Long COVID, Total Knee Replacements, and Spinal Stenosis

By: Jill Murphy, DPT, LAT, CSCS

The earliest research is just coming out on different ways that healthcare providers can help patients mitigate long COVID symptoms.  The latest article in the British Medical Journal Open was a qualitative study with a small number of subjects on returning to physical activity and all aspects of normal, healthy living after COVID-19 infection.  Researchers found that patients struggled with knowing how much and when to return to daily living activities, and later more physical activities all while attempting to cope with cognitive issues like brain fog and overall worsening cognition, psychological barriers, and overall physical fatigue.  This study demonstrated the need for healthcare providers such as physical therapists to be there to coach patients in how to determine appropriate levels of function without flaring symptoms on the road to recovery and return to working out.

Also in the medical news recently, some info for those anticipating a knee replacement in the near future.  In a study of over 67,000 subjects, researchers found that at least 6 visits of physical therapy within 30 days after total knee replacement surgery reduces the risk of using opioids to treat pain beyond 90 days after surgery.  No doubt, having a physical therapist providing tips and tricks on reducing swelling, improving mobility, and performing the correct amount of activity each day, will help you feel better and return to normal life much more quickly compared to those who never received much or any physical therapy. 

In another study on over 60,000 Medicare beneficiaries, researchers found that patients who have been recently diagnosed with spinal stenosis in the low back or lumbar spine and received physical therapy within the first 30 days of diagnosis had lower risks for opioid use and need for hospitalization, spinal surgery, and spine imaging.  Subjects who received physical therapy early on were compared to subjects who didn’t.  Despite these great results, most patients who receive a diagnosis of spinal stenosis are never sent to physical therapy.  Only 1.9% of the Medicare beneficiaries in the study were sent to physical therapy, despite the amazing results that kept patients from needing pain meds, surgery, and hospitalization.  The take home point here is to always ask your doctor if physical therapy could help you.  Overall, only 7% of patients of any age with low back pain are sent to physical therapy, despite positive results in returning patients back to their prior level of function with fewer pain meds, less imaging, and less likely need for surgery.  Try PT first, and don’t forget to remind your doctor to refer you to PT first as well! 


  1. Humphreys H, Kilby L, Kudiersky N, et al. Long COVID and the role of physical activity: a qualitative study. BMJ Open 2021;11:e047632. doi: 10.1136/bmjopen-2020-047632
  2. Aoyagi K, Neogi T, Peloquin C, et al. Association of Physical Therapy Interventions with Long-term Opioid Use After Total Knee Replacement. JAMA Netw Open. 2021;4(10):e2131271. doi:10.1001/jamanetworkopen.2021.31271
  3. Schmidt CT, Ogarek J, Resnik L. Physical Therapy and Health Care Utilization for Older Adults with Lumbar Spinal Stenosis. J Geriatr Phys Ther. 2021 Sep 24. doi: 10.1519/JPT.0000000000000328. Epub ahead of print. PMID: 34570040.