiplies. Unnecessary imaging, specialist referrals, procedures, medications, and prolonged disability claims create a silent economic burden that strains the healthcare system.
This burden is preventable. A more accurate, muscle-informed diagnostic approach could shift patients into earlier, conservative, and lower-cost treatments that resolve pain before it becomes an intractable chronic condition.
When patients cycle through the healthcare system without answers, trust erodes. They begin to doubt clinicians, the system, and even themselves. Many are told their pain is “in their head” or that nothing more can be done. These statements are not only demoralizing, they can delay proper care for years.
Neglecting muscular evaluation is not merely a diagnostic oversight; it carries tangible human costs.
