by Chaim Backman PT
Many of us have been stricken with Covid 19 but are BH on the way to recovery. After fighting off the initial acute stage of this illness, we are now entering the second stage of recovery.
During the acute stage, many people were in bed or possibly even hospitalized for an extended period of time. Most people also suffered from difficulty breathing and shortness of breath and maybe even pneumonia. BH, the overwhelming majority of people with Covid 19 will recover from the initial stage of this severe illness.
After the initial stage is over, then the recovery stage starts. Almost all recovering patients will find themselves feeling much weaker physically. They may have muscle loss and atrophy. Some people, especially if they were hospitalized for an extended period of time, may even need assistance to sit and/or stand up and walk.
Almost everyone reports feeling out of breath with the slightest exertion. They also report having a constant and nagging dry cough, to the point that it’s hard to take a deep breath or complete a sentence without stopping to cough. Many others complain of rib cage pain, as painful as if they broke a rib, due to the severe cough. These respiratory issues place the recovering patient at a much higher risk for lung issues, such as infections or even pneumonia.
Another very common but serious occurrence is the high rate of blood clots that have been found in recovering patients. The rate is much higher than in typical patients recovering from a bad illness such as the flu. The cause is unclear at this time, but may be due to some effect Covid 19 has on stimulating the blood clotting mechanism. This increase in clots can be very dangerous and even fatal, as clots can cause a stroke, heart attack or pulmonary embolism.
In order to counter the above listed sequela and lessen all the above risks; ie counter the physical deconditioning, decrease the chance of developing a lung infection or even pneumonia, as well as decrease the risk of clots; there are a few basic steps to take.
Every person must get up and walk at least 5-10 mins per hour during the day. From the time they wake up, until they go to sleep for the night, they must move regularly. If they feel very weak; they can stand up next to the bed and march in place, or break up the walking to a few minutes every half an hour. Always have someone near them for safety while walking or standing to prevent a fall.
Try to keep out of the bed as much as possible. It’s ok to take a nap as needed, but while awake; try to be out of the bedroom and sitting upright in a chair. Just getting up and dressed and getting out of the bedroom already helps to improve one’s spirits and mood. Also it is easier to walk regularly once sitting in a chair rather than when lying all comfortable in a bed. In addition, being upright is better for the breathing as well as helping to prevent bed sores and clots.
Every hour: perform Deep Breathing Ex’s as detailed below:
To breathe properly, one has to use your diaphragm to expand your lungs and fill them with air. That means, your abdomen should expand (push outwards) and the rib cage should lift up and outwards. They should not be sucking in their abdominal area and lifting their shoulders/collar bones and chest when taking a deep breath.
Practice using the “breathe in slowly through the nose as they mentally count of 4” technique. As they breathe in, they should push out their stomach as if they have a balloon in their abdominal area and are filling it with air (often times it helps to have them place a hand over their stomach and feel it rise as they breathe in). Hold the air inside and count slowly to 4 in their mind. Then, form the lips into a circle (as if they were blowing out a candle) and slowly blow out ALL the air in the lungs till totally empty. Repeat this 10 times slowly.
After the breathing ex’s, try to perform 10 deep strong coughs. This is important as it helps to loosen up and expel any junk from the bottom of the lungs. Even if they don’t feel any phlegm coming up to spit out, the cough alone will stir up the junk along bottom of lungs and the body will naturally get rid of it and it won’t sit there and become an infection.
Many people are sent home with an Incentive spirometer. This is the device with a tube and chamber and ball that floats upwards when the person breaths in. Most people never use it correctly. To use it properly, have the pt concentrate on the very first floating indicator and not on the large tube that measures total volume inhaled. The goal is to breathe in slowly and steadily, causing the small indicator to float upwards and hang in the middle of the tube for as long as possible. A goal time would be 5-10 secs floating time. The longer it floats: the more air the person is inhaling and therefore the more the lungs are expanding. The person should take 10 such slow deep breaths per hour.
While the pt is laying in bed or sitting; they should perform 10 ankle pumps every hour. This just means to raise toes/foot by flexing at the ankle as far as possible, then extend and push toes/foot down as far as possible. This helps to activate the calf muscles and prevent swelling and fluid accumulation and decrease the risk of blood clots. As the person feels stronger, then a more complete and appropriate full body exercise routine needs to be implemented.
This routine will help to start a person on the road to a full recovery. It will decrease the many risks that come with being sick in bed and immobile for an extended period of time. As always, make sure to discuss all health issues and questions with the physician. Many people may also need some sort of blood thinner or other form of medication to help counter any clotting issue or other health threat.
For further information or more specific advice; please contact me directly at:
Chaim Backman PT
email: [email protected]
Home/telehealth visits available.
Chaim Backman is a physical therapist who specializes in homecare physical therapy and rehab of the post surgery/illness or hospitalized patient. He is currently working with multiple Covid 19 patients. He is also a member of Crown Heights Hatzalah.