Rehabilitation cannot wait because of COVID

15 September 2020

Physiotherapists note that many patients postpone rehabilitation because of fear of the coronavirus. However, time is crucial in case of this kind of therapy, and some of the consequences of "waiting out" cannot be repaired.

Rehabilitation is necessary even during a pandemic - tissue healing processes cannot be "postponed". This applies to all patients – those preparing for surgery and those after surgery, as well as those struggling with pain problems on a daily basis.

If we want to improve our quality of life and enjoy mobility, we should not delay rehabilitation. It is better to work with the problem when it occurs than to wait for it to turn into a chronic form of pain, which will have to be dealt with for much longer - says Łukasz Markiewicz, physiotherapist at the Carolina Medical Center.

Rehabilitation after surgery is an absolute necessity

Rehabilitation is an integral part of a successful treatment.

Patients are often unaware that in order to fully recover, they must work before and after the surgery. Some of them assume that the operation itself will solve their problem, and rehabilitation can be avoided if you take "some medications" - adds Łukasz Markiewicz - When the patient does not undergo physical therapy after the surgery, such a break of several weeks can lead to serious problems. The patient cannot fully benefit from the effects of the operation, since the elasticity of his tissues is limited, pain occurs when moving. There is no guarantee that these changes will be completely reversible: we may not be able to regain the full range of motion and performance that the patient could achieve through surgery and rehabilitation in a timely manner.

The operation can "fix" the problem that the patient has experienced - such as a torn tendon or ligament - but the necessary condition for the tissues to be fully functional is efficient rehabilitation” - explains Łukasz Markiewicz – Tissue healing processes cannot be "postponed". Unfortunately, in patients who did not decide to undergo rehabilitation after surgery during the pandemic, irregularities are visible - e.g. lack of the range of joint mobility, i.e. adhesions in the joints. The consequence may even be another operation: arthrolysis, that is, the release of the joint from these adhesions. We also have to take into account the lengthy rehabilitation process: it may take even a year or more to reach the effect that could be achieved in 3-4 months if started earlier.

Before surgery - rehabilitation on the remote system

Preoperative rehabilitation, started before elective surgery, allows you to function better after surgery.

Such rehabilitation is not as demanding as others - says Łukasz Markiewicz – For example, when working on muscle strength, many exercises can be done at home, by patient himself, under the supervision of a physiotherapist. In such cases, the form of teleconsultation or video advice works best. These forms are used under certain conditions and for selected groups of patients - those who don’t need manual tissue workout.

Remote methods of physiotherapy can be used, for example, by patients whose aim is to strengthen the muscles so that the tension of these tissues is adequate before the surgery. Sometimes these forms are used in relation to patients working on a range of mobility - provided that the therapist decides that the exercises previously implemented and performed by the patient are effective and that the patient will be able to achieve this range without pain. The patient then exercises himself at home and occasionally visits a physiotherapist to check the progress and degree of tissue regeneration.

Video advice enables visual contact with the patient. A physiotherapist can assess how the patient moves, what his posture is, gives the opportunity to control the technique of exercising and possible corrections - adds the physical therapist – Acute pain is a definite contraindication to remote methods of physiotherapy.

Conservative rehabilitation and working from home

Conservative rehabilitation applies to patients who have not undergone surgery, and it is used in cases of problems that significantly worsen the quality of life, often - limiting the ability to work. As a result of the remote work model that has been common for several months, the number of patients undergoing conservative rehabilitation has significantly increased. Meanwhile, many employers extend the home office model until the end of the year.

Employees often do not have optimal conditions - they do not have an appropriate chair or desk: they generally do not have a workplace that could provide them with comfortable and ergonomic use of the equipment for the same hours as in the office - says Łukasz Markiewicz – That is why a large number of patients who visit specialists have back problems. It can be considered a civilization disease, which is the result of many hours sitting in front of a computer. These problems spilled over from offices to homes

Conservative rehabilitation in such patients plays a very important role.

If we do not make sure that we work in ergonomic conditions and adjust the place where we currently work, the problems will increase – adds physiotherapist.

How has the pandemic affected rehabilitation?

In March and April, rehabilitation was not possible, in May - by the decision of the authorities - visiting physiotherapists was possible again.

Some of the patients continued rehabilitation, especially those who underwent surgery and those with acute condition. Unexpectedly, the pandemic period also had good results: the patients who worked at home were not as time-constrained as before and could arrange rehabilitation at a convenient time for them, or receive more help from family members - says Łukasz Markiewicz – In our clinic, we immediately introduced strict sanitary requirements: patients fill in the questionnaire, have their temperature measured, and must wear a mask or a visor. Physiotherapists are also required to wear gloves, masks and visors. In rehabilitation rooms, we maintain an appropriate distance between exercise stations, we limited the number of patients who may be subject to treatments at the same time, we introduced a technical break when the room is disinfected and aired. Fluids for hand disinfection and equipment disinfection are available in the rooms. These precautions persuade patients to visit.