• Barry Cooper

Catch a virus such as flu, and you would expect to be lacking in energy for a few days until your body recovers. But in some cases this tiredness persists long after the virus has cleared up. This is a fairly common occurrence, known in the medical world as ‘post-viral fatigue’. The condition has been under the spotlight recently as many people have suffered ‘Long Covid’, when symptoms of coronavirus persist for more than a month. One of these symptoms is indeed a persistent fatigue. This blog will consider how exercise – balanced with rest – can help alleviate symptoms of post-viral fatigue, in order to help you make a full recovery.

Symptoms and Causes


Symptoms of post-viral fatigue can very from person to person, and can fluctuate in severity. As well as the obvious tiredness, someone with post-viral fatigue may experience anything from headaches and muscle pain, to poor sleep and flu-like symptoms such as dizziness and poor temperature control. (For a full list of symptoms read our newsletter which you can access here).

In this way, it is very similar to Chronic Fatigue Syndrome; indeed, the two are often confused. However, while there is no consensus as to a cause for CFS, it is widely agreed that post-viral fatigue is caused when the immune response to a virus continues in the body once the virus has passed. Chemicals known as cytokines that are released to fight off a virus remain present, causing inflammation and preventing the body from functioning as normal. Unlike CFS, it is possible in most cases to make a relatively quick recovery from post-viral fatigue, when a carefully managed recovery programme is followed. Key to this is a good balance of exercise and rest.

Exercise as a Recovery Strategy from Post Viral Fatigue


As a profession, we are normally the first to extoll the benefits of exercise: getting the body moving again after an injury can help speed up the recovery process, and the benefits of a good endorphin rush to everything from sleep to general wellbeing cannot be overstated. Indeed, we often encourage patients to get moving as soon as possible after an injury to aid their recovery. So it might sound a little strange to hear us saying that when it comes to exercise to alleviate post-viral fatigue, you should proceed with caution.

The reason for this is that when suffering from post-viral fatigue, your body is particularly susceptible to ‘post-exertional malaise’. As your energy levels can fluctuate from day to day, you might feel like you can take on your normal 5k one day, only to find you feel much worse the next. Sometimes it only takes a very minimal level of activity to provoke symptoms of post-viral fatigue; certainly doing too much too soon can actually impede your recovery. For this reason, we would recommend adopting a ‘Graded Exercise Therapy’ approach. Again we have a leaflet on this, which you can download at the following page. You can find more about this here, Click here

but in essence this involves the following steps:

  • Find your baseline level (i.e. what you can comfortably do every day, even on a bad day). Note this might be much less than you would normally be used to doing. Gentle stretching and walking are good ways to start.

  • Commit to doing this every day. (It helps if the exercise is something you enjoy).

  • Build up in small steps as you are ready.


The most important part of this process is the first – finding a baseline level and building your exercise routine around this to make sure that you do not over-exert yourself. This is also known as ‘pacing’ and again we have a leaflet covering this topic at the following link. Clinic here .

In just the same way that a marathon runner would pace themselves during a race to make sure they don’t go too fast too early, you should find a level of exercise that you will be able to consistently sustain throughout your recovery period. This pacing also relates to activities that require mental exertion such as work, daily chores or socialising.



It can help to set yourself goals, but make sure these are achievable and realistic in order to keep yourself motivated. It doesn’t matter how long it takes to regain your fitness – the most important thing is to exercise frequently. For more on setting realistic exercise expectations, see this helpful document at this link. Clinic here




Rest


When suffering from post-viral fatigue, the rest you take is just as important as the exercise you do. It might seem strange, but in this condition that makes you feel tired all the time, the quality of your sleep is often one of the areas that suffers most. Luckily, there are some simple steps you can take to improve your ‘sleep hygiene’. Having a regular bedtime routine in place that involves relaxing activities such as a bath or perhaps some breathing exercises can help ‘train’ your body to sleep. It is important to avoid too much stimulation before bed, so try and turn off screens (that includes your phone!) at least an hour before you go down.



It is also a good idea to establish a morning routine. Set an alarm and commit to getting up at the same time each day, no matter how tired you might feel. The sleep you get after hitting the snooze button is rarely restorative, and can result in that ‘groggy’ morning feeling.


Finally, no matter how tired you might feel during the day, avoid taking naps. The aim is to establish a solid sleeping pattern, ideally around eight hours, in which your body has the deep, restorative rest it needs. We’ve covered sleep hygiene in more detail at this link. Click here

Other Considerations


We have focused on the physical areas of exercise and rest in this post, though it should be acknowledged that post-viral fatigue is considered a ‘biophsychosocial’ condition, meaning that while it may originate biologically, it affects - and can be affected by – our mental state and social conditions as well. For this reason it might be worth considering some alternative ways to look at treating the condition.


CBT


Cognitive behavioural therapy is a form of talking therapy that can help you realise when and how your thoughts might not be helping you achieve the outcomes you desire. The underlying theory behind CBT is that our patterns of thought are extrinsically linked to our feelings, behaviour and physical sensations. This is not to suggest that post-viral fatigue is ‘all in the mind’; rather, exploring CBT as a way to aid recovery from the condition is to acknowledge that it can have an affect on your mental state as well.


When suffering from a condition such as post-viral fatigue, it can be easy to slip into a pattern of negative thoughts, which can affect everything from your motivation to exercise, to your body’s ability to recover. CBT offers a practical, proven way to address these issues. We’ve produced a leaflet covering CBT for post-viral fatigue here at this link: Click here


Socialising


It is also important to acknowledge the effect that social support can have on recovery from post-viral fatigue. The symptoms of PVF can leave you feeling reluctant to socialise and like you want to withdraw until you feel better. However, it is important to maintain some social activity, as

isolation can add to feelings of fatigue and have a negative impact on your wellbeing. If seeing your friends feels like too much, it may be worth considering a support group for those with PVF.



In Summary

In summary, post-viral fatigue is a very real, and debilitating condition that affects those suffering in a variety of different ways. If not managed correctly, it can lead to the more serious, long term Chronic Fatigue Syndrome. However, by taking a proactive approach to managing the condition, with techniques such as Graded Exercise Therapy and CBT, the condition will usually abate over time.


For advice on structuring your Graded Exercise routine, or on any other aspect of the topics we have covered today, give our clinic a call and we’ll be happy to help design a programme that best fits your current condition and goals.


Best regards


Barry Cooper at Myotherapy Clinic


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Swimming is one of the most popular sports in the world.


We swim in the sea, pools, lakes, streams, rivers and even ponds. And given 70% of the Earth’s surface is water, we’re not short of opportunities.

And while swimming is considered a ‘low-impact’ sport due to the fact that the water supports a large percentage of, more than 84% of regular swimmers suffer from some type of overuse type injury caused by swimming.


Why? The main reason is the high repetition number and forceful nature of the shoulder revolutions which takes our shoulder joint through its full range of motion (which is one of the greatest of all our joints), against resistance, over and over again.


And as 50-90% of the power generated to propel you forward comes from the shoulders, you can see why they are the most frequently injured joint.


However, swimming also puts stress on your back, to hold you level in the water; on the neck when raising your head out of the water to breathe and if you favour breaststroke as a stroke, there’s added pressure from the unnatural twisting motion on the knees.


So, despite it seeming to be a low-impact sport, swimming actually carries a surprisingly high risk of injury.


Let’s take a look at those injuries, why they happen and what you can do about them.

Swimming injuries generally stem from two sources, and often these sources will combine:

  1. Muscle imbalances

  2. Stroke technique issues

Muscle Imbalances


Our everyday posture, particularly if you spend a lot of time sitting at desk or in a car, or generally not moving around, creates all sorts of muscle imbalances from short hamstrings, tight muscles around the neck, back and shoulders. We unconsciously adopt a curved forward upper back, round shoulders and chin poke, which not only add to shoulder problems in swimmers but neck pain too.


Poor posture is the biggest culprit of short tight trapezius and pectoral muscles and weak anterior (front) neck and upper back muscles. These muscles can be painful and develop trigger points which are hyperactive spots in the muscle, commonly referring pain and causing headaches. Tight muscles may also limit your neck movements. Good posture ensures good alignment of the joints and ligaments which allows for optimal contraction of your muscles and off-loads underlying structures.


Stroke Technique


This a big topic to cover because it depends what stroke you’re swimming mostly with and what kind of injury you may have but issues include: a wide, swinging arm recovery which requires excessive internal rotation, causing impingement on the joint; thumb in first with hand entry, which again causes excessive internal rotation in the shoulder and a dropped elbow or straight arm pull through which creates a long lever and overloads the shoulder.


In our set of resources which you can access at this link Click Here we’ve put together a Stroke Technique Cheat Sheet which for each injury area, identifies key stroke issues, with suggested solutions.

What does all of this mean to you? You shouldn’t swim? You should reduce your training or change your sport?


The bottom line is that the benefits of swimming - whether it’s for general fitness and physical activity, the desire to win competitions, or just to find your quiet place for stress relief - far outweigh the risk of injury.


And with this in mind, we’ve put together a set of resources to help you manage, or better yet prevent, swimming injuries altogether.


These resources include

  • Stroke Technique and Injury Cheat Sheet

  • Common Swimming Injuries Cheat Sheet

  • Sink or Swim? Treating and Preventing Swimming Injuries

  • Swimmer's Shoulder - Advice and Exercise Rehabilitation Leaflet

  • Breaststroker's Knee - Advice and Exercise Rehabilitation Leaflet

  • Muscle Cramp in Swimmers - Advice Leaflet

  • Back Pain in Swimmers - Advice and Exercise Leaflets

  • Neck Pain in Swimmers - Advice and Exercise Leaflet

These resources are packed with practical tips and advice, along with exercise leaflets that combine to help you swimming happily, healthily and injury free into the future.



Regards



Barry at Myotherapy Clinic



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  • Barry Cooper

We’ve probably all been told to “stand up straight” or to “stop slouching”, at some point in our lives.

What most of us may not realise however, is how damaging a bad posture can be not only to our physical health but in many other aspects of our mental health and wellbeing, and even more so as we age.


It’s also a habit we tend to fall into at an early age, which makes it even more important to remedy as quickly as possible. That said, it’s never too late to start!


Unfortunately, modern lifestyles are becoming increasingly sedentary, whether that’s through the use of transport instead of walking, or sitting at desks or computers for long periods of time, or binging for hours on Netflix, or gaming and social media, or most likely, all of the above to some degree.

But all these factors, mean that our postural muscles are being used less and less, which means they tire more easily when they are used. That in turn makes it harder to maintain a good posture when you are standing or sitting, so you slump, slouch more or lean on walls, tables or bus stops when standing.


Think about it when next catch yourself standing around.


The relationship you have with your postural muscles may have flickered out over time but the end result is that poor posture puts your body at risk for spinal wear and tear and chronic pain.


Not only that, having poor posture can affect your health in many ways, some of which may surprise you. While the obvious consequences are the deterioration of your neck and spine and associated ligaments, muscles and tendons, the less obvious consequences are headaches, decreased flexibility, loss of mobility, nerve entrapment, poor balance (potentially leading to falls), bad digestion, difficulty breathing, reduced energy levels, and even negative self-esteem.


It’s surprising how widely the impact of poor posture can stretch.


The good news is that bad posture is just a habit we’ve got into, and as we know, habits can be broken.


Musculoskeletal practitioners like physical therapists, osteopaths, chiropractors and massage therapists can all help by giving you specific exercises to help you strengthen weak muscles and stretch tight ones, thereby improving your posture.


Getting that perfect spine isn’t always achievable or a quick fix, but small changes to daily routine, becoming more body conscious and performing exercises a couple of days a week will go a long way to helping improve your posture, reduce the risk of injury and prevent pain.


We’ve put together a range of resources to help you firstly identify what type of posture you’re likely to have, and then some stretching and strengthening exercises that will help you to start to correct that posture.


There are also some additional advice leaflets and infographics giving guidance on the correct set up of your workstation and how to reduce your risk of getting into poor postural habits.


Sign up here for a monthly newsletter : Click here


As usual, if you have any concerns or questions, please feel free to get in contact with us. We’re here to help.


Barry at Myotherapy Clinic

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