Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Myalgia and Myositis


Related Terms

  • Muscle Ache
  • Muscle Pain

Differential Diagnosis

Specialists

  • Dentist
  • Internal Medicine Physician
  • Neurologist
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Rheumatologist

Comorbid Conditions

  • Alcoholism
  • Chronic disease
  • Drug abuse
  • Immune system disorders
  • Kidney disease
  • Liver disease
  • Malnutrition
  • Muscle wasting

Factors Influencing Duration

Although they are two distinct conditions, myalgia and myositis may initially produce similar effects. However, with myositis, the individual's response to treatment and symptom progression merits close attention. Depending on what has caused the condition, some individuals may not be able to return to work as quickly as others. Disability depends on the underlying disorder, the individual's response to treatment, and the type of work duties involved.

Medical Codes

ICD-9-CM:
729.1 - Myalgia and Myositis, Unspecified; Fibromyositis NOS; Fibromyalgia

Overview

Myalgia refers to muscle pain. The pain may be localized, as in a muscle strain or crush injury, or generalized pain caused by an underlying disease such as a viral infection. The most common type of localized muscle pain is caused by muscle overuse or injury from strenuous activity.

Myositis refers to muscle inflammation. Myositis can lead to muscle pain, swelling, and weakness. Temporary myositis may be caused by over exercise or injury to the muscles, and chronic forms can develop from viral and bacterial infections, medications, certain diseases, and autoimmune disorders. Both myalgia and myositis are symptoms of underlying conditions. Effective relief of myalgia and myositis requires diagnosis and treatment of the underlying condition causing these symptoms.

Diseases that may cause myalgia or myositis include viruses such as HIV, influenza, Epstein-Barr, herpes simplex, or poliomyelitis (Enterovirus), and connective tissue diseases (collagen vascular diseases), including autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, fibromyalgia, and polymyalgia. Myalgia may be associated with the involuntary muscle movement (spasticity) of central nervous system disorders such as multiple sclerosis, amyotrophic lateral sclerosis (ALS), and spinal cord injuries. Muscle pain also can accompany the rigidity associated with Parkinson's disease and myofascial pain syndrome.

Bacterial infections such as strep throat (Streptococcus), Lyme disease, and tetanus may be accompanied by myalgia or myositis. Fungi that cause histoplasmosis and parasites associated with malaria, toxoplasmosis, and trichinosis also can create symptoms that include myalgia and myositis. Muscle pain and inflammation may result from reactions to vaccinations (immunizations) or medications (e.g., anticonvulsants, antibiotics, anticancer agents, cholesterol-lowering agents, diuretics); abuse of substances such as alcohol, amphetamines, cocaine, or narcotics; poisons such as strychnine and snake, insect, or spider bites; and exposure to toxic chemicals and environmental factors such as ultraviolet light. Deficiencies in B-complex vitamins and vitamin C, mineral deficiencies, and electrolyte imbalances involving calcium, magnesium, phosphorus, potassium, or sodium, can cause myalgia. The condition also can result from certain endocrine and metabolic disorders such as hypothyroidism, hyperthyroidism, Addison's disease, hypoparathyroidism, diabetes mellitus, metastatic neoplasm, and diabetic neuropathy. Eosinophilia-myalgia with accompanying severe or chronic muscle pain can be an acute reaction to the ingestion of a contaminated dietary supplement known as L-tryptophan.

Other conditions in which myalgia and / or myositis may be present include sarcoidosis, compartment syndrome, certain inherited metabolic disorders, and muscle pain with no apparent physical basis (psychogenic myalgia). Individuals diagnosed with myositis may have underlying conditions such as pneumonia or other lung diseases.

Incidence and Prevalence: Since myalgia and myositis are symptoms rather than disorders, their specific incidence is unknown.

Source: Medical Disability Advisor



Diagnosis

History: A complete health history should be obtained, including current and prior illnesses, injuries, and medications. The individual should be asked whether the onset of pain was gradual or sudden and whether symptoms are constant or intermittent. The exact location of pain or discomfort should be noted. Individuals may report that trauma, an insect bite, or drug ingestion preceded muscle pain or weakness. Individuals may describe symptoms occurring virtually anywhere in the body, with pain ranging from dull or aching to cramping, and discomfort that may include stiffness, weakness, or swelling. Constitutional symptoms of the underlying condition may include fever, chills, sweats, and weight loss. The individual may experience neurological symptoms such as tingling (paresthesia), numbness, tremor, visual disturbances, or ringing in the ears (tinnitus). Depression, sleep disturbances, fatigue, or rash may be reported. Respiratory, cardiac, or gastrointestinal symptoms sometimes accompany myalgia and myositis.

Physical exam: A complete physical examination is needed to help identify possible underlying causes of myositis or myalgia. Stiffness or weakness may be evident in the individual's gait, posture, and coordination. Wasting (atrophy), enlargement (hypertrophy), or permanent shortening (contracture) of the muscles may also be evident. Muscle tone (natural tension) and strength are assessed through range of motion and resistance exercises. Touching (palpating) during exam may reveal tenderness or abnormal muscle tension (spasm). Joint disease can be ruled out with examination of joints for swelling, redness, accumulation of fluid (effusion), localized tenderness, increased temperature, and mobility.

Tests: Blood tests detect inflammation and rule out underlying conditions. They may include a complete blood count (CBC) and measurement of the speed of sedimentation of red blood cells (erythrocyte sedimentation rate, or ESR). Various tests to detect the presence of specific antibodies in the blood may be needed to identify underlying diseases. Tests may also be administered to evaluate levels of electrolytes, hormones, and various other chemistries (calcium, phosphate, serum enzymes) to help determine presence of injury or breakdown in muscle tissue. A urine test (urinalysis) assists in the diagnosis of muscle disorders. Electromyography (EMG) and nerve conduction studies (NCS) measure the electrical activity and proper functioning of muscles. X-ray, CT, and bone scans can diagnose bone and joint disorders, differentiating them from muscle disorders. A muscle biopsy may be needed to identify inherited metabolic disorders, connective tissue disease, eosinophilia-myalgia, sarcoidosis, trichinosis, and possible toxic agents. Other imaging tests, including MRI and ultrasonography, can detect any inflammation.

Source: Medical Disability Advisor



Treatment

Treatment depends on the specific underlying diagnosis. Nonspecific myalgias due to overexertion, systemic viral infection, or immunization usually can be relieved by over-the-counter pain medication (analgesics). Other types of treatment are dependent on the underlying cause of muscle pain or inflammation. Passive stretching, heat, or massage may provide temporary relief. Ultrasound, nerve stimulation (transcutaneous electrical nerve stimulation, or TENS), and application of deep pressure to tender or trigger points are useful in some types of myalgia such as fibromyalgia. Treatment of myofascial pain related to temporomandibular joint dysfunction may include the use of a dental appliance fitted over the teeth (mouth guard). Steroids and immunosuppressive medications may be prescribed to reduce the inflammation of myositis associated with chronic diseases such as rheumatoid arthritis, lupus erythematosus, or fibromyalgia.

Source: Medical Disability Advisor



Prognosis

Since myalgia and myositis are symptoms of an underlying condition, the expected outcome depends on the specific diagnosis, its acuity, and the effectiveness of treatment. Nonspecific myalgia due to overexertion or immunization is usually mild and self-limited. Myalgia accompanying widespread (systemic) infection usually resolves along with the underlying condition, and myalgia following immunization for yellow fever may last 2 to 3 weeks. However, if ongoing (chronic) diseases such as multiple sclerosis or diabetes mellitus are the underlying cause, symptoms may continue indefinitely.

Source: Medical Disability Advisor



Rehabilitation

Rehabilitation treatment for myalgia and myositis depends on the specific diagnosis or cause of the present symptoms. In conjunction with pharmacological management, the aim of rehabilitation is pain control and preserving function (Rider). Modalities such as heat and cold may be useful to decrease pain (Braddom). If any loss of motion or strength accompanies the painful condition, individuals may be instructed in range of motion and strengthening exercises appropriate for involved body parts (Ahlgren). The intensity of these exercises must be adjusted relative to the individual's discomfort and with regard to the underlying etiology (Mahowald). Aquatic exercises may be beneficial when available.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistMyalgia and Myositis
Physical TherapistUp to 30 visits within 12 weeks
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Complications

Complications may develop in any of the acute or chronic diseases or conditions responsible for causing myositis or myalgia; certain complications can prolong the symptoms of myositis or myalgia or cause them to become chronic. Serious underlying injuries such as those involving the spinal cord can create chronic muscle pain and inflammation. Avoiding complications depends upon appropriate treatment of the underlying disease.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Muscle pain, stiffness, weakness, or fatigue may necessitate brief limitations on physical activity. The nature and duration of the limitations depend on the specific diagnosis, affected muscles, and severity of symptoms. Workplace accommodations may include avoidance of tasks that require physical exertion or that may stress certain affected muscles. Time off may be required for rest and recovery from underlying conditions such as an infection or disease. Individuals with myositis may require additional time off for physician appointments to monitor progression of the primary disorder. If the underlying condition causing symptoms is chronic and progressive, the individual may require permanent reassignment to less physically demanding activities.

Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Is underlying condition that is causing the myalgia and / or myositis known?
  • Does individual have any viral illnesses?
  • Has individual experienced any recent trauma?
  • Does individual have a bacterial, fungal, or parasitic illness?
  • Has individual recently received any vaccinations?
  • Is individual taking any medications that produce the side effect of myalgia or myositis or both?
  • Does individual abuse alcohol or drugs such as amphetamines, cocaine, or narcotics?
  • Has individual recently been exposed to any poisons? Toxic chemicals? Ultraviolet light?
  • Does individual have any vitamin or mineral deficiencies? Any metabolic disorders such as diabetes?
  • Has individual ingested L-tryptophan?
  • Does individual have any connective tissue disorder or collagen vascular disease? Central nervous system disorders? Parkinson's disease? Fibromyalgia? Myofascial pain syndrome? Sarcoidosis? Psychogenic myalgia? Peripheral vascular disease?
  • How does individual describe pain or weakness (fever, chills, sweats, or weight loss)?
  • Does individual report any numbness, tremor, visual disturbances, ringing in the ears, depression, sleep disturbances, fatigue, or rash?
  • Are there respiratory, cardiac, or gastrointestinal symptoms?
  • Was onset of the symptoms gradual or sudden? Are they constant or intermittent?
  • Were any abnormalities noted in the individual's gait, posture, or coordination?
  • Is there any atrophy, hypertrophy, or contracture of the muscles? Is strength normal? Was there any muscle tenderness on palpation? Joint tenderness?
  • Has individual had blood tests and urinalysis? EMG? Nerve conduction studies? X-rays? CT scan? Bone scan? MRI? Ultrasound?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has underlying condition been determined?
  • Is it being treated?
  • Has individual responded positively to treatment?
  • Has physical therapy or a home exercise program been prescribed?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that could affect ability to recover?
  • Has individual developed any complications of the underlying illness?

Source: Medical Disability Advisor



References

Cited

Ahlgren, C., et al. "Effects on Physical Performance and Pain from Three dynamic Training Programs for Women with Work-Related Trapezius Myalgia." Journal of Rehabilitation Medicine 33 4 (2001): 162-169. National Center for Biotechnology Information. National Library of Medicine. 17 Oct. 2008 <PMID: 11506214>.

Braddom, Randolph L. Physical Medicine and Rehabilitation. 3rd ed. Philadelphia: W.B. Saunders, 2006.

Mahowald, M. L. "The Benefits and Limitations of a Physical Training Program in Patients with Inflammatory Myositis." Current Rheumatology Report 3 4 (2001): 317-324. National Center for Biotechnology Information. National Library of Medicine. 17 Oct. 2008 <PMID: 11470051>.

Rider, L. G., et al. "Defining Clinical Improvement in Adult and Juvenile Myositis." Journal of Rheumatology 30 3 (2003): 603-617. National Center for Biotechnology Information. National Library of Medicine. 17 Oct. 2008 <PMID: 12610824>.

General

Van Voorhees, Benjamin. "Muscle Aches." MedlinePlus. 17 May. 2007. National Library of Medicine. 23 Mar. 2009 <http://www.nlm.nih.gov/medlineplus/ency/article/003178.htm>.

Source: Medical Disability Advisor






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