The SARS-CoV-2 infection (COVID-19) is a serious pandemic that has caused significant mortality and morbidity throughout the world. Approximately 80% of those affected had mild to moderate disease, and 5% of those with severe disease went on to acquire critical illness. Coronavirus disease 2019 (COVID-19) can cause a wide range of signs and symptoms. However, researchers have reported newer and newer symptoms with the constantly permuting virus. This article aims to highlight the symptom of neck pain after COVID-19 infection.
Is neck pain a sign of covid?
Muscle pain is medically referred to as ‘myalgia.’ Myalgia is a symptom of muscle pain or discomfort, and it is mostly caused by systemic or local infection. Myalgia (either localised or generalised) is one of the most frequently encountered pain symptoms among COVID-19 patients.
A study has shown that pain during COVID-19 was found to be higher compared with pre-infectious and post-infectious states. The most frequent painful areas were reported to be the neck and the back before infection, whereas the head and the limbs were more common during infection.
Myalgia is closely related to SARS-CoV-2 test positivity and can be used as one of the strongest predictors. The number of COVID-19 positive patients presenting with myalgia, while without any initial respiratory tract symptoms, has been noted in literature. Therefore, pain can be considered an early sign of COVID-19 infection.
However, most of the patients who tested positive for the Covid-19 disease, presented with widespread body pain, without known respiratory symptoms of viral disease.
General myalgia is very common in patients with COVID-19, but focal myalgia should alert the doctor that the patient may have other medical conditions like rhabdomyolysis, meningitis, etc.
Thus while covid-19 can definitely induce neck pain, a single manifestation of neck pain may not be enough to diagnose an active covid-19 infection.
Neck pain after covid
What could be the possible reason for neck pain during or after covid?
Most of the musculoskeletal pain symptoms can be due to the result of tissue destruction that occurs during an active infection. Something known as the Angiotensin-converting enzyme 2 (ACE-2) receptors are present in the musculoskeletal system. The covid-19 virus may enter into this system through these receptors. This direct invasion of the virus in the cells could lead to injury and thereby cause pain. However, because this is a bodily system, pain is often seen to be generalised during an ongoing Covid-19 infection.
Headache is also one of the most common symptoms of covid-19 disease. Sometimes the neck pain can be actually a referred pain caused by the accompanied headache, as well.
What are the symptoms of neck pain after covid?
Like most infections, the COVID-19 disease also recovers quickly. However, for some people, the signs and symptoms of the disease last for weeks or even months. This is known as Long Covid. It is also known as post-Covid syndrome. It can be continuous or relapsing and remitting in nature. There can be the persistence of one or more symptoms of acute COVID, or appearance of new symptoms.
However, the majority of people with post-COVID syndrome are PCR negative.
Depending upon the duration of symptoms, post COVID or Long COVID can be divided into two stages-post acute COVID where symptoms extend beyond 3 weeks, but less than 12 weeks, and chronic COVID where symptoms extend beyond 12 weeks.
It is necessary to pinpoint the precise mechanism causing the symptoms to continue. The duration of chronic inflammation or immune response/auto antibody generation, rare virus persistence in the body, non-specific hospitalisation effects, sequelae of critical illness, post-intensive care syndrome, complications related to corona infection, or complicating factors can all contribute to the persistence of symptoms.
How does neck pain after covid affect the range of motion?
Pain in and around the neck may cause the muscles around the site of pain to go into a spasm (a state of involuntary muscle contraction). A state of spasm causes more pain and leads to what is known as the pain-spasm cycle. This may cause trouble in performing activities of daily living.
Other possible side effects of neck pain after covid?
Constant neck pain may force one to adapt to an incorrect posture. This maladaptive posture could further lead to muscle imbalance and worsen the pain.
How to reduce or prevent neck pain after covid?
Pain due to Covid-19 may not be preventable but can definitely be reduced or prevented from worsening. You can do the exercises below are some range of motion exercises for the neck (cervical spine and the muscles surrounding it). These neck and shoulder exercises should be done gently and within the limitations of pain, without overstretching or inducing intolerable pain.
You can check your neck range of motion using Neck Checkup, and get some recommended exercises.
All images are taken from Kisner Carolyn and Lynn Allen Colby. 2012. Therapeutic Exercise: Foundations and Techniques. 6th ed. Philadelphia: F.A. Davis.)
Chin tucks: It is a simple exercise that can be done at home or at work. Initially, it can be done in a sleeping position with pillows under the head.
Scapular retractions: this exercise can help with the correction of the position of the scapula (shoulder blade) which has an effect on the position of the neck. To do this exercise, one must try to touch their shoulder blades together
Trapezius stretching: This exercise helps stretch the trapezius muscle which is known to go into a spasm.
Levator scapulae stretching
Levator scapulae stretching: This is another common muscle that goes into a spasm along with the trapezius. Stretching this muscle is important to gain a complete cervical range of motion.
Stretching of the scalenus muscle
Stretching of the scalenus muscle: Another known muscle that restricts the complete cervical range of motion.