Back pain is a common symptom associated with SARS-CoV-2 infection (COVID-19). This muscle discomfort, medically termed myalgia, is frequently reported, often appearing early in the illness alongside typical symptoms like fever and fatigue. While body aches are common in viral infections, back pain, particularly in the lower back, has been a significant complaint for many people with COVID-19. The severity of this pain can vary, ranging from a mild, generalized ache to severe discomfort that can limit mobility. Recognizing back pain as a potential manifestation of the illness is important for managing the acute phase and understanding long-term health effects.
Back Pain During Acute Infection
Back pain often manifests early in the course of an acute COVID-19 infection, sometimes even before the onset of respiratory symptoms. This acute pain is generally described as a deep, pervasive ache, often reported in the lower back, rather than a sharp, stabbing sensation typical of an injury.
Myalgia affects a significant number of patients, with some research indicating it is among the initial symptoms for up to 36% of individuals. The muscle pain experienced during this period is widespread and tends to be less responsive to changes in posture compared to mechanical back pain. For most people, this acute pain resolves as the body clears the active infection, typically within a few weeks. However, the intense, persistent coughing that can accompany the illness may also strain the muscles and joints of the upper back, contributing to localized pain between the shoulder blades.
Understanding the Biological Cause
The primary reason COVID-19 causes back pain lies in the body’s vigorous immune response to the viral invasion. When the SARS-CoV-2 virus enters the body, the immune system releases pro-inflammatory signaling molecules called cytokines. This systemic inflammatory reaction activates pain receptors in muscle tissue, leading to generalized body aches and myalgia.
The virus also engages with the angiotensin-converting enzyme 2 (ACE2) receptor to enter cells, and these receptors are present not only in the lungs but also in skeletal muscle tissue. Direct or immune-mediated damage to muscle cells can occur, evidenced by elevated levels of muscle-related enzymes like creatinine kinase in some patients. Furthermore, the inflammatory state can lead to conditions like hyperlactatemia, where impaired oxygen delivery causes muscle tissues to become ischemic, contributing to pain similar to intense physical exertion.
Persistent Pain in Post-COVID Conditions
For some individuals, the back pain does not resolve with the acute infection but persists for weeks or months afterward, becoming a feature of Post-Acute Sequelae of COVID-19 (PASC), often termed Long COVID. This chronic myalgia and musculoskeletal pain is a frequent long-term complaint, affecting nearly half of PASC patients. Unlike the acute phase, the persistent pain is thought to be driven by ongoing, low-grade inflammation, immune system dysregulation, or even direct nerve involvement.
Multiple factors may contribute to chronic back pain in the post-COVID period, moving beyond the initial cytokine-driven response. Extended periods of bed rest or reduced activity during the acute illness can lead to muscle atrophy, particularly in stabilizing muscles like the multifidus and erector spinae. This deconditioning and loss of core strength can destabilize the spine, significantly increasing the risk of chronic lower back pain. Moreover, the systemic inflammation may affect the nervous system, potentially leading to neuropathic pain or the exacerbation of pre-existing degenerative spinal conditions.
Practical Steps for Relief and When to Seek Help
For managing COVID-related back pain, especially during the acute phase, simple home care strategies can offer relief. Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, can help reduce the pain and inflammation. Applying heat, such as a warm compress or a heating pad, can help relax tense muscles and improve blood circulation to the affected area.
Maintaining light activity and avoiding prolonged bed rest is important to prevent muscle deconditioning and stiffness. Gentle stretching and movement, even while ill, can prevent the back muscles from cramping and weakening. For persistent pain lasting weeks or months, physical therapy may be recommended to rebuild core strength and address any postural issues or muscle imbalances. Specific breathing exercises can also be beneficial, as respiratory muscles play a role in spinal stability.
While most back pain associated with COVID-19 is manageable, certain symptoms are considered “red flags” and require immediate medical attention:
- New or worsening weakness, numbness, or tingling in the legs.
- Loss of bladder or bowel control.
- Severe pain that does not improve after several days.
- Pain accompanied by a high fever after the acute infection has passed.