What If Your COVID Symptoms Don't Go Away?

What If Your COVID Symptoms Don't Go Away?

What If Your COVID Symptoms Don't Go Away?

You may have heard about people who got a COVID-19 infection and have symptoms for weeks or months after. This is now referred to as Long COVID. In this article, we're going to dive into what Long COVID is, what the symptoms are, and who it affects. Later in the article, we'll talk about strategies that are helping people with Long COVID and where Barkman & Smith Physical Therapy fits in. Let's get started.


Long COVID is generally defined as ongoing signs or symptoms lasting 12 weeks or more after a COVID-19 infection.


Like all things COVID-19, we don't fully understand Long COVID and new information is being discovered all the time. Long COVID tends to involve more than one system and currently has a list of over 200 possible symptoms. The most common are:

  1. Fatigue
  2. Post-exertional symptom exacerbation (PESE)
  3. Problems with memory or concentration often referred to as "brain fog"

Other common symptoms are shortness of breath, chest pain or tightness, insomnia, muscle or joint pain, depression/anxiety, and stomach problems like stomach aches, loss of appetite, or diarrhea.


Long COVID fatigue is extreme exhaustion that isn't relieved by rest or sleep. It's not fatigue after some physically demanding task. People experience exhaustion for no obvious reason. The fatigue is so severe that it impacts the ability to complete daily tasks.


Post-exertional symptom exacerbation is a disabling and often delayed exhaustion disproportionate to the effort made. Patients are referring to this as a "crash". PESE is very common in people suffering from Long COVID. 75% of people who have Long COVID have PESE after 6 months. The activity that brings on the crash is something that the person could easily tolerate before their COVID-19 infection. Things like taking a shower, walking, attending a social activity, or even being in a high sensory environment with flashing lights and loud noises may all now trigger a crash.


This is difficult to answer. We still don't understand what causes some people to have symptoms long after their initial infection. What we do know is that about 25% of people who get COVID have symptoms that last at least a month. Around 10% of the people who get the virus will experience Long COVID. Long COVID isn't related to how severe your initial symptoms were, or if you were hospitalized. It also doesn't appear to be related to your previous health as it affects children and people who were previously fit and healthy.

Now that you know what Long COVID is, in our next installment we'll talk about what's being done for it and how physical therapy helps.

What If Your COVID Symptoms Don't Go Away?

What Barkman & Smith Physical Therapists can do to help people living with Long COVID you may ask. Early in the pandemic, therapists started seeing people with what would later be known as Long COVID. They noticed that some of the symptoms people were describing overlapped with conditions they had treated before. Specifically, Myalgic Encephalomyelitis and Chronic Fatigue Syndrome also caused severe fatigue and delayed symptoms after activity. Because of this overlap, the current treatment for Long COVID is heavily based on what we know works to manage these diseases.

Here are a few strategies to managing Long COVID symptoms: 


The first strategy that can help manage Long COVID symptoms is pacing. This is simply doing less activity than you have energy for. By keeping bouts of activity short with lots of breaks, pacing can help avoid severe fatigue immediately after activity. It can also avoid the delayed "crash" of PESE. A useful metaphor is to think of your energy level as a battery. When you do activities, you drain your battery. When you rest, you charge it back up a little bit. Physical therapists can help patients learn how much energy is in their "battery" and work to teach them strategies to conserve it. When used effectively, pacing can help patients with Long COVID accomplish more with less fatigue and fewer bouts of PESE.


Another strategy that comes from ME and CFS management is heart rate monitoring. With the huge number of wearable devices that monitor heart rate, this is becoming an easier strategy to use than ever. Heart rate monitoring uses your heart rate as a gauge of how hard your body is working. It's based on your resting heart rate, which should be taken after you've been lying down, relaxed for at least 20 minutes. First thing in the morning before you get out of bed is a great time to measure your resting heart rate. Once you have your baseline, the goal is to keep your heart rate within 15 beats of your RHR while you're doing activities. This keeps your heart rate below the threshold at which your muscles start to produce lactic acid. Build up of lactic acid is what gives you "the burn" when you're working out really hard. It also causes your muscles to fatigue more quickly - by keeping activity light enough to avoid lactic acid, we can also reduce fatigue.


What about exercise? Sure, lots of people think about exercise when they think about PTs. But exercise can make some diseases worse. For people living with Long COVID, CFS, or ME, "toughing it out" or "pushing through it" won't make them stronger. It will cost them days of their lives - leaving them barely enough energy to get out of bed or complete basic tasks. For long-term, sustainable recovery, the first goal of rehabilitation of these folks is to stabilize and manage their symptoms. Using pacing, heart rate monitoring, and other strategies like breathing exercises can stop the fatigue cycle and start to get the body responding to activity more normally. Only then can we very gradually and cautiously introduce exercise into the mix, monitoring symptoms during and after activity to make sure we don't overdo it.

As we learn more about the pathology behind Long COVID's symptoms, rehabilitation will surely change and improve. But people who are living with Long COVID can't afford to wait until science figures everything out about their disease. Fortunately, physical therapists have training and strategies that can help improve their lives right now.

We would love to help you in any here at Barkman & Smith Physical Therapy, please feel free to reach out to us with any questions you may have.



- Private Practice Section (ppsapta.org)