The physical therapist’s words shocked me and brought quick tears. After hearing about my experience on Mt. Kilimanjaro and my love for hiking, he said, “Well, it’s not realistic to expect to be back at full hiking strength anytime soon, if ever. I’ve worked with long COVID patients since they were first being identified during the pandemic, and I’ve never seen anyone fully recover.” My immediate reaction was Holy cow!! (actually, it was a bit stronger), and then I thought What a terrible thing to say to a patient! It was my first appointment with a physical therapist as part of my treatment for long COVID, and I left distressed and discouraged.
I was hugely disappointed in early August 2024 not to have reached the summit of Kilimanjaro when the effects of COVID-19 resulted in an early descent about halfway through the climb, but I expected to bounce back easily as soon as the acute infection was over. Instead, in mid-September I joined the unfortunate 5-30% of people who develop long COVID.
My form of COVID-19, both the initial infection and the long COVID symptoms, affected the muscular system instead of causing the more common respiratory issues. This variant can cause rhabdomyolysis, usually associated with athletes who over-train, which prevents the muscles from properly using the oxygen in the blood stream. The result is extreme muscle weakness in addition to the chronic fatigue, which is a hallmark of long COVID.
A couple of my earlier blogs have mentioned long COVID in passing, and the reality is that I’ve been far more debilitated than I have shared. Many days during the last four months I was non-functional, unable to complete basic daily tasks. I went from being “Kili fit” – physically and mentally conditioned to hike the highest free-standing mountain on the African continent – to being unable to walk to my mailbox, a distance of about twenty yards. The extreme fatigue often kept me in bed or on the couch. If I pushed to do something important to me, like sharing my story with Bethesda Workshops participants (perched on a high stool instead of standing) or walking a few hundred yards up my favorite trail to bolster my emotional health, those enjoyable minutes often cost me for days.
My primary care physician recommended I contact the long COVID clinic at Vanderbilt Hospital. The first available appointment was over three months away, which left me on my own to deal with the debilitating symptoms. Finally, the specialist I saw at Vanderbilt prescribed a promising medication, as well as the possibility of a clinical trial. She also recommended physical therapy to facilitate an extremely gradual ramp-up of exertion, designed to increase stamina without causing a crash. I had experienced several of those after apparently doing too much on days when I felt better. (“Too much” is still very little compared to my normal activity, even before I started training for Kilimanjaro.)
I was referred to Vanderbilt’s physical therapy center, which has specialists who work with long COVID patients. The therapist assigned to my case, the one whose words crushed me during our intake session, chose to start with aquatic therapy because the muscles don’t have to fully support the body weight as well as do their work. (Yes, I decided to give him a second chance since I was desperate for help.) So far, the process involves about 30 exercises — I’d describe them more as movements — with only FIVE reps of each. They are simple motions like lifting your knees or moving arms out and then back in front of your chest. The therapist called it a low-cardio, full-body workout, and that description felt right by the time we finished a surprisingly tiring first session. After I got a shower, I needed to sit for fifteen minutes before I could head to the car, which was parked a five-minute walk away.
Because I was going through the routine independently between appointments, I had strict instructions not to increase reps or add other activity in order to be sure we had a baseline of exertion that wouldn’t tank me. (So far, so good.) I was also told to prioritize this activity over everything else — that the dailyness of “managed exertion” is important. I can do some other mild effort, like an errand or household chore if I feel like it, but not for a couple of hours after aquatic PT. Eventually, over many weeks, we’ll gradually increase the reps and add other exercises.
Like everything related to trekking Kilimanjaro, the lessons from physical therapy are plentiful. As I reflected on them, I realized that the principles equally apply to healing from trauma or recovery from addiction or betrayal. I needed to reframe the process of PT into viewing this plan as the opposite of what I did for Kili. That was a specific daily training program to push me into higher levels of activity. This is a specific daily program to keep me from pushing myself. On Kilimanjaro, this approach is called Polé, Polé!, which is Swahili for “slowly, slowly!”
Recovery-related healing is also counter-intuitive at times. Instead of trying to control other people, situations, or consequences, we learn to focus on ourselves. Rather than looking for the quick fix, we keep at something for the long haul, which almost always involves a much slower process than we’d prefer.
Embracing a new paradigm helps my impatience with my progress. I was chaffing to get back to walking my neighborhood routes and eventually to hiking, and on good days I walked too far without realizing it. Instead, I was told to walk for two minutes, stop and rest, and repeat after an hour or two if I felt up to it. I have realized that I can chafe at what I can’t do, like walking as far as my emotions desire, or I can accept my limits and trust that ten two-minute walks will get me to my goal better than one twenty-minute push.
Similarly, an important recovery slogan is, “My own best thinking got me here.” In my case, that applied to my thought process that I could walk farther when I felt like it, which only earned me a crash most of the time. Healing in recovery almost always demands a different approach from the ideas we’ve come up with on our own – a new paradigm that involves acceptance, surrender, and frequently sacrificing the now for the sake of the later.
Physical therapy reminds me that daily disciplines are important. I can tell that completing this regimen every day is paying off. The progress is subtle, but it’s there. I can get upright from the floor without having to “slow walk” up the side of the couch, so I’m getting back a tad of quad strength. I’m not quite as tired now after the workout.
The phrase “one day at a time” is a cornerstone of Twelve Step recovery and has become part of the general vernacular. The point is about focusing on the present, but it’s also the prescription for “working the program” every day, which means doing the tasks and maintaining the attitudes of recovery. Daily disciplines are key for healthful living physically, mentally, emotionally, and spiritually.
Like the daily aqua movements, I was told to do simple breathing exercises, which I admittedly found insulting at first. I’ve been able to stretch gently the last couple of months, which includes breathing intentionally, so I thought I had that area covered. Instead, I was assigned five breathing sequences once an hour, eight to ten times every day. Again, I’m finding that the repetitive process yields better results. My shortness of breath and dizziness are less frequent now, and I learned that humility pays off more than being a know-it-all.
The lesson of refusing to be discouraged by pessimism is the one that engaged me in physical therapy when I was tempted not to return after the initial appointment. In tears that first afternoon, I reached out to my people, who quickly responded with encouragement. One said that I had often beaten poor odds. Another was sure that I would see improvement and emphasized the importance of a positive mindset. Eventually, after I got the anger out of my system, I decided I had nothing to lose by trying PT. I remembered how I had eventually thrived despite difficult circumstances, and I decided that if this time wound up with a different outcome, it wouldn’t be for lack of trying.
In recovery situations, uninformed (or ignorant or wounded) people often insist that healing isn’t possible. They tell addicts that they will never be sober or tell partners that they will always be crushed by the pain of betrayal. Couples are cautioned that relationships rarely heal and that regaining trust is nearly impossible. Individuals are often forewarned that their happiness depends on what someone else does or doesn’t do. Malarkey!
People who are hurting need hope more than they need a reality check, and they need a plan for making things better. Five reps of ridiculously simple movements may not sound like much, but slow progress is still progress. Polé, Polé!
Marnie C. Ferree
Bethesda Workshops Founder