Physiotherapy for Long-haul COVID-19 sufferers?
And you thought all we did was muscles, bones and joints! Let me explain. It’s new turf for everyone. But I hope to make sense by the end of this. Let’s start with some definitions:
What is ‘Long COVID?’
This has been preliminary defined as the presence of signs and symptoms that develop following COVID-19 which continues for 12 weeks or more. Many people living with the disease were previously fit and healthy. One-in-10 of all cases will exhibit symptoms for a period of 12 weeks or longer. Most common lasting symptoms are: shortness of breath; Post-Exertional Symptom Exacerbation (PESE); extreme exhaustion (fatigue); heart palpitations; chest pain/tightness; brain fog; and dizziness.
What is Rehabilitation?
Rehabilitation is defined as a set of interventions to optimize functioning in everyday activities, support individuals to recover or adjust, achieve their full potential and enable their participation in education, work, recreation and meaningful life roles. Phew! That’s a mouthful.
So, as wine lovers say, this is the perfect pairing. Let’s join the two definitions and concepts together.
What does a Post COVID-19 Recovery and Rehab Program entail?
There are four main areas of focus for a physiotherapist-guided COVID-19 recovery and rehab program. These areas of focus address some of the main signs and symptoms of long-haul COVID – shortness of breath, exercise intolerance, general exhaustion and fatigue. Physiotherapists have the skill set and knowledge to tackle these. We can help formulate a plan for:
• Breathing issues;
• Fatigue and Post-Exertional Symptom Exacerbation (PESE);
• 4 Ps : Prioritize, Plan, Pacing, Pleasure.
General education and support
Safe and effective rehabilitation is a fundamental part of recovery from any illness, injury or disease. It must be tailored to the individual, depending on their symptoms. With the current research and information available at this time the World Health Organization (WHO) recommends that Long COVID Rehab should include educating people about resuming everyday activities conservatively. An appropriate pace that is safe and manageable for energy levels. Exertion should not be pushed to the point of fatigue or worsening of symptoms. This is where physios shine. Long-haul COVID patients need us in their corner.
Let’s move past definitions now. I like to keep it real and relevant to readers. How did we start this at Spine and Sports? Well, we had our first Long-Haul COVID-19 patient several months ago. The very next day our professional association sent members information and guidelines regarding the emerging post-COVID-19 and physiotherapy approach. The timing seemed perfect. We were paying attention.
Within a week there was more information sent out. Clearly some collaboration of medical minds had been occurring for awhile! More emails. More guidelines. Basically letting our profession know we can step up and help. It’s definitely within our scope of practice. The more we read the more we realized that we were perfectly suited for this moment. Our team of six physios met and reviewed the literature and how we could help. We quickly realized that it’s a blend of cardio-respiratory physio, graduated fitness programming and concussion-type rehabilitation (pacing and planning strategies that involve not overtaxing the brain/body/mind).
In addition, our team recognized the importance of collaborating with other health professionals as various tests may be carried out to find the cause of symptoms such as breathlessness, chest pain, fatigue , dizziness, heart palpations, brain fog and more.
In summary, the ultimate goal of a physiotherapist is being able to get the person back to their healthy best self. COVID-19 Rehab has our attention. We need to get the word out. Stay tuned for more on this. In 500 words or less I will soon cover Breathing Exercises for Long-Haul COVID-19, followed by PESE and the 4 Ps. Until we meet again ….
Cheryl Witter is a physiotherapist and the owner of Spine and Sports North End Physical Therapy and Massage Therapy