We now know that the effects of COVID-19 can be experienced well after the initial acute phase of infection. A recent study by the Australian National University found that 29% of Australian adults with a confirmed case of Covid-19 continued to experience what has now become known as "Long-Covid".
What is ‘Long COVID?’
The Australian Physiotherapy Association (APA) stated recently that Long-Covid is most commonly felt by people as:
fatigue
shortness of breath
cognitive issues (brain fog)
These symptoms may persist for 12 weeks or more.
Why is this Important?
We are hearing about more and more people experiencing Long Covid, so as physiotherapists we feel it's an important time to let our community know that we are engaged in this complex condition, and that our Long Covid Physiotherapy Treatment Program may be a valuable support for you if you are experiencing Long Covid.
In this blog we aim to provide an insight into Long COVID, including common signs and symptoms, the potential drivers behind Long COVID, and how physiotherapy treatment can help you recover.
What signs & symptoms should I look out for?
It’s important to remember that long COVID is a multi-system condition, with over 200 different symptoms being identified. These occur in different combinations and can present in varying patterns of flare-ups and remissions.
Common symptoms to look out for include:
Fatigue, often worse after exertion
Shortness of breath
Cognitive issues (brain fog) that may impair memory and concentration
Muscle and/or joint pain
Persistent cough and/or sore throat
Chest pain or tightness
Difficulty sleeping (insomnia)
Heart palpitations and elevated heart rate
Dizziness
Depression and anxiety
Diarrhea/stomach issues
Loss of appetite
A high temperature
Changes to sense of smell or taste
Pathophysiology:
The evidence surrounding why symptoms still occur post-COVID is limited and the available studies differ from one another, so it's hard to draw any firm conclusions yet.
Associate Professor Louis Irving, a Royal Melbourne Hospital respiratory physician who has been running a long COVID clinic interstate, stated recently that the SARS-CoV-2 virus interacts with the whole person, meaning its impact can be wide-ranging.
‘How much of this is new disease and how much of it is activation of a background tendency I think is unclear,’ he said.
‘There is certainly not a single disease called long COVID, nor is there a test nor a unifying pathophysiology.’
There are many proposed mechanisms that trigger Long COVID, including:
Long term inflammation
Underlying immune system disorders
Micro blood clots
Persistent virus particles
What we do know is that Long COVID is a multisystem disease and according to the Australian Physiotherapy Association, physiotherapy can play an important role to improve the symptoms of Long Covid. As physiotherapists we will ensure that any rehabilitation is appropriate for each patient by listening and responding to the patient’s responses to exercise-based rehabilitation, especially symptoms of fatigue.
How can a physiotherapist help?
Before commencing safe rehabilitation your physiotherapist will conduct a thorough initial assessment including:
Thorough history taking, including general health and past medical history
Auscultation (listening to your chest)
Baseline measures including:
Heart rate
Blood pressure
Oxygen saturation
Spirometry
Relevant fitness/goal specific tests
Outcome measures such as the Borg Category Ratio (perceived rate of exertion)
Goal setting together with your physiotherapist (informed by your baseline measures)
As Long COVID is an emerging condition that is not yet well understood, there are no consistent guidelines for rehabilitation from Long COVID symptoms. Therefore we will adapt our usual safe practices towards rehabilitation in which we personalise the program to each individual's experience and needs. This is likely to include up to 2x weekly physiotherapy sessions for 6 weeks.
Your Long Covid Physiotherapy Treatment Program may include:
Baseline measures
In order to establish your benchmark we will measure certain attributes depending on your symptoms. These may include heart rate, blood pressure, oxygen saturation, spirometry, relevant fitness/goal specific tests, Borg Category ratio.
Pacing Plan
Your physiotherapist can work with you to develop a pacing plan to balance activities with rest to avoid exacerbation of symptoms. Pacing should include realistic goals, monitoring of physical, cognitive and social activities and their effect on energy levels.
Breathing Techniques
Specific breathing techniques can help with some of your symptoms including fatigue, shortness of breath, chest tightness, wheezing, etc. Breathing exercises and physical exercise have been shown to have a positive impact on repairing lung damage due to lung disease and a positive effect on reducing symptoms of Long COVID.
Manual Therapy/Hands on treatment
Your physiotherapist may provide some passive modalities in the early phases of your rehabilitation including assisted breathing techniques, percussions, positional drainage and vibrations to help clear mucus from the lungs.
Graded Exercise Therapy and safe return to physical exercise
A steady return to exercise is a crucial part of any rehabilitation, especially when suffering from fatigue and respiratory symptoms. Your physiotherapist will design a tailored exercise program and provide you with strategies to help you manage your day to day life and activity.
Reassessment of baseline measures
In order to monitor your progress and ensure you are working towards achieving your goals, your baseline measures will be re assessed as needed. Reassessment can also be extremely helpful to show if your symptoms are not improving. In this case, you may require a referral to a specialist for further assessment/intervention.
Interdisciplinary approach
At Saltfleet clinic we are extremely proud to have an interdisciplinary clinic. Having various allied health disciplines means that we can help you get back to being yourself sooner! We provide psychology and dietetics services; these can also be extremely beneficial services when managing Long COVID symptoms.
Outcomes
Various literature has shown the positive effect of breathing exercises and physical exercise in reducing persistent symptoms of COVID-19. Persistent symptoms that have been shown to improve following physiotherapy treatment include:
fatigue
breathlessness
dry cough
lung capacity
How To Get Started
If you or someone you know is suffering from Long COVID and feel that our physiotherpay treatment plan may assist then please don't hesitate to book an appointment with one of our physiotherapy team members.
There is a Long Covid Physiotherapy Initial Consult available to book online or call the clinic on 81861963 and ask for a Long Covid Initial Physiotherapy Consult.