Post-covid Physiotherapy

Post-COVID physiotherapy is therapy given to patients who have recovered from COVID -19 but are suffering from the long-term side- effects of COVID-19. Post-COVID physiotherapy helps to improve the functionality of the musculoskeletal, cardiovascular, and respiratory systems. It also improves cognition and decreases depression and anxiety.

Post-COVID physiotherapy not only improves overall strength and cognition but also decreases depression and anxiety. Other benefits are:

• Improves oxygenation
• Improves ventilation.
• Decreases dyspnea
• Causes easy and effective breathing
• Decreases fatigue
• Increases muscle strength and functionality

Relaxation Exercises

Relaxation increases the flow of blood around our body and thus generates more energy. It helps to improve memory, concentration, and positive thinking.

Bronchial Hygiene Techniques:

Postural drainage:

• Postural drainage is a technique used for cleaning the airways through chest physiotherapy. This technique includes percussion, huffing, coughing, and clearing the secretions by placing the patient in various gravity-assisted positions.
• The forced expiratory technique is used to expel the sputum and reduce coughing and energy consumption. Positive expiratory pressure technique used to assist forced expiration.

Percussion:

• Percussion is a rhythmic clapping technique with cupped hands over the involved lung segment. Percussion should produce a hollow sound, and not result in overpressure on the soft tissues of the chest.  It should impart an energy wave transmitted through the chest wall to cause the loosening of bronchial wall secretions. The hand should create an "air cushion"  impact, which, dislodges the pulmonary secretions. Percussion is performed during both inspiration and expiration. The trapped air which makes a hollow sound is believed to be responsible for loosening the secretions.

Vibration:

• Vibration is used in conjunction with postural drainage. Vibration is the intermittent compression of the chest wall performed during expiration. It may be initiated for a few seconds before the expiratory phase and extended to the beginning of the inspiratory phase. This technique should be performed over the involved area of the lung.

Coughing:

• Coughing is effective in the removal of excessive quantities of sputum.  Airway clearance is an important part of the management of patients with respiratory conditions. During a normal cough, there is an inspiratory effort that causes the Glottis to close. There is an increase in intrathoracic and intra- abdominal pressures as the abnormal muscle contract and the diaphragm elevates causing the Glottis to open and explosive expiration of air occurs.

Breathing Exercise

Self-Awake Proning:

• The patient lies in a prone posture on the abdomen or belly by facing down toward the bed. A pillow is kept below the neck and chest. Two pillows were kept below each shin. Make sure that the patient lies comfortably. Spend not more than half an hour in each position. (i)Lie on your stomach by the stomach facing towards the bed for 30 minutes. (ii) Side-lying position to the right side in side-lying, lie on your right side for 30 minutes. (iii)Sitting up, sit up in the bed with your back supported and both legs extended for 30 minutes. (iv) Side-lying position to left side: lie on your left side for 30 minutes. (v) Lying on your stomach, return to lying on your stomach by facing towards the bed for 30 minutes.

Diaphragmatic breathing:

• When the diaphragm is functioning effectively as the primary muscle of inspiration, ventilation is efficient and the oxygen consumption of the muscles is very low during quiet relaxed breathing. Diaphragmatic breathing, help decrease the work of breathing, improves the efficiency of ventilation, increases the excursion of the diaphragm, and improves gas exchange.

Lateral costal Expansion:

• The lateral costal expansion focuses on the movement of this portion of the lower rib cage (bilaterally or unilaterally) and is thought to facilitate diaphragmatic excursion.

Pursed lip breathing:

• Controlled expiration with gentle pursed-lip breathing. This mechanism keeps the airways open by creating backpressure in the airways. Pursed lip breathing increases the tidal volume decreases the respiratory rate and improves exercises tolerance.

Incentive Spirometry:

• Incentive spirometry is a technique used for maximal inspiration. It is a form of ventilation training that focuses on sustained maximum inspiration. The spirometer provides visual or auditory feedback when the patient inhales and breathes as deeply as possible.

Mobilization:

• The patient is made to do active and passive joint range of motion (ROM) & stretching exercises, which lead to an increase in muscle strength and functionality. Initially, a functional assessment is done to evaluate the motor condition of the patient.
• Neuromuscular electrical stimulation can also be given to strengthening the limb muscles.

Low-intensity activity Exercises:

• Low-intensity activity exercises can be done and gradually moved towards more intense activities. These exercises can be Shoulder circles, Shoulder shrugs, Knee lifts, Ankle circles, Ankle taps, Side bends, Step-ups, Bicep curl, Wall push-off, Arm raises to the side, Knee straightening, Heel raise, and Squats.

Muscle stretches:

• Stretching the muscles can help to reduce soreness.  Each stretch should be performed gently and should be held for 15-20 seconds such as Side-stretching, Shoulder, stretching, Back thigh (Hamstring) stretching, Lower leg (Calf stretching, Front thigh (Quads) stretching,  Stretching can also be done by sitting down on a stable chair.

 Strengthening exercises by Resistance Training:

• Strengthening exercises include cervical isometrics, upper limb dumbbell exercises, plank on the ball, plank-side for core strengthening, push-ups, bridging, gluteus sets, quadriceps sets, hamstring sets, heel raises, squats, etc with a reduced load and repeated 8-12 times, 1-3 times a day, with 2-min rest in between the sets, 2-3 sessions per week for 6 weeks should be done. Load should be increased each week, the patient should also do balance exercises to improve balance.

Aerobic Exercises:

• Aerobic exercises like individualized walking, brisk walking, slow jogging, and swimming programs should be started with low intensity, for a short duration, 3-5 sessions per week, each session should last for 20 - 30 min.

Education

• Patient and caregiver education plays an essential role, smoking cessation, peripheral muscle training, bronchial hygiene, adequate nutrition, a healthy mind, and oxygen therapy are important in improving lung function. Precautionary measures should be strictly followed such as hand washing at frequent intervals, wearing masks in public places, and maintaining social distancing.

Post-COVID Physiotherapy should not be given to patients with other complications or in case a few chosen techniques are given then they should be given after the consultation of the physiotherapist or other medical professional. These conditions include:

• Pregnancy
• Deep venous thrombosis.
• Major cardiac conditions.
• Fractures
• Bleeding
• Pneumothorax
• Pulmonary emboli.
• Increased ICF
• Uncontrolled hypertension
• Head and neck injury.