What is the role of physiotherapy during the COVID-19 pandemic?

Today, physiotherapists increasingly see patients with COVID-related complaints such as fatigue, shortness of breath, memory and concentration issues, muscle and joint pain, fever, sore throat and changes in smell and taste. The provisional definition states that we can speak of long COVID when people continue to have symptoms for more than 12 weeks after infection with the virus. Although much is still uncertain about the (long-term) consequences of the virus, it is clear that patients benefit from treatment by a multidisciplinary team, which may include a general practitioner, an occupational therapist, a psychologist, a speech therapist, a dietician and, of course, a physiotherapist. On the occasion of World Physical Therapy Day, today 8 September, we spoke to physiotherapists Lisa, Jasper and Evie about their experiences during the pandemic.

Which complaints can be relieved by physiotherapists after a COVID-19 infection?

The three therapists are in complete agreement: there is no such thing as your typical COVID-19 patient. And that’s only logical if you consider the over 200 related symptoms that have been registered to occur in various combinations and degrees. Besides, some patients already had underlying issues. Evie: “We see patients who were healthy before their COVID-19 infection and then developed various symptoms. But some patients have other diseases or conditions in addition to the effects of COVID-19.”

And just like there is no typical patient, there is not just one treatment either. Lisa: “As always, we look at the patient as an individual. We first identify the disorders and limitations and then start targeted therapy. In this way, all relevant COVID-19 symptoms presented by the patient are addressed during the treatment, but within the possibilities and limitations that any comorbidities entail.”

In order to identify the disorders and limitations, the therapist first take an anamnesis. During this process, the patient talks about his or her own experiences and the patient’s subjective problems are recorded. After that, the physiotherapist will examine the patient and identify the objective problems and combine the results of both parts of the examination. A restriction in load capacity experienced by the patient can be explained, for example, by reduced muscle strength in the leg and/or respiratory muscles and reduced endurance. The treatment is then adjusted accordingly.

What role do physiotherapists play in the treatment of patients with long COVID?

The help that a physiotherapist can offer a patient with (long-term) symptoms after a COVID-19 infection depends on the symptoms and is therefore very diverse. Evie: “A 52-year-old man came to see me more than six months after his COVID-19 infection with a persistent reduced energy level, lowered ability to work and shortness of breath. Whereas he could normally walk for hours, now he could do so for only 10 minutes. We focused on slowly increasing the load capacity by means of exercise therapy aimed at both endurance and muscle strength. The treatment worked well: after about three months, his shortness of breath no longer restricted his activities.” Jasper: “A patient in her late 60s suffered from altered taste perception after a past infection, but was also extremely tired and short of breath. In her case, I started with breathing exercises to prevent pneumonia.” Evie: “I have also seen patients with tension problems in their back and neck because they are bedridden and cough frequently. In these cases, in addition to physical activation, my treatment consisted of loosening the affected muscles, for example through trigger point treatment, massage and stretching. If necessary, I also taught them relaxation exercises for at home.”

How can the physiotherapist help with indirect effects of COVID-19?

The physiotherapist can help not only with direct consequences of the virus, but also with indirectly related complaints. Evie: “In the last year, I have seen more patients than usual with neck and/or back pain because they are required to work from home in a poorly organised work setting, which it entails for many people. To optimise a person’s home office, I call in the help of occupational therapy. I teach patients posture exercises and give them tips and advice on how to reduce the strain on the body under the modified conditions.” Jasper: “I have seen patients who have become very passive due to the prolonged closure of their gym or club, which has led to weight gain and back problems. In that case, I try to teach them exercises that they can do at home, so that they are less dependent on their club.”

Physiotherapists thus provide patients with an insight into their issue and, together with them, find a way to optimise the situation, whether it is work, sport or general daily life. Physiotherapists also refer patients - if necessary and whether or not via the general practitioner - to other (para)medical disciplines. A multidisciplinary team is therefore a must for any COVID-19-related problem. Lisa: “I have seen patients, especially adolescents, who came to me with physical symptoms unrelated to COVID-19, but who also had mental issues due to social isolation. In those cases, after consulting with the patient, I first contact a general practitioner for a possible referral to a psychologist. Then we start an exercise programme together because it has been proven that activation helps to alleviate mental health problems.” The physiotherapists who were interviewed also see more patients as a result of delayed care by the hospital. Lisa: “The worst cases I have seen are the people who suffered from a delay in mainstream care. I am talking, for example, about people with severe arthrosis of the hip or knee. Physiotherapy is the only thing that keeps the pain and the associated restrictions somewhat bearable. The focus is not only on pain relief, but also on maintaining functionality. I often use dryneedling, joint mobilisation and exercise therapy for this.”

When should I contact a physiotherapist?

Some physical and/or psychological problems do not resolve themselves. It is no different with COVID-19 symptoms. There is nothing wrong with giving the body a little time to find its own way, but as soon as progress is slow or stagnant, it is wise to get professional help. The importance of a multidisciplinary team should not be underestimated. And a physiotherapist makes a useful and indispensable contribution to that multidisciplinary team. So if you have had COVID-19 and are experiencing symptoms and limitations in movement, be sure to make an appointment with a physiotherapist.