Case Study: Physical therapy treatment for post-COVID, Long Covid/ Post-Acute Sequelae SARS CoV-2 (PASC) with POTS style approach

Patient: Previously healthy and active individual who developed POTS symptoms after a COVID infection.

Symptoms: Dizziness, nausea, “coat hanger pain,” overwhelming fatigue.

Patient’s Functional Goals:

• Able to complete one hour shopping trip without stopping due to dizziness, nausea, brain fog, or fatigue.
• Able to walk for more than 30 minutes without stopping and without increased fatigue without post-exertional malaise (PEM).
• Ability to safely drive 20 minutes or more to visit family without exacerbating symptoms mentioned above.

For the past two months I have been treating a previously healthy and active patient who suffers from “Long Covid”/ Post-Acute Sequelae SARS CoV-2 (PASC).?Although she had no history of heart disease, she. began?demonstrating?persistent symptoms associated with Postural Orthostatic Tachycardia Syndrome (POTS) following a Covid infection.

Like most patients?experiencing?the post-Covid symptoms of POTS, she had tried many other?treatments?and modalities to address her symptoms,?but it only got worse until she eventually lost her job.

We did not realize that a protocol of horizontal exercise was necessary.??

Several months?ago?her physician recommended LE strengthening exercises completed in horizontal and recumbent positions twice a week, and?low level?cardio training of no more than 25 minutes (including warm up and cool down) on a home recumbent bike three alternate days of the week.?

During treatment, while?monitoring heart rate variability (to ensure it doesn’t elevate) and blood pressure, I have been able to address and gradually progress this patient on one piece of equipment, the MAT Table. Completing all strengthening TE on one piece of equipment has proven helpful as frequent standing transfers?exacerbate?symptoms such as dizziness, nausea, “coat hanger pain” and overwhelming fatigue.

For improving strength and endurance in patients with long Covid during therapeutic exercise (TE), I have found the following exercises to be beneficial:

• Bridges,
• Four Direction Straight Leg Raise (SLR),
• Clamshells,
• Short Arc Quads (SAQ),
• Mini crunches,
• Planks (side and prone)
• Partial incline squats,
• Single lower extremity ankle plantarflexion and dorsiflexion
• Hamstring and quad stretches.???

I also found gradually inclining the MAT Table throughout her sessions and introducing the above exercises to be helpful in improving tolerance to upright positions with decreased symptoms.

This treatment approach, based on the POTS style of exercise, emphasizes gradual progression and avoidance of activities that exacerbate symptoms. It is important to monitor the patient's heart rate variability and blood pressure during exercise to ensure that they are not overdoing it.

Exercises performed on one piece of equipment (MAT Table) to minimize standing transfers and exacerbation of symptoms:

• LE strengthening exercises completed in horizontal and recumbent positions.
• Low-level cardio training of no more than 25 minutes (including warm up and cool down).
• Exercises gradually progressed from horizontal to inclined positions.

This patient has successfully?progressed from low-rep exercises inline, to exercises with partial incline position, and increased reps. The patient is expected to tolerate and progress to strengthening in upright positions in the next 4-8 weeks.

For more information or to schedule a demo of the MAT Table, call Brian at 269-569-4414.

Sources: APTA, University of Michigan Post-Covid website