Effects of Long COVID in Physical Therapy Patients

As more individuals recover from COVID-19, physical therapists are seeing a growing number of patients with lingering symptoms that affect their daily function.

These long-term effects, often referred to as post-COVID conditions or long COVID, can interfere with movement, endurance, and quality of life. Physical therapy plays an important role in helping patients regain their strength, mobility, and independence as they navigate ongoing recovery. This article explores the most common long-term effects of COVID seen in physical therapy settings and how therapists can address these challenges with targeted interventions. 

Related CE course for PTs: Long-Term Effects of COVID-19 in Post-Acute and Residential Care Settings

What is long COVID? 

Long COVID refers to the different types of symptoms that last weeks, months, or even longer after a person has recovered from the acute phase of COVID-19. It’s typically considered “long COVID” when symptoms persist for at least 2 months. These symptoms can affect multiple systems and may vary a lot between individuals. 

While some patients experienced mild COVID cases initially, they may still go on to develop symptoms that require medical and rehabilitative support. Physical therapists are often among the first providers to find and identify functional deficits during their evaluations. 

Common long-term effects of COVID in PT patients 

While symptoms differ from person to person, common effects of long COVID seen in physical therapy include:  

1. Fatigue and activity intolerance 

Many post-COVID patients report ongoing fatigue that does not improve with rest. Even simple things like standing or walking short distances can feel exhausting. 

Physical therapists should remember the following with fatigue and activity intolerance: 

• May limit participation in daily activities and exercise
• Often requires pacing strategies and gradual reintroduction of activity
• Patients may benefit from rest breaks and energy budgeting throughout the day

2. Muscle weakness and deconditioning 

Prolonged inactivity or hospitalization can lead to general deconditioning. Some things to think about in regard to this include: 

• Loss of muscle mass and strength impacts balance and mobility
• Weakness may be more obvious in lower limbs, affecting gait and transfers
• Resistance training and functional strength exercises can boost progress

3. Respiratory and cardiovascular challenges 

Some patients experience ongoing breathing issues or low exercise tolerance. Things to consider here include: 

• Dyspnea, chest tightness, and decreased oxygen saturation may appear with exertion
• May require breathing retraining and aerobic conditioning
• Monitoring vitals before, during, and after activity helps guide safe progression

4. Joint pain and stiffness 

Inflammatory responses and inactivity can contribute to musculoskeletal symptoms. Physical therapists should remember: 

• Common complaints include shoulder, neck, and back pain
• Limited joint mobility could restrict movement during therapy
• Range-of-motion exercises, stretching, and manual techniques are often useful

5. Balance and coordination problems 

Post-COVID neurological symptoms may include dizziness or impaired balance. This: 

• Can increase fall risk during mobility tasks or more complex movements
• Requires targeted vestibular and balance training
• May benefit from temporarily using assistive devices to support safety

6. Cognitive and psychological symptoms 

Brain fog, anxiety, and depression are common effects of long COVID. Physical therapists should note that this: 

• May affect memory, concentration, and motivation
• Influences participation and adherence to home exercise programs
• May require the therapists to incorporate cognitive strategies and refer for mental health support as needed

How physical therapists can help manage effects of long COVID 

Physical therapists are uniquely positioned to provide individualized care for patients with long COVID. A proper evaluation helps identify specific limitations, and treatment plans can be adjusted over time based on patient response.

Key areas of focus include: 

• Graded exercise and aerobic conditioning
• Balance and gait retraining
• Breathing techniques and energy conservation
• Pain management through manual therapy or stretching
• Strength training adapted to individual tolerance
• Cognitive strategies and structured routines to support adherence
• Establishing daily routines that support movement without triggering fatigue

Importance of patient education 

Patient education plays a key role in managing expectations and supporting recovery. Some topics that should be considered include: 

• The value of pacing and avoiding overexertion
• Monitoring symptoms and adjusting activities accordingly
• The difference between normal fatigue and warning signs
• Setting realistic, short-term goals for progress
• Understanding the potential for symptom variability from day to day

Physical therapists might also recommend lifestyle changes like sleep hygiene, hydration, and nutrition to support overall recovery. Clear communication during sessions and follow-ups can help reinforce these strategies. 

Collaboration with other healthcare providers 

Because long COVID can affect multiple body systems, interdisciplinary collaboration improves patient outcomes. Physical therapists may work with: 

• Physicians for medical management and diagnostic clarification
• Occupational therapists for fine motor skills and daily task adaptations
• Respiratory therapists for breathing support
• Mental health providers for emotional well-being and cognitive support
• Social workers or case managers to help patients navigate community resources

Clear communication between providers allows for continuity of care and avoids duplication or gaps in treatment. 

Challenges in rehabilitation for the effects of long COVID  

Treating long COVID in a physical therapy setting can present challenges, especially given the unpredictable nature of symptoms. Some challenges include: 

1. Variable symptom patterns 

• Patients may have good days and setbacks, even without new exposures or exertion
• Flexibility in planning is needed to accommodate these fluctuations

• Reassurance and education help patients manage expectations 

2. Limited research 

• While emerging data supports many rehabilitation strategies, long COVID is still being studied
• PTs have to stay informed and use clinical judgment to guide care
• Networking with other professionals and attending continuing education can support evidence-based decision-making

3. Patient frustration 

• Slow progress or fluctuating symptoms may discourage patients
• Therapists can provide reassurance, validation, and structured goals to support motivation
• Setting frequent checkpoints helps recognize small wins

Tracking progress over time 

Progress may be gradual, but consistent tracking helps guide decisions and show improvements. Some ways to measure progress over time include: 

• 6-minute walk tests or timed up-and-go assessments
• Strength and balance scales
• Self-reported symptom logs
• Quality of life or fatigue questionnaires
• Functional mobility assessments tailored to daily goals

Frequent re-evaluation allows physical therapists to adjust plans, celebrate wins, and re-engage patients in their recovery goals. 

Conclusion 

The effects of long COVID can really impact physical function, independence, and quality of life. Physical therapists are a key part in helping patients recover mobility, manage fatigue, and rebuild strength through individualized and adaptable care.  

By recognizing the range of symptoms associated with long COVID and collaborating with other providers, PTs can support patients as they work toward meaningful goals – no matter where they are in their recovery journey.  

Ongoing support, careful pacing, and clear communication can help make the road to recovery feel more manageable and hopeful for both patients and providers.