Older people will need rehab after lockdown, GP warns

Unsupervised Covid-19 lockdown exercise regimes keeping physios busy

 GP Ray Walley says older people  are losing power in their thigh muscles as they are not getting out and exercising as much as they would have prior to Covid restrictions. Photograph: Alan Betson

GP Ray Walley says older people are losing power in their thigh muscles as they are not getting out and exercising as much as they would have prior to Covid restrictions. Photograph: Alan Betson

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The health service is going to have to concentrate on rehabilitating older people who were previously fit but have experienced a drop in mobility due to the Covid-19 pandemic, a Dublin GP has warned.

Dr Ray Walley said the biggest problem he was seeing among older people was loss of power in their thigh muscles as they are not getting out and exercising as much as they would have prior to Covid restrictions.

“A lot of older people, who were perfectly mobile before, are not mobilising as much as they would have previously, they’ve put on some weight, their energy output has reduced, this is not just older people but once you reach 40 you lose 2 per cent of your muscle mass every year,” he said.

“There needs to be a push on educating people to the fact to keep activity going in the same way, for example, the Department of Health advised that everyone over 65 should be on vitamin D.”

Dr Walley said he was advising his older patients to clear their back gardens of any obstructions and to walk around its perimeter repeatedly.

“We need to adapt and have ambition with that adaptation. It is quite amazing many of my older patients have adapted to using the internet and things like that,” he added.

“Beaumont provides a lot of mental health advice and a lot of other advisories with regards to exercise, they just need to be signposted.

“Some of our elderly, by way of their children or grandchildren, have adapted to a lot of the stuff but we can’t afford to leave other people behind though.”

Hip fractures

Dr James Cashman, consultant orthopaedic surgeon at the Mater Private Hospital, said he had also seen “a concerning uptick” in older patients presenting with hip fractures.

“These would typically be patients who have been isolating or cocooning and they wouldn’t have been getting their regular exercise and then when things opened up they were getting a little bit of exercise but would have been a little frail, fell and broke their hip,” he said.

“So when things opened up, particularly after the first lockdown, we saw an uptick in hip fractures which are quite a significant injury.”

Dr Cashman said “ideally” everyone should be continuing to do some form of exercise, but older people who had been cocooning should “take that extra little bit of caution” if they were out exercising.

Hospital Report

Confirmed cases in hospital Confirmed cases in ICU
448 88

“From my point of view, I think swimming is a huge loss for older people because running and field sports don’t really work for a lot of people and even walking, people might be worried about walking out in the environment with social distancing and that,” he said. “As an exercise, I think swimming is a huge loss. People have lost out on that as an outlet in a big way.”

Sport injuries

Meanwhile, Dr Enda King, head of rehabilitation at the Sports Surgery Clinic in Santry, Dublin, said he had seen a “huge increase” in injuries when people who played sports returned to competitive training.

Dr King said there was a rise in injuries when team sports returned to training last summer following the easing in lockdown restrictions.

“People who play recreational or more competitive sports in non-Covid times, when they go back to their sports we’re finding a huge increase in injuries. Even though they’re doing exercises at home, they’re doing their 5km runs or whatever else, it’s not reproducing the intensity or the demands of a movement type that are specific to their game,” he said.

“For example, at the intercounty level, club GAA or rugby, lots of teams are in better shape than they’ve been for a long time aerobically, both male and female.

“However, when they go back to sport, because of the demands of change direction and high-speed sprinting, especially under competitive circumstances, you’re seeing a large spike at all levels in soft tissue and joint injuries.”

Dr King said those who were hoping to return to team sports over the coming weeks and months should be getting exposure to high-intensity activity such as sprinting twice a week.

“If team sports gets the go-ahead at junior or league level over the next few weeks and everyone else a couple of weeks after that, you’ll see people making a big burst in training to get back playing matches very quickly without necessarily having enough time to build back up that level of intensity,” he said.

“You can do all the running and aerobic work you want, but it’s much more demanding when you have to sprint and accelerate and change direction in response to a ball or a competitor. You see that people just aren’t prepared for the demands of that.”

Another trend physiotherapists are dealing with during lockdown is people “over-training” because they are not being supervised at a gym or by a club coach.

Over-training

Bob Firo, of the Dublin Sports Injury Clinic, said frustrated amateur athletes were “doing too much, too quick and for too long”.

“This week I had five patients who were over-training,” he said.

“Because they don’t have access to the gym, people are mostly running or doing home workouts. Unfortunately, because they don’t have a programme to follow and they have more time on their hands, they are doing too much of it.”

Firo said some people presenting at his practice were exercising every day without taking any time for recovery.

“It feels good at the start, almost addictive and it’s one of the only things people can do,” he said.

“But at some stage something will go wrong, because the body needs to recover as well. You have to give it a break, and look at your food and your sleep as well.”

One man who attended his clinic during the week couldn’t understand why he had a sore, swollen knee. It turned out he had been running 24km every week since the start of the first lockdown in March last year.

“That might be fine for six weeks, eight weeks, 10 weeks but not for a year,” the physical therapist said.

Firo has noticed a lot of people turning to running in particular during the restrictions.

“If you take up running seriously, you need to have a plan,” he said.

“People are running without any plan, any goal, because there are no organised runs or marathons at the moment. People are just running to do something, sweat it out and feel good.”

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