Over the past two months, many people I know have gotten COVID, even two in my own household. Luckily, most people are recovering quickly, but what happens when symptoms persist over 4 weeks?
Throughout the pandemic, health care providers have recognized that some people continue to have symptoms long past the initial infection. These symptoms are now recognized by many names, Post-COVID Syndrome, Long COVID, Long Haulers, PASC (Post Acute Sequalea SARS- CoV-2). Research shows that about 10% of people between ages 18-49 who have COVID -19 get Long COVID. Those odds go up for those over 70 and those with other underlying medical conditions or those who were hospitalized for COVID.
Symptoms after acute COVID-19 are highly variable and wide ranging. The most commonly reported symptoms include (but are not limited to) the following:
Treatment for Long COVID involves a multidisciplinary approach from your health care providers, including physical therapists.
What Can Physical Therapists Do To Help Long COVID?
PEM - Post Exerctional Malaise
Fatigue from Long COVID is variable day to day. Some days energy levels are good, and the person is active and productive during the day. Then after a good day (and possible overexertion) the next few days (or even a month)may present with disabling fatigue. This leads to frustration, not knowing which each day will bring. Our society, work and home expectations lead people to push through the fatigue, ignoring their bodies, until they physically just can't do it anymore and present with other complications. These symptoms have been labeled as Post Exertional Malaise (PEM), and it can be caused by not just physical, but also mental activities. Post-exertional symptom exacerbation is a feature of the inability to produce sufficient energy on demand.
PEM has been a symptom that has been long identified with other chronic disorders such as Epstein Barr Virus, MS, and Chronic Fatigue Syndrome. One technique that has been used by those suffering from PEM is labeled "Stop, Rest, Pace".
If you or someone you love is suffering from symptoms of Long COVID or Post-Exertional Malaise, reach out and talk to one of our physical therapist to get expert advice and direction on recovery.
During the holidays we often find ourselves standing for long periods of time while cooking, shopping, or going to parties. If you aren’t used to standing for long periods your low back may feel tight or stiff, sometimes nagging for the rest of the day.
Do not fear! This is a common problem and it is estimated that 80% of our population suffers from back pain at some point in their life. We want to share some possible causes, a few tips to prevent this from happening and some stretches to help relieve the pain when it does.
Postural Stress and Muscle Fatigue
Postural Stress - In standing, the pelvis pushes or drops forward, increasing the curve in the lower back and thus increasing the pressure on the spine and the surrounding muscles. The increased pressure on your spine can make the lower back muscles tighten and go into spasm and cause pain.
Muscle Fatigue - Without good core/abdominal muscle strength AND endurance to offset the load on the spine during prolonged standing, the muscle spasm or pinching of the nerves will occur sooner and may be more intense. People who are overweight may be at increased risk for muscle fatigue while standing for long periods.
Common Underlying Spinal Changes
If your body and spine has any underlying degenerative changes, pressure on the nerves may be increased and pain may be more intense with postural stress and fatigue. Here are some common causes of back pain...
Spinal Stenosis- This is a narrowing of the spaces along the spine which increases pressure on the spinal cord and nerves. Spinal stenosis symptoms may include leg weakness, numbness in the buttocks or the back of the legs, and relief by leaning forward.
Degenerative Disc Disease - With age, the protective discs between each vertebrae may have “wear and tear”, shrinking or loss of height due to loss of water, or bulging/herniated discs. The degeneration of the disc leads to pressure between the vertebrae and along the nerves coming out along the spine.
Hyperlordosis - Also known as “swayback”, this is an excessive curvature of the lumbar spine causing the stomach to stick out and the buttocks to become more prominent. This increased curvature places pressure along the back of the spine. It also creates a muscle imbalance between the abdominal muscles and back muscles, leading to core weakness and decreased spinal stability.
Osteoarthritis - This is wearing of the cartilage along the bones in the joints, which affects the smooth movement of the bones and can cause pressure on surrounding nerves.
Pinched Nerves or Sciatica -Pain from the nerves may be caused by pressure from any of the above changes in the bones, cartilage, or muscles surrounding the spine.
How to Relieve the Pain Standing for a Long Period of Time
What if I Can't Relieve My Back Pain When Standing or Walking?
If the low back pain remedies listed above do not help, it may be worth seeing a physical therapist. We are movement specialists and can get to the root cause of your pain and assess exactly what exercises and pain relieving techniques you need to use. Click Here if you need to speak with a movement specialist!
The first principle of water is buoyancy. The definition is the amount of upward force equal to the amount of water displaced. It's the same reason boats float. Because of buoyancy we feel unweighted in the water. The deeper you are in the water, the more water is displaced, and the more lift you feel in the water. Frequently, clients tell me, my legs (or my body) just FEEL SO HEAVY. That's where water becomes a solution. Those heavy legs are unweighted, allowing for free movement. We have people who can run in our pool who wouldn't be able to jog 10 ft without the assist of buoyancy. Not only does it feel the unweighting relieve a lot of pain, but the movement builds confidence and feelings of achievement that are sometimes hard to get in the gym.
The next principle of water is viscosity, which is technically "a measure of its resistance to deformation at a given rate". Basically, how thick is the fluid. It would be a lot harder to move through syrup than water because it's so thick. But the cool thing about about water viscosity is that it allows you to control the amount of resistance in each movement. The faster you move in the water, the more resistance you will feel. Each person can easily control the amount of resistance in each movement by controlling their speed. Liftng weights or using a machine can seem intimidating, plus, lifting weights only works your muscles in one direction. In the water, you get resistance in every diagonal or circular move you make. The water allows you to strengthen you bodies in movement patterns that you use everyday such as lifting, carrying, steeping, or climbing. One client practices the movement pulling up her pants while in the water. The movements don't matter how big or small.
My favorite reason for water exercise or therapy is the positive emotional and relaxation state that being in and around water provides. In his book, A Blue Mind: The Surprising Science That Shows How Being Near, In, On, or Under Water Can Make You Happier, Healthier, More Connected, and Better at What You Do, Wallace J Nichols talks about research shows the brain's reaction around water. The research proves that water can put us in a mildly meditative state, decreases our stress hormones, and increases our ability to focus. That state of mind is very difficult for those dealing with chronic pain, which makes getting in the pool, the perfect place to start a journey to recovery.
It’s mid January, which is about the time that resolutions start to fall off. Some research suggests that by February each year, 80% of resolutions have already been broken. Making a new habit is hard enough, but especially hard if you have other challenges or pain to overcome.
Or maybe, you didn’t even make a new resolution because you are resigned to inactivity due to back pain? So far this year (and it’s only the first full week), I’ve had clients tell me that..
1. Get Your Joints Moving!!
Movement is the key! Moving you to better health! These are phrases spoken in our clinic frequently. But when your joints are stiff, movement is often a challenge. It’s important to gain movement in the joints before strengthening, or else you will start compensating and create a whole new problem. Sometimes a hot shower is enough to get you moving, or maybe it’s getting back to a stretching program that has been helpful in the past. If you have a chronically stiff back, I recommend you see a movement expert (like a physical therapist) to learn a safe way to regain mobility before you start a strengthening program.
2. Pace Yourself!
We all tend to get very excited about new goals and jump in full force. How many of us have felt SO motivated with a new workout and then couldn’t move the next day? (I did it last week). Even when you have a good, safe exercise plan, “overdoing it” will could cause muscle soreness, inflammation, or re-injury to the low back. Our muscles provide support around the spine, but with an exercise routine those muscles are not prepared for, they will easily fatigue and fail to provide the necessary support your body needs for optimal function.
3. Stay Hydrated
One of the biggest mistakes that could be contributing to your pain and zapping your energy is being dehydrated. Dehydration can cause muscle aches, pains, fatigue, and dizziness. Recovery after a workout is delay with dehydration. Try to drink water throughout the day and avoid excess caffeine, including coffee, tea, alcohol.
4. Get Assessed by an Expert.
Your first thought may be to see your doctor before starting a fitness plan. While that’s not a bad idea for medical clearance, not all medical doctors are fully experienced at evaluating back pain. Medical doctors will send you for imaging and look for serious problems, like broken bones, but they do not take the time to assess your movement in detail and look and muscle imbalances. A specialist physical therapist will assess you in detail and will be able to give you more specific information on how your pain may affect any exercise or activity that you want to start. A physical therapist can make recommendations of how to customize your plan, give you reasonable expectations, and send you off towards your new goal with decreased risk for injury. If you need help trying to figure out a way to start – click here to schedule a free discovery visit with me to create a resolution you can stick with.
Happy New Year – Keep moving toward better health!!!
Do I need to get a MRI first??
This is a very frequent question that I get from clients, especially those with neck and back pain.
Many clients think they need an MRI or Xray before starting physical therapy because “I don’t want hurt myself more”. Or, like my own mother said… “I don’t want to go to the doctor because they will make me get a MRI and I’m not going into that tube!” It’s normal to be anxious about your care, especially when you’re having pain shooting down your leg, or numbness in your arm. But don’t let those fears keep you from getting the care you need. The sooner you start addressing your symptoms the more likely you are to get relief without medication, surgery or injections.
I can certainly understand why it’s tempting to get an MRI, especially when looking for an answer and cause of your pain. MRIs are an amazing advancement in technology that can easily diagnose abnormalities in the spine or joints, tumors, cysts or other tissue damage. However, MRIs, and Xrays too, can give a lot of false alarms, especially when talking about back and neck pain.
What? False Alarms?
You see, MRIs are so good at what they do that they find many problems and disc degeneration that most of us already have starting as early as our late 30’s. Just because you have degeneration, doesn’t mean you have pain. Multiple studies have shown that MRI results of stenosis, disc herniation, and nerve compression are positive, even on test subjects with NO PAIN! In addition, the radiologists reading the MRIs have no clinical context of what pain the patient is having, and they will address any degenerative changes they see creating a list of diagnoses that may have NOTHING to due with the cause of pain. Even if the MRI is detecting a problem that is the site of the pain, the MRI can not predict your own body’s ability to heal. I’ve had a few myself, but in the end, they have made no difference in my recovery.
So how do I find out the ROOT CAUSE of the pain?
Most people don’t realize that 70-80% of all spine and musculoskeletal problems are “mechanical”, which means the problem is related to the way you move. You could have muscle imbalances, tight muscles and joints related to bad posture, previous injuries, or general “wear and tear” on our joints. Many of these problems start to show up in our 40’s, 50’s, and 60’s due to years of bad movement patterns and compensation. The easiest way to find out about these “mechanical issues” is to ask a physical therapist. These movement and strength imbalances are best corrected with … Movement and Strengthening!
Why not be over cautious and get an MRI anyway?
If you have had a traumatic accident, a fall, or a long history of pain, then YES, seek medical advice and probably a MRI. But it you have a history of a nagging pain, that has recently gotten worse, or started to affect your ability to do the activities you enjoy, then seeing a physical therapist is a good idea. A physical therapist is a movement specialist and can determine if it is not a mechanical problem and if you need to be referred to a physician. A physical therapist may be able to save you money for the cost of the MRI and the anxiety of “going into the tube”.
Here's another article that gives even more information about the overprescription of MRIs and how they can lead to chronic pain, use of medications, and higher disability scores.
You can always download our Free E-Book 9 Ways to Relieve Back Pain without Taking Pain Medications or Missing the Activities You Love for tips to try and manage back pain at home.
We help active adults get back to exercising, feeling fit, and participating in the activities they love without medications, injections, or surgery.
Catherine Courtney, PT
Specialist Physical Therapist