From the Guidelines
Proximal muscle weakness can occur after COVID-19 infection as part of post-COVID syndrome, and treatment should prioritize a combination of physical therapy, rest, proper nutrition, and vitamin D supplementation to improve morbidity, mortality, and quality of life outcomes. If you're experiencing proximal weakness (difficulty with movements involving shoulders, hips, and proximal limbs), you should consult a healthcare provider for proper evaluation. The most recent and highest quality study, published in 2023 in Nature Reviews Microbiology 1, highlights the importance of addressing neurological and cognitive symptoms in long COVID, which can include sensorimotor symptoms, memory loss, cognitive impairment, and autonomic dysfunction.
Key Considerations
- Treatment typically involves a combination of physical therapy with gradual strengthening exercises, adequate rest, proper nutrition with sufficient protein intake (1-1.5g/kg/day), and vitamin D supplementation (1000-2000 IU daily if deficient) to improve muscle strength and overall health.
- For pain management, acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) may help if not contraindicated, as suggested by previous studies 1.
- This weakness may result from direct viral effects on muscle tissue, inflammatory responses, prolonged immobility during illness, or steroid treatments used during COVID-19, as discussed in the context of respiratory muscle performance and COVID-19 1.
- Recovery time varies from weeks to months depending on severity, and it is crucial to seek immediate medical attention if weakness is severe, progressive, or accompanied by other neurological symptoms, as it could indicate more serious conditions like Guillain-Barré syndrome or critical illness myopathy.
Additional Recommendations
- Given the potential for long COVID to encompass multiple adverse outcomes, including cardiovascular, thrombotic, and cerebrovascular disease, type 2 diabetes, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and dysautonomia, especially postural orthostatic tachycardia syndrome (POTS), a comprehensive approach to management is necessary, as highlighted in the 2023 study in Nature Reviews Microbiology 1.
- The study also emphasizes the importance of considering risk factors, such as female sex, type 2 diabetes, EBV reactivation, the presence of specific autoantibodies, connective tissue disorders, attention deficit hyperactivity disorder, chronic urticaria, and allergic rhinitis, in the management of long COVID.
- Further research is needed to fully understand the pathogenesis of long COVID and to develop effective treatments, but current evidence supports a multifaceted approach to addressing the complex symptoms and outcomes associated with post-COVID syndrome.
From the Research
Proximal Weakness after Covid
- Proximal weakness is a symptom that has been reported in patients after Covid-19 infection, and it is often associated with myopathy or myositis [ 2, 3, 4 ].
- Studies have shown that Covid-19 can cause muscle inflammation and damage, leading to symptoms such as weakness, fatigue, and myalgia [ 2, 3, 4 ].
- The exact mechanisms of Covid-19-related myopathy are not fully understood, but it is thought to be related to immune-mediated responses and direct viral infection of muscle cells [ 2, 3 ].
- Histopathological studies have shown that patients with post-Covid-19 fatigue and weakness have skeletal muscle histopathology changes, including muscle fiber atrophy, inflammation, and mitochondrial changes [ 4 ].
- The symptoms of post-Covid-19 syndrome, including proximal weakness, may be similar to those of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and studying the pathogenesis of ME/CFS may provide insights into the mechanisms of post-Covid-19 syndrome [ 5 ].