Physiotherapy and how it can be used to treat the after effects of Coronavirus

Irene Muwanguzi* contracted Covid-19 with no severe symptoms, except cough. She was admitted to Mulago Hospital. While in the hospital she was given a series of chest exercises, including a bit of ambulation (moving around).  

While on treatment, she lost her husband and was not able to go for burial.

At the time of her husband’s death, her blood oxygen levels were low, mainly affected by inactivity. She remained in hospital for about two months until she tested negative. She was discharged but still had the symptoms of fatigue, chest pain, and breathlessness.

When she returned to hospital with these symptoms, the doctor carried out a chest Computed Tomography (CT) scan to find out why her oxygen saturation was low only to find out that the virus had affected part of her lungs. Fibrous tissues had developed on the lungs and she had also developed high blood pressure.

The doctor recommended that she get plenty of rest and that it would help her recover over time but when she sought medical advice from a physiotherapist regarding her persistent low oxygen saturation and easy fatigability, she was started on rehabilitation.

Her therapy included a series of exercises, including breathing exercises, assisted active coughing, walking, upper and lower limb exercises, stretching, resisted exercises among others. 

A month later, she had greatly improved, her heart was no longer racing, she felt stronger, her breathing improved, and slowly went back to doing her duties as a mother.

Why you need physiotherapy

Muwanguzi is one of the many people that suffered the aftereffects of the Coronavirus infection yet still some of them do not know where to go for help. One in every 10 people that suffer from the Coronavirus end up having these aftereffects and these symptoms may appear 12 weeks after infection even after the laboratory results come negative.

Many people after suffering mild to severe cases of the Coronavirus infection develop aftereffects such as extreme tiredness, memory loss, chest tension, sore throat, insomnia, shortness of breath, pain and difficulty in breathing, heart palpitations, dizziness, anxiety and depression, muscle and joint pain.

According to Isaac Kakooza, a senior physiotherapist and president, Uganda Association of Physiotherapists, there are some people that feel so tired after doing some things which they previously did with ease (post exertion exhaustion) and this can only be treated with physiotherapy, to help them run their normal activities again.

He says; “Long term consequences of Covid-19 which usually presents with clusters of symptoms, often overlapping, can fluctuate and change over time and can affect any system in the body for more than 12 weeks.”

“The role of physiotherapy is to restore, maintain and optimise the body function for people who have been affected by the virus. Knowing that the virus affects the lungs, the exercises and workout in physiotherapy can help in decongesting the lungs and help the patient breath even when they are in the ICU,” he says.

Safe and effective rehabilitation is a fundamental part of recovery. Rehabilitation for Covid-19 aftereffects must be designed for the individual, depending on their symptoms, severity of the disease, goals and preferences.

Regardless of the symptoms you experience, your physiotherapist will treat you as an individual and get to know the underlying cause before starting treatment.

In order to best meet your needs, a physiotherapist will work with other health professionals as part of your assessment and rehabilitation programme. Various tests may be carried out to understand and find the cause of symptoms such as: breathlessness, chest pain, heart palpitations, fatigue, feeling faint, fizziness and low oxygen saturation.

The range of activities

Physiotherapists prescribe activities depending on your need after an assessment. They also depend on the level of severity, situation and stage of treatment a patient is in.

 Generally, all patients need breathing exercises. Deep breathing is important in strengthening the respiratory muscles and helps in taking in more oxygen than the usual breathing and also clears the airway.

The mobilisation technique helps to improve movement and functioning of muscles, joints and ligaments. It is done by moving limbs (both arms and legs), raising shoulders and these reduce pain while improving flexibility.

Muscle strengthening exercises and joint mobilisations are also essential because if the muscles are strong enough, they get the required nutrients which boost the immunity of the body to fight the disease.

Once one is out of the ICU, they can have assisted ambulation up and down the stairs to help strengthen the muscles in the legs to help them walk again. At home, the patient can play around with children or a ball to help in mobility.

Annette Grace Nakalyango, a physiotherapist at Mulago Hospital says, “Balance and coordination exercises are also very essential for patients that have been immobile for some time. They will have lost the balance and fear to walk because they usually fall. They instead sit back which weakens their muscles even more.”

Many people that get rehabilitation after the Coronavirus infection often get immediate results. This however, depends on the age of the person, the extent of the disease and how committed one is in following the instructions given by the therapist.

“There are some symptoms that may take some time for you to feel the change and these need persistence. You may start doing the exercises in shorter durations but with time, you gradually increase the time and intensity of the exercises,” she remarks.

The World Health Organisation recommends that long Covid-19 rehabilitation should include educating people about resuming everyday activities conservatively, at an appropriate pace that is safe and manageable for energy levels within the limits of current symptoms, and exertion should not be pushed to the point of fatigue or worsening of symptoms.

It is also important to avoid going to the open gym unless it is inside your house to avoid getting a reinfection. Only do the exercises you feel comfortable doing and those that do not make your symptoms worse.

Patients in the ICU need to be laid in a prone position that helps support breathing, open their lungs and increase their oxygen intake. There is also need for assisted coughing, percussions (rhythmical clapping motion on the chest wall with a cupped hand to loosen the secretions from the sides of the lungs), vibrations to help clear secretions and prevent chest infections.

The urgency 

Annette Grace Nakalyango, a physiotherapist at Mulago Hospital says that one needs to start physiotherapy right from the time one is diagnosed with the virus.

The coronavirus attacks the lungs mainly which impairs the breathing and the lung tissues and structures become fluid-filled which necessitates the help of a respiratory physiotherapist to help the person improve their breathing. “Patients need physiotherapy even in the early stages of treatment as long as one has been diagnosed with the virus before the disease progresses to the extent of weakening the lung muscles which impairs breathing,” she says. 

She remarks that you do not have to wait for the lungs to get impaired for you to start physiotherapy. The earlier you start rehabilitation, the faster the results, “but it is never too late for anyone to join rehabilitation,” she remarks.

One needs physiotherapy at the time when they find out that they are infected and throughout treatment (acute period) especially those that need machines to support their breathing in the Intensive Care Unit by helping to position the patient in such a way that helps decongest the lungs. The package for those in the ICU and have difficulties in breathing can include breathing exercises.

Nakalyango says, “You need physiotherapy to clear airways, strengthen breathing muscles and the general body, the core muscles for balance, the legs and help you walk again especially those that have been hospitalised for a long time.”

The urgency 

Annette Grace Nakalyango, a physiotherapist at Mulago Hospital says that one needs to start physiotherapy right from the time one is diagnosed with the virus.

The coronavirus attacks the lungs mainly which impairs the breathing and the lung tissues and structures become fluid-filled which necessitates the help of a respiratory physiotherapist to help the person improve their breathing. “Patients need physiotherapy even in the early stages of treatment as long as one has been diagnosed with the virus before the disease progresses to the extent of weakening the lung muscles which impairs breathing,” she says. 

She remarks that you do not have to wait for the lungs to get impaired for you to start physiotherapy. The earlier you start rehabilitation, the faster the results, “but it is never too late for anyone to join rehabilitation,” she remarks.

One needs physiotherapy at the time when they find out that they are infected and throughout treatment (acute period) especially those that need machines to support their breathing in the Intensive Care Unit by helping to position the patient in such a way that helps decongest the lungs. The package for those in the ICU and have difficulties in breathing can include breathing exercises.

Nakalyango says, “You need physiotherapy to clear airways, strengthen breathing muscles and the general body, the core muscles for balance, the legs and help you walk again especially those that have been hospitalised for a long time.”

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