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COVID-19 can cause muscle pain and weakness, with nearly 45% of patients experiencing muscle pain during their illness. This pain can be severe and long-lasting, and it can affect people differently, with some experiencing more widespread body pain and others experiencing more localized pain. The pain and weakness are believed to be caused by actual muscle damage from the illness, with studies finding evidence of rhabdomyolysis, a breakdown of muscle tissue, in COVID-19 patients. In addition, the virus's ability to directly attach to and damage muscle cells may also contribute to the pain and weakness experienced by patients. For those experiencing muscle weakness after COVID-19, physical therapy and rehabilitation can help improve muscle strength and endurance.
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What You'll Learn
Muscle pain and weakness may be linked to statin use
COVID-19 can cause muscle pain and weakness. Research shows that muscle pain occurs in 29% of patients, and its severity is linked to the intensity of other COVID-19 symptoms. While muscle pain is not the most common symptom of COVID-19, it is a prevalent symptom of other viral infections, such as influenza and the common cold.
Statins are a class of drugs used to lower cholesterol levels. They are commonly prescribed to individuals at risk of cardiovascular disease or those who have experienced a heart attack or stroke. One of the most common side effects of statin use is muscle pain and cramping, known as myalgia. Women tend to report statin-related muscle symptoms more frequently than men, possibly due to differences in age, body size, and the presence of additional health issues.
In individuals taking statins who subsequently contract COVID-19, there may be an increased risk of muscle pain. A study found that while muscle pain was described as mild in COVID-19 patients not using statins, the intensity was higher in those taking statins. Statin users with COVID-19 also exhibited elevated CK levels, which can indicate muscle damage. However, despite these findings, the study recommended against routinely discontinuing statins in these patients, as the symptoms resolved upon recovery from COVID-19.
It is important to note that not all statin users will experience muscle pain, and the symptoms may vary in severity and frequency. Some individuals may find relief from muscle pain by exercising regularly, losing weight, adopting a heart-healthy diet, or taking supplements like vitamin D and coenzyme Q10. In some cases, a doctor may suggest lowering the statin dose or switching to a different type of statin or cholesterol-lowering drug.
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COVID-19 can cause muscle damage
During an acute COVID-19 infection, motor neurons and adjacent muscles can be directly damaged, and some patients may even develop acute Guillain-Barré syndrome. COVID-19 can also cause damage to the anterior spinal cord, resulting in myelopathy, which can present as muscle wasting and brisk reflexes. Specific plexopathies, such as brachial neuritis and lumbosacral plexopathy, have also been reported following COVID-19 infection.
The risk of muscle damage and weakness increases with the severity of COVID-19 symptoms. Patients with severe symptoms such as a severe cough, high fever, severe headache, and severe rhinitis are more likely to experience severe muscle pain. Additionally, prolonged bed rest during recovery can lead to muscle atrophy and further weakening. Older patients may find it particularly challenging to overcome muscle weakness due to the natural decrease in muscle mass with age.
The good news is that physiotherapy and rehabilitation can play an integral role in preventing and treating muscle weakness associated with COVID-19. Early mobilization and inspiratory muscle training have been shown to improve functional independence at hospital discharge. Neuromuscular electrostimulation (NMES) and strength training can be effective in improving muscle strength and endurance, especially in the leg muscles.
It is important to note that muscle weakness can also be a sign of underlying neuromuscular disorders or vitamin deficiencies, so a detailed assessment and examination are necessary to guide further investigation and referral.
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Long COVID services and rehabilitation
Covid-19 can cause muscle pain and weakness, and these symptoms can persist for long Covid sufferers. Long Covid, or post-Covid-19 syndrome, is characterised by a range of symptoms that last for 12 weeks or more after the initial infection. Common symptoms include fatigue, breathlessness, pain, and brain fog.
One aspect of rehabilitation is helping individuals manage their energy levels and return to everyday activities. This may include guidance on self-care practices such as sleep, as well as advice on gradually increasing physical activity through exercises like Neuromuscular Electrostimulation (NMES) and Active Limb Mobilization (ALM). NMES has been shown to improve muscle strength and endurance, particularly in the leg muscles, which can increase walking distance and overall quality of life.
Nutrition and lifestyle consultations are also offered as part of long Covid rehabilitation to support individuals in their return to work, sports, and hobbies. These services often begin with a preliminary medical screening to determine the patient's suitability and establish a baseline to work from. Progress is then monitored and reported to referrers upon completion of the program.
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Muscle weakness and brain fog
While research is still ongoing on the long-term effects of COVID-19, muscle weakness and brain fog are among the symptoms that have been observed in patients after their initial recovery from infection.
Muscle weakness can be caused by exercise or ageing, but it can also be a sign of an underlying condition. In the case of COVID-19, muscle weakness can be attributed to the disease itself or the use of mechanical ventilation during critical illness. Intensive care unit-acquired weakness (ICUAW) is a common condition in critically ill patients who are mechanically ventilated for prolonged periods, and it can lead to muscle atrophy and loss of muscle mass.
Brain fog, on the other hand, may be linked to low levels of acetylcholine, a neurotransmitter that plays a role in muscle contractions, sleep regulation, learning, memory, and cognitive function. While there are over-the-counter supplements that claim to support acetylcholine levels, it is important to note that the role of these supplements in increasing acetylcholine levels directly is still uncertain.
The relationship between COVID-19 and brain fog is not yet fully understood, but studies have found that cognitive dysfunction can persist for 1-5 months after SARS-CoV-2 infection. More research is needed to determine the long-term effects of COVID-19 on cognitive function and to develop effective interventions for managing brain fog in COVID-19 survivors.
In summary, muscle weakness and brain fog are potential symptoms of COVID-19 that can have a significant impact on a person's quality of life. Early mobilization, inspiratory muscle training, and neuromuscular electrostimulation can help prevent and treat ICUAW, while the management of brain fog may involve addressing potential acetylcholine deficiencies and monitoring cognitive function over time.
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Muscle atrophy and bed rest
COVID-19 can cause muscle pain and weakness. In fact, muscle pain is a very common symptom, occurring in 29% of patients. The risk of muscle pain and weakness increases with the severity of COVID-19 symptoms. Furthermore, the use of statins alongside a COVID-19 infection can increase the risk of muscle pain. However, statins do not need to be discontinued as the symptoms resolve after recovery.
Muscle atrophy and decline in muscle strength occur rapidly with prolonged bed rest. Even short periods of bed rest, such as hospital stays of 5 days or less, can cause significant decreases in muscle mass and size, leading to functional decline. The greatest rate of muscle strength decline and atrophy occurs in the early stages of bed rest, with muscle strength declining faster than muscle atrophy. Within the first 2 weeks of bed rest, muscle strength declines much faster than muscle atrophy. This decline in muscle strength and atrophy is due to mechanical unloading and physical inactivity.
To prevent muscle atrophy and strength loss during bed rest, exercise interventions can be implemented. Resistive exercise, treadmill exercise, and neuromuscular electrostimulation (NMES) are some examples of exercises that can help maintain muscle mass and strength. NMES has been shown to be particularly effective in improving muscle strength and endurance in the leg muscles, which can improve quality of life and walking distance.
Overall, COVID-19 can cause muscle pain and weakness, and prolonged bed rest can lead to muscle atrophy and strength loss. Exercise interventions can help mitigate these effects, improving muscle strength and endurance.
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Frequently asked questions
Yes, COVID-19 can cause muscle pain and weakness. Research has shown that nearly 45% of patients experience muscle pain during their illness. In addition, muscle weakness can occur due to prolonged bed rest, which is common during recovery from COVID-19.
Muscle pain and weakness in COVID-19 patients can be caused by the virus directly damaging motor neurons and adjacent muscles or by the body's immune response. In addition, statin use may increase the risk of muscle pain in COVID-19 patients.
Treatment for muscle pain and weakness in COVID-19 patients may include physical therapy, rehabilitation, and strength training. Vitamin D and B vitamin supplementation may also be beneficial.
