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Can’t manage the long walk to your post-COVID freedom? By Sujatha Dawnarain.


The term ‘Long-COVID’ is used to describe persons with COVID-19 who experience symptoms for longer than 28 days after diagnosis


You are not alone!

A US Centers for Disease Control and Prevention study, interviewing individuals with proven COVID-19 who had not been hospitalised, demonstrated that even in young adults, symptoms may be slow to resolve; 26% of interviewees aged 18 - 34 years reported not having returned to their baseline health within 14 - 21 days of their test, this rising to 47% in those aged ≥50 years. The greater the number of pre-existing chronic conditions, the greater the likelihood was that symptom resolution would be delayed (Mendelson et al., 2021).


What is “Long-COVID” (lo-co)?

Persistence or development of new symptoms relating to SARS-CoV-2 infection late in the course of COVID-19 is an increasingly recognised problem facing the globally infected population and its health systems. The term ‘Long-COVID’ is generally used to describe those persons with COVID-19 who experience symptoms for longer than 28 days after diagnosis (Mendelson et al., 2021).


Many of those affected are active people: working, running households, raising children, caring for elderly parents, growing food, paying off homes. As one Long COVIDer Paul Garner, Professor at the Liverpool School of Tropical Medicine put it “I have had to re-frame my life practically, psychologically and spiritually.” He reports how he has had to learn to “rest and pace” (A National COVID-19 Resilience Programme - The Physiological Society, 2021).


Another Long COVIDer, author Dr Helen Moffat, writes that she finds it helpful to look back at where she has come from to keep her hope. Dr Moffat writes “What’s more helpful (after a rather rotten four weeks) is to observe that I’m ‘less worse’.”


The symptoms of Long-COVID are likened to that of a roller-coaster by Dr Moffat “first comes the breathlessness, the dropping O2 sat level, the chest pain, the headaches, the night of sleeplessness, the day when I can’t stop sleeping, the gastro, the rash, the conjunctivitis and ‘hello’, we’re back at the breathlessness.”



Can we predict who will get Long-COVID?

According to the COVID Symptoms Study App, persons with more than five symptoms in the first week of their illness were four times more likely to develop Long-COVID than those with fewer symptoms. The five most predictive symptoms of Long-COVID in the first week of illness were fatigue, headache, shortness of breath, hoarse voice and myalgia. Long-COVID was also more likely to occur in women, older people, and those with obesity (Mendelson et al., 2021).



So how can a physiotherapist help me?

Frequently assuming resting positions (includes hunching over, to control your shortness of breath, cough, or other reasons) creates muscles imbalances and you would benefit from stretching the anterior chest muscles, strengthening of the diaphragm, thoracic expansion, thoracic mobilisations, posture correction exercises. A physiotherapist can compile a stretching and strengthening exercise regime for you to follow and can monitor your progress and adjust the exercises accordingly.


Wearing a facemask for supplementary oxygen (if it was needed to meet the body’s oxygen demands), may create an altered breathing pattern (i.e. mouth breathing), breathing proprioception, breathing patterns, and breathing ratios needs to be re-educated to help optimise blood oxygenation, prevent atelectasis, prevent, or improve hyper/hypo-inflation of lungs. Once again, a physiotherapist can assist with ways to increase your oxygen intake.


Have you heard the expression: “you snooze, you lose”? The same applies to your muscles: the wasting of the muscles occur within 24 hours of not using them. Fatigue, malaise (feeling awful), myalgia (muscle pain) can be improved with a strengthening programme. Your physiotherapist can advise you on the muscle groups which need to be strengthened as well as advise you on pacing activities. This is necessary to assist you in achieving your post COVID fitness goals, be it returning to your weekend walk on the promenade, hike at that nature reserve you love or returning to a sport you have missed.


If you have been experiencing headaches in your long COVID phase (can result from prolonged postures) or as a symptom of the COVID vaccine process, your physiotherapist will be able to assist you in relieving it with a combination of massage techniques, advice, and cervical joint mobilisations to normalise the stressed muscles and strained joints.


Different systems are affected in multiple people, your physiotherapist will assess you to determine how those systems present symptomatically and will use an individualised treatment approach.


Debbie Cameron Physiotherapy are specialising in a Long-COVID programme which focusses on diet, exercises to build up strength and endurance, and mental health. If you are still experiencing symptoms (breathlessness, fatigue, muscle pain), some time after contracting COVID, contact the practice on 031 765 8898 to find out more.


References:

1. Mendelson, M., Nel, J., Blumberg, L., Madhi, S.A., Dryden, M., Stevens, W. and Venter, F.W.D., 2021. Long-COVID: An evolving problem with an extensive impact. SAMJ: South African Medical Journal, 111(1), pp.10-12.

2. The Physiological Society. 2021. A National COVID-19 Resilience Programme - The Physiological Society. [online] Available at: <https://www.physoc.org/policy/covid19resilience/> [Accessed 18 March 2021].

3. Taylor, S., Asmundson GJG. (2020) Life in a post-pandemic world: What to expect of anxiety-related conditions and their treatment. Journal of Anxiety Disorders, vol 72, pp. 1-3. Available from Elsevier. [15 March 2021]

4. COVID-19 rapid guideline: managing the long-term effects of COVID-19 NICE guideline. (18 December 2020) accessed from: www.nice.org.uk/guidance/ng188

5. Tucker, P., Czapla, C. (2021). Post-COVID Stress Disorder: Another Emerging Consequence of the Global Pandemic. Psychiatric Times, vol 38(1) Available from Elsevier. [15 March 2021]

6. https://www.saphysio.co.za/media/180970/2020-no-08-physiosa-december.pdf


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