Suggestions needed for reducing severe muscle tension.

November 25, 2014 8:42 AM

I suffer from what I call background anxiety that manifests as extreme muscle tension. Has anyone successfully dealt with this? Is there hope for me?

I am and always have been a very very tense person. I come from a long line of worriers and catastrophisers who instilled in me from childhood a deep-seated subconscious belief that doom and danger lie just around every corner. The muscles in my neck, shoulders and jaw are constantly clenched tight and my entire upper back is a sea of trigger points. This is my baseline state; when there's something legitimately anxiety-inducing going on in my life, such as an impending work deadline, then my gut gets involved and everything is 10 times worse. My massage therapist, whom I visit regularly, can't go over how tense I am and how the tension doesn't seem to abate despite her skilled ministrations. Every morning I wake up with my face in a grimace of tension, teeth clenched tight, neck muscles barely functional, with a throbbing headache. So, I am looking for some non-pharmaceutical suggestions to dial back the tension that grips my body relentlessly. I would particularly appreciate suggestions for really good relaxation programs on Audible.com, as I have 6 credits to use up there before I can close my account. I have tried several of these programs already but most of them seem to just instruct you in a soothing voice to relax your feet, relax your legs, now relax deeper, etc. I need something more specific, with comforting affirmations such as, "everything is alright, you are capable of handling any difficulty, you are safe and loved, there is nothing to fear", etc. One final note, I know vigorous exercise would help me work off some of this tension, but right now I'm nursing a sore hip joint and can't walk very far without pain. I'm working on this in PT but it's slow going.

TLDR: My subconscious mind is apparently in a constant state of high alert and any advice you might have on how to switch off this setting would be greatly appreciated.

posted by miaou to Health & Fitness (31 answers total)

Is there a reason you're focused on treating the muscle pain and not the anxiety causing it?
posted by DarlingBri at 8:47 AM on November 25, 2014 [5 favorites]

Physical stuff that's helped me:
- Epsom salt baths
- Magnesium supplements
- This thing, which I call my sadness cape.

What my therapist has told me, which I find helps, is to notice and be aware of the tension in a non-judgmental way, just like, "Huh, my neck is really tense.", instead of going AARGH STUPID MUSCLES STUPID ME STUPID LIFE, which I definitely have a tendency to do, and which totally makes things worse. I find for me it's often a vicious cycle, in that getting anxious makes me tense, and noticing I'm tense makes me more anxious, so if you can break that cycle, it really helps. But it's definitely hard to do, and I totally sympathize.
posted by ITheCosmos at 8:54 AM on November 25, 2014 [5 favorites]

heat and muscle relaxants will help. (have a heating pad that drapes over my shoulders- similar to the "sadness cape" but plugs in)


Treating the underlying anxiety will probably help the most.
posted by larthegreat at 8:59 AM on November 25, 2014

Hi, I'm prone to this as well due to some really bad habits picked up in acting class in college of all places.

And actually, there is an exercise thing that could help, which you could even do with your hip - if you can get to a gym and use a shoulder press machine, that did wonders for me. The first time I tried using one of those, when I was done with my first set of reps and started relaxing, all of the other tension I had in those muscles was released as well, to the point that I got a major head-rush. I still get that when I use a shoulder press, and my residual tension is a lot less.

It should also be hip-friendly - you just sit and push a bar up and down.
posted by EmpressCallipygos at 9:08 AM on November 25, 2014 [1 favorite]

Response by poster: I should have mentioned, I've seen several professionals over the years to try to treat the underlying anxiety, but they all seem to want to prescribe drugs. I've tried: 3 different muscle relaxers (make me sleepy so I can't take during the day), at least 6 anti-depressants of the SSRI/SNRI/Tricyclic varieties (aggravate RLS, sexual and other side effects that didn't go away even after 6+ months of use, plus they didn't really help my muscle tension) and about 3 different benzos (also cause daytime sleepiness to the point where I'm too tired to do my work). I've also tried hypnosis, and I own that exact sadness cape, which helps while i'm using it but the effect doesn't last. I will definitely seek out a shoulder press machine as I have not tried anything similar to that yet.
posted by miaou at 9:20 AM on November 25, 2014

Best answer: Hi! We have very similar issues. I'm a constant worrier and I have crazy upper back tension and suffered from years of constant headaches and jaw pain and TMJ. I have asked questions related to my jaw in the past on MetaFilter but nothing helped me here.

So for my upper back and shoulder tension I have yet to do anything. I'm a powerlifter so in addition to being super tense I also exercise my upper back and my neck muscles quite which probably helps me. But if anyone tries to massage my upper back I'm in tear-inducing pain. For now I just live with it although it is definitely a daily issue and I have a lot of upper back pain.

I've suffered from jaw related issues for about 3 years. I would wake up with headaches and jaw pain for that time. I broke a tooth because of the clenching. It was horrible, I know exactly where you're coming from. Eventually I did a ton of research and I recently ended up at the Tufts Craniofacial Pain Center. I'm very very lucky that I live in Boston and that my health insurance covered everything. They diagnosed me and created a plan to fix my issues. They have been amazing. Here's what they did and random things that they explained to me:
- I was met by three different Doctors/researches and was interviewed about all my symptoms for many hours, and I also participated in a study which was interesting.
- Your jaw muscles are connected to your neck and back muscles and shoulders, and so all of your pain is related and connected. If you can stop the stress on your jaw muscles you will eventually get to the point where you can actually do massages on your neck and shoulders and have it help. But as long as you're clenching and grinding and messing with your jaw muscles, that probably won't happen.
- Usually treatment can be a mix of both psychological (therapy/drugs) and/or physical (a device to use).
- For me the initial treatment plan was to give me a special device to wear at night and then if that didn't help in the long run my Doctor may have prescribed some muscle-relaxant drugs, but he thought I didn't need them (and he was right! no drugs for me). And therapy I've been in for years and hasn't helped. Note that I've been wearing mouth guards since I learned I had this to protect my teeth, but no dentist ever told me about pressure distribution before I went to Tufts:
- They created a custom mouth guard for me that distributes the pressure when I bite down and clench at night. Instead of the pressure being on my back teeth and causing all my jaw muscles to hurt and be tense and to cause me headaches, the pressure is distributed evenly across all my teeth and my jaw muscles aren't affected. This has been a life-saving device. From the first night I used it, my quality of life increased ten-fold. I no longer have headaches. I no longer have jaw pain. I am slowly clenching my teeth less and less throughout the day. It's just the best thing I have ever done for my health.
- They gave me specific exercises to use on my jaw muscles to help relax them.
- They are monitoring me on a monthly basis. I go back and they make sure the device fits and that I'm biting down correctly with and without it.

I think you need to find a specialist that deals with Craniofacial Pain. There aren't many places like the Tufts Craniofacial Center, and I don't know where you're located. If you are in the US, give them a call and see if they can refer you to a colleague near you. The Tufts Craniofacial Pain center is basically a research lab at the Tufts Dental School that also happen to treat people. They know their other Dental school colleagues that treat these issues.

Please message me if you want more info.
posted by carmel at 9:31 AM on November 25, 2014 [13 favorites]

I had a massage therapist working on my head and neck marvel at the strength of my jaw muscles and say they were stronger than any she'd ever felt (I am a petite female). In general, heat is good--hot baths; the aforementioned heating pads; warm, comforting foods like soup and ramen. Avoid chewy or crunchy foods. Make sure you wear your glasses if you have them, or get checked to see if you need them--eye strain and squinting makes it a lot worse for me. You may want to invest in a Tempur-pedic pillow; it didn't CURE me, but it made a noticeable difference. (So did leaving a job I was miserable in!)

Not sure if OTC counts as "pharmaceutical", but I found Aleve (or any other naproxen) to work best for this kind of thing (over Tylenol [acetomenophin] or Advil [ibuprofen]).

Glad you updated just now about what you've tried so far. When I went to my doctor with this same problem (my face in a grimace of tension, teeth clenched tight, neck muscles barely functional, with a throbbing headache), we also determined that it was very much anxiety-based; however, I was adamant about not getting on anything too heavy, and definitely not benzos because of the addiction risk). She prescribed me Buspirone (Buspar), and that has helped more than anything. It's an anti-anxiety, but not a benzo; my understanding is that it's about as low-grade as you can get in the RX anti-anxiety category. The only "effect" I've ever noticed is that I don't clench my teeth anymore, and my face doesn't constantly hurt. I take it once in the morning, once at night, and it never makes me drowsy (though I do find that I fall asleep much easier when I get in bed with the intention of falling asleep, rather than lay awake, thoughts spinning like before). I implore you to at least talk to your doctor about it.

(Sorry, I just had to throw that out there because it was, unequivocally, "the solution" for me and it didn't sound like you'd tried it yet.)
posted by lovableiago at 9:32 AM on November 25, 2014 [2 favorites]

Best answer: I'm quite prone to this too. I hear you on the neck muscle tension and clenched teeth. It used to be hard for me to unclench my teeth.

Things that helped:
1. Meditation (Awareness of your sensations can help stop the feedback loop of anxiety and physical tension)
2. Acupuncture (Seriously, helped way more than massage. No idea why.)
3. Getting my anxiety under control (therapy, medicine, lifestyle changes)
4. Yoga (I don't do this now, but it gave me really good muscle control, and I learned how to actually make myself physically be at ease.)
5. Just worrying less about stuff and trusting that for the most part, things will work out. This is not a constant state, however, and it changes depending on how much I'm on top of the meditation and anxiety management front.

Feel free to memail me if you want specifics.
posted by Hawk V at 9:35 AM on November 25, 2014

After reading carmel's comment, I just wanted to chip in and say I also wear a dental mouth guard at night. Come to think of it, the jaw clenching did stop right around the time I procured the mouth guard.
posted by Hawk V at 9:43 AM on November 25, 2014 [2 favorites]

Nthing acupuncture. I'm a reasonably serious amateur singer, and I get acupuncture not only for anxiety but also to keep tension out of my neck and jaw for auditions and so forth. It works very well for me for neck and jaw tension. (Just as a side note, my TMJD also improved a lot through acupuncture.)
posted by holborne at 10:00 AM on November 25, 2014

I too carry my tension in my shoulder & neck area to the point that massage therapists have commented on how difficult it is to loosen up. It is a lot better when I regularly attend a "gentle" yoga class. Emphasis on gentle, though: I tried more athletic yoga classes for a while and not only did they not help much, I think some poses actually made my neck worse.
posted by superna at 10:19 AM on November 25, 2014 [2 favorites]

Regarding listening: I believe I have pimod him before, but Andrew Johnson has apps and mp3s on chilling out with various different themes. He has a lovely gentle Scottish accent and a very ... permissive ... patter, like he says to do X or Y if it feels comfortable or natural for you. Basically exactly as you request "you are capable, you have the energy to meet the challengesin front of you, you are making good cchoices for your health" etc depending on theme.
posted by Iteki at 10:29 AM on November 25, 2014 [2 favorites]

You need a good physical therapist. Regular old PT.

Through a combination of reasons, my back/shoulder dysfunction and tension were setting off migraines to a point that became unmanageable last winter. I agreed to try PT (nothing else was doing it, so.). PT really helped.

What I realized it helped with was putting ME in control of my muscles. It gave me a vocabulary for how to contract and relax them voluntarily. Strengthening always helps, in that weak muscles give in to day-long tension and produce pain too easily, while strong muscles are better up to the task. But being able to contract them, and then end the contraction, voluntarily, is key. It puts you in the driver's seat.

Massage and acupuncture et al. are nice, as are meds and meditation, but you need to be in better specific control of your own musculature than you are right now. PT is the way to do that.
posted by Dashy at 10:35 AM on November 25, 2014 [3 favorites]

Nthing acupuncture. If you happen to live in NYC, I can recommend an MD who does it and takes insurance.
posted by melissasaurus at 10:53 AM on November 25, 2014 [1 favorite]

I will suggest you try nutritional supplements. Some things I would try would be magnesium, calcium and potassium. If magnesium or calcium help, you can also look into vitamin D and vitamin K. There may be some other things I am not thinking of. Magnesium and calcium work together in the body in such a way that if you are deficient in one, you are probably deficient in the other and vitamins D and K are necessary to properly absorb them.

When I start having muscle cramps and muscle tension, I try to get more magnesium, potassium and calcium in my diet. Magnesium and calcium both have a reputation for making people feel more "relaxed" once they start supplementing them. Also keep in mind that some forms of these things are more bio-available than others. Off the top of my head, calcium citrate and magnesium glycinate are food forms. Calcium carbonate is the most common form in supplements you can buy at a store and it is the least bio-available. So if you try calcium and see no benefit, you might want to read the label and, if it is a poorly absorbed form, try something more bioavailable and/or try adding vitamins D and K to the mix to help your body process it properly.
posted by Michele in California at 11:14 AM on November 25, 2014

Best answer: In the past it has helped me to do a "check-in" every hour or so to see if I'm clenching anything. If so, I just try to relax and unclench...the repetitive checking every hour helps me be more aware of what I'm doing with my body in the space between. I have also done this along with writing down 5 positive things every hour on the hour which helped me be more aware of my thought pattern. You could do 5 positive affirmations like you mentioned above (""everything is alright, you are capable of handling any difficulty, you are safe and loved, there is nothing to fear", etc.") instead.

If you go the meditation route and are looking for a relaxing mantra, this one from Thich Nhat Hanh helps me:
"Breathing in, I calm my body.
Breathing out, I smile.
Dwelling in the present moment
I know this is a wonderful moment."
posted by Shadow Boxer at 11:30 AM on November 25, 2014 [4 favorites]

Best answer: here are some ideas.

PT, acupuncture, massage, etc.
go to the sauna/hot tub (like a korean or russian bath house, or just a gym with a sauna)
make sure you have good mineral nutrition and good hydration, always
you can also do epsom baths for mineral help and they are relaxing
muscle relaxant Rx? and/or topical painkiller (ex. voltaren)
electric heating pad, or heated mattress pad, or electric blanket, whichever you prefer
yoga (preferably hot, but then drink your electrolytes)
a spiritual practice (meditation or something similar)
a program like primal move which will teach you strength and flexibility
anti anxiety Rx? (or weed, in a pinch)
THERAPY to deal with sources of underlying anxiety

and once your hip heals, pick up an intense sport. because when you're tired enough, you can't be tense from anxiety anymore. this has been the secret solution for me. i just workout til i drop when it gets really bad and that what kept me from being too anxious.
posted by zdravo at 11:44 AM on November 25, 2014

Best answer: Yoga will help with the underlying anxiety and also relax your muscles. I recommend taking a class rather than just using an app or video, because your really get the whole experience.

I like Calm.com (and the app), which have guided meditations with the types of affirmations you mention.

I have an rx for Klonapin (benzo) but only use it as needed. I take like a quarter pill which helps take the edge off. 1/2 pill puts me to sleep.

You might want to see a dentist or orthodontist about getting a bite splint. It won't fix your jaw problems but will give you something soft to bite on.
posted by radioamy at 12:22 PM on November 25, 2014

Best answer: My boyfriend used to suffer from this sort of stress-based muscle tension, intensely, most of his life. What helped him immensely was the Alexander Technique. PM me if you'd like his specific recommendation for a teacher, if you're in the NYC area. He basically credits this for making his life bearable.
posted by millipede at 1:52 PM on November 25, 2014

Best answer: Depending on how open you are to alternative therapies, I would recommend a Hakomi counselor for your anxiety. It's a body-based therapy that addresses underlying psychological states through working with tension in the body. It's more hands-on than traditional therapies, in that there was actual physical contact between me and my therapist, but I found that to be extremely helpful in training me to learn how to relax. The touch was always respectful, discussed and really impactful at helping me be aware of my body and what it is doing. I had seen other therapists before, but talk-based therapies and medication weren't for me. YMMV.

Personally, I combined it with weekly massage therapy for maximum effect. Thinking through Hakomi exercises while having someone else work specifically on my muscles helped me get over some of the mental blocks I had to relaxing. Then, the more relaxed muscles helped the therapy be more effective and I was able to make real progress and lasting change.

Now, I can manage my anxiety with yoga and meditation, but I definitely needed to start with something more focused before I could get there.
posted by ohisee at 2:11 PM on November 25, 2014

Best answer: That you're having trouble with your hip joint right now, and have had back problems when sleeping with your legs straight are making me think that both your anxiety and your muscle tension might be caused by underlying joint hypermobility syndrome:

Anxiety and joint hypermobility

A 1998 study linked panic disorders and joint hypermobility. The prevalence of joint hypermobility syndrome among patients with a panic disorder was 67.7% compared to the control psychiatric group (10.1%). Women and younger subjects were found to be over 20 times more likely to have hypermobile joints than their counterparts in the control group. The study also found a higher prevalence for mitral valve prolapse (8%). Depression and anxiety were other correlated symptoms.[3]

A 2003 study found that 78% of people with hypermobility also had orthostatic intolerance, which can lead to chronically high adrenalin and chronic anxiety.[4]

Hypermobility syndrome

Hypermobility syndrome is generally considered to comprise hypermobility together with other symptoms, such as myalgia and arthralgia. It is relatively common among children and affects more females than males.

Painful muscle tension develops because muscles are being used to stabilize joints which would otherwise be prone to excessive range of motion which could damage the joints themselves or associated tissues, such as the nerves in the spine in the case of joints in the spine.
posted by jamjam at 2:49 PM on November 25, 2014 [1 favorite]

FYI:

12 Common Magnesium Deficiency Symptoms:

1. Anxiety
2. Weak Bones
3. Low Energy
4. Weakness
5. Inability to Sleep
6. PMS and Hormonal Imbalances
7. Irritability
8. Nervousness
9. Headaches
10. Abnormal Heart Rhythm
11. Muscle Tension, Spasms, Cramps
12. Fatigue

I have also heard people say low back is a common symptom, though searching is not bringing anything up that corroborates that.

I am also seeing muscle cramping listed as a symptom of calcium deficiency.
posted by Michele in California at 3:13 PM on November 25, 2014

I would have a dentist look at the jaw pain and clenching, you might be a candidate for mouth guards or similar. Opening your mouth will relax your neck. You might look like an idiot but try walking around with your mouth way open for a long period of time.

I agree with regular old PT being useful to stretch and strengthen neck and shoulder area. You could also augment with personal training or pilates apparatus classes.

You can also try intramuscular stimulation (IMS, aka dry needling) to work on the trigger points. This hurts a lot and sort of worked on my neck. I am now getting trigger point injections with saline in the neck, this is a lot more effective and hurts way less. IMS is offered by PT, trigger point injections are offered by doctors.

For anxiety, you should be looking at CBT or related modalities such as MBCT or ACT. There should be audio workbooks for CBT/MCBT on Audible. I like the work of Jon Kabat-Zinn on MBCT.
posted by crazycanuck at 3:41 PM on November 25, 2014

Best answer: PS - with multiple pain sites (neck and hip) you might want a referral to physiatrist to manage the pain/rehab of both. Hip problems can exacerbate or even cause a neck problem. Try to avoid twisting and pulling, straining with neck or shoulder muscles to do work of the lower body (open your mouth when you lift), reaching across the body or reaching in general with same hand of bad hip, etc. You can also use long handled bath brush and reacher to avoid issues. Rearrange your house to be hip friendly (no bending or reaching for common items), this may assist your neck.
posted by crazycanuck at 3:49 PM on November 25, 2014

This is sort of weird and not really a long term fix, but I found myself drastically unclenching my shoulders and neck when I learned how to knit and realized that my knitting tension wasn't right unless my upper body and arms were relaxed. If I was tense, my knitting was tense. When I realized, so did my knitting. It's a somewhat soothing, old school awareness/biofeedback mechanism.
posted by MadamM at 5:33 PM on November 25, 2014

The audio you're describing is Progressive Muscle Relaxation (PMR). The reason it works, if you practice it often, is that you learn, by consciously tensing and relaxing, what the relaxed state feels like. You (and I!) have carried the tension at such a high level for so long that "relax your shoulders" is as useful a command as "now flap your arms and fly". But if you practice PMR, it will help.

I'm not suggesting it's the only thing you should do, but it's a very well studied and well validated technique for helping with your exact problem.
posted by The Noble Goofy Elk at 7:10 PM on November 25, 2014

I also wanted to suggested progressive muscle relaxation. If you can get yourself relaxed enough to tense your muscles and then relax them, it may help.

That Tufts place sounds mint.

Anyway, a link to some audio by Dr. Michael Breus here. Sometimes it helps me, sometimes it doesn't.
posted by simulacra at 7:55 PM on November 25, 2014

Nthing mag if you haven't already tried it. Run it by your doc just to be sure, but it is definitely useful for physical/mental tension.
posted by brevator at 8:00 PM on November 25, 2014

"I also wanted to suggested" ---> "I also wanted to suggest"
posted by simulacra at 9:39 PM on November 25, 2014

Here's what helped me and gave me better quality of life:

1) If you've given up on nightguards because you chew through them , I found that the NTI nightguard (worn every other night) was pretty effective in training my jaw to stop clenching so much when I slept.

2) I joined a yoga practice. Mine loosened me up, improved my body awareness so that I knew when I was tensing, and taught me what to do to relax the tensed muscles. It also taught me to be aware of my breath, regulate it when it was going too fast, and to take the kinds of breaths that expand and relax the chest. It is also the most unthreatening, non-competitive exercise I've ever participated in; it does not trigger the "MUST WIN" (I play hockey and run) anxiety loop in my brain at all but still produces enough endorphins that I go to bed more relaxed.
posted by rhythm and booze at 10:38 AM on November 26, 2014

I have similar problems, and posted this question (http://ask.metafilter.com/263419/Full-body-tension-while-sleeping-leads-to-hours-of-pain-in-the-morning) earlier this year. I signed up for a moderate-impact, twice-weekly fitness class and the effect has been astounding: virtually no more morning pain, less acne and less painful periods, plus some relief of my IBS symptoms. I cannot believe how much it's helped, especially at only twice a week. Having a physical outlet for mental tension is much more important than we realize.
Edit to add: Do a little research on the types of magnesium before you start taking it. For example, magnesiumg citrate is great for treating constipation, but it's not ideal for muscle relaxation (that might be mag oxide or mag malate).
posted by possumbrie at 1:09 PM on November 29, 2014 [1 favorite]