Long Covid and Dysautonomia: A Physiotherapist’s Perspective
At Prime Health and Performance in Vancouver, we observed a rise in Long Covid cases with symptoms like heart rate fluctuations, exercise intolerance, and “brain fog.” Drawing from our experience with similar conditions like POTS and CFS, we adapted treatment strategies to manage dysautonomia, a common issue in Long Covid. Our approach includes graded exercise therapy, heart rate monitoring, and vestibular rehab. If you’re experiencing persistent symptoms post-COVID-19, contact us for a personalized treatment plan.
When the COVID-19 pandemic first hit, we at Prime Health and Performance in Vancouver, like many healthcare providers, were focused on the immediate respiratory symptoms of the virus. However, as time went on, we began to see a new pattern emerge among our patients.
It started with a trickle – patients who had recovered from the acute phase of COVID-19 but were still experiencing unusual symptoms. They reported spontaneous heart rate elevations at rest, severe exercise intolerance, and delayed negative effects after physical activity. At first, these cases seemed isolated, but soon we realized we were dealing with a larger phenomenon that would come to be known as Long Covid.
Emergence of Long Covid Symptoms: A New Challenge
As physiotherapists, we found ourselves in uncharted territory. The healthcare world had to quickly adapt, pulling knowledge and research from other areas of medicine and health rehabilitation to treat Long Covid while new research was still in its infancy.
We drew on our experience with conditions like Postural Orthostatic Tachycardia Syndrome (POTS), Chronic Fatigue Syndrome (CFS), and post-concussion syndrome. For instance, the exercise intolerance and post-exertional malaise we saw in Long Covid patients closely resembled symptoms seen in CFS. This allowed us to adapt pacing strategies and graded exercise therapies that had proven effective in CFS management.
Similarly, our understanding of autonomic dysfunction in conditions like POTS became crucial. We applied heart rate monitoring techniques and orthostatic tolerance exercises that we had previously used with POTS patients to our Long Covid treatment protocols.
The concussion management strategies we had in place, particularly those addressing vestibular and cognitive symptoms, proved invaluable. Many Long Covid patients reported “brain fog” and dizziness, symptoms eerily similar to those seen in post-concussion syndrome.
Understanding Dysautonomia in Long Covid Patients
But why does COVID-19 cause dysautonomia? The exact mechanisms are still being studied, but current research suggests that the SARS-CoV-2 virus can directly or indirectly affect the autonomic nervous system. This may occur through viral invasion of the brainstem, immune-mediated damage to autonomic nerves, or as a consequence of the body’s inflammatory response to the virus.
Dysautonomia is a dysfunction of the autonomic nervous system, which controls involuntary bodily functions like heart rate, blood pressure, digestion, and temperature regulation. As physiotherapists, we assess for dysautonomia using several methods:
- The NASA Lean Test (formerly known as the Poor Man’s Tilt Table Test): This involves measuring heart rate and blood pressure while the patient is lying down, then again after they stand and lean against a wall for 10 minutes. A sustained increase in heart rate of 30 beats per minute or more, or a drop in blood pressure, can indicate orthostatic intolerance.
- The Buffalo Concussion Bike Test: Originally developed for concussion management, this test involves monitoring heart rate response to increasing levels of exertion on a stationary bike. Abnormal responses can indicate autonomic dysfunction.
- The Buffalo Concussion Treadmill Test: Similar to the bike test, this assesses heart rate and symptom response to increasing walking speed and incline on a treadmill.
Common Assessments and Treatments
Common assessment findings in Long Covid patients with dysautonomia include:
- Orthostatic intolerance (symptoms worsen when upright)
- Exercise intolerance
- Tachycardia (elevated heart rate) at rest or with minimal exertion
- Blood pressure fluctuations
- Fatigue and post-exertional malaise
- Cognitive difficulties (“brain fog”)
- Sleep disturbances
Treatment strategies for Long Covid-related dysautonomia often include:
- Graded exercise therapy: Carefully monitored, progressive increases in activity levels.
- Heart rate-guided exercise: Keeping exertion within specific heart rate zones to avoid symptom exacerbation.
- Breathing exercises: To help regulate the autonomic nervous system.
- Hydration and salt intake management: To support blood volume and reduce orthostatic symptoms.
- Sleep hygiene improvements
- Stress reduction techniques
- Vestibular rehabilitation: For those experiencing dizziness or balance issues.
With the right approach, many patients see significant improvements. We’ve had patients go from being unable to walk for more than a few minutes to returning to work and recreational activities. Others have seen substantial reductions in fatigue and cognitive symptoms, allowing them to re-engage with their daily lives.
How Prime Health Can Help
If you’re experiencing unexplained fatigue, exercise intolerance, heart rate fluctuations, or other symptoms that persist after a COVID-19 infection, you may be dealing with Long Covid-related dysautonomia. At Prime Health and Performance, we have the expertise to assess your condition and develop a tailored treatment plan. Don’t let these symptoms limit your life – reach out to us today, and let’s work together towards your recovery.
