It's a nasty little virus, that chikungunya. I never thought I would succumb, until two weeks ago when a sneaky mosquito flung me off my cloud of invincibility. I now feel 40 years older, with the arthritic pains reflective of such an age.
Thankfully, my symptoms were not as severe as others have experienced. Although laid up for a week, I could at least still walk, albeit it very slowly, with apprehension about sudden movements. The rash was the worst. Little bumps raised like tiny ant bites all over my extremities, that itched and burned as if an invasion of ants themselves had attacked me. After 24 hours of poor sleep and itching to the point of drawing blood, I succumbed to the lure of messy calamine lotion. Alas! I could have been mistaken for a masquerader in a J'ouvert band!
The worst part of the virus came after it had run its course. After a week of bed rest I thought (against everything I knew) that I could easily return to my previous level of functioning, as I was a reasonably fit individual. However, the realisation of how much I had deteriorated in strength, endurance and function hit me like a slap in the face.
Two weeks after the onset of symptoms, the joint pains lingered, and the fatigue at the end of the day took me by surprise. It was a good reminder of what I preach to patients on a daily basis-use it or lose it! After one week of bed rest I am reduced to a physical fragment of my former self.
Having peeled my ego off the floor, I began formulating ways of progressing to my former level of function. Two things I had to consider were the joint pain, and the loss of conditioning due to bed rest.
The joint pain was typical of arthritis, and manifested in joints I use a lot, namely my feet and hands. They were sensitive to weight-bearing, and painful after being in one position for a prolonged period, particularly when getting out of bed in the morning. So movement helped, once it was not prolonged weight-bearing activity.
Before getting out of bed, I did simple range of motion exercises with my painful joints, which helped lubricate them and decrease the pain. Warm showers also helped a lot. This is typical of arthritic pain, as warm water or moist heat can help loosen and ease painful joints. Some days I took up to 4 baths! However, heat is not recommended during the acute phase of the disease, and cold compresses may be more beneficial at that time for pain management.
Having overcome the brunt of the virus, I began doing gentle cycling on a stationary bike which also provided some relief to the aching joints. Being non-weight bearing, cycling promotes range of motion and lubrication of the knees, hips and ankle joints. In fact, the World Health Organisation recommends mild non-weight bearing exercise in the management of chikungunya-related joint pains after the acute phase.
Once I returned to work, I looked forward to sessions of pool therapy with patients. The warm water provided an environment of decreased weight-bearing in which I could do exercises such as squats and other strengthening and range of motion activities safely.
The second issue of fatigue and decreased conditioning was the most frustrating as it limited what I wanted to do on a daily basis. Like a runner who wants to progress to that marathon, I had to increase activity little by little. I could not return to my previous level of function immediately, just as a beginner runner cannot immediately run a marathon.
I began with returning to work for 3 days the first week out. There was no added exercise, as a day of work was enough to leave me spent. By week two I was able to work 5 days. Although still fatigued at the end of the day, I was much less so than the first week. Wearing soft shoes with cushioning (sneakers) helped with the pain in my feet. The third week out to work begins on Monday and I plan to introduce weight-bearing exercise into my routine. This will not be at the same level as before, but simple exercises geared to safely increasing strength and endurance, joint pain allowing. I will gradually work up to my previous level of training as the body accommodates to the activity.
It is important to understand that while the above routine is working for me, it may not work for everyone. Each individual is different, and will have different manifestations of the virus. Therefore, each person should seek medical advice on what types of exercise and pain management is best suited for him/her.
EDITOR'S NOTE: Carla Rauseo, DPT, CSCS, ATRIC is a Doctor of Physical Therapy and a Certified Aquatic Therapy Rehabilitation Instructor at Total Rehabilitation Centre