William W. Forgey, MD
Orthopedics part 1 – Muscle Pain
Updated: Nov 13, 2020
Muscle Pain (part 1 of a weekly series of posts focusing on Orthopedics)
Excerpt from The Prepper's Medical Handbook. Page reference numbers point to more in-depth treatment and self-reliant care.available within the book. MANAGEMENT OFF THE GRID Orthopedics includes the study of bone, joint, and muscle function and disorders. This section establishes basic protocols for the assessment and care of orthopedic disorders. General concepts of care will be followed by a systematic evaluation by anatomical region with suggested care plans. No condition can be more debilitating or restrict operations more than an injury or simply the development of pain that interferes with your ability to survive or function in the challenging circumstances of living off the grid. While diagnosis and management can be complex, this chapter will provide an approach to caring for these concerns in a reasonable and often definitive manner, even in the case of a nonexistent grid! The following chart refers you to general management principles and to diagnosis and treatment plans by anatomical region.
Diagnosis and Treatment Plans Concepts of Orthopedic Care
Muscle Pain-No Acute Injury 155
Muscle Pain-Acute Injury 156
Joint Pain-No Acute Injury 158
Joint Pain-Acute Injury 159
Open Fracture 163
Muscle Pain-No Acute Injury Muscle aches can arise from chronic inflammation disorders such as lupus and fibromyalgia, but the discussion here will be limited to those conditions that might reasonably arise when performing strenuous or repetitive activities. When associated with a fever, consider an infectious basis for the pain. Without a reasonable method of diagnosis, it would be best to treat with both an antibiotic and appropriate pain medication. Even in North America, several serious conditions can present in this manner that require antibiotic treatment, such as Rocky Mountain spotted fever. Regardless of cause, it is appropriate to start ibuprofen, 200 mg tablets with 2 to 4 tablets each dose, repeated every 6 hours, for fever and muscle aches. While it's best to have a physician see the patient and to draw the appropriate lab tests before commencing antibiotics (when you are on the grid and can obtain tests), if the pain is localized to a specific area and accompanied by swelling, redness, and especially fever, start doxycycline, 100 mg twice daily. If you might be treating Lyme disease, this treatment will need to be continued for at least 2 weeks (see page 228). Under conditions of heat stress, heavy exertion causing sweating, or diarrhea and vomiting, or the use of diuretics causing increased urine output, muscle cramping may be caused by the resulting electrolyte abnormality. Appropriate fluid and electrolyte replacement is necessary, as discussed on page 88. Overuse syndromes cause pain in muscles that go beyond the mild ache you are accustomed to feeling after a workout at the gym. While it is possible to suddenly tear muscles with sudden movements, significant pain that starts gradually or soon after the exercise is over could be tendinitis, spasm caused by a pinched nerve, or significant inflammation in the muscle. The treatment for these conditions is the same as that employed for tendinitis, as described in that section on page 158. Additionally, the use of a muscle relaxer is of benefit. From the Non-Rx Oral Medication Module, take Percogesic, 2 tablets every 6 hours, or from the Rx Oral/Topical Medication Module, use Atarax, 25 mg every 6 hours. These medications can be used in addition to the others prescribed for tendinitis, unless the condition is relatively mild, when the use of ibuprofen alone should suffice. Muscle Pain-Acute Injury Pain occurs immediately after a significant muscle injury, a contusion or strain being the general cause. RICE is the acronym that applies here: rest, immobilize, cold, elevate or, more classically, rest, ice, compress, and elevate. An elastic bandage, cold stream water, elevation of a limb, and rest may not all be possible, but they comprise the initial treatment. The application of cold is most important as it decreases tissue bleeding from constricting blood vessels, though be careful not to cause freezing injury. Compression can provide stability as well as accomplishing much the same benefit. Contusions cause bleeding into the surrounding muscle tissue through the rupture of small blood vessels. Using the RICE technique will minimize the bleeding and local swelling. Strains on muscles result in either microscopic muscle fiber tears or muscle mass tears. These are classified from grade I (microscopic) to grade IV (total tear of a muscle). Grades II and III are partial tears of a muscle mass. A total tear would require surgical repair. All will be treated similarly in an off-grid situation: Initially use RICE, as indicated above. If significant swelling of the muscle occurs, consider that you are dealing with a grade III or IV tear and continue RICE for 2 days. Otherwise use RICE for the first 24 hours. The next step in treating significant muscle injury is to apply local heat. In the case of minor injuries, apply it the next day. For more serious injuries, delay the use of heat for 2 days. Continue the use of the compression dressing. Splint or sling as necessary for comfort. Decrease activity to a level where the pain is tolerable. A full rupture of a muscle body will generally result in a bulging of the muscle mass and a loss of strength during the late recovery period. This may not be noticeable at first, as the swelling would initially be attributed to local bleeding and pain would restrict use. Once the pain is gone, continued swelling, especially after several weeks have passed, is probably due to a significant muscle tear or a ruptured tendon. This should be repaired when possible, but do not despair if it is not, as this is a tolerable injury. The acute pain of a muscle belly tear will subside within a few weeks, noticeable discomfort after 6 weeks, and then scar tissue forms and the body will replace the primary actions of the torn muscle (if fully torn) by using accessory | muscles to the extent that it can and the injured individual will have to subsequently adapt to the weakened condition that will result. It is amazing how well we can perform with some of these injuries, one of the most common being total tear of the biceps muscle or tendon. The muscle contracts, which means that it will bulge, but its major action, that of pronation (e.g., turning a screwdriver), will be greatly weakened. Fortunately, accessory muscles will aid in most function of the upper arm, such as flexion of the elbow.
Be sure to check out part 2 of our Orthopedic series next week on the subject of joint pain.