Myalgia, or muscle pain and body aches, is a widely reported symptom experienced by people infected with COVID-19. This musculoskeletal discomfort is often one of the first signs of illness and can range from a dull, generalized ache to significant soreness that affects daily activities. While unpleasant, the presence of myalgia signifies the body’s immune system actively engaging the SARS-CoV-2 virus.
The Mechanism Behind COVID-19 Myalgia
The intense, widespread muscle pain associated with a COVID-19 infection is primarily a side effect of the body’s robust immune response. When the SARS-CoV-2 virus enters the body, the immune system floods the bloodstream with inflammatory signaling molecules known as cytokines. These molecules, which include Interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-α), are designed to fight the infection but also induce a systemic inflammatory state.
This systemic inflammation is the main driver of myalgia because these inflammatory chemicals sensitize nerve endings in the muscle tissue, leading to pain. In severe cases, the release of these molecules can become uncontrolled, a phenomenon sometimes referred to as a “cytokine storm,” which causes widespread tissue irritation.
However, the exact mechanism is still being studied. While immune-mediated inflammation is the most accepted cause, the possibility of direct viral involvement in muscle tissue has also been hypothesized. Some studies suggest the virus may invade muscle cells (myocytes), potentially leading to localized inflammation known as myositis. Other research, particularly in animal models, reinforces the idea that the pain is largely an indirect consequence of the whole-body immune reaction.
Typical Presentation and Duration
COVID-19 myalgia typically presents as a deep, generalized ache, often compared to the body aches experienced with the flu. This discomfort commonly affects large muscle groups, with patients frequently reporting soreness in the lower back, shoulders, neck, and legs. Myalgia is one of the most prevalent early symptoms of the illness, often appearing within the first few days of infection.
For most people experiencing an acute, mild case of COVID-19, the muscle pain tends to be short-lived. The myalgia usually peaks early in the illness and resolves completely within approximately two to four weeks. As the body successfully clears the infection and the systemic inflammation subsides, the muscle aches gradually diminish.
A significant concern is the persistence of muscle pain in post-acute COVID-19 syndrome, commonly known as Long COVID. For a subset of patients, muscle and joint pain can persist for 12 weeks or longer after the initial infection has passed. The prevalence of myalgia in the four to twelve weeks following acute infection has been reported to be as high as 18%.
This chronic pain can be characterized by a fluctuating pattern, where symptoms may temporarily improve only to return later, sometimes months after the initial illness. This pain is often accompanied by other symptoms, such as fatigue and post-exertional malaise. The presence of myalgia during the acute phase of illness is considered a possible risk factor for developing persistent musculoskeletal pain later on.
Strategies for Symptom Relief
Managing COVID-19 muscle pain centers on supportive care to ease discomfort while the body fights the infection. Rest is a primary recommendation, as it allows the body to dedicate resources to immune function and reduces stress on sore muscles. Staying well-hydrated is also important; drinking plenty of water, clear broths, or electrolyte-containing beverages helps support overall bodily function.
Over-the-counter (OTC) pain relievers are the most common approach for reducing myalgia and fever. Acetaminophen (Tylenol) is effective for pain relief and fever reduction. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve), can also be used as they work to reduce both pain and the underlying inflammation.
Always follow the dosing instructions and be aware of any pre-existing medical conditions, such as liver or kidney issues, that might affect the safe use of these medications. For localized relief, applying temperature therapy can be highly effective. Cold packs can be applied to inflamed or painful areas to numb pain receptors and reduce acute inflammation.
Conversely, heat therapy, such as a warm bath or a heating pad, can help relax stiff muscles and increase blood flow to the area. For severe or persistent pain that does not resolve within a few weeks, or for pain accompanied by other concerning symptoms, it is important to consult a healthcare provider. A doctor can help rule out other conditions and offer a comprehensive management plan for chronic symptoms.