Understanding ‘Long Covid’
Long Covid or Post Covid Syndrome is more formally known as post-acute sequelae of SARS-CoV-2 (PASC). It is a complex multisystem condition where symptoms persist for 12 weeks or more after a person initially suffers the Covid-19 virus. More than 200 varied symptoms have been linked to long covid.
Common symptoms seen in long covid include fatigue, brain fog, autonomic dysfunction, joint and muscle pain, breathlessness, palpitations and chest pain.
Respiratory physiotherapy can be a vital tool to support individuals on a path to recovery. The management of long covid involves understanding the full picture. We don’t yet understand why some people get long covid when others fully recover, therefore it is vital to look at the past medical history and other medical factors that may have been exacerbated. Alongside this, psychological and social factors also need exploring as mental health and the surrounding environment can play a big role in how symptoms are managed and the course of recovery.
The term ‘Long Covid’ was coined by patients in 2020 when the realisation hit that people were struggling to recover from the new virus which caused a worldwide pandemic. The World Health Organisation first started gathering information from patients in August 2020 and the first NICE ‘post covid-19 syndrome guidelines’ were published in the UK in December 2020. For healthcare professions tasked with supporting individuals with long covid a significant challenge has been posed. Research moves relatively slowly but long covid emerged in real time. There is research being done and theories as to the mechanism and long term impact of the covid virus are being looked at all the time. However, this has not yet translated to clinical practice. To my knowledge, and at the time of writing, in the UK we do not have any evidence based medications or treatments that can be given specifically for long covid. With a lack of evidence and a lack of time for large scale research studies, the healthcare community has had to base the support it can give around 1. what is already known in other post-viral presentations and 2. ensuring other medical explanations have been ruled out.
Dysfunctional Breathing Patterns in long covid
A high number of people presenting to long covid clinics have been found to have dysfunctional breathing also known as a breathing pattern disorder.
During the acute phase of COVID-19, the body adapts to lung inflammation by changing how it breathes. This is normal. When the body is under stress from an illness, compensations take over to help fight the attack. When the illness passes the body should return to its normal state of wellness. With covid-19 the period of illness can typically be longer and accompanied by significant stress and lifestyle changes with the circumstances of the pandemic. When these factors persist a breathing pattern disorder can develop where the body doesn’t re-set itself once the illness has passed.
A breathing pattern disorder is characterised by inefficient shallow breathing; it requires more energy, increases the heart rate, and can trap the body in a persistent state or chronic stress. Even after the virus is gone, the brain may stay "locked" into this emergency breathing mode, making even simple tasks like talking or walking feel exhausting.
How Respiratory Physiotherapy Helps
1. Breathing Re-education
The first goal is to "retrain" the brain and body into a more optimal breathing pattern. Respiratory physiotherapy uses techniques like diaphragmatic breathing to encourage slower calmer breathing, using the belly instead of the upper chest. It is not about deep breathing but restoring the natural state of more efficient breathing.
2. Airway Clearance and Cough Management
A persistent cough is a regular feature of the long covid picture and can be debilitating, irritating and impactful on quality of life. Respiratory physiotherapy can help explore the causes of a cough, ensure the right investigations have been completed and provide strategies to manage, control and hopefully get rid of the cough altogether.
(Please note if you have had a cough for more than 3 weeks it is essential to be reviewed by a GP before exploring other treatment strategies.)
3. Symptom Pacing and Energy Conservation
Similarly to some other post-viral conditions, Long Covid often involves Post-Exertional Malaise (PEM)—a "crash" in energy after even minor activity. Physiotherapy helps patients find their baseline combining rest and activity with breathing well to support staying within the energy available. Long term understanding of breathing, heart rate and signs the body needs to rest, balanced with realistic day to day demands is the cornerstone of managing fatigue and starting to move forward.
While there is a lot we still don’t know about long covid and currently there are no specific tests or medications to diagnose or help the symptoms, there is so much value in looking holistically at the health changes long covid has brought about. Respiratory physiotherapy provides a bridge between the illness and a return to normal life. By introducing practical management techniques and holistic understanding of the long covid picture and health as a whole the therapeutic approach can help achieve forward progress.
Get in touch to see how Breathe and Move techniques may help.
Written by Jennie Harmsworth. Having qualified with a degree in Physiotherapy, Jennie spent more than 10-years working in intensive care and post-surgical rehabilitation at both University College London Hospital (UCLH) and Guys and St Thomas’ Hospital.
As a vastly experienced respiratory physiotherapist, Jennie has specialist expertise in dysfunctional breathing, breathlessness management, airway clearance and chronic cough as well as a range of respiratory conditions such as Asthma, COPD and bronchiectasis.