Muscle pain can come from trigger points, overuse, joint instability, hypermobility, dystonia, nerve irritation, inflammation, fibromyalgia, pelvic mechanics, headache patterns, or chronic pain sensitization.
Muscle pain isn't always caused by overuse. Dr. Siefferman explains the difference between primary and secondary myofascial pain, why trigger points develop, and why identifying the underlying cause is essential for lasting relief.
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Hi, I’m Dr. Jason Siefferman, interventional pain specialist and medical director at Manhattan Pain Medicine. Muscle pain can either be primary or secondary. Primary muscle pain means that the muscle has been overused and because of the overuse, the muscle is sore.
Now, of course, if you intermittently overuse a muscle, that’s called working out and the muscle will get stronger. If you chronically overuse a muscle more than it can adapt to, you will end up with an overuse injury of that muscle where that muscle really hurts because it’s been overused and it can’t keep up with the stress and strain that’s been placed on it.
This is a situation where trigger points may develop. And a trigger point is an area of the muscle where it’s stuck in a contracted state and it can’t actually release. That area becomes highly sensitized and pain will refer. The area becomes really uncomfortable and then the rest of the muscle ends up guarding that trigger point just to protect it. This is when patients come to us, we release it with dry needling or trigger point injections, let the muscle heal. And of course, we couple this with physical therapy because the primary overuse problem also has to be addressed. That’s primary myofascial pain.
Secondary myofascial pain is defined by something driving that muscle to be overactive rather than the patient overusing it themselves. If there’s a source of pain that that muscle is guarding, that is a secondary overuse. Or if there is some neurologic dysfunction like spasticity or radiculopathy that will cause a muscle to be overused, that will also lead to myofascial pain. In both of those situations, doing trigger points and physical therapy for that muscle will get the patient nowhere.
We really have to understand why that muscle is being overused, what’s driving the overuse, and treat that primary issue in order for that muscle to stop hurting. And we’ll know it’s secondary myofascial pain either by the pattern that the patient comes in with cuz we’ll just recognize it cuz we’ve seen it 100 times or they’ll treat it like primary myofascial pain and it won’t get better. If you approach secondary myofascial pain like primary myofascial pain, it may feel better for a day or two, but within 2 weeks for sure that pain will return and then we know that there’s something driving it. We have to go after that process, treat that process, and then the myofascial pain will get better.
Muscle pain, also called myalgia, can feel like aching, soreness, tightness, cramping, burning, stiffness, spasms, or deep tenderness. It may affect one area, such as the neck, shoulder, back, jaw, pelvis, or leg, or it may feel widespread across the body.
While muscle pain is sometimes temporary, persistent or recurring muscle pain can have many possible drivers. These may include myofascial trigger points, overuse, injury, joint instability, hypermobility, dystonia, nerve irritation, spine or pelvic mechanics, inflammatory disease, fibromyalgia, central sensitization, medication effects, or another medical condition.
At Manhattan Pain Medicine (MPM), evaluation begins by identifying what is driving the muscle pain. The goal is not simply to treat a tight or painful muscle, but to understand whether the pain is muscular, nerve-related, joint-related, inflammatory, dystonia-related, hypermobility-related, pelvic, headache-associated, centralized, or mixed.
At MPM, care begins with a detailed review of the pain location, pattern, triggers, duration, movement limitations, muscle tenderness, referral patterns, prior imaging, prior treatment response, and related symptoms. For patients looking for muscle pain treatment in Manhattan, MPM evaluates whether symptoms may reflect myofascial pain, trigger points, dystonia, fibromyalgia, hypermobility-related muscle guarding, pelvic floor muscle pain, headache-associated muscle tension, nerve irritation, inflammatory disease, or a broader chronic pain condition.
Treatment may include movement-based care, acupuncture, Feldenkrais, biofeedback, trigger point injections, botulinum toxin injections in selected muscle overactivity patterns, and coordination with physical therapy, neurology, rheumatology, pelvic floor specialists, headache specialists, or other clinicians when appropriate.
Jason W. Siefferman, MD
Medical Director | Interventional Pain Management | Headache Medicine
Luis Aranguren, MD
Interventional Pain Management
Tayyaba Ahmed, DO
Physical Medicine & Rehabilitation | Pelvic Pain
Adam Rosenberg, PA-C
Board-Certified Physician Assistant
Jordan Shankle, PA-C
Board-Certified Physician Assistant
Nino Mikaberidze, MD
Director of Rheumatology & Internal Medicine
Muscle pain is common, but chronic muscle pain is not always simple soreness. Pain that feels muscular may actually be related to a joint, tendon, ligament, nerve, spine segment, pelvic floor pattern, inflammatory condition, medication reaction, dystonia, fibromyalgia, or central pain sensitization.
This is why MPM uses a diagnosis-first approach. The evaluation looks at the painful muscle, but also considers surrounding joints, mobility, posture, gait, cervical mechanics, pelvic mechanics, trigger points, nerve pathways, headache overlap, hypermobility, inflammatory history, medication history, and chronic pain processing. This broader view helps determine which treatments are most appropriate and when additional specialty evaluation is needed.
Muscle pain can sit at the intersection of several MPM Zones of Expertise, including Complex Chronic Pain, Hypermobility, Musculoskeletal issues, Pelvic Pain, and Headache.
A patient with hypermobility may develop muscle guarding because muscles are working harder to stabilize loose joints. A patient with pelvic pain may have pelvic floor muscle overactivity or referred pain. A patient with headache may have neck, jaw, or shoulder muscle tension contributing to symptoms. A patient with fibromyalgia may have widespread muscle tenderness and amplified pain processing.
MPM evaluates these relationships carefully so treatment can be directed toward the correct pain drivers rather than treating muscle pain as one single diagnosis.
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Muscle pain can be caused by overuse, injury, strain, inflammation, infection, medication effects, trigger points, joint instability, nerve irritation, dystonia, fibromyalgia, central sensitization, or another medical condition. Some muscle pain is temporary and improves with time, while persistent or recurring muscle pain should be evaluated to identify the underlying driver.
Muscle pain may be considered chronic when it persists beyond the expected healing window, keeps returning, spreads to other areas, or continues to interfere with movement, sleep, work, exercise, or daily function. Chronic muscle pain may involve local tissue irritation, myofascial trigger points, joint instability, nerve sensitivity, dystonia, fibromyalgia, or broader nervous system sensitization.
Myofascial pain refers to pain involving muscles and the surrounding connective tissue called fascia. It is often associated with tender trigger points or taut bands of muscle that may cause local pain or referred pain in another area. Myofascial pain can affect the neck, shoulders, back, jaw, pelvis, hips, or limbs and may overlap with posture, movement, stress, injury, joint instability, or chronic pain patterns.
Trigger points are sensitive areas within muscle that may feel tender, tight, or rope-like. They can cause pain directly in the muscle or refer pain to another region. For example, trigger points in the neck and shoulder may contribute to headache-like symptoms, while pelvic trigger points may contribute to sitting pain, pelvic pain, or referred discomfort. Trigger points should be evaluated in context because they may be part of a broader pain pattern.
Yes, hypermobility can contribute to muscle pain in some patients. When joints are more mobile or less stable, muscles may work harder to provide support. This can lead to guarding, fatigue, spasms, trigger points, or recurrent muscle tightness. In patients with EDS or hypermobility spectrum disorder, MPM evaluates joint stability, movement patterns, muscle compensation, nerve irritation, and chronic pain sensitivity together.
Fibromyalgia can cause widespread muscle pain, tenderness, fatigue, poor sleep, brain fog, stiffness, and heightened sensitivity. Fibromyalgia pain is real and often involves changes in how the nervous system processes pain. MPM evaluates whether muscle pain is primarily related to fibromyalgia, another pain generator, or an overlap of fibromyalgia with inflammatory, musculoskeletal, neurologic, pelvic, headache, or hypermobility-related conditions.
Yes, dystonia can cause muscle pain when involuntary muscle contractions, abnormal postures, pulling, cramping, or sustained overactivity place stress on muscles and joints. Cervical dystonia, focal dystonia, pelvic dystonia, or other dystonia patterns may contribute to pain, tightness, fatigue, headaches, or functional limitation. In selected cases, botulinum toxin may be considered to reduce overactive muscle contraction, depending on the diagnosis and muscle pattern.
Treatment depends on the cause of the muscle pain. Options may include movement-based therapy, activity modification, acupuncture, Feldenkrais, biofeedback, trigger point injections, botulinum toxin injections for selected muscle overactivity patterns, and coordinated care with physical therapy, neurology, rheumatology, pelvic floor therapy, headache care, or pain psychology when appropriate. MPM does not treat muscle pain as one single diagnosis. The plan depends on the pain generator, symptoms, function, and goals of care.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Jason W. Siefferman, MD
Jason W. Siefferman, MD
MPM
MPM
Muscle pain is one of the most common reasons patients seek care, but it is also one of the most misunderstood. Some muscle pain follows a clear trigger, such as exercise, strain, injury, or overuse. Other muscle pain persists for months, returns repeatedly, spreads across multiple regions, or does not respond to stretching, massage, rest, physical therapy, or medication.
When muscle pain becomes persistent, the question is not only “where does it hurt?” The more important question is “why is this muscle painful?”
Muscle pain can come from many different sources. It may be related to local muscle irritation, myofascial trigger points, muscle guarding, overuse, injury, joint instability, hypermobility, pelvic floor dysfunction, headache-related muscle tension, dystonia, nerve irritation, spine referral, inflammation, fibromyalgia, medication effects, or central pain sensitization.
This is why MPM evaluates muscle pain as a symptom pattern rather than one fixed diagnosis. The same area of muscle pain may have different causes in different patients.
For example, neck and shoulder muscle pain may be related to myofascial trigger points, cervical dystonia, headache patterns, cervical spine referral, hypermobility-related guarding, TMJ disorders, stress physiology, or peripheral nerve irritation. Pelvic muscle pain may involve pelvic floor overactivity, pelvic mechanics, nerve irritation, endometriosis overlap, pelvic dystonia, or chronic pain sensitization. Widespread muscle pain may suggest fibromyalgia, central sensitization, autoimmune or inflammatory overlap, medication effects, or another systemic condition.
Myofascial pain is muscle and fascia-related pain that is often associated with trigger points. A trigger point is a sensitive area within a muscle that may feel tight, tender, or rope-like. Pressing on a trigger point may reproduce local pain or send pain to another area.
Trigger points may develop after injury, overuse, repetitive strain, prolonged postures, joint instability, stress-related muscle guarding, pelvic floor dysfunction, or chronic pain sensitization. They can also coexist with other conditions, meaning that treating the trigger point alone may not be enough if the underlying driver remains active.
At MPM, trigger points are evaluated as part of the larger clinical picture. The team looks at where the trigger points are located, what movements reproduce the pain, whether pain refers elsewhere, and whether the muscle is compensating for joint, nerve, spine, pelvic, or headache-related dysfunction.
Patients with EDS or hypermobility spectrum disorder often describe chronic tightness, spasms, fatigue, or muscle pain despite being flexible. This can feel confusing. A person may be hypermobile and still feel very tight.
One reason is that muscles may overwork to stabilize joints that have increased laxity. Over time, this can create guarding, trigger points, fatigue, and pain. Hypermobility may also change how the body transfers load through the spine, pelvis, hips, shoulders, knees, or jaw.
MPM evaluates whether muscle pain is related to joint instability, altered mechanics, recurrent strain, nerve irritation, connective tissue differences, or chronic pain sensitization. Treatment may involve improving movement quality and stability rather than forcing aggressive stretching.
Widespread muscle pain may be related to fibromyalgia or central sensitization. Fibromyalgia can involve widespread pain, tenderness, fatigue, poor sleep, brain fog, stiffness, sensory sensitivity, and symptom flares. Central sensitization describes increased sensitivity within the nervous system, where pain may feel stronger, spread more widely, or persist longer than expected.
This does not mean the pain is imagined. It means the nervous system may be playing a major role in maintaining or amplifying pain. MPM evaluates whether symptoms suggest fibromyalgia, central pain syndromes, inflammatory disease, nerve pain, musculoskeletal pain, autonomic symptoms, or a mixed pattern.
Treatment may include movement pacing, biofeedback, pain psychology, sleep support, medication management through the appropriate clinician, acupuncture, Feldenkrais, and other strategies that support nervous system regulation and function.
Dystonia is a neurologic movement disorder that can cause involuntary muscle contractions, pulling, cramping, twisting, abnormal postures, or task-specific movement problems. Dystonia may cause pain because muscles are contracting excessively or in abnormal patterns.
Cervical dystonia may cause neck pain, headaches, shoulder tension, and abnormal head posture. Focal dystonia may affect the hand, arm, face, jaw, or another localized region. Pelvic dystonia may contribute to pelvic muscle overactivity, pain, and functional limitation.
MPM evaluates whether muscle pain reflects ordinary muscle tightness, myofascial pain, dystonia, nerve irritation, joint instability, or another neurologic or musculoskeletal condition. In selected dystonia or muscle overactivity patterns, botulinum toxin injections may be considered. This requires careful diagnosis, muscle selection, dosing, and risk discussion.
Muscle pain in the neck, jaw, scalp, shoulders, and upper back can overlap with headache and migraine conditions. Tension headache, migraine, TMJ disorders, cervical dystonia, neck pain, and myofascial trigger points may interact.
Some patients feel that muscle tension is the main trigger for headaches. Others have headache disorders that cause secondary neck and shoulder guarding. MPM evaluates both possibilities. The goal is to determine whether treatment should focus on muscle pain, headache pathways, TMJ dysfunction, cervical spine contributors, dystonia, or a combination.
Pelvic muscle pain can affect sitting, walking, exercise, intimacy, bowel function, bladder function, and daily activity. It may involve pelvic floor muscle overactivity, trigger points, nerve irritation, endometriosis overlap, hip or SI joint mechanics, pelvic instability, abdominal wall pain, or central pain sensitization.
MPM evaluates pelvic muscle pain within the broader Pelvic Pain Zone of Expertise. Treatment may require coordination with pelvic floor physical therapy, gynecology, urology, gastroenterology, neurology, psychology, or other specialists depending on symptoms.
Treatment depends on the diagnosis and pain pattern. Some patients benefit from movement-based care, strengthening, pacing, or changes in activity load. Others may need targeted care for trigger points, dystonia, hypermobility-related instability, pelvic floor overactivity, headache overlap, nerve irritation, or chronic pain sensitization.
Treatment options may include acupuncture, Feldenkrais, biofeedback, trigger point injections, botulinum toxin injections in selected cases, and coordinated rehabilitation or specialty care. These tools are not interchangeable. A trigger point injection may be appropriate for one patient with focal myofascial pain, while botulinum toxin may be considered for another patient with dystonia or specific muscle overactivity. Biofeedback may help patients who need nervous system regulation, muscle awareness, breathing coordination, or downtraining.
Muscle pain should be medically evaluated when it is severe, unexplained, persistent, worsening, widespread, or associated with weakness, swelling, redness, warmth, rash, fever, dark urine, medication changes, tick bite, poor circulation, neurologic symptoms, or loss of function.
Patients should seek urgent evaluation for trouble breathing, dizziness, severe weakness, high fever with stiff neck, severe injury, inability to move, chest pain, fainting, new neurologic deficits, rapidly worsening symptoms, or signs of infection.
MPM approaches muscle pain through a diagnosis-first, coordinated model. The goal is to identify whether the pain is myofascial, dystonia-related, hypermobility-related, nerve-related, inflammatory, pelvic, headache-associated, centralized, or mixed.
For patients looking for muscle pain treatment in Manhattan, MPM offers a careful evaluation of the muscle pain pattern, contributing conditions, functional limitations, and treatment history. The care plan is individualized and may include conservative strategies, movement-based therapies, trigger point injections, botulinum toxin when appropriate, biofeedback, acupuncture, Feldenkrais, and coordination with the right specialists.
