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COVID-19 can cause muscle weakness, among other symptoms. During an acute COVID-19 infection, motor neurons and adjacent muscles can be directly damaged by the virus or by the immune response. A study by the University of Malta found that SARS-CoV-2, the coronavirus responsible for COVID-19, attaches to the ACE2 receptor, causing a breakdown in communication between nerves and muscles. This breakdown can result in prolonged muscle weakness, with nerve fibre regrowth taking 2-3 years. COVID-19 can also cause anterior spinal cord damage, leading to myelopathy and a range of symptoms, including muscle wasting and weakness.
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What You'll Learn
Muscle weakness may be caused by vitamin B and D deficiencies
COVID-19 can cause muscle weakness, with some patients experiencing acute Guillain-Barré syndrome and others prolonged muscle weakness. In addition to COVID-19, there are several other causes of muscle weakness, including vitamin B and D deficiencies.
Vitamin B deficiencies can cause a wide range of symptoms, including muscle weakness. There are eight types of vitamin B, and deficiencies in each can cause different symptoms. For example, a vitamin B12 deficiency may cause tiredness, headaches, irritability, heart palpitations, shortness of breath, and numbness, whereas a vitamin B1 or B2 deficiency may cause confusion and cracks along the sides of the mouth. Vitamin B3, also called niacin, helps convert food into energy and regulates digestion and appetite, so a deficiency may cause digestive issues such as nausea and abdominal cramps. A severe vitamin B3 deficiency may also cause mental confusion and a condition called pellagra. Vitamin B9, also called folate, is important for red blood cell production, so a deficiency may lead to anemia. Eating a well-balanced diet that includes lean proteins, grains, fruits, and vegetables can help increase vitamin B levels.
Vitamin D is known to help with muscle repair and contraction, and a deficiency can lead to a loss of muscle strength. A study published in the journal Calcified Tissue International and Musculoskeletal Research found that people deficient in vitamin D were 70% more likely to develop dynapenia, or age-related loss of muscle strength, than those with normal vitamin D levels. People can avoid vitamin D deficiency by getting careful sun exposure, eating vitamin-rich foods, or taking supplements. However, extremely high vitamin D levels can be harmful and cause nausea, vomiting, confusion, excessive thirst, and kidney stones.
In summary, muscle weakness may be caused by vitamin B and D deficiencies. While COVID-19 can cause muscle weakness, it is important to consider other potential causes, such as vitamin deficiencies, when diagnosing and treating patients.
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COVID can cause direct damage to motor neurons and muscles
COVID-19 can cause muscle weakness, which can be a symptom of long COVID. During an acute COVID-19 infection, motor neurons and adjacent muscles can be directly damaged by the virus or the immune response. This damage can result in myelopathy, which affects the anterior spinal cord. Myelopathy can present as a purely motor syndrome, with a combination of upper and lower motor neuron features such as muscle wasting and brisk reflexes. Patients may also experience abnormal sensory findings, with changes in temperature and pain sensation.
COVID-19 can also cause acute Guillain-Barré syndrome, which is associated with muscle weakness. Regrowth of nerve fibres following such an event can take 2–3 years. In addition, COVID-19 can cause inflammation and immune responses in central nervous system tissues, leading to "brain fog" symptoms such as concentration difficulties.
The SARS-CoV-2 virus, responsible for COVID-19, attaches to the ACE2 receptor on cell surfaces, acting as a doorway for the virus to infect cells. This process can lead to a breakdown in communication between nerves and muscles, compromising several key molecules required for nerves to send messages to muscles. This discovery was made by researchers from the University of Malta, providing valuable insights into the development of treatments for individuals who have not fully recovered from COVID-19.
It is important to note that muscle weakness can also be caused by other factors, such as vitamin B and D deficiencies, ageing, and certain medications. Therefore, a detailed history and examination are crucial to differentiate between 'typical' long COVID weakness and other muscle pathologies triggered by COVID-19.
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A COVID infection can lead to Guillain-Barré syndrome
COVID-19 can cause muscle weakness, which can be a symptom of the acute infection or a sign of long COVID. During an acute COVID-19 infection, motor neurons and adjacent muscles can be directly damaged by the virus or the body's immune response. In some cases, patients may develop acute Guillain-Barré syndrome (GBS), a rare but serious autoimmune neuropathy that involves the destruction of peripheral nerves and can lead to rapidly ascending paralysis.
GBS can present as acute-onset bilateral leg weakness and paresthesia, along with other neurological symptoms. Cerebrospinal fluid analysis can help diagnose GBS by revealing albuminocytological dissociation. The definitive pathophysiology of COVID-19-associated GBS is still being studied, but it is suspected that the SARS-CoV-2 infection promotes molecular mimicry and induces the development of autoantibodies against peripheral nerves, leading to GBS and its associated symptoms.
The British Journal of General Practice has published guidelines for managing muscle weakness in the context of long COVID, recommending a detailed history and examination to differentiate between long COVID weakness and other muscle pathologies triggered by COVID-19. Modifiable causes, such as vitamin D deficiency, should be identified and treated, and B vitamin supplementation should be considered as these vitamins are essential for nerve regrowth.
In addition to GBS, COVID-19 can also cause damage to the anterior spinal cord, resulting in myelopathy, which can present with a mixture of upper and lower motor neuron features, including muscle wasting and brisk reflexes. Specific plexopathies, such as brachial neuritis and lumbosacral plexopathy, have also been reported following COVID-19 infection and vaccination. These disorders may be bilateral or unilateral and can affect the upper and lower limbs.
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Muscle wasting may coexist with weakness
COVID-19 can cause muscle weakness, which can be a symptom of long COVID. A study by the University of Malta found that one in three individuals who recover from COVID-19 continue to experience muscle weakness, among other symptoms.
During an acute COVID-19 infection, motor neurons and adjacent muscles can be directly damaged by the virus or the body's immune response. This can result in prolonged muscle weakness, with regrowth of nerve fibres taking 2-3 years.
In some cases, COVID-19 can cause damage to the anterior spinal cord, resulting in myelopathy. Myelopathy patients may experience muscle wasting and brisk reflexes, affecting either the lower limbs, or upper and lower limbs depending on the location of the affected area.
While muscle wasting may coexist with weakness, it can be challenging to identify. A physical examination may not exclude an organic cause for post-COVID muscle weakness. Therefore, further investigations are often necessary to identify other causes or exacerbating factors.
It is important to note that muscle weakness can also be caused by other factors, such as vitamin B and D deficiencies, ageing, or certain medications.
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Long COVID can cause persistent muscle weakness
COVID-19 can cause muscle weakness, and in some cases, this symptom may persist long after the initial infection, becoming a case of long COVID.
During an acute COVID-19 infection, motor neurons and adjacent muscles can be directly damaged by the virus or the immune response. Some patients may experience acute Guillain-Barré syndrome, while others may suffer from prolonged muscle weakness. In addition to muscle weakness, patients may also experience symptoms such as "strange", "energy-sapping", and often fluctuating muscle fatigability.
University of Malta researchers have discovered a potential cause of the persistent and often debilitating symptoms experienced by long COVID-19 patients. The SARS-CoV-2 virus, which causes COVID-19, attaches itself to the ACE2 receptor, which acts as a doorway for the virus to infect cells. When analyzing organisms with downregulated ACE2 levels, Maltese scientists discovered a breakdown in communication between nerves and muscles. Several key molecules required for nerves to send messages to muscles were found to be compromised.
The discovery of this mechanism sheds light on the lasting impact of COVID-19 infection and paves the way for therapeutic approaches to mitigate chronically disabling complications. Vitamin B and D deficiencies may also be contributing factors to muscle weakness in long COVID, and supplementation should be considered.
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Frequently asked questions
Yes, COVID is known to cause muscle weakness, nerve damage, and metabolic damage.
During acute COVID infection, motor neurons and adjacent muscles can be directly damaged by the virus or by the immune response.
Symptoms of COVID-induced muscle weakness include fatigue, shortness of breath, and 'brain fog' (concentration difficulties).
It can take 2-3 years for nerve fibres to regrow following COVID-induced muscle weakness.
B vitamins are essential for nerve regrowth, so supplementation may be beneficial. Physical therapy or exercises may also help to regain muscle strength.
