Ask the Doctors: Exercise routine may need to change after COVID-19

Hello, dear readers, and welcome to the monthly letters column. Are we too far into 2023 to wish you all a happy New Year? We're deep into flu season, as well as lose-those-holiday-pounds season. Both are topics in your letters, and of future columns. And now, your questions.

— Our ongoing columns about post-COVID-19 exercise continue to generate mail. "When is it OK to resume my walking regimen of about 3 miles daily?" a reader asks. "I have been walking outdoors, but I find myself tiring easily." We continue to learn about the aftereffects of COVID-19 infection, and guidance for resuming exercise continues to evolve. People who are dealing with fatigue or exhaustion are urged to forget their pre-COVID-19 routines. Instead, treat each day as a unique unit, and exercise to the abilities of that day. Pushing oneself, as we do when we're healthy and trying to improve strength or stamina, can backfire after being infected with COVID-19. Assess yourself each day, listen carefully to the feedback from your body, and stop before you are fatigued.

— A reader from Virginia is dealing with rheumatoid arthritis, an inflammatory condition that affects the joints and other tissues. He asked about anti-inflammatory medications. "In an article about RA, you mentioned newer medications, but didn't give any names," he wrote. "While I hope I never need them, I would like to be prepared to have a conversation with my rheumatologist if I do." Mild cases of RA are typically treated with ibuprofen, naproxen and similar nonsteroidal anti-inflammatory drugs. Corticosteroids are also used. When you talk to your rheumatologist about newer medications, ask about biologics and if they would be appropriate for you. This is a class of engineered drugs that target specific inflammatory cells or processes to fight and manage disease. Biologics include monoclonal antibodies, several of which have recently been approved for use in certain cases of RA.

— We recently wrote about listeriosis, a serious infection caused by the bacterium Listeria monocytogenes. It usually arises from eating contaminated food. Listeriosis causes a range of symptoms, including stomach and body aches, fever, headache, chills and diarrhea. It's particularly dangerous for pregnant women, newborns and those with compromised immune response. A reader from Illinois asked for clarification regarding rates of listeriosis infection. "You wrote that about 1,600 people get it each year, and about 260 of them die," he said. "I would like to know if those figures are for the United States or for the world." Thank you for the chance to clarify. Those numbers come from data collected by the Centers for Disease Control and Prevention and focus solely on cases of listeriosis in the U.S. Worldwide, the numbers are higher. While exact data aren't available, it is estimated the bacterium sickens at least 24,000 people throughout the world each year and causes more than 5,500 deaths.

Thank you, as always, to everyone who took the time to write. We love hearing from you and are happy to learn that so many of you find the columns helpful.

Dear Doctors: I am 33 years old, and I've been diagnosed with sciatica. It's hard to sit at my desk for my job. Sometimes the pain wakes me up at night. Could this have happened from lifting boxes when we moved? My husband says I should see a chiropractor. Is there anything else that can help?

Dear Reader: When you have sciatica, it means that something is putting pressure on, is irritating or has caused damage to the sciatic nerve.

Although it is referred to in the singular, the sciatic nerve is a complex structure that includes two different bundled and branching nerves and multiple nerve roots. Taken together, these form the longest nerve in the body. The sciatic nerve originates in the lower back. It then travels through the pelvis and buttocks, runs down the back of each leg, and ends at each heel. It helps to animate the muscle groups that we use to stand and walk, and it contributes to sensation in the parts of the body that it serves. That's why, in addition to inflammation and pain, sciatica can sometimes result in numbness.

The heavy lifting that you did during your move may indeed have led to your case of sciatica. Incorrect lifting can contribute to one of the main causes of the condition, which is a bulging, herniated or misaligned disc in the spine, which presses on the sciatic nerve. Additional causes can include a narrowing of the spinal canal, known as spinal stenosis; tightness or spasms in the muscles that stabilize the spine; and new or preexisting damage to the structure of the spine.

Pregnancy, diabetes, being overweight, being sedentary and slumping while seated can all add to the risk of developing sciatica. Symptoms include a sharp and sudden pain in the buttocks, back of the leg or along the outer calf; numbness; tingling or a pins-and-needles sensation in the leg or the foot; and muscle weakness in the leg, ankle or foot. Standing is difficult when you have sciatica, and lying down often eases the pain. In some cases, the symptoms ease a bit when walking.

The first line of treatment often begins with medications. These are to ease inflammation and, if needed, manage muscle spasms and pain. Once those are under control, patients are typically referred to a physical therapist, who works with them on appropriate exercises, improving posture and preventive ergonomics. It's not common, but in some cases surgery may be needed to relieve pressure on the nerve.

Chiropractic care, which involves manipulation of the spine, can be useful in sciatica. It can relieve pain without medication and can help with the alignment issues that triggered the condition. Be sure to find a chiropractor with experience in dealing with sciatica, and ask them how they will approach your case. While chiropractic treatment is considered a safe therapy for sciatica, it's always a good idea to vet your health care provider and be familiar with what the treatment will entail.

Going forward, it's important to avoid heavy lifting, and be careful about maintaining good posture, particularly while spending long hours at your desk.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.