Even after recovering from COVID-19, many patients continue experiencing symptoms that linger for weeks or even months. These lingering effects, known as long COVID, can impact physical and cognitive functioning, disrupt daily routines and significantly affect quality of life. But there is hope, especially through specialized care from experts in physical medicine and rehabilitation, better known as PM&R.

At CU Medicine, the largest community-based physician group practice in Colorado, PM&R providers work closely with patients navigating long COVID symptoms and their health teams to help those suffering regain function and comfort.

We spoke with Dr. William Niehaus, a physical medicine and rehabilitation specialist provider at CU Medicine, to learn more about what long COVID looks like from a rehabilitation standpoint and how patients can start to feel like themselves again

What is long COVID?

Long COVID means having symptoms that last three months or more after a suspected COVID-19 infection, according to a 2024 report from the National Academies of Sciences, Engineering, and Medicine.

Long COVID is different for everyone. “Typically, there’s a layer of fatigue, cognitive slowing, body aches, and/or interrupted sleep patterns,” Dr. Niehaus shares. “There are also some folks who report having rashes, allergic reactions, and gastrointestinal symptoms.”

How is long COVID diagnosed?

Doctors usually diagnose long COVID by looking at your symptoms and medical history. You might have had a confirmed or suspected COVID-19 infection. If your symptoms have lasted more than 3 months after an infection — come and go or have worsened existing health issues — you might be experiencing Long COVID.

Common issues include tiredness, brain fog, pain, sleep problems and worsening symptoms from things like arthritis or depression.

A diagnosis is often made if symptoms last more than three months.

The role of PM&R in long COVID care

PM&R doctors like Dr. Niehaus help people who have trouble moving or doing daily tasks. They focus on improving strength, comfort and quality of life. For long COVID, this might mean helping with:

• Feeling tired after small activities
• Trouble breathing
• Nerve or muscle pain
• Thinking clearly
• Balance and heart rate problems

"We look at the whole person and help them manage their symptoms safely," Dr. Niehaus shares.

Managing chronic pain and fatigue

Pain is common with long COVID. People often search for a pain doctor near them, but it's important to find someone who understands post-COVID problems. At CU Medicine, PM&R doctors work with a team that may include physical therapists, occupational therapists, mental health providers and primary care doctors.

"One of the biggest parts of treatment is learning to pace yourself," Dr. Niehaus said. "We help people balance activity and rest so they don't crash."

Long COVID can look like other illnesses, such as chronic fatigue syndrome or fibromyalgia. PM&R doctors help patients understand their symptoms and take back control.

Why a team-based approach matters

Long COVID can affect many parts of the body. That is why it's important to have an integrated care team. Dr. Niehaus likes to refer to these team members as your health collaborators. These collaborators may look like:

• Primary care doctors
• Heart doctors (cardiologists)
• Lung doctors (pulmonologists)
• Brain and behavior specialists
• Rehab and therapy experts

Unfortunately for some, patients wait for weeks or months to get a diagnosis due to providers and peers not believing them or understanding their symptoms.

"These symptoms are real," Dr. Niehaus said. "You are not making them up. We are here to help."

Hope for recovery

Many people with long COVID do get better, especially when they have the right support.

"People do improve," Dr. Niehaus said. "It can take time, but we see real progress." That might mean going back to work part time, taking a short walk or getting better sleep.

Specific treatments include medications and therapies tailored for each person’s unique case.

The Anschutz Medical Campus is also involved in the NIH-sponsored Researching COVID to Enhance Recovery (RECOVER) Initiative which studies the long-term effects of COVID.

“Boiled down, we try to help people get better sleep and/or figure out what recharges their battery so they can get back to the things they love and their life,” explains Dr. Niehaus.

If you or someone you know still has symptoms after COVID-19, you are not alone. Help is available.

• Learn more about CU Medicine's physical medicine and rehabilitation clinics.
• Learn more about Dr. William Niehaus by visiting his provider page.
• Find a primary care doctor to begin your recovery journey.
• Multidisciplinary collaborative guidance on the assessment and treatment of patients with Long COVID: A compendium statement