Physiotherapy plays a supportive and rehabilitative role in dengue fever management, focusing on symptom relief, functional recovery, and preventing complications, especially during the recovery phase.

Phases of Physiotherapy Intervention

Acute Phase (During Fever/Hospitalization): During the acute phase, medical management (fluid balance, platelet monitoring) is paramount. Physiotherapy is typically minimal and cautious:

• • Rest: Emphasize complete physical rest to conserve energy and reduce metabolic demands.
  • Positioning: Advise on comfortable and therapeutic positions to ease body aches, prevent stiffness, and reduce the risk of pressure sores for bed-ridden patients.
  • Gentle Passive Range of Motion (PROM): If medically cleared and well-tolerated, very gentle passive movements can help maintain joint flexibility and prevent stiffness, while being extremely cautious due to potential low platelet counts and bleeding risk.

Sub-Acute / Recovery Phase (Post-Fever/Discharge): This is the most crucial phase for physiotherapy intervention. Many patients experience significant post-dengue fatigue (Post-Dengue Fatigue Syndrome – PDFS), generalized muscle weakness, and lingering body aches.

• Pain Managment:
  • Gentle Manual Therapy:
    • Myofascial Release (MFR): Apply very gentle, sustained pressure to areas of muscle soreness and fascial tightness. This can help improve circulation, reduce muscle stiffness, and alleviate widespread body aches often experienced after dengue.
    • Gentle Soft Tissue Mobilization: Light effleurage or kneading can promote circulation and reduce muscle soreness. This must be done with extreme caution due to the risk of bruising, especially if platelet counts are still recovering.
    • Gentle Joint Mobilization: If there is mild joint stiffness from prolonged immobility, low-grade mobilizations can be applied cautiously to restore normal joint play, strictly avoiding any forceful or painful techniques.
    • Cryotherapy/Thermotherapy: Local application of cold packs for acute joint pain or heat packs for muscle aches, as tolerated.
    • TENS (Transcutaneous Electrical Nerve Stimulation): May be used for pain modulation, if medically cleared (avoiding areas prone to bleeding).
    • Stretching: Gentle, sustained stretches for muscles prone to tightness due to bed rest or muscle guarding.
• Fatigue Management (Post-Dengue Fatigue Syndrome – PDFS):
  • Energy Conservation Techniques: Crucial education on pacing activities, prioritizing tasks, breaking down activities into smaller steps, and scheduling regular rest periods to prevent post-exertional malaise.
  • Graded Exercise Therapy (GET): A carefully structured and progressive exercise program. It starts with very low intensity and short durations (e.g., 5-10 minutes of gentle walking or seated exercises) and gradually increases duration before intensity. Close monitoring of fatigue levels is vital to avoid overexertion.
  • Aerobic Conditioning: Introduce low-impact activities like gentle walking, stationary cycling, or swimming (once fully recovered and not a risk for infection) to gradually improve cardiovascular fitness and reduce fatigue.
• Strength and Endurance Training:
  • Progressive Resistance Exercises: Begin with bodyweight exercises, gradually advancing to resistance bands or light weights as strength improves. Focus on major muscle groups that may have atrophied.
  • Functional Exercises: Incorporate movements relevant to daily activities (e.g., sit-to-stand, stepping, reaching) to restore functional independence.
• Chest Physiotherapy:
  • This becomes particularly relevant if the patient develops respiratory complications such as fluid accumulation in the lungs (pleural effusion), pneumonia, or atelectasis due to prolonged bed rest.
  • Breathing Exercises:
    • Diaphragmatic Breathing: To encourage deeper breaths and improve lung ventilation.
    • Thoracic Expansion Exercises: To promote expansion in all lung segments.
    • Pursed-Lip Breathing: To slow down breathing and improve exhalation in cases of shortness of breath.
  • Airway Clearance Techniques:
    • Assisted Coughing/Huffing: Teaching effective techniques to clear secretions.
    • Postural Drainage: Positioning the patient to use gravity to help drain secretions (used cautiously, considering patient’s condition).
    • Percussion and Vibrations: Gentle clapping or shaking over the chest wall to loosen secretions. This must be used with extreme caution and only if platelet counts are stable and high enough to avoid bleeding or bruising.
    • Active Cycle of Breathing Techniques (ACBT): A structured cycle of breathing control, deep breathing exercises, and huffing/coughing.
  • Early Mobilization: Encouraging regular changes in position and early ambulation (sitting up, standing, walking) to prevent lung complications.
• Neuromuscular Re-education and Balance Training:
  • Some patients may experience transient neurological symptoms like dizziness or mild balance issues. Physiotherapy can help restore coordination and balance.
  • Exercises include static and dynamic balance drills, proprioceptive exercises (e.g., standing on uneven surfaces), and coordination tasks.