Long Covid

On September 8th 2021 it was World Physiotherapy Day, which celebrates the work that physiotherapists across the world do to help their patients on their healthcare journey. This year’s topic is Long COVID, and those that live with it, and how physiotherapy can help.

Long COVID is currently described as the presence of signs and symptoms that develop during or following the infection COVID-19, when they continue for 12 weeks or more.  It is currently suggested this affects 1 in 10 people who have had the COVID19 infection. It is important to see a GP if you have on-going symptoms after 12 weeks so they can fully assess you.  

I became involved in working with Long COVID following my own recovery from pneumonia. I had many similar symptoms and I did a lot of research to help myself at the time.  I now help patients by sharing what I have learnt along the way both on the NHS and privately at Walnut Grove Clinic.  I also now sit on the Executive Board for a peer support, education and advocacy association called Long COVID Physio.  I want to share with you some tips I give for the two most common complaints, on how to best manage fatigue and breathing. 

Fatigue

This is a normal part of the body’s response to fighting a viral infection like COVID-19, but frustratingly can continue for some time after the initial infection has cleared. It can be easy to fall into the trap of pushing through it, doing too much, then crashing and having a period of extreme fatigue, known as the Boom Bust effect. This becomes an unpredictable cycle. 

I saw a great analogy on twitter for how it feels to have fatigue and why we need to pace.  Consider our favourite essential item, the mobile phone.  Imagine a brand new phone that has a fully charged battery of 100%.  That new phone lasts for a good couple of days before you need to charge it up again, and just keeps on going. Now picture the old mobile phone that’s a few years old, and although you fully charge it to 100% it just doesn’t hold its charge for long, and you end up plugging it in every few hours!  This latter one is like fatigue.  You start with the same amount of energy, but it’s used up much quicker, and you need to recharge in order to carry on. Here are some tips to help pace and manage in an effective way:

1. Prioritise things that are essential to your day or week.  Take a moment to work out what you really need to do.  Don’t be tempted to overcommit and squeeze things in, and do learn to accept help.  
2. You should always aim to leave some energy at the end of an activity, and not push on through, so you may need to modify those tasks that involve more energy.  This may be by breaking up tasks into smaller more manageable amounts, such as housework. Or you may want to change the position you do these tasks in.  For example, using a chair when you would otherwise stand. 
3. Next factor in some real rest breaks to help you manage your day more effectively.  It is often surprising to know that rest doesn’t include sitting watching TV, using the internet or social media, looking at our phones, or even sitting chatting with others. It is the quiet time that is most beneficial, and can involve doing breathing exercises, meditating, and sleep.  
4. Lastly, always save some of your energy each day to do something you love and enjoy.  My new found love this past year has been gardening, and working in my front garden.  Although it is active, I found it quite mindful and rewarding, and I could modify what and how I did things. Like asking my very tolerant husband to do the hard graft and digging of holes for new plants!

It can be useful to use an activity diary to help you get the baseline of what you can comfortably manage day to day, and highlight what your triggers are.  World Physio has a great downloadable activity diary to do this. 

Breathing

After COVID and many respiratory infections, it is being found that an important part of the recovery is improving your breathing pattern and technique.  Breathing can significantly affect your energy levels if you breathe with a poor pattern, or too fast. Here are some tips on good breathing.

1. Breathe in and out through your nose. Mouth breathing is not good while you are sitting relaxed. You should breathe through your nose while resting. Your nose is very important as it cleans, warms and moistens the air that goes into your lungs; it also controls the flow of air going through to your lungs. It is ok to breathe through your mouth when you are exercising.
2. Quiet silent breathing is important. Hearing your breathing may mean that you are breathing too much. Your breath size needs to be smaller so that you cannot hear it.
3. Your breathing rate should be 8-12 breaths per minute.  Time one minute and see how many breaths in and out you take.  If you breathe more than 12 per minute then you may be breathing too fast which uses more energy, and has an effect on the body’s inner workings.
4. At rest your diaphragm should be doing 80% of the work of breathing. This should mean that your tummy rises and falls as you breathe in and out, and your upper chest stays still. It is, however, important that your upper chest does move when you do exercise. 

Try sitting or lying, and place a hand on your tummy and upper chest and see where you breathe from.  Focus on a gentle unforced rise and fall from your tummy as you breathe in and out.  Breathe through your nose silently and slowly. Now do this focussed breathing for 5-10 minutes, while breathing in for a count of 4 and out for 6. As your body adapts to this way of breathing, you will find it requires less time and energy and is more relaxing. The more time put into practising, the sooner you will see an effect. 

The websites Longcovid.physio and longcovid.org have lots more information about managing the varying symptoms left after COVID infection. If this all sounds familiar and you would like more advice and personalised support with your Long COVID symptoms, please contact Walnut Grove Clinic.