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COVID-19 Rehab: Your Questions Answered (And How Physio Can Help)

COVID-19 Rehabilitation and Long-COVID Recovery

It is staggering to think that these words never existed two years ago. Now, entire market sectors are dedicated to them. In January 2020, the World Health Organisation (WHO) called the new Coronavirus outbreak a “Public Health Emergency of International Concern”.

Three months later, a global pandemic was declared, and life as we knew it changed. Early on, the WHO did not expect a vaccine in less than 18 months. Then, against all odds, the world’s institutions combined their forces and produced a vaccine within 11 months.

Hope was renewed, and a way forward pathed.

With more than half of the UK population now vaccinated, it’s tempting to assume the COVID nightmare is almost over. But, this may be short-sighted. Although we’ve made progress, there’s still much more to learn about this disease before we can move on from this pandemic.

The reality is the world is healing, and many people have a long journey ahead of them.

These are the most common questions we get from patients and carers, and we hope by the end of this article you will have found the answers you’re looking for.

1. WHAT IS CORONAVIRUS AND COVID-19?

Coronaviruses (CoV) are a large family of viruses that cause illnesses ranging from mild common colds to more severe conditions like SARS and MERS. The Coronavirus at the centre of the pandemic is a new strain called SARS-CoV-2. The virus spreads through direct contact or respiratory droplets that contact the nose, mouth, or eyes.

Data shows Black and Asian ethnic minority populations have poorer outcomes but, ongoing symptoms occur across all population groups. The WHO reports, ‘anyone can get sick with COVID-19 and become seriously ill’. Those found to be at most significant risk of severe COVID-19 illness are:

Men
People over 60
Those with an underlying health condition.

2. WHAT ARE THE MOST COMMON SYMPTOMS OF COVID-19?

COVID-19 can show up as a mild or severe disease. In some cases, it can progress quickly, so knowing the symptoms and understanding the difference between mild and severe cases helps save lives. These are the most common symptoms:

Covid-19 rehabilitation, covid-19 symptoms

COVID-19 Coronavirus Symptoms (Source: WHO )

As with any new outbreak, little is known about the condition until more studies are conducted. Time brings more information, improved knowledge, and ultimately, better management of the disease or condition.

Since COVID-19 is a new condition, the list of symptoms may change in the future. Therefore, it’s best to keep up to date with current evidence.

3. HOW LONG DOES IT TAKE TO RECOVER FROM COVID-19?

COVID-19 recovery is different for everyone. The WHO reports most people (about 80%) will recover without needing hospital treatment. Around 15% will require oxygen treatment, and 5% will need intensive care due to critical illness.

Many people get back to their normal activities within a few weeks, but most recover within 12 weeks. Unfortunately for some, symptoms can last longer than 12 weeks. New initiatives provide guidance and support for those dealing with COVID-19, either directly or indirectly.

The NHS has done a terrific job with its website, www.yourcovidrecovery.nhs.uk. It’s an incredible resource for anyone needing support through their or a loved one’s COVID-19 recovery.

4. WHAT IS ‘LONG-COVID’?

Long-COVID is the extended period of illness after initial COVID-19 infection.

The National Institute for Health and Care Excellence (NICE) develops COVID-19 care guidance based on these definitions and timelines:

Acute COVID-19: Signs and symptoms up to 4 weeks
Ongoing symptomatic COVID-19: Signs and symptoms from 4 -12 weeks
Post-COVID-19 syndrome: Signs and symptoms presenting as clusters during or after COVID-19 infection, with no alternative diagnosis and lasting longer than 12 weeks
Long-COVID includes both the ongoing symptomatic COVID-19 and post-COVID-19 syndrome stages

Image: Vitality Physiotherapy. Source: NICE

In a joint UCL 2021 study, researchers found patients hospitalised with COVID-19 still had symptoms more than seven weeks after hospital discharge.

These included:

Persistent breathlessness (53%)
Cough (34%)
Fatigue (69%)
Depression (14.6%)

They also found that 38% of Chest X-Rays remained abnormal and 9% showed worsening.

As much as we want this pandemic over, some symptoms are an ongoing reality in many people’s lives.

Long-COVID symptoms are wide-ranging and fluctuating, and these can change in nature over time.

Covid-19 rehabilitation, symptoms, Long covid — **LONG-COVID SYMPTOMS**

Image: Vitality Physiotherapy, Source: NHS

5. WHAT CAUSES LONG-COVID?

The research is scarce about the causes of Long-COVID. However, a theory about viral persistence has emerged. Certain body parts (brain, testes, eyes, spinal cord) are considered ‘safe havens’ or immune-privileged organs to our immune cells. These are ‘no-go areas’ for immune attacks.

When viruses hide out in these body sites and come out later, causing relapses, it’s called viral persistence. In these organs, damage from an immune attack is riskier than allowing an invader (a virus, for example) to infect the cells.

In June 2020, a National Geographic article called ‘How long does Coronavirus last inside the body?’ explored viral persistence and explained how it impacts your recovery.

6. WHO CAN GET LONG-COVID?

The short answer? Anyone who gets COVID-19 can get Long-COVID. Many people believe they will not experience severe symptoms if they are not at risk.

The chances of having long term symptoms does not seem to be linked to how ill you are when you first get COVID-19.
– NHS

The NHS clarifies an important aspect here – your initial and post-COVID symptoms may not be related. But why can’t we predict how unwell we’ll get with COVID-19 or tell whether we will develop long-term symptoms?

In a review into the global health strategies surrounding COVID-19, a researcher explained it like this:

‘What follows after the acute phase of SARS-CoV-2 infection depends on the extension and severity of viral attacks in different cell types and organs.’
– Aging clinical and experimental research

In other words, how sick you become after acute infection depends on how severely the virus attacked during the acute phase.

Viruses also affect our immune systems differently. Unfortunately, we cannot predict which patients will have a worse outcome from the limited clinical evidence and research data.

This NHS video discusses how post-COVID symptoms affect healthy young people. For example, a 26-year-old former marathon runner describes how ten weeks after her initial infection, she still couldn’t walk for more than 15 minutes at a time in this BBC article.

These stories, along with countless others, demonstrate that no one is safe from Long-COVID.

7. WHAT HAPPENS IN A COVID-19 PHYSIO APPOINTMENT?

Your appointment will include a thorough assessment and a concise treatment plan.

Assessment includes:

A screen for serious illness
A discussion about your case history to find out about your current and previous functional abilities and challenges
A respiratory examination
A musculoskeletal examination

Treatment includes:

A uniquely designed custom treatment plan according to your specific goals and functional requirements determined in your assessment.

8. HOW CAN PHYSIOTHERAPY HELP?

COVID-19 Rehabilitation tools, techniques and exercises help:

Reduce breathlessness
Increase your lung capacity
Pace your activities
Manage fatigue
Improve your exercise tolerance
Rehabilitate muscle and joint dysfunction

We show you a way forward and help you manage your symptoms better so you can live your life.

In any holistic Physiotherapy Rehabilitation programme, an onward referral network is essential. We work with experts to help you recover fully.

If we suspect you need further investigation, we will refer you to our trusted colleagues for extra help:

Specialist Medical Physicians
Respiratory consultants
GP’s
Psychiatrists
Sports and Exercise Medicine Consultants
Speech and Language Therapists
Occupational Therapists
Psychotherapists

There is more to COVID-19 than just a virus. You can feel the impact on every aspect of your life – physically, mentally, socially and financially.

Have you waited long enough for things to improve on their own? You are not alone on this journey – we’re on your team!

COVID-19 is a complex puzzle, and we are here to help you solve it! Don’t wait any longer to restore your quality of life and start doing the things you love again!

Get in touch with our specialist team now!

Top 5 Summer injuries and how to prevent them

1. Gardening injuries

We kicked off June with a very balmy Jubilee weekend and it’s been a brilliant summer so far! If you enjoy a chilled glass of rosé, weekend BBQs, and a spot of gardening too, you’ve found good company!

Gardening injuries, however, are quite common, so here are some handy hints to help you get the most of your long summer days. Extended pruning time, using inappropriate tools, and heavy lifting with poor technique are often the biggest culprits!

Try the following to keep your love for gardening alive:

Warm up before you weed-up! Try taking a brisk walk to get your heart rate up, prior to starting your gardening session.
Sit on a stool or kneel on foam pads to help prevent knee and back pain when planting or weeding.
Long handle tools will reduce the work and prevent you from overstretching.
Impose a 20-minute limit (to make a cuppa of course) to take a short break especially if you’re a gardening novice!

Don’t spoil a perfect day in the garden with a pesky injury! If you have any questions about an injury or wondered whether we can help, book a free 15min call to chat about how we could help you.

2. Neck strains

If catching some rays on your back is a priority this summer, be sure to set a timer or get someone to wake you. Apart from the obvious perils of turning into a lobster and the pain associated with it, getting a stiff neck from lying prone (on your tummy) on the beach will certainly put a damper on your holiday. Reading for long periods on a sun lounger can also cause a crick in the neck, so be sure to do a few neck stretches every so often to keep your neck mobile. Here are some useful neck stretches to try.

Tilt your head to one side and hold for 15-20 sec and then to the other side.
Roll your shoulders forwards 5 times and then backward.

3. Running shin splits

Trying to get beach-fit quickly? Trying to run away those extra pounds? A sudden increase in running thresholds (especially if you’ve never run) is one of the biggest single causes of shin splints. This, together with wearing inappropriate footwear, a higher BMI and flat feet are among the top factors that can result in shin splints. Try switching to swimming or cycling instead and seek physiotherapy advice before hitting the pavement again to avoid this common summer injury.

4. Plantar fasciitis

In warmer weather, we tend you to swap our more supportive shoes for flip-flops, pumps, and sandals. Whilst increasing the airflow helps us feel cooler, our feet have to work a lot harder to help us move. This can cause aching burning feet at the end of the day. The intrinsic foot muscles may have deconditioned over the long winter and therefore be subject to strain and fatigue. If you suffer from burning feet, try doing the following:

Place a bottle of water in the freezer for an hour or so. Place it under your foot to act as an ice roller- trust me, it will absolutely hit the spot to relieve your burning feet!

5. Cycling injuries

Fair weather cyclists the world over can all relate to a “dead pinky” or lower back pain after getting into the saddle. Bike setup is crucial to your cycling comfort and can also contribute to the work of cycling. Your pre-bike fitness however will set you up to ensure you’re recruiting the correct muscles for your pedal power and avoid injury. Weak glutes are sometimes responsible for overworking the lumbar spine or hamstrings. A simple bridge exercise is useful for hip mobility and strength, particularly for cyclists as it replicates the action of the downward force of pedaling and isolates glut muscles.

We hope that these few simple golden nuggets will help keep those summer injuries at bay and that you have a wonderful and long summer!

5 injuries you didn’t think you could get from cycling

1. Runner’s knee

Yes, I said it! You can get runner’s knee from cycling. Contrary to popular belief, this painful problem is not confined to those who hit the pavements in their trainers alone. In fact, there’s a growing number of cyclists that land up on my treatment table that have been plagued with this pesky problem. The problem with cycling (cue “gasp” from our lycra-clad friends) is that the answer may not always be straight forward.

Football season is on: watch that hamstring!

The Premier league season has just started with a couple of big surprises already. The transfer market is heading for a record this year but the number one priority of every club will be to keep their players in shape, whether they are new recruits or existing ones.

Hamstring injuries in particular will be watched very closely by the clubs’ physios. According to Football Association Medical Research Programme, hamstring strains are the most common injury sustained costing an estimated 90 days and 15 matches missed per club per season. [1]

Usain Bolt – a biomechanical perspective on a sprinters’ foot

That’s it, we won’t have the delight of seeing Usain Bolt competing ever again. And despite his disappointing result at the 2017 World Championships here in London he is still the man to beat with an incredible World Record set at 9.58secs. We at Vitality Physiotherapy wish him very well after his injury in the 4x100m.

In his television interview on the BBC a couple of years ago, Usain said that he was less hard working than his younger teammate, Yohan Blake (who incidentally thanked his physiotherapist when he won Silver in the 100m men’s final in 2012). Bolt, however attributes much of his success to his talent!

Do you get a side stitch when you run?

There are more than a million downloads of the couch to 5K running app, running has become one of the most popular sports to kickstart in the summer. For both novice and experienced runners alike, most would have experienced a side stitch (exercise-related transient abdominal pain (ETAP)) at some point.

It is usually experienced just below the ribs, often affecting the right side. It usually results in a complete halt to running!

What are the causes of a side stitch?

Some biomechanists suggest that it is caused by the reduced blood supply to the diaphragm. The diaphragm is the main muscle we use to breathe. This theory however has been largely disregarded as a possible reason for pain.
Other medical scientists have proposed that pain was due to the downward pulling of visceral ligaments (ligaments that connect your abdominal organs such as the spleen, liver and stomach). This mechanism couldn’t explain why swimmers could experience stitches because these ligaments are not pulled downwards during a swim.
A more plausible and recent theory is parietal peritoneum irritation. The parietal peritoneum is one of two membranes that lines the abdomen. This membrane has a good nerve supply. The other membrane is called the visceral peritoneum. Between these two layers, is a naturally occurring fluid, which helps to allow the two membranes to slide against each other
When the stomach is full, the two layers can rub against each other and can cause pain.
If we don’t drink enough water, our parched bodies can become dehydrated. This can compromise the amount of fluid lying between the two membranes causing friction. Which in turn can cause that sharp pain in your side!
Eating or drinking just before running causes the stomach to expand and distend. This too can cause a build-up of pressure against the membrane.
Other factors include poor fitness, insufficient warm-up, and abdominal or core muscle weakness

Top Tips to avoid a stitch:

Eat 1.5 to 2 hours before exercising, preferably carbohydrate richer and protein poorer meal.
Before you run, ensure that you have drank enough fluid. The more slowly you do this, the better.
Plan the progression of your running regime- by consulting your Physio, Personal trainer, or Running coach. Progressive gradual increases of no more than 10% of training volume a week are recommended to both keep injury-free and stitch-free.
Include Pilates and other core stability exercises specifically for running as part of your strength and conditioning routine.

Top Tips if you have a stitch:

Lower the intensity of your run. Slowing down to about 50% of your current effort will ease the tension you feel.
Are you breathing through your mouth? Try nasal breathing instead! This will encourage breathing from your diaphragm and have loads of other health benefits too!
Breathe deeply in for 4 sec, hold for 5sec, and breathe out for 7 sec. Breathing control is a powerful tool to stop that stitch in its tracks!
Then, apply firm and gentle pressure on the painful area for a few seconds until the pain dissipates.
Raise your arm above your head and side bend away from the pain.

References

Characteristics and Etiology of Exercise-Related Transient Abdominal Pain,’ Medicine and Science in Sports and Exercise, Volume 32 (2), pp. 432-438, 2000

The Lore of Running, Tim Noakes, Publisher: Human Kinetics Publishers Date Published: 1991

Johnson. “Side Stitches: Cause and Cure”. Retrieved 9 September 2011.

Quinn, Elizabeth. “The Side Stitch”. About.com. Retrieved 4 November 2012

Sports Medicine 32(6): 2002. 261-269 The human spleen during physiological stress, Stewart & McKenzie

“Snow” need to worry about a niggly knee this ski season!

Thinking of warming away the winter blues with a bit of Alpine Sun? Concerned about an injury? Fear not, Vitality Physiotherapy is here to help!

The most common injury sustained on the slopes, is an ACL tear. The Anterior Cruciate Ligament (ACL) is located within the knee joint and connects the tibia (leg bone) to the femur (thigh bone). It is an important stabiliser of the knee joint. The ACL is commonly ruptured as a result of quick decelerations, hyper extension or excessive rotation.

Vitality Physio featured in Women’s Fitness Magazine

Lead Physiotherapist, Janine Enoch talks to Amanda Khouv from Women’s Fitness Magazine in the Ultimate Runner’s Guide April 2012.

In this article, Janine recommends a few general principles to avoid running injuries but remember, always consult your GP or Physiotherapist if you suspect that you may have sustained an injury or are at risk of developing one.

Size Matters

It’s a month to Christmas. If you are one of those very organised people, chances are that you’ve started on your Christmas shopping list. You inspire me! I am a scrambler – yes one of those loons trekking down Oxford Street on Christmas Eve searching for at least one dodgy Christmas jumper and the mandatory pair of socks for an unsuspecting, and admittedly unlucky relative.

Shin Splints

Have you got a place for the Virgin London Marathon? Want to challenge Kenya’s Patrick Makau magnificent 2hrs 3min 38sec set at this year’s Berlin marathon, perhaps? Plagued by shin splints, and don’t know how to get rid of them? Well, look no further, Vitality Physiotherapy has the solution for you!

Shin Splints, is a global term often used to describe pain in the leg below the knee. It can occur on the front outer aspect of the leg (anterior shin splints), or on the inside of the leg (medial shin splints). They can affect novice athletes who do too much too soon, or experienced athletes who modify their exercise programme by increasing their mileage or gradient excessively.

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