Muscle Attachments to Bone as an unrecognised cause of pain

The Muscle Enthesis

There are approximately 650 muscles in the body.

Damage or injury to a muscle anywhere along its course may be associated with pain.

There are two types of muscle attachment (enthesis) to the bone.

A direct attachment where the muscle quite literally inserts directly to the bone. A common site for this configuration is the abdominal wall muscles that may attach directly to the brim of the pelvis.

An indirect attachment occurs where the muscle forms a tough elastic fibrous band termed a tendon which then attaches to the bone as in Figure 1. Most large muscles have this type of attachment.

This cartoon shows the muscle structure. Injury or damage anywhere in these tissues may be associated with pain. Damage to the enthesis may cause pain and may go undiagnosed. This site is devoted to providing a better awareness and knowledge about enthesis related disorders of muscles and beyond.

Given that most muscles have 2 attachments sites:

  • An origin
  • An insertion

Then there is in the region of 1300 muscle attachments in the body.

Figure 2 and 3 below show the large muscles that may be associated with enthesitis or enthesopathy.

Pain related to enthesopathy including the anchorage to the underlying bone may be a cause of poorly diagnosed muscle pain.

If you suffer from such pains then this site may help determine if you have an entheseal originating problem.