Over the better part of the past year, the effects of the COVID-19 pandemic have extended into nearly every aspect of our lives. For most Americans, work, childcare, family life, and social or public engagements have all changed to some degree or been completely overhauled in ways that we never thought possible. On top of this, some people’s bout with SARS-CoV-2—the virus that causes the respiratory disease COVID-19—does not end once they are free of the virus, with lingering effects continuing to bother them for weeks or months afterwards.
The term used to describe this condition is post-acute COVID-19 syndrome (PACS), or long COVID. These “long haulers”—as they are commonly known—have already “recovered” from COVID-19 and no longer test positive for the virus, but report dealing with a range of symptoms that can last up to several months after their initial experience with the disease. The various physical and mental symptoms of PACS often takes an additional toll on these patients and further degrades their quality of life, which in many cases was already impacted by their first run-in with COVID-19.
Fortunately, physical therapists have been paying close attention to the emergence of this novel complication and are perfectly equipped to manage patients who are impaired by PACS. Here at Dynamic Sports Physical Therapy in New York City, we’ve partnered with Mt. Sinai Hospital to offer a comprehensive treatment program for PACS that addresses patients’ functional limitations through a variety of strategies. With that in mind, we’d like to take a closer look at the wide-ranging effects of PACS and explain the steps that we take to address this bothersome condition.
An abnormal path from an elusive disease
Individuals who have been diagnosed with COVID-19 may or may not experience symptoms at any time, and about 40 to 50% of patients are classified as asymptomatic, or symptom-free. For those who do develop symptoms, about 80% of cases are mild to moderate, while only 14% of patients are severely affected. A wide variety of symptoms—which usually arise between 2-14 days after being exposed to the virus—have been reported, but the most common are fever, fatigue, dry cough, loss of appetite, shortness of breath, and loss of smell.
The course that COVID-19 takes in each patient depends on several factors, particularly their age, weight, and the presence of any other health conditions like heart, lung, or liver disease. Although it’s clear that COVID-19 can be a devastating disease, especially for those who have multiple risk factors, most patients will go on to make a complete recovery. It can take as little as a few days to several weeks, but eventually these patients’ symptoms resolve entirely as their immune systems eradicates the virus.
However, this is not always the outcome with COVID-19. As explained above, a certain group of patients continues to be symptomatic for weeks or months after their original diagnosis. By this point, these individuals are technically free of SARS-CoV-2 and should have already recovered from it. The exact number of patients who become long haulers is unclear because there is no established definition of PACS, but research has suggested that at least 10% to 13% of patients report dealing with symptoms lasting for more than three weeks. According to the Center for Disease Control and Prevention (CDC), the most frequently reported symptoms of PACS are similar to those seen with the initial bout of illness and include the following:
- Shortness of breath
- Joint pain
- Chest pain
Other common symptoms include brain fog, anxiety and depression, muscle pain, headache, and general weakness. It’s not entirely understood why these patients are beset by these residual symptoms, but studies suggest that older individuals, those who are overweight or obese, and patients with asthma or extensive symptoms early on are more likely to become long haulers. Please note that these are not prerequisites, however, as some patients with mild-to-moderate illness initially will also develop PACS.
Once they reach this stage, the lasting physical and psychological impairments present can complicate daily life and prevent patients from moving and functioning normally. Long haulers may report difficulties exercising or even in performing basic activities like walking, standing up and sitting down, or doing household chores. These patients are often restricted by fatigue and shortness of breath, and their limitations may be further compounded by joint and muscle pain.
Regaining strength, balance, and function with physical therapy
The practice of physical therapy is uniquely positioned to help these patients who are coping with the residual effects of PACS. Physical therapists are movement experts who work with patients on an individual basis to alleviate their pain and address their impairments through a variety of strategies. While treating patients with other painful conditions throughout the pandemic—often remotely through telehealth—physical therapists have also been closely tracking the discovery of long haulers who require additional care. In the process, physical therapists throughout the country have learned about the most common symptoms and particular needs of these patients, and in response, have designed customized treatment programs to address them.
Dynamic Sports Physical Therapy in New York City has heeded this call as well, by recognizing those with PACS as a group that will benefit from physical therapy and making it clear that our services are available to them. That’s why we have partnered with Mt. Sinai Hospital to develop a comprehensive rehabilitation protocol specifically made for long haulers who are being held back by their lingering illness.
The goal of physical therapy for those with PACS is to enable patients to increase their physical activity levels and exercise capacity. This is primarily accomplished by targeting strength, endurance, balance, and functional abilities with a wide scope of movement-based interventions. In addition, extra concern is given to each patient’s response to activity, particularly their respiration—or breathing—while performing these tasks. Therefore, patients’ oxygen saturation—which measures how well they are breathing—is monitored and regulated before, during, and after physical activity to ensure it does not exceed a certain level.
Our PACS rehabilitation protocol is exercise-based and consistent with evidence-based practices for similar conditions. In addition to monitoring respiration, we assess the following parameters during a patient’s first visit and at each subsequent appointment:
- Exercise and functional capacity
- Presence of pre-existing conditions
- Muscle and joint range of motion
- Ability to complete normal activities of daily living
Once these baseline assessments are recorded, your physical therapist will design a personalized treatment program based on your specific symptoms, impairments, and goals. Programs vary from patient to patient, but in most cases the following interventions are used:
- Generalized strengthening exercises to build back muscles that may have been weakened by inactivity
- Progressive aerobic and cardiovascular endurance exercises to increase activity levels and exercise capacity
- Mobility and stretching exercises to improve flexibility and range of motion
- Neuromuscular electrical stimulation to assist with muscle strengthening
- Biofeedback, a technique that teaches patients to voluntarily control certain bodily processes through electrical sensors and audio/visual cues
- Mindfulness-based techniques, which help patients identify and understand triggers that exacerbate their PACS symptoms; when combined with biofeedback, these two techniques can train patients to downregulate these processes and effectively reduce their symptoms
We will carefully guide you on how to perform these interventions at first, and then monitor you throughout their entire course of care to ensure that the workload and pacing is appropriate. If you respond well to your initial plan and don’t show any signs of an adverse response, the next step will likely be to gradually increase the frequency, intensity, duration, and type of exercises in your program as you progress.
Reach out now if residual COVID-19 symptoms are holding you back
So if you’re currently bothered by symptoms that are related to PACS, we invite you to get in touch with us to find out what we can do for you. You can access our PACS rehabilitation program either in person or virtually through our telehealth services if you prefer to avoid coming into our clinic. For more information or to schedule an appointment, call Dynamic Sports Physical Therapy in New York City at 212-317-8303.