Persistent pain deserves careful examination. Muscles and related soft tissues can contribute to pain, including when symptoms continue after other treatment. FRAME supports research and physician education to improve how muscle pain is recognized and treated.
Muscles are a significant source of chronic pain, yet their role is virtually absent from medical education. FRAME works to expand training in muscle examination and treatment so that clinicians have more ways to evaluate persistent pain.
Back pain has several possible sources. A clinical evaluation can consider muscles alongside the spine, nerves, and other tissues. Pain that persists after treatment warrants further evaluation; it does not, by itself, identify which tissue is responsible.
Muscle examination can include strength, flexibility, tenderness, and whether movement reproduces familiar pain. Tenderness alone does not establish the source: pain can also be felt away from the tissue generating it.
A 2013 study published in Pain Medicine reported lasting reductions in pain and its interference with daily life after muscle-focused treatment. The study included 56 people with persistent low back pain despite previous treatment. These findings give clinicians a reason to examine muscles as a potential source of pain. Controlled studies are needed to establish how the treatment compares with other approaches. Explore the clinical evidence.
Dr. Hans Kraus, the physician who treated President Kennedy’s back pain, described four categories of muscle pain. This framework informed Dr. Norman Marcus’s clinical work. The descriptions below introduce those categories; they are not a way to diagnose pain without an examination.
Muscle tightness that persists rather than easing with relaxation.
An involuntary muscle contraction that may be brief or sustained and can make movement painful.
Kraus’s term for muscle weakness or limited flexibility, which he considered when examining people with pain.
Tender areas in a band of muscle that may produce pain locally or elsewhere in the body.
What imaging can and cannot tell us: Imaging can help identify changes in bones, discs, and soft tissues, but it does not always establish what is generating pain. When imaging does not explain the pain, muscles may warrant further examination. A clinician considers imaging together with symptoms, medical history, and examination.
“Pain affected every part of my daily life. Not a single moment was comfortable, and even sleep offered no relief.
Treatment gave me my career back, my love of travel back, and my enthusiasm for life back.”
Desiree Lee lives with Ehlers-Danlos syndrome. After years of pain, she found effective muscle-focused treatment. That experience informs her work as FRAME’s president and her commitment to improving the recognition and treatment of muscle pain.
Desiree Lee, FRAME Foundation President
FRAME supports research and education to improve the recognition and treatment of muscle pain. Our plans include developing clinician partnerships and helping people living with pain find reliable information. These efforts build on clinical experience while addressing questions that still need research.
Developing a network of clinicians with experience in muscle pain examination and treatment. Our goal is to help people find providers who can evaluate whether muscles contribute to their pain.
Working with researchers to understand how muscles generate pain and to evaluate methods of diagnosis and treatment.
Working toward connections between people living with chronic pain and clinicians, as well as opportunities to share experiences with one another.
We aim to fund clinical studies that test muscle pain examination and treatment methods, alongside training programs that help physicians evaluate the evidence and apply it in practice.
Learn about the research, prepare questions for your clinician, or share your experience with FRAME.
Experiences of seeking a diagnosis and treatment help us understand what matters to people living with pain. If you would like to share yours, we welcome hearing from you.
Contact UsConsider asking: Could muscles be contributing to my pain? What would an examination involve? How would the findings affect my treatment options? These questions can support a discussion of the possible sources of pain and appropriate next steps.
Learn MoreGifts support FRAME’s work in clinical research, physician education, and patient advocacy. Our board consists entirely of volunteers, many with personal experience of soft tissue pain.
DonateYour support helps FRAME develop research and training programs that give muscle pain greater attention in clinical care.