Are you tired of being tired all the time? If you have experienced any form of Covid symptoms in the last year then you are not alone.
Data from the BC Centre for Disease Control and Prevention (BCCDC) suggests that almost 80% of BC population has been affected by Covid-19 or its variants, that number refers to the documented cases alone.
In this post-pandemic era, it has been quite nerve-wracking to read about Covid-19 and its variants. In addition to the threat of variants, provincial health authorities are urging the public to monitor for residual symptoms of Covid, also known as Post Covid or Long Covid, most easily camouflaged as plain old fatigue.
What is Long Covid?
- While there is ongoing research to determine the definition and time parameters involving the post-Covid syndrome, Long Covid is best described as the post-acute sequelae of Covid-19. In other words, long Covid is what happens in your body when you are no longer infectious with the virus.
- Research on the subject is mounting but long covid is not yet well established, i.e. risk factors, hospitalization, and treatment. What we know from existing research is that it can be extremely disabling causing activity limitations and social participation restrictions.
- Long Covid can seem like a milder but extended form of Covid 19 that fluctuates in both severity and consistency causing severe distress to anyone experiencing it.
- Fatigue and brain fog are the most common symptoms identified. Among others are chest tightness, shortness of breath and dizziness. It can be accompanied by mental health challenges such as low mood, heightened anxiety and occasionally depressive episodes.
- It is also evident that long covid impacts multiple body systems such as respiratory, cardiac, endocrine, and neurological systems.
- Given the wide scope of long covid, rehabilitation is a key aspect of recovery. That’s where Physiotherapists, we come into the picture.
Physiotherapy role in Long Covid
1. Establish a strong therapeutic relationship
- Much like other conditions, physiotherapy in long covid is highly person-centered and goal-oriented.
- We recognize the value in providing a safe space for you to share your concerns and your experience, especially since science is still in the process of catching up to lived patient experience.
- We use patient-reported outcome measures to evaluate the efficacy of the rehabilitation program.
2. Screen for Post-Exertional Symptom Exacerbation (PESE)
- Before prescribing an exercise program, you will be screened for PESE. This means your symptoms will be monitored from absent to varying levels of physical activity.
- Fatigue is the most common symptom, persistent fatigue that cannot be explained by any unusually difficult task. Most patients, in existing research, describe it as episodic and triggered sometimes by cognitive exertion or even mild physical tasks.
- While treatment for fatigue is a graded exercise program, if not tailored to individual experience, it can cause further fatigue and therefore be rendered ineffective.
- The screening for Post Exertional Symptom Exacerbation is obtained as a self-report. A brief 5-item questionnaire is used to elicit the most accurate result, based on which we determine the next steps.
3. Screening for potential Cardiac impairment
- This specifically applies to athletes and other high-intensity enthusiasts. If you are experiencing long Covid and are anticipating a return to the sport you will require medical imaging and tests to rule out cardiac conditions.
- As we saw earlier, long covid can affect multiple systems, cardiac being a primary target. Regardless of whether you present with cardiac symptoms or not, if you are hoping to return to high-intensity activities this is an important step.
- As physiotherapists, we understand that movement and return to recreational activities will contribute to health and well-being, but safety always comes first. We cannot begin your rehabilitation program until your physician has given you the all-clear with regard to your cardiac health. This rule applies to those of you returning to strenuous jobs as well.
In order to avoid Post Exertional Symptom Exacerbation, a physiotherapist will teach you Pacing as a self-management strategy. You are guided to less activity than you have energy for, keep activities short and rest often.
Pacing involves the following steps:
- Learn about your energy reserve
- Track your energy expenditure
- 4 P’s- Priorities, Plan, Pace and Pleasure
- Learn how to save energy
- Learn to rest between activities
Your physiotherapist will also teach you to monitor your own heart rate with the goal of keeping it under 15 beats per minute to reduce the risk of PESE
5. Manage Exertional oxygen desaturation
- Your physiotherapist will actively monitor oxygen saturation using a pulse oximeter while introducing your graded exercise program. A mild drop in saturation is acceptable, anything beyond 4% can present with increased distress for you, the client.
- All fluctuations will be recorded and exercises will be modified accordingly to ensure slow but safe and steady progress.
6. Screening for Autonomic Dysfunction
- With long covid, sometimes sudden changes in posture can lead to inconsistencies in heart rate and blood pressure. Keeping that in mind, it is most likely that your physiotherapist will ensure a thorough medical exam has been carried out with specific screening for orthostatic hypotension and heart rate differences.
In addition, as physiotherapists, we will provide you with an ongoing exercise prescription tailored to your individual needs while educating you to optimize recovery and regain function.
At Revere, we are here to address your rehabilitation concerns and curate an exercise program specifically for you.
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