Long COVID is defined as ongoing symptoms for more than 12 weeks after the initial infection. Exactly what those symptoms are varies. There’s currently a list of over 200 possible symptoms – but most people have the 3 most common. Those are: extreme fatigue, post-exertional symptom exacerbation, and problems with memory or concentration – commonly referred to as “brain fog.”

The extreme fatigue associated with Long COVID affects the ability to complete daily tasks. It causes severe tiredness that you can’t get rid of with rest or sleep. It’s also not related to doing some physically demanding task.

Post-exertional symptom exacerbation, or PESE is a disabling and often delayed exhaustion disproportionate to the effort made. Patients are referring to this as a “crash”. The activity that brings on the crash is something that was easily tolerated before the COVID-19 infection. Some examples would be taking a shower, walking, attending a social activity, or even being in a high sensory environment with flashing lights and loud noises.

“Brain fog” isn’t a medical condition. Instead, it’s a term used by patients to describe thinking that is sluggish or fuzzy. In severe cases, people describe it as feeling like their brain shuts down. They could be in the middle of a sentence and not be able to think of anything more to say. They could be at work doing a task they’ve done a thousand times and be unable to think of the next step. Just like the extreme fatigue and PESE we’ve already described, the brain fog associated with Long COVID is disabling and affects every aspect of daily life.

We’re still learning exactly what causes Long COVID and how best to manage it. What we do know is that Long COVID has an ongoing effect on patients. It touches every part of their lives.  We also know that we need to learn more about this condition and how to help people who have it.

Physical Therapists play an integral role in helping people with Long COVID.  I’ve had the privilege of working with clients suffering with Long COVID. Working together, we do get people back to the activities they love. Call us today to discuss how we can help you!

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• COVID 19 recovery

The second one is much longer, and it tells the story of recovery after the ICU. Being that ill has far-reaching effects. Significant losses of physical, mental and cognitive abilities after discharge aren’t uncommon. This group of problems is called Post-Intensive Care Syndrome or PICS. It’s a serious issue that’s now recognized as a public health burden. 

The effects of PICS are wide-reaching. Physical declines can lead to serious difficulty completing basic daily tasks like getting to the bathroom, preparing a meal, or walking to the mailbox. 50% of ICU survivors still have limitations in daily activities 1 year later, showing how serious and long-lasting this problem is.

Mental health issues are common for ICU survivors. They show significant rates of depression, anxiety and PTSD. These conditions have a real impact on the quality of life after leaving the ICU. 

ICU survivors also commonly show declines in cognitive abilities. 77% have cognitive impairments at 3 months post-discharge and 71% have impairments 1 year out. Cognitive issues can take the form of poor memory, slower thinking, difficulty making decisions, or difficulty concentrating. 

An important professional in combating PICS is the physical therapist. They typically begin seeing the patient in the ICU. PTs are vital in getting the patient up and walking early. A progressive exercise program is also started as soon as it’s safe for the patient.

While PICS isn’t totally preventable, recognizing the losses that remain after discharge from the ICU is an important step. Involving physical therapists and other rehab professionals early helps combat the effects of PICS and allows patients to return to higher-quality lives.

I’ve had the privilege of working with many COVID survivors in their recovery. I’ve listened to their stories, held their hand, and encouraged them as they work hard in my clinic to regain their strength, endurance, mobility and independence.  The toll that the virus has taken on them is very real and unique for each individual. Some have lost their strength and balance. Some suffer from severe dizziness and vertigo. Some suffer from vague multi-joint pain. All are survivors. All are brave.  And I’m continually humbled by the opporunity to help them in the next phase of their recovery. 

5 Reasons you need a Physical Therapist to Coordinate your Fitness Regimen

YOU WANT A BASELINE

When you see a physical therapist to improve your fitness, you’ll get an assessment of your strength, range of motion, posture and movement patterns. This not only helps your physical therapist design a customized program just for you, it gives them a baseline to compare things to in the future should you start having pain or suffer an injury.

YOU WANT EXPERT GUIDANCE

Sure, other professionals could help with your fitness routine, but the fitness industry is not well regulated. Some certifications just require an online course and paying a fee. There are no licenses or other requirements to use many titles. Becoming a physical therapist requires at least a bachelor’s degree and most PTs practicing today have a doctorate. Every PT has passed a national board exam and maintains a state license. That guarantees you that every physical therapist is a verified expert in human movement.

YOU WANT TO PREVENT INJURY

Physical therapists don’t just work to heal injuries, they are also experts in preventing them. After a thorough assessment, a PT can help you design a program that will not only help you reach your fitness goals, but that can address any issues that increase your risk for injury.

YOU WANT UNBIASED ADVICE

Yoga instructors will want you to do yoga. Personal trainers will want you to come to their gym. Pilates instructors will want you to do Pilates. Strength coaches will want you to strength train. A physical therapist doesn’t have a bias or vested interest as to what type of fitness regimen you choose. They are only interested in helping you reach your goals.

YOU HAVE A HISTORY

If you have some kind of history that affects your ability to exercise, a PT is the best person to help you design a fitness regimen. It doesn’t matter if it’s an old injury from athletics or work, back pain that comes up from time to time, COPD, arthritis or heart disease, a PT can help you safely work around it and meet your fitness goals.

Each and every year I see clients that have set resolutions around their health and fitness. They join a local gym, start their new exercise program, get sidelined with an injury and give up on improving their health and fitness because now they are in pain and they don’t know what to do to overcome their injury or how to prevent it from recurring again in the future.

This is the problem with most community-based gyms and fitness centers. Each member gets put into a big class with a program that is supposed to be embraced by each member.  But this doesn’t work. Each individual’s fitness needs are unique and dependent upon a variety of factors that only a physical therapist is specialized in assessing and treating.  Fitness trainers are not movement experts and they are not trained to assess, treat and prevent injuries. 

A physical therapist  is an expert in human movement, and can help you safely reach your fitness goals. People think of PTs as the person to see after an injury, but a visit before you change your activity level could prevent injury in the first place. An evaluation by your PT will include assessment of your strength, range of motion, and functional movement patterns – think jumping, running, squatting, carrying. 

Most common injuries from new fitness routines are caused by underlying weakness, range of motion deficits, or compensatory movement patterns. Your PT will find these during your assessment. They can then prescribe exercises or movements to address the issues found and get you safely moving into the new year! The other common way people get injured working towards their resolution is with overtraining, or doing too much too soon. Physical therapists are also experts in exercise prescription and program design. Your PT can help you create a routine specific to your needs and goals that will progress appropriately and keep you out of trouble. 

So stop only thinking of your PT after you’re injured. In this case, it’s true that an ounce of prevention is worth a pound of cure. Seeing your physical therapist before you start on your resolution can keep you on track, injury free, and help you reach your goals for the new year!

Ready to tackle your New Year Resolutions and Goals for a Healthier 2022? Contact us today!

Warm up right

A good warm up is always important, but because of the tendency for joints to be stiffer, and blood flow to muscles to be reduced in the cold, it’s even more important that you do it right this time of year. To start, do something to get your heart rate up a bit, maybe a brisk walk or light jog. Follow that up with a dynamic warm up rather than static stretches. This could include walking or jogging while pulling your knees up high to your chest. Maybe some high kicks in front of you with straight knees to get your hamstrings loosened. A walking lunge with an upper body twist can get your whole body moving. Cater your warm up to what you have planned in your workout. If you’re not sure how it should look, ask your physical therapist!

Dress right

Dressing in layers allows you to adjust your insulation to your activity level. After you warm up, you might want to take off a layer to avoid getting too hot during your main activity. You’ll have it there later to put back on when your activity level drops and you start getting too cold.

Don’t forget about the sun either – just because it’s cold doesn’t mean the UV rays are gone. Sunscreen and sunglasses aren’t just for the summer. A lip balm with SPF can protect you not only from the sun but from the wind too.

Stay hydrated

Drink water before, during, and after your workout. The temperature may be down, but you’ll still sweat and you’ll still lose water vapor in your breath. The drier air in winter lets your sweat evaporate more quickly, so it’s easy to underestimate how much fluid you’ve lost.

Cool down

When you’re done, don’t rush to get inside and crawl under a blanket. Cool down properly. Keep moving with a walk or another form of active recovery to let your heart rate come down. After exercise is the right place for static stretching. You can also head inside for some foam rolling or self-massage.

The days being shorter and the temperatures being lower don’t mean you’re stuck inside for all of your exercise. If you follow these tips, you can safely keep moving outside. If you’d like a customized warm up or cool down, or have questions about your exercise routine, your physical therapist is a great person to ask!

Runners and athletes of all skill levels and ages continually seek out the best strategy to decrease recovery time and boost their performance.  The respiratory system’s recovery mechanisms are complex and highly integrated and involve the buffering of metabolic by-products to maintain homeostasis which in turn helps to regulate the excitation-contraction process in localized muscle tissue.  Failure to maintain this homeostasis affects athletic performance and often develops when the respiratory system lacks its ability to maintain this homeostasis and exercise-induced diaphragmatic fatigue sets in. The diaphragm is a large muscle that sits at the base of the lungs.  Your abdominal muscles help the diaphragm move in a way that gives you power to empty your lungs.  

New research suggests that an athlete can accelerate their immediate recovery from exercise by maximizing the surface area of the diaphragmatic zone of apposition (ZOA). The ZOA is maximized when the spine is in a position of flexion (as in when bending over at the waist) as opposed to spinal extension (as occurs when arching your back which occurs when you position your hands on your head).  Thus, if the work of the diaphragm is maximized in a posture of flexion, it would appear that the Hands on Knees (HK) posture is the preferred posture of recovery. 

This specific study looked at  the effects of these recovery postures in female soccer players after performing repeated sprint intervals.  Research results revealed that the soccer players that assumed the hands on knees posture demonstrated marked improvement in recovery measures than those who assumed the hands on head posture.  

The hands on knees posture causes spinal flexion and internal rotation which maximizes the work of the diaphragm.  The Hands on head posture places the diaphragm in a suboptimal position, decreasing its efficiency, thus affecting the recovery of the athlete. 

The ability to recover efficiently and quickly is a critical component of optimizing performance and preventing recovery.  At our clinic, we incorporate the hands on knees posture with the athletes we work with in the rehabilitation of their injuries and to improve their performance. 

The next time you or your athlete needs assistance in recovery from high intensity exercise, try the Hands on Knees posture. I think you will be pleased with the results. 

1. Michaelson J, Brilla L, Supra D, McLaughlin W, Dahlquist D. “Effects of Two Different Recovery Postures during High-Intensity Interval Training” Transitional Journal of the ACSM 2019: Vol 4 (4): 23-27 

Postural Neglect

The most common cause of low back pain is postural stress.  Examples of this include  sitting for a prolonged period of time, prolonged forward bending, awkward or heavy lifting, or standing or lying down for a prolonged period of time in an awkward position.  With these postural stresses, the natural curve in our back, our lordotic curve, is flattened, thus placing stress on the intervertebral structures. Unfortunately many of us spend several hours a day with our low back in a flexed posture.  Over time, we lose the ability to maintaining our natural lordotic curve in our back and our low back becomes flattened, placing stress on soft tissues in our spine and surrounding tissues. This flattening of the lumbar spine often leads to chronic low back pain.

When pain from postural stress is initially felt, it can be eliminated by correcting the posture. However, as time passes, if poor posture becomes habitual, changes can occur in the joints, leading to excessive wear and premature aging of the spine. The effects of this poor posture can be as serious as severe and harmful injuries to the spine. 

Elderly who exhibit deformities of the spine are an example of poor postural habits. The bent, stooped posture is not the normal effects of aging. Rather, this bent, stooped posture is the result of years of poor posture that after years, becomes difficult if not impossible to reverse.  This is why it is so important to be attentive to maintaining good posture with sitting, standing, lifting and while resting. 

Sitting Posture

Poor sitting posture often leads to low back pain.  Once low back pain has already developed, poor sitting posture exacerbates the condition.  When we sit with a flattened low back posture for a period of time, the muscles that support our low back become tired and they relax. Our low back sags and this results in a slouched sitting posture.  If we maintain this posture long enough, it causes overstretching of ligaments of our spine and produces pain. Once this slouched posture has become a habit, it causes distortion of the discs contained in the intervertebral joints of the spine. Once this occurs, movements as well as positions produce low back pain. 

Prolonged Sitting

People with sedentary desk jobs often easily develop low back pain as they often sit with a slouched posture for several hours at a time. At first you may experience discomfort in the lower back while sitting for a prolonged period of time or when attempting to stand up from the sitting position.  This is caused by overstretching of the soft tissue structures of the spine.  As this progresses, you may find that you need to stand up and move around to cause the pain to resolve. As this postural neglect in sitting persists, you will find that you are not able to relieve the pain as easily and have difficulty standing up straight or walking.  Eventually you will reach a stage where you experience severe pain  that has resulted from major distortion of the affected joints and the affected joints cannot regain their normal shape and function to achieve normal movement. When a movement is attempted,, a disc bulge increases strain on the overstretched surrounding soft tissues. Further, the disc bulge may press on the sciatic nerve, leading to pain and possibly numbness and tingling down the leg. 

If you find that you experience low back pain with sitting and are having difficulty ridding yourself of your low back pain, you can benefit from McKenzie MDT-based treatment at our clinic. Britt Zink will assess your condition and will provide you with recommendations on how you can rid yourself of your low back pain once and for all. 

Concussions fall into six clinical trajectories each with specific symptoms and each trajectory demands specific treatment intervention to bring resolution to the symptoms.

The first week post concussion many of these symptoms are present in most individuals recovering from a concussion and typically most individuals will recover within the first 14 days while being closely monitored by a healthcare provider who has completed specialized training in the assessment and management of concussion.  10-20 percent of individuals do not fully recover in the first 14 days following their injury and their treatment must be specifically tailored to the needs of the individual and their clinical trajectory presentation. 

The concussion clinical trajectories often do not occur in isolation and often there is overlap with individuals suffering from symptoms in multiple clinical trajectories.

The 6 Clinical Trajectories are:

• Anxiety/Mood
• Vestibular
• Post Traumatic Migraine/Headache
• Ocular-Motor
• Cognitive
• Cervical

The Anxiety/Mood Trajectory often presents with persistent emotional and mood changes. This is commonly seen in individuals who have a history of being high-functioning performers and students. This trajectory often presents in females and their return to activity must be closely balanced with their symptoms. These individuals often have trouble turning their thoughts off, worry excessively and may become anxious.

The Vestibular Trajectory often presents with problems with balance and motion. Individuals with this clinical trajectory often experience motion sickness, dizziness, fogginess, feeling detached, nausea, difficulty in busy environments, anxiety, increased emotional intolerance to over-stimulating busy environments, difficulty focusing, fatigue, blurred vision and impaired balance. 

The Post-Traumatic Migraine/Headache Trajectory  presents with persistent chronic headaches, sensitivity to light, noise and nausea. Symptoms are exacerbated with certain activities.  These individuals often have a history of suffering from migraine headaches prior to their concussion.  

The Ocular-Motor Trajectory presents with individuals having eye pain, headaches, slowed reaction time, slowed processing, difficulty with their eyes not moving together and not moving in tandem. Their symptoms are often made worse with screen time on their computer, phone, or when watching television.

The Cognitive Trajectory presents with individuals feeling “slowed down,” and they often experience drowsiness, fatigue, light/noise sensitivity, dizziness, difficulty remembering, difficulty concentrating at school, misplacing items, difficulty concentrating and impaired memory.

The Cervical Trajectory is often overlooked and individuals will present with neck pain, headaches, decreased range of motion and flexibility. 

Concussions follow different clinical trajectories in different people. Treatment needs to be directed to focus on resolving the specific clinical trajectory symptoms and factors for optimal recovery.  

It is important that individuals are treated by a healthcare provider who specializes in assessing and treating the six clinical trajectories.  Britt Zink is a certified concussion specialist and can work with you to bring resolution to your symptoms. 

Many patients seek help at our clinic to get relief from their pain.

At our clinic we discuss the pain experience with our patients.  There is, of course, the origin of pain which may be one or more of several sources which may include the intervertebral disc, ligaments, muscles, tendons, the intervertebral structure or other soft tissues. The source of pain with these structures is often mechanical in nature.

But pain is a complex thing: not only do we have the physical mechanical source of the pain, but other factors affect the pain experience as well. For example, emotional and psychological stressors in our lives can magnify the pain experience.  In discussing this with patients, I emphasize the importance of them incorporating stress-relieving activities into their day. We all have “stress” in our lives, but how we handle the stress in a healthy way can make our pain more manageable.  I often tell my patients to identify those activities that are stress relievers for them and to “DO MORE OF WHAT BRINGS YOU JOY.”

In addition to our stress-coping strategies, nutrition, hydration and sleep play an important role in affecting our pain experience and when incorporated effectively into our daily routine, can play a significant role in helping our bodies to heal and recover.  You don’t have to have visible swelling or edema in a joint to have the presence of inflammation in your involved joints or extremities.  In reality, we all have some degree of inflammation in our body but when our inflammation is increased, it magnifies our pain and affects our pain experience.  Foods that are inflammatory act to increase our inflammation and this can lead to increased pain. 

Below is a list of  some of the foods that are anti-inflammatory in nature. That is, they help to decrease inflammation in our body which in turn, positively affects our pain experience and helps the body to heal.

1. Berries, Grapes and Cherries: These fruits are full of antioxidants and vitamins that help to decrease inflammation.
2. Bell Peppers: Full of vitamin C, they are powerful antioxidants. The more color the better!
3. Green tea: Contains anti-inflammatory compounds that have been linked to decrease the risk of hear disease, certain cancers and obesity.
4. Turmeric:  Contains a compound that has been found to decrease arthritic pain and has been found to have anti-cancer and anti-diabetic features as well.
5. Dark Chocolate: Yes,  you read that right! Dark chocolate contains cocoa which is full of anti inflammatory antioxidants that reduce inflammation in nerves, our brain and arteries.
6. Ginger: contains anti-inflammatory compounds that act to inhibit pro-inflammatory compounds in our body.  It also helps to boost our immune system.

Combine healthy eating, good hydration and exercise prescribed by our physical therapist and you’ll be on the right path to positively impact your pain experience!

• Myth 1: Acute back pain is short-term pain
  • The belief that back pain is a short term problem denies the evidence of research. Many studies show that instead of being short-term, over 50% of patients suffer from recurring attacks of back pain or have persistent or chronic pain following their initial injury.
• Myth 2: Spinal manipulation is the best and most effective treatment for back pain
  • The treatment of back and neck pain by adjustment or manipulation of the spine has been a popular form of treatment, but over the past 10-20 years, research has demonstrated that benefits of spinal manipulation have been greatly exagerated. Though some feel they attain some pain relief initially, the pain relief is short lived, is minor and often has other detrimental effects.  These types of passive treatments create patient dependance and are losing credibility.  The focus is now on activity and exercise, which both have the potential to allow empower patients to manage their own problem and become independent of relying on clinicians to make them feel better. 
• Myth 3: Ultrasound and electrical stimulation treatment get rid of back pain.
  • Not so! No research exists that ultrasound, electrical stimulation, heat or other modalities alleviate pain.  In fact, they can cause harm in that they create a passive approach to the management of back pain, creating dependence on a clinician to alleviate the pain.  These treatments provide no long-term benefit, and do nothing to treat the underlying problem, and there is no scientific evidence that they accelerate healing. 
• Myth 4: Back pain is caused by inflammation
  • Though this belief is wide-spread, it is untrue. Acute low back pain is usually almost entirely mechanical in nature, that is, resulting from the spraining of ligaments supporting the spine and/or distortion that may result in displacement of the intervertebral disc.  This is often referred to as a “slipped disc” but the disc does not actually “slip.” 
• Myth 5: Back pain is caused by arthritis or osteoarthritis
  • These conditions are often referred to as “degenerative arthritis,” “degenerative disc disease,” or “degenerative osteoarthritis.” The changes noted on x-ray are common and does not mean it is the cause of the pain. There are many people who demonstrate these changes on their spinal x-ray but they don’t have any pain. 
• Myth 6: You should take it easy and avoid vigorous activity.
  • This advice may be warranted for the first one to two days after your initial injury but otherwise it is best to regain your mobility as soon as possible.  The longer you are sedentary and inactive, the worse it is for your joints and muscles.
• Myth 7: You will have to stop jogging, running, football, golf or tennis, etc
  • This is untrue and in most cases, harmful advice. It is common to attribute the onset of back pain with sporting activities but rarely the cause of the back pain. There are many more likely causes for the onset of your pain.  Few back problems are serious enough to justify ceasing the activities that you love.  While you may have to pause the activities you love while you recover, permanent abandonment of the recreational activities you love is usually unnecessary,
• Myth 8: Back pain is caused by damp conditions or the weather or sitting in a draft.
  • Climate and weather have often been deemed the cause of back and joint pain.  There is some as yet invalidated evidence that barometric pressure may have some influence on the pain experienced during the passage of very high or very low pressure systems, but sitting in a draft is not the cause of back pain, but rather the sitting posture of the individual is the cause. None of these weather events are the cause of joint or back pain.

Most that suffer from back pain desire a rational explanation of why they hurt.  Patients need education in posture and exercises that will help their condition that will allow them to remain free of disabling problems.  They need advice on how to avoid detrimental postures and forces encountered in daily living activities so they can learn how to apply beneficial strategies.  

All patients deserve the opportunity to learn how to manage their back pain without dependence on a clinician to “cure their pain.”

The McKenzie Method is such an approach that empowers the patient to take an active approach in their management of their pain. Your therapist will perform a thorough assessment, and will work with you to develop an individualized exercise plan that will alleviate your pain, prevent its recurrence and empower you to participate in all the activities you love!