The further we move through this pandemic the more we are familiarising ourselves with the effects, both short and long, of COVID-19 infections. In news we like about as much as the sound of nails on a chalk board, it has been discovered that many individuals recovering from infection are experiencing residual problems, commonly referred to as ‘Long COVID’. These ‘Long Haulers’, as they have also been termed, may have a variety of symptoms including ongoing loss of smell (anosmia), fatigue, chest pain and shortness of breath, as well as many others. The concern at hand is, how do we best care for these individuals, especially when these residual symptoms are often a secondary complaint when presenting to chiropractic clinics?
Few of us could have guessed nearly a year and a half ago, that we would still be in the grip of pandemic lockdowns and fierce health debates almost eighteen months on. The disease is real, and its management complicated, but while appropriate health professionals grapple with how to contain the outbreak, it seems likely that chiropractic clinics may be one place where post-COVID long haulers turn up looking to get their health back on track
Research is beginning to point to the daunting possibility that, when we move past COVID-19 running at pandemic levels, millions of individuals will continue to experience symptoms and clinical problems. “These are people who have won the battle against the virus, but the battlefield – the patient’s body – is left damaged by the fight,” researchers have remarked .
As these individuals will be a part of the population seeking chiropractic care, we should be prepared to assist them in the best way we can.
It is predicted that “Long Haulers” will likely present to clinics with a musculoskeletal complaint, mentioning comorbidities as an afterthought. These patients present us with an opportunity to care for them in a holistic manner, not disregarding the non-musculoskeletal complaints. Adopting a broad-minded, and dynamic approach to care in this post-pandemic world is vital in delivering the best care possible to our patients and practice members [1-3].
It takes a tuned-in chiropractor to notice these queues that may indicate long-COVID complications, and this is why research (including the case report below) is important to bear in mind.
THE CASE REPORT
The issue of post-COVID infection research is an interesting one. We know that research takes time. Usually, we look for papers examining recovery some months or even years out. But we are far too close to the metaphorical ground zero of this global disaster to have strong data on this virus.
What we do know is this: case reports are beginning to emerge. While case reports do not give us the ability to generalise or make wide-spread claims, what they do give us is clinically relevant insight. And that is just what a recent case report in the Asia Pacific Chiropractic Journal served up .
The case covered in this article referred to a woman who had recovered from COVID-19 infection, in that she was no longer experiencing severe symptoms and had been free of fever for over 72hrs.
She presented with the primary complaint of chronic low back pain. During the visit the patient dropped the hint that she was experiencing olfactory dysfunction. She was surprised post-adjustment she could smell the fragrance of the hand sanitiser. In the following visits the chiropractor started asking about this, as she had concluded the patient was experiencing anosmia, and the chiropractic care appeared to be easing symptoms. In the following visits the patient reported that she had been able to detect the flavour of garlic while at the family dinner table. As the detection of flavour is a combination of taste and smell, it signified her olfactory sense was returning.
Significant in this case is the chiropractor’s skills of observation in that she was able to follow the hints given by the patient and expand her knowledge of patient symptomatology beyond musculoskeletal alone. Also advantageous to this situation was an awareness about the symptoms of Long COVID, an expectation that they may be quite prevalent, and the ability to look for them and ask about them. Subjective and more qualitative measures, such as questioning about olfactory function in daily life, provide valuable information in the treatment and their progression/improvement etc.
While other case reports involving chiropractic care and restoration of olfactory function do exist, we are yet to understand the mechanism behind these improvements. What is plainly obvious from the long COVID research we have is that caring for the body and nurturing the nervous system that runs it may be important long after the tests come back negative.
- H.E. Davis et al., Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine (2021) https://doi.org/10.1016/j.eclinm.2021.101019
- Menges D, Ballouz T, Anagnostopoulos A, Aschmann HE, Domenghino A, Fehr JS, et al. Burden of post-COVID-19 syndrome and implications for healthcare service planning: A population-based cohort study. PLoS ONE (2021) 16(7): e0254523. https://doi.org/10.1371/journal.pone.0254523
- Ayoubkhani D, Khunti K, Nafilyan V, Maddox T, Humberstone B, Diamond I et al. Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study BMJ (2021) 372 :n693 doi:10.1136/bmj.n693
- Masarsky CS. The wide-angle lens: The post-pandemic research era. Asia-Pac Chiropr J. (2021) 1.4. URL www.apcj.net/papers-issue-2-1/#MasasrskyLongHaulers