If you have been through imaging, injections, even surgery, and your pain persists, the problem may be soft tissue-related. Muscles are the largest organ system in the body, a common source of chronic pain, and often not properly examined.
Muscles are a significant source of chronic pain, yet they are virtually absent from medical education. Physicians are not trained to diagnose soft tissue-generated pain, and they are not trained to treat it. It is a gap in the curriculum, and the effects of this gap reverberate through the lives of pain patients.
When you see a doctor for back pain, they look for what they were taught to look for: structural problems in the spine. A disc. A nerve. A vertebra. They order imaging. They may try injections. They may recommend surgery. What they were never taught to consider is whether the pain is coming from the soft tissue itself.
This is not a failure of any individual physician. It is a failure of the system that trained them. Muscle pain is not part of the medical school curriculum. It is not part of residency training. There is no existing fellowship dedicated to it. A doctor cannot diagnose what they were never taught exists.
30–50% of spine surgeries for back pain are unsuccessful
80,000–90,000 new failed back surgery cases occur every year in the US
These numbers are not an argument against surgery. They are evidence that in a significant number of cases, the source of pain was never correctly identified, because the diagnostic framework did not include soft tissue.
Dr. Hans Kraus, the physician who treated President Kennedy's back pain, identified four categories of muscle pain. They remain foundational to diagnosis today.
Sustained contraction in muscles that never fully release. Often driven by stress, posture, or repetitive activity, and frequently misattributed to structural problems.
Involuntary contractions that can be brief or sustained, producing acute pain and significantly restricting movement. A common feature of back pain episodes.
Weakness or stiffness from deconditioning, disuse, or chronic guarding. The resulting instability often generates pain that worsens over the course of the day.
Hyperirritable areas within taut muscle bands that produce localized tenderness and, critically, can refer pain to distant sites in predictable patterns.
Why imaging misses it: Standard imaging studies (MRI, X-ray, CT) visualize bone and disc but do not show muscle-generated pain. A clean scan does not mean there is no source. It means the source is in tissue that the scan was not designed to evaluate. Muscle pain can also produce referred pain, where a muscle in the lower back generates symptoms down the leg, or an abdominal muscle produces pain felt elsewhere entirely.
"When I was 25 years old, I couldn't sit in a restaurant and eat. I didn't go to plays. I didn't go to restaurants. I couldn't get on a plane to see my family without being in crisis."
Desiree has Ehlers-Danlos Syndrome, a connective tissue disorder in which muscle pain is a primary feature. For years, her life was defined by pain that no one could effectively treat.
"I was one of the lucky ones. I managed to find a clinician who was educated in muscle pain and who offered me treatment that was effective. That treatment transformed my life."
Desiree Lee, FRAME Foundation President
FRAME exists to reduce the suffering felt by millions of people living with soft tissue-generated pain, whether from Ehlers-Danlos Syndrome, car accidents that never fully resolved, or conditions that have been misdiagnosed, mistreated, or dismissed entirely. When the wrong problem is treated, the consequences compound: time is lost, and pain increases. FRAME advocates for the patients and families who live with this pain every day and who know its impact firsthand.
Identifying clinicians who are focused on treating soft tissue pain and can offer their patients real, effective treatment. Building a network so that patients can find providers who know what to look for.
Working with researchers focused on understanding the mechanisms of soft tissue-generated pain, improving diagnosis, and developing targeted treatments.
Building connections between patients and providers who can help, and between patients who share the experience of living with chronic pain.
As FRAME grows, we intend to fund the research that will change the paradigm in medicine: clinical studies that establish soft tissue as a significant and treatable source of chronic pain, and training programs that ensure the next generation of physicians knows how to find it.
Changing the standard of care requires patients, not just researchers. There are concrete ways to help.
Patient experiences are essential to building the case for change. If you have lived with undiagnosed or misdiagnosed muscle pain, your account matters to this work.
Contact UsAt your next appointment, ask whether your muscles have been evaluated as a potential source of pain. If your provider is unfamiliar with muscle pain diagnosis, that itself is part of the problem FRAME is working to solve.
Learn MoreEvery dollar goes directly to clinical studies, physician training, and patient access programs. FRAME's board is entirely volunteer, made of people who have been personally impacted by soft tissue pain.
DonateThe research needed to transform how chronic pain is diagnosed and treated requires funding from people who understand what is at stake.