Muscle pain, medically known as myalgia, is a widely recognized symptom of COVID-19. This discomfort can range from mild to severe, affecting individuals differently during the course of the illness. Some estimates suggest that up to 86% of those diagnosed with COVID-19 report muscle pain.
The Biological Basis of COVID Myalgia
The primary reason for muscle aches during a COVID-19 infection relates to the body’s immune response. When the SARS-CoV-2 virus enters the body, the immune system activates to fight the infection. This activation involves the release of proteins called cytokines, such as interleukin-6 (IL-6), interleukin-1 (IL-1), and tumor necrosis factor-α (TNF-α). These cytokines contribute to widespread inflammation throughout the body, which can lead to muscle and joint pain.
The inflammatory response is a natural defense mechanism, but its systemic nature can cause discomfort in various tissues. Beyond this generalized inflammation, some research suggests a more direct interaction between the virus and muscle tissue. The SARS-CoV-2 virus can attach to angiotensin-converting enzyme 2 (ACE2) receptors on muscle cells, potentially leading to direct muscle damage. In some instances, particularly with Long COVID, muscle pain might stem from ischemic myalgia, a condition describing muscle pain from reduced blood flow.
Characteristics and Duration
COVID-related muscle pain often presents as a dull, aching sensation throughout the body, though it can also be localized. Many individuals describe feeling this pain in their legs, neck, head, lower back, and shoulders. The discomfort can vary in intensity from mild to debilitating, sometimes limiting mobility.
This type of muscle pain often differs from soreness experienced after physical exertion, which is typically localized to muscles that were recently worked. COVID-19 myalgia, conversely, is more widespread and does not necessarily follow strenuous activity. It frequently emerges as one of the first symptoms of the infection, sometimes even before respiratory symptoms like cough or shortness of breath appear.
For most individuals with an acute COVID-19 infection, muscle aches resolve within approximately two weeks. However, for a subset of people, muscle pain can linger for weeks or even months as part of Long COVID, a condition where symptoms persist beyond the initial infection. In these cases, the duration and severity of pain can fluctuate considerably.
Management and Relief Strategies
Managing COVID-related muscle pain often involves home-based strategies. Adequate rest allows the body’s immune system to conserve energy, fight infection, and reduce inflammation. Staying well-hydrated is also beneficial, as dehydration can exacerbate muscle discomfort.
Applying warm compresses or taking warm baths can help relax sore muscles and alleviate pain. Gentle stretching can improve flexibility and reduce stiffness in affected areas. When appropriate, engaging in mild aerobic exercise, such as walking, can help rebuild muscle strength and stamina as recovery progresses.
Over-the-counter pain relievers can offer additional relief from muscle aches. Medications such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are commonly used. Individuals should consult a pharmacist or healthcare provider before starting any new medication to ensure it is suitable for their specific health situation.
When to Seek Medical Attention
While most COVID-related muscle pain is manageable at home, certain signs warrant immediate medical consultation. Seek professional help if the pain is severe or debilitating, making it difficult to move or perform daily activities. Muscle pain accompanied by noticeable muscle weakness, or localized swelling and redness in a specific area, also suggests a need for medical review.
It is also important to seek attention if the muscle pain persists for several weeks without improvement, or if it begins to worsen despite at-home care. A particularly concerning symptom is the development of dark-colored urine, sometimes described as tea or cola-colored, which can indicate a serious condition called rhabdomyolysis. Other emergency warning signs include trouble breathing, persistent chest pain or pressure, new confusion, or an inability to wake up or stay awake.