Understanding ‘Long Covid’
Long Covid, formally known as post-acute sequelae of SARS-CoV-2 (PASC), is a complex, multisystem condition where symptoms persist for 12-weeks or more after the initial infection.
For many, the most debilitating symptoms are respiratory, including chronic breathlessness, a persistent "irritable" cough, and profound fatigue. Respiratory physiotherapy can be a vital tool to support individuals on a path to 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, Covid-19. 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.
With a lack of evidence and a lack of time for large scale studies to help the healthcare community understand the causes and generate treatments, largely Long Covid management has centered around what is already known in other post-viral presentations and ensuring other medical explanations have been ruled out.
Common symptoms seen in long covid include fatigue, brain fog, joint and muscle pain, breathlessness, palpitations, chest pain.
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 many people note a longer period of illness 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 heart rate, and can trap the body in a persistent "fight or flight" state.
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 diaphragm to restore a better breathing pattern. Physiotherapists use techniques like Diaphragmatic Breathing to encourage slow, deeper breaths into the belly. It is not about deep breathing but restoring the natural state of breathing less and with more efficiency.
Breathing Control: Learning to relax the shoulders and neck and breathe abdominally to reduce the "work" of breathing.
Nasal Breathing: See ‘Nasal breathing - the right way to breathe’ for further information.
Resonant Breathing: Practicing a specific rhythm (usually 5–6 breaths per minute) to help balance the autonomic nervous system and reduce anxiety.
2. 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 forwards.
3. 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.)
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 introducing practical management techniques and holistic understanding of the long covid picture to 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 other respiratory conditions such as Asthma, COPD and bronchiectasis.