Covid-19 & Respiratory Dysfunction: A Case Study

This article was submitted by Aparna Rajagopal and LeeAnn Taptich. Both practitioners are based out of the Henry Ford Macomb Hospital in Michigan where Aparna Rajagopal, PT, MHS is the lead therapist of their pelvic dysfunction program, and Leeann Taptich DPT, SCS, MTC, CSCS leads the Sports Physical Therapy team. Michigan. They work very closely together at the hospital which gives them a very unique perspective of their patients. Aparna and LeeAnn instruct the Breathing and the Diaphragm course. This remote course explores how the diaphragm, breathing, and the abdominals can affect core and postural stability through intra-abdominal pressure changes.

COVID-19 has been a part of our vocabulary for almost 2 years now and has changed the world we live in. COVID-19 is a virus that affects the cardiovascular, digestive, urinary, and respiratory systems. We still do not have adequate evidence to guide our treatment of COVID -19 patients in their sometimes prolonged recovery phase. Research continues to be made available about the short and long-term effects of the virus on our bodies.

An example of a post-COVID-19 patient was a female with complaints of difficulty taking in a deep breath. She also reported that the physical act of breathing felt like a lot of work/effort. She had undergone all sorts of respiratory and cardiac testing and had been cleared from a medical standpoint. Upon talking to the patient, it was discovered that she wasn't complaining of shortness of breath/dyspnea.

Instead, this patient was complaining about having to expend a lot of energy to perform the mechanical action of breathing. She reported that this had started after she had experienced moderate COVID - 19 symptoms for about a month. The patient did extremely well with a plan of treatment aimed at improving mobility in the soft tissues and joints of the thorax while working on establishing a breathing pattern with a focus on improved overall expansion. An incidental benefit of her treatment was a dramatic reduction in her symptoms of urinary urgency which she had developed during her COVID-19 recovery stage.

Recently, a clinical commentary in the Journal of Women’s Health Physical Therapy talked about the possibilities of pelvic floor dysfunction developing on account of COVID-19 (1). Since COVID 19 affects the respiratory system, we can postulate that something involving the respiratory system will possibly have an effect on the pelvic floor due to the unique relationship shared between the pelvic floor and the diaphragm.

Recovering COVID 19 patients may have changes in their musculoskeletal system. These changes may include increased accessory muscle use, decreased chest wall mobility (including the associated joints and muscles), and altered breathing mechanics due to both the disease process and possibly the immobility of bed rest.

The upcoming Breathing and the Diaphragm course helps practitioners understand the connection of dysfunction pertaining to respiration and how it can affect the pelvic floor. In this course, Aparna Rajagopal and LeeAnn Taptich will instruct you to look at the body as a whole while assessing and treating for mobility deficits, motor control deficits in terms of breathing dysfunction presented by these patients.

References:

1. Siracusa C, Gray A. Pelvic floor considerations in COVID-19. Journal of Women’s Health Physical Therapy. 2020; 44(4): 144-151.